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83 Cards in this Set

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