Knee & Hip Sports IOT Day 3: Answers and Explanations, Exams of Medicine

Download Knee & Hip Sports IOT Day 3: Answers and Explanations and more Exams Medicine in PDF only on Docsity! Sports IOT - Day 3 (Knee&Hip) with Complete Solutions **True or False: The acetabular labrum extends around the entirety of the hip socket - ANSWER-False It's a horseshoe shape **Which ligament is connected to the femoral head and aids in stabilizing the hip socket? - ANSWER-Ligamentum Teres **True or False: Most FAI contains mixed pincer/cam lesions - ANSWER-True True or False: FAI can be defined as the repetitive abutment between the femoral neck and acetabular rim that occurs within ranges of motions which can cause symptoms - ANSWER-True Cam impingement can be defined as - ANSWER-An aspherical femoral head, usually anterosuperior "aspherical extension" All of the following are functions of the acetabular labrum, EXCEPT: 1. Provides a suction seal to the hip 2. Adds stability to the hip by deepening the socket 3. Acts as a shock absorber, with its most thick portion superiorly 4. Serves as an attachment for the ligamentum teres - ANSWER-Answer = 4 The ligamentum teres is NOT an attachment site In which compartment of the hip would you address a CAM lesion? Central Peripheral Peri trochanteric - ANSWER-Peripheral True or False: The articular cartilage of the acetabulum has a horseshoe shape - ANSWER-True True or False: A CAM deformity is a bony overgrowth of the femoral neck and is associated with chondral defects o n the acetabular transitional zone cartilage, while a pincer deformity is an overgrowth of the acetabulum and is associated with 'pinching' of the labrum and labral tears - ANSWER-True True or False: The MPFL is the main passive stabilizer against lateral patellar displacement - ANSWER-True True or False: The MPFL is tightest in knee flexion - ANSWER-True When referring to knee lower alignment, what is the normal Q angle for a female? - ANSWER-18 degrees True or False: The new MPFL kit comes with 3.5SL and Tightrope RT - ANSWER-True Zones of the meniscus are determined by what? - ANSWER-Blood supply What is the goal of meniscal resection? - ANSWER-- Remove degenerative tissue - Spare as much of the meniscus as possible - Reproduce meniscal contour This is the more C-shaped meniscus that has connections with the ACL and the capsule MCL: Medial or Lateral? - ANSWER-Medial Which meniscus is more mobile due to less capsular attachments? - ANSWER-Lateral A meniscus tear in what area is least likely to heal? - ANSWER-White-white zone What does blumensaats line refer to? - ANSWER-- Known as the intercondylar line - Line drawn along the roof of the intercondylar notch of the femur on a sagittal view of the knee The ridge of bone that separates the AM and PM bundle of the ACL on the femur is? - ANSWER-Bifurcate ridge When preparing standard graftlink using a single tendon the ideal TOTAL length before suturing is? - ANSWER-250-270mm In the ACL deficient knee, which way does the tibia translate? - ANSWER-Anteriorly The PCL inserts on the ___? - ANSWER-medial femoral condyle and posterior tibia When performing a pediatric ACL reconstruction, the potential complication from drilling across the physis is? - ANSWER-Premature bone growth A patient with severe varus deformity in the knee would be at risk for developing what? - ANSWER-Medial compartment arthritis Of the major knee ligaments, which one is NOT intra-articular? - ANSWER-LCL True or False: Females are 4-5 more prone to ACL injury - ANSWER-True TT-TG distance is considered abnormal if? - ANSWER->20mm The polyester suture sheaths of the FiberStitch implant are connected by what? - ANSWER-A continuous 2-0 FiberWire suture How long is the drill sleeve step? - ANSWER-7mm What is the purpose of the drill sleeve step? - ANSWER-Cortical preservation Where should the drill guide be lined up for the Tibial socket of an ACL Reconstruction - ANSWER-Posterior aspect of the Anterior horn of Lateral meniscus In a BTB ACL reconstruction, what instrument is used before fixating an IF Screw in the socket? - ANSWER-A tap When fixating the tibial end of the graft, do you fixate the Internal Brace or ABS button first? - ANSWER-IB Sizes of Flipcutter III reamers - ANSWER-6mm-12mm. 7-12mm in 0.5mm increments When the flipcutter III blade is straightened, what is the drill's diameter? - ANSWER- 3.5mm Size of tightrope button extender - ANSWER-20x5 Smallest size diameter an ACL should be - ANSWER-At least 8mm Sizes of FastThread IF Screws - ANSWER- What drilling style is Flipcutting considered? - ANSWER-Retrograde What style of ACL drilling uses a tightrope drill pin and a low-profile reamer through the AM portal? - ANSWER-Antegrade What are 30mm FastThread IF Screws ideal for? - ANSWER-Tibail fixation of soft tissue What is the purpose of retrieving both femoral and tibial fiberstick/tigerstick sutures at the same time? - ANSWER-Help avoid a tissue bridge What is the main disadvantage of BTB ACL reconstruction? - ANSWER-Graft tunnel mismatch What size IF screw is typically chosen in a BTB ACL reconstruction - ANSWER-2mm smaller than the tunnel size How frequent does graft tunnel mismatch occur in BTB ACL reconstructions - ANSWER-13% Sutures used for a Quad tendon autograft - ANSWER-#2 FiberLoop or #2 FiberLoop FiberTag Suture used in a Meniscal root repair - ANSWER-0 TigerLink and 0 FiberLink Whats included in a meniscal repair kit? - ANSWER-Knee scorpion needle, FlipCutter 2 reamer, Passport Button cannula (8mm x 3cm), 2-0 FiberStick, 0 FiberLink, 0 TigerLink, 4.75 x 19.1mm SL, Spade tip drill bit, SL hard bone anchor tap, SutureLasso Technique used for MPFL Reconstruction - ANSWER-Anatomic Double Bundle MPFL Technique Deciding factors for choosing between an ACL Repair vs ACL Reconstruction - ANSWER-Location of tear & quality of tissue When should a surgeon do an ACL repair instead of a reconstruction - ANSWER-When it is a Type 1 or Type 2 tear with good tissue quality Techniques used for ACL repair - ANSWER-1. Anchoring both ACL bundles individually with 4.75 SL at their femoral attachments2. Using a TightRope on femoral side with FiberTape running parallel with the graft to be fixated as Internal Brace on tibial side Risks of failure when ACL graft is less than or equal to 8mm - ANSWER-6.8 times greater risk Allograft failure rates in younger populations - ANSWER-27% Benefits of Internal Brace - ANSWER-45% stronger load to failure and 33% less cyclic displacement What drilling technique is utilized for a femoral IF Screw - ANSWER-AM portal or Transtibial drilling What does Transportal mean - ANSWER-Drilling through the AM portal Suture for FiberStitch - ANSWER-2-0 FiberWire CL Suture for ZoneNavigator - ANSWER-2-0 SutureTape What is function of the ALL - ANSWER-Resists tibial internal rotation Goal of ALL - ANSWER-Eliminate residual laxityPrevent ACL graft rupture ALL first described by ______ in ______ - ANSWER-Paul Segund in 1879 ACL innervated by - ANSWER-posterior articular branch of tibial nerve The femoral footprint of the ACL is located on the - ANSWER-lateral femoral condyle All of the following are reference points for the femoral isometric point during MPFL reconstruction except: - ANSWER-Posterior border of the femurBlumensaats linePosterior consolesTrochlear groove of the femur *** What is an abstract? - ANSWER-a summary of a magazine or journal article, written by someone other than the original author What does an abstract cover? - ANSWER-1. Background 2. Purpose/objective 3. Study design 4. Methods (most important) 5. Results 6. Conclusion Benefits of ACL Tightrope - ANSWER-1. One size fits all 2. Saves time by eliminating steps 3. Maximizes graft in socket 4. Precise tensioning and ability to re-tension graft ^^Best feature 5. Strength of cortical fixation All-Inside Quadlink or Graftlink technique points - ANSWER-1. Anatomic 2. No need to hyperflex 3. Longer sockets 4. Lower morbidity 5. Precise tensioning and retensioning 6. Less pain 7. Equivalent stability and improved outcomes compared to BTB ABS system sizes - ANSWER-- 8 x 12mm ABS - 14mm ABS round - 3.4mm x 13 ABS oblong - 11mm concave (4mm collar) - 14mm concave (7mm collar) - 20mm concave (9mm collar) Allograft options for ACL - ANSWER-- Pre-sutured & pre-sized graftlink and quadlink - 7.5mm-10.5mm diameter; 60-80mm long - Passing sutures in each end for BTB TR2 or ABS loop Evolution of screws - ANSWER-1. Metal IF 2. Bio IF What portal do you introduce the anterior zone navigator through? - ANSWER- Contralateral What tape and needle goes with the zone navigator system? - ANSWER-0.7 stainless steel needles Mini suturetape (0.9mm wide) What increments does the zone navigator advance the needle? What is the purpose? - ANSWER-1cm increments Control of suture placement What sizes of Fiberstitch do we offer? - ANSWER-12 degree (1st gen & most commonly used) 24 degree Reverse Straight What is the suture and implant in Fiberstitch? Depth stop options? - ANSWER-2-0 coreless fiberwire 10-18mm (2mm increments) *Always starts on 18 Where do you clamp the graft clamp on the end of a quadlink graft? - ANSWER-2mm from the end of the graft What kind of suture technique is it when attaching the FiberTag TR to a quadlink graft? - ANSWER-Speedwhip rip-stop technique How many passes do you complete when attaching the FiberTag TR to the graft? - ANSWER-4 The angle of the knee scorpion is what? The low profile jaw measures to be what? - ANSWER-5 degrees 3.2mm Hip fibertak is what mm bone socket? - ANSWER-1.8mm Advantages of Hip Fibertak - ANSWER-- Adjustable tensioning to control labrum - No risk of knots - Simple, reproducible perc insertion techniques - Easily maintain the drill guide trajectory while drilling and inserting - Curved and straight guides What can be used to pass the repair suture for the hip fibertak technique? - ANSWER- Swiftstitch suture passer Birdbeak Hip suturelasso Hip joint differences to shoulder - ANSWER-1. Constrained joint 2. Acetabular labrum is like a gasket vs bumper 3. Fixate labrum away from joint vs towards 4. Thick, tight capsule (5-8mm) Arthoscopic compartments of the hip - ANSWER-1. Central (Femoral head) 2. Peripheral (Femoral neck) What is considered normal and not normal for a lateral center edge angle in the hip? - ANSWER-Below 20 degrees may indicate dysplasia 25-40 degrees is normal Above 40 degrees is considered over coverage What ligament is the strongest in the body? What is it's purpose within hip arthroscopy? - ANSWER-Iliofemoral ligament It's the ligament that's cut to gain access to the joint What kind of joint is the hip? - ANSWER-Ball and socket joint Size of the trim-it cannula What are the working lengths you can cut the cannula to? - ANSWER-8.25mm x 15cm 7cm - 15cm Primary surgical portals of the hip - ANSWER-1. Anterior (A) (Location up be ASIS) **Anchor placement** 2. Anterolateral (AL) **Primary viewing** 3. Posterolateral (PL) **Anchors on posterior rim** 4. Midanterior (MAP) **Anchor placement (safe trajectory) 5. Distal anterior lateral accessory (DALA) **Good/unique angles for anchor placement) Hip anchors - ANSWER-2.4mm mini hip pushlock 2.9 pushlock 2.9 short pushlock 2.0 Mini hip suturetak 2.4mm suturetak 3.0mm knotless suturetak Hip Fibertak Mini hip pushlock overview - ANSWER-- 2.4 x 8.9mm - Smallest knotless hard anchor on the market - 41% less material than the 2.9 PL - 12mm drilling depth Mini hip suturetak overview - ANSWER-- 2.0mm x 8.6mm w #1 fiberwire suture - Straight and 16 degree curved guides What are our capsule closure options? - ANSWER-1. Capsule close scorpion 2. Hip length suture lasso 3. Birdbeak options Why SL fixation for MPFL? - ANSWER-- Less bone removal and possible stress riser than full tunnel or diverging tunnels - More healing potential than onlay techniques MPFL landmarks are based on what? - ANSWER-Schottle (and Redfern) - 1mm anterior to the posterior cortex extension line - 2.5mm distal to the posterior articular boarder of the medial femoral condyle - Proximal to the level of the posterior point of Blumensaat's line What is Schottle's Point? - ANSWER-Helps describe the point where the femoral tunnel is drilled during MPFL ligament reconstruction "Radiographic landmark depicting the isometric point of femoral insertion during MPFL reconstruction" What screw size is in the 4.75 MPFL kit? - ANSWER-6x23mm BC IF screw What screw size is in the 3.9mm BC MPFL kit? - ANSWER-6x20 BC FT screw - 22% less material - Faster implantation and engagement What is Trochlear Dysplasia? - ANSWER-Abnormal geometry of the femoral part of the patello-femoral joint. One of the main factors causing patellar dislocation What causes meniscus extrusion? Most commonly found where? - ANSWER-Insufficiency on the medial side Meniscal root injuries Meniscus extrusion technique? - ANSWER-- Kwires are placed parallel to the tib plateau - Place either side of the extrusion - If greater than 1cm apart, use a third kwire Why use a retractable burr in the hip? - ANSWER-- Protect the labrum What size suture does Knee scorpion accept? - ANSWER-2-0 FW, 0 FW ; profile jaw = 3.2mm Quadlink Benefits - ANSWER-- Reproducible graft sizing