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83 Cards in this Set
- Front
- Back
ACL: 2 bundles?
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AM - AnteroMedial
PL - PosteroLateral |
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ACL: which bundle tight in extension?
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PL
PosteroLateral |
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ACl: Which bundle tight in flexion?
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AM - AnteroMedial
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PCL: 2 bundles?
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AL - AnteroLateral
PM - PosteroMedial |
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PCL: Which bundle tight in flexion?
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AL
AnteroLateral |
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PCL: Which bundle tight in extension?
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PM
PosteroMedial |
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Where is Ligament of Humphrey?
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anterior
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Where is Ligament of Wrisberg?
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posterior
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Superficial MCL?
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Tibial collateral ligament
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Deep MCL?
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Medial Capsular Ligament
Attachment to meniscus (coronary ligaments) |
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When is LCL tight?
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in extension
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force and direction of failure for ACL?
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2200 N (Anterior)
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Force and direction of failure for PCL?
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2500N (Posterior)
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Force and direction of failure for MCL?
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4000N (Valgus)
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Force and direction of failure for LCL?
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750N (Varus)
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Components of posteromedial corner?
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Sartorius
SuperficialMCL, POL (Posterior Oblique Ligament), SM (SemiMembranosus) Deep MCL |
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Components of Posterolateral Corner?
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Superficial: Biceps, ITT
Deep: LCL, Popliteus, Popliteofibular ligament |
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What is the major blood supply to the ACL?
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Middle Geniculate Artery
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What is the proper description of tension of the components of the PCL when the knee is taken from full extension to 90 degrees flexion?
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AL band is lax and becomes tight; PM is tight and becomes lax
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What is the relationship of the LCL and Popliteus tendon on the femur?
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the popliteus insertion is more distal, anterior, and deep
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List the 4 ligaments of the knee in order of weakest biomechanical strength (load to failure) to strongest:
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LCL, ACL, PCL, MCL
p412 |
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PE for Posterolateral Corner?
**** |
check at 30 and 90 degrees flexion: laxity only at 30 degrees indicates isolated PLC; at 90 indicates PLC and PCL!
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Grading ligamentous instability?
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Gr I: <5mm
Gr II: <10mm GrIII: >10mm (complete) |
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Dial test?
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test for ER asymmetry in knees. "+" indicates injury to posterolateral complex
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KT 1000/2000 positive?
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>3mm side-to-side is abnormal
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Xray: Segond Fx?
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aka lateral capsular sign.
indicates ACL tear |
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Xray: Pellegrini Stieda?
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MCL
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Xray: Fairbanks changes?
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Post menisectomy OA
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Xray OCD?
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lateral aspect MFC
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Xray Widen/cup?
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discoid meniscus
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What to think of w adolescents w knee varus/valgus laxity?
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Physeal fracture!!!
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How document PCL injury?
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Post drawer stress radiographs
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What MRI "bone bruises" indicate ACL?
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LFC mid 1/3 and
LTP post 1/3 |
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Best portal for PHMM?
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AL and PM
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Best portal for patellar tracking?
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superior
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Segond fx is a result of avulsion of what structure?
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lateral capsule
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pt sustains ACL tear. MRI likely to show bone contusion to what structure?
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middle 1/3 of LFC and post 1/3 LTP
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20yo football player with "pop" in knee as a result of noncontact deceleration injury. PR 24 hours later shows large effusion. Incidence of ACL rupture in this situation is?
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70%
p 417 |
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PCL insufficiency w Quad Active test is confirmed w tibial translation ...?
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anteriorly at 70-90 degrees flexion
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What PE finding best indicatess posterolateral instability of the knee?
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Increased ER of the foot relative to the contralateral side at 30 degrees of knee flexion only (Dial test)
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Is ACl injury primarily contact?>
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No! 70% noncontact!
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Incidence of Segond fx?
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<5%
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Quadriceps Avoidance Gait?
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Stiff-knee gait
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nat Hx of ACl untreated injuries?
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Arthritis issue unresolved
meniscus tears increase w time cartilage injuries increase w time |
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ACl hamstring v BPTB?
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equal
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ACL 2 incision v endoscopic?
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equal
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ACL accurate tunnel placement?
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femoral tunnel position within 1-3mm of OTP position
tibial tunnel behind intercondylar roof |
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def "Cryopreservation"?
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chemicals used to remove cellular water and freezing rate is controlled to prevent ice crystals formation
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How does preconditioning affect ACL grafts?
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Preconditioning of grafts can reduce stress relaxation up to 50%!
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risk of HIV transmission for ACL allografts?
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1:1 million
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Most common cause of ACL reconstruction failure?
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Technical error.
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Xray criteria for proper placement of Blumenstat's line?
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must be posterior to it.
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position of 2 tunnel ACL?
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Good in lab but clinically unproven.
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Findings "Cyclops lesion" in ACL?
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fibroproliferative tissue blocks extension
"click" at terminal extension |
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female athlete ACL prevention?
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plyometrics/neuromuscular training benificial
focuses on improving balance |
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When is ACl bracing effective?
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only in skiers.
noneffective in transition from NWM to WB |
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When operate on PCL injury?
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only when combined injury!!!
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positive physical findings for PCL?
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Posterior Drawer
Quad Active test reverse pivot shift |
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tensioning of PCL double bundle technique?
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AL graft tensioned at 90 degrees
PM graft tensioned in 30 deg flexion |
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risk of transtibial PCL technique?
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Popliteal artery injury
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MCL opening at 30 degrees indicates?
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isolated MCL injury
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MCL opening at 0 degrees indicates?
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-injury to posteromedial capsule
-usually with ACL +/- PCL injury |
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Tx MCL injuries?
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hinged knee brace 6-8 weeks
delayed reconstruction in combined MCL/ACL injuries note: prox (femur) heal better than distal (tibial) injuries |
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MCL reconstruction technique?
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Modified Bosworth technique.
Allograft reconstruction |
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LCL opening at 30 degrees only?
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isolated LCL injury
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LCL opening at 0 degrees?
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-injury to posterolateral capsule (+Dial)
-usually w ACL and/or PCL laxity |
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components of posterolateral complex?
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biceps
ITB popliteus popliteofibular ligament arcuate ligament LCL |
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Mech of -Inj for posterolateral complex?
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-direct blow to anteromedial tibia
-hyperextension/varu |
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PE for posterolateral complex?
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-increased external rotation (30 deg, 90 deg)
-posterolateral external rotation test -reverse pivot-shift test -external rotation excurvatum |
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partial Posterolateral complex treatment?
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3 weeks immobilization in a cast
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complete posterolateral complex treatment? (acute0
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primary repair best, augment with allo/auto graft
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Ass'd risk of injury w knee dislocation?
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-popliteal artery 32%
-peroneal nerve 20-30% -tibial plateau fx 60% |
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knee dislocation surgical indication: acute?
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**vascular injury**
open fx/dislocation compartment syndrome |
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knee dislocation classifications?
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see p 433
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PGA absorption?
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PolyGalactic Acid - absorbs in weeks
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PDS absorption?
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PolyDiaxone - absorbs in months
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PLLA absorption?
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Poly-L-Lactide absorbs in years
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delayed ACL/MCL/meniscus reconstruction will decrease the risk of developing what?
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arthrofibrosis.
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Rx for bony avulsion isolated PCL injury in 25yo?
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repair of injured structures.
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32 yo w fall knee flexed and foot in PF, ?+Lachman, equal passive ER at 30 anjd 90 degrees flexion, +Quad active test. Tx?
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PT program (p435)
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Results of cadaver studies w PCL sectioning?
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increased contact pressures in medial and PF joints
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Where immobilize knee p PCL recon to minimize post sag?
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0 degrees
p 435 |
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Incidence of vascular inj w ant knee dislocation is?
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30-50%!
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