He undergoes operative repair of the injury with standard technique. Revision of medial unicondylar knee arthroplasty (UKA) to TKA for aseptic loosening, Varus deformity >20 degrees with LCL incompetency. WebAnatomy. Web(OBQ05.166) An 8-year-old boy was playing at school and took a direct blow to his knee causing pain and swelling. Extends the hip and Radiographs show no evidence of a stress fracture, an alpha angle of 45 degrees, and a lateral center edge angle of 30 degrees. Right ankle fracture-dislocation. Increasing articular conformity of the tibial polyethylene insert of a fixed-bearing total knee arthroplasty (TKA) prosthesis will have which of the following biomechanical effects? Right ankle fracture-dislocation. KD IV. sartorius (femoral n.) tensor fascia lata (superior gluteal n.) Presentation. Osteology. is the origin of the direct head of the rectus femoris (femoral n.) Orthobullets Team Knee & Sports - Incompetence of which of the following ligaments in Figure A is most commonly associated with his condition? WebA tibial eminence fracture, also known as a tibia spine fracture, is an intra-articular fracture of the bony attachment of the ACL on the tibia that is most commonly seen in children from age 8 to 14 years during athletic activity. WebAnatomy. Figure A demonstrates a total knee prosthesis design. Extensor mechanism of the knee. anatomical axis of the distal femur is 6-11 degrees of valgus . Team Orthobullets 4 Knee & Sports - Quadriceps Tendon Rupture; Listen Now 8:44 min. retinacular structures (medial and lateral inferior geniculate arteries) Biomechanics. Which of the following rehabilitation exercises provides for restoration of range of motion while limiting stress on the repair of a ruptured patellar tendon? accessory lateral collateral ligament. WebPCL anatomy. (ACL) posterior cruciate ligament (PCL) medial collateral ligament (MCL) Orthobullets Team Trauma - Distal Femur Fractures Technique Guide. Web(OBQ18.115) A 29-year-old female presents with worsening activity-related groin pain and occasional mechanical symptoms. Which of the following radiographic views is most sensitive for detecting knee joint degenerative changes? Partial tears may need an MRI to confirm the diagnosis. His range of motion is limited from 10-85 degrees with pain over the medial epicondyle of the knee. Classification. 1% (66/6400) 2. Which of the following is true of the medial meniscus when compared to the lateral meniscus? Pain is exacerbated by weightbearing and physical exam is significant only for TTP over the medial joint line. 10/15/2019. Team Orthobullets 4 Treatment is closed reduction and casting or surgical fixation depending on the degree of displacement. Anatomy. Web(OBQ13.257) A 38-year-old man is being considered for medial meniscus transplantation following an arthroscopic subtotal meniscectomy performed at the time of ACL reconstruction. Osseous. Lateral Ulnar Collateral Ligament Injury is a ligamentous elbow injury usually associated with a traumatic elbow dislocation, and characterized by posterolateral subluxation or dislocation of the radiocapitellar and ulnohumeral joints. WebPCL anatomy. 2 parts. A posterior cruciate retaining total knee arthroplasty is contraindicated in all of the following patients EXCEPT? Treatment is closed reduction and casting or open reduction and fixation depending on the degree of displacement and whether it can be Quadriceps tendon. Posterior stabilized design with under-resection of distal femur, Posterior stabilized design with under-resection of proximal tibia, Posterior stabilized design with under-resection of posterior femur. You can rate this topic again in 12 months. articular. anatomy. On exam, he hyperextends to 15 and flexes to 120 with global instability of the knee. Web(OBQ12.99) A 15-year-old female cross country runner presents with 5 weeks of right knee pain. What technique should be utilized to optimize her function and to prevent the recurrence of her deformity? WebACL Tear PCL Injury MCL Knee Injuries LCL Injury of the Knee Posterolateral Corner Injury Anatomy. Web(SBQ16SM.18) A 30-year-old active-duty woman presents to your clinic with right knee pain and without any history of trauma. He has failed all nonoperative measures for his right knee pain. commonly associated with Schatzker IV fracture-dislocations. He denies fevers or mechanical knee symptoms. Webbony anatomy. More anterior translation with extension and less posterior movement with flexion, Less anterior translation with extension and less posterior movement with flexion, More posterior translation with extension, Fewer capsular attachments to the meniscus periphery, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, 2019 Winter SKS Meeting: Shoulder, Knee, & Sports Medicine, Is There a Role for Orthobiologics in Meniscal Repairs? horse-shoe shaped structure continuous with transverse acetabular ligament . Team Orthobullets 4 He denies any acute traumatic injuries. If he continues to develop further degenerative changes and needs arthroplasty what type of implant should be utilized? Physical exam and radiographic evaluation demonstrate femoroacetabular impingement with an associated labral tear. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Baseball Sports Medicine: Game-Changing Concepts, Elbow Cases Panel Discussion - Christopher S. Ahmad, MD, 2019 FORE/AANA World Series of Live Surgery (Prev. Orthobullets Team Knee & Sports Web(OBQ15.258.2) A 62-year-old female Zumba instructor presents to your clinic reporting progressive left knee pain and effusion that has been present for the past few months. (OBQ11.244) medial meniscus. lateral meniscus. well suited for imaging edema and pathology. Laboratory tests are shown in Figure A. WebA tibial eminence fracture, also known as a tibia spine fracture, is an intra-articular fracture of the bony attachment of the ACL on the tibia that is most commonly seen in children from age 8 to 14 years during athletic activity. anatomy. Osteology. Anatomy. commonly associated with Schatzker IV fracture-dislocations. Sinding-Larson-Johansson (SLJ) syndrome is an overuse injury seen in adolescents leading to anterior knee pain at the inferior pole of patella at the proximal patella tendon attachment. Pain is exacerbated by weightbearing and physical exam is significant only for TTP over the medial joint line. normal ACL fibers appear steeper than the intercondylar roof and in continuity of fibers all the way from the tibia to femur. On physical exam his ACL and PCL are intact, however he is noted clinically to have Grade 3 posterolateral corner laxity and varus malalignment of his knee. What would be the most likely finding pre-operatively? posterior tibial sulcus below the articular surface. An ambulatory 57-year-old man with post-polio syndrome presents for follow-up of his right knee pain. tibial plate is a solid block of polyethylene as opposed to a metal tray with a poly insert. (OBQ05.265) Tibial tubercle is a secondary ossification center. WebThese tests evaluate for anterior cruciate ligament (ACL) injury (Table 2 5, 11 and Table 3 4, 6, 11, 34). Web(OBQ12.99) A 15-year-old female cross country runner presents with 5 weeks of right knee pain. 11/8/2019. Which of the following motions is constrained in this particular design: Complete anterior-posterior translation constraint only, Partial varus-valgus angulation constraint only, Partial varus-valgus angulation and partial internal-external rotation constraint, Complete internal-external rotation constraint only, Complete varus-valgus angulation and anterior-posterior translation constraint. Increased wear on the articular side of the polyethylene, Less wear on the articular side of the polyethylene, More wear at the backside of the polyethylene, Less wear at the backside of the polyethylene. She reports no constitutional symptoms and notes the pain is worse with using stairs or sitting for long periods of time in the backseat of a car. Left knee ACL tear. average thickness is 4 to 5mm. They are cause by either a direct blow (more severe tear) or a non-contact injury (less severe). Anterior inferior iliac spine. semitendinosus. WebTibial tubercle fractures are a common fracture that occurs in adolescent boys near the end of skeletal growth during athletic activity. Passive stability. Web(OBQ15.258.2) A 62-year-old female Zumba instructor presents to your clinic reporting progressive left knee pain and effusion that has been present for the past few months. Proper management should include which of the following, Physical therapy for range of motion followed by surgical reconstruction with patellar tendon autograft, Hinged knee brace locked at 30-degrees of flexion for 6 weeks followed by physical therapy for range of motion, Medializing tibial tubercle osteotomy with lateral retinacular release, Arthroscopy for debridement versus repair. WebTibial stress syndrome (also known as shin splints) is an overuse injury or repetitive-load injury of the shin area that leads to persistent dull anterior leg pain. lateral radial collateral ligament (LCL) but a suture plication of the anterior capsule to the broken tip increases stability and can be placed with the aid of ACL type guide. What ligament has been injured? WebACL Tear PCL Injury MCL Knee Injuries Anatomy. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Right ankle fracture-dislocation. Lateral collateral ligament complex consists of 4 components. (OBQ11.28) (SAE07HK.39) abnormal orientation. Attachment. pivot-shift) may demonstrate radial head subluxation, may not be helpful in the setting of recurrent instability and LUCL attenuation as visualizing ligament difficult due to oblique course, can identify acute avulsion of LUCL in acute instability, LUCL pathology identifed in 50% of patients. Muscles that originate from ASIS. medial meniscus. average thickness is 4 to 5mm. Blood supply. 1% 4 muscles. has been described as having 2 to 4 distinct layers. Osseous. Her pain is located directly over her medial femoral condyle (MFC). common peroneal nerve is most common nerve injury . origin. lateral tibial plateau. WebACL Tear PCL Injury MCL Knee Injuries Anatomy. (OBQ12.92) proximal to the medial plateau. She is an avid runner and is part of the Army 10-miler team. short head. Orthobullets Team Trauma - Knee Dislocation; Listen Now 19:45 min. long head. partial tears may need an MRI to confirm the diagnosis. Which of the following implant designs theoretically reduces poylethylene wear and reduces bone-implant-interface stress? lateral radial collateral ligament (LCL) but a suture plication of the anterior capsule to the broken tip increases stability and can be placed with the aid of ACL type guide. Copyright 2022 Lineage Medical, Inc. All rights reserved. retinacular structures (medial and lateral inferior geniculate arteries) Biomechanics. Which of the following should be done to achieve a successful outcome? average thickness is 4 to 5mm. convex in shape. near sulcus terminalis. Thank you. (OBQ18.251) The Lachman test is the most commonly used technique for assessing the ACL 6, 7 (Figure 2 6). Muscles that originate from ASIS. (SAE07SM.70) Osteology. labrum. patellar tendon. Treatment is closed reduction and casting or open reduction and fixation depending on the degree of displacement and whether it can be horse-shoe shaped structure continuous with transverse acetabular ligament . Copyright 2022 Lineage Medical, Inc. All rights reserved. more common in type IV and VI fractures (25%) injury. Web(OBQ20.108) A 21-year-old recreational hockey goalie presents to your clinic with 6 weeks of right hip and groin pain. WebAnatomy. 2 parts. WebAnatomy. You can rate this topic again in 12 months. long head. articular. (OBQ07.100) age 11y, tubercle is cartilaginous. Osteology. Plantar plate. lateral tibial plateau. articular. Gross Shape. WebAnatomy. 16% (529/3399) 4. She reports no constitutional symptoms and notes the pain is worse with using stairs or sitting for long periods of time in the backseat of a car. intracondylar groove . Ligamentous exam reveals a stable ACL and MCL, but opens to a varus stress and a 3+ posterior drawer and positive dial test at both 30 and 90 degrees of flexion. posterior tibial sulcus below the articular surface. Anatomy. Which of the following outcomes most appropriately describes the difference in females compared to males for this procedure? Web(OBQ10.139) A 37-year-old male presents with continued knee pain and instability 6 months status-post combined ACL and PCL reconstruction after a traumatic knee injury. WebACL Tear PCL Injury MCL Knee Injuries Anatomy. broad, crescent-shaped footprint. patient lies supine with affected arm overhead; forearm is supinated and the examiner's index finger is placed under the radial head and the thumb over it. On physical exam his ACL and PCL are intact, however he is noted clinically to have Grade 3 posterolateral corner laxity and varus malalignment of his knee. Treatment may be nonoperative in patients with partial tears and intact extensor mechanism. WebACL Tear PCL Injury MCL Knee Injuries LCL Injury of the Knee Posterolateral Corner Injury Posteromedial Corner Injury Anatomy. (OBQ18.106) quadriceps tendon. Web(OBQ20.108) A 21-year-old recreational hockey goalie presents to your clinic with 6 weeks of right hip and groin pain. (SBQ16HK.19) sartorius (femoral n.) tensor fascia lata (superior gluteal n.) Presentation. tibial tubercle. The medial and lateral joint surfaces have different tibiofemoral geometry. origin. Attachment. medial patellofemoral ligament (MPFL) femoral origin-insertion is between medial epicondyle and adductor tubercle . anterolateral medial femoral condyle. 11/8/2019. They are cause by either a direct blow (more severe tear) or a non-contact injury (less severe). His body mass index (BMI) is 28kg/m2. retinacular structures (medial and lateral inferior geniculate arteries) Biomechanics. 1% Extends the hip and normal ACL fibers appear steeper than the intercondylar roof and in continuity of fibers all the way from the tibia to femur. Copyright 2022 Lineage Medical, Inc. All rights reserved. average thickness of 3 to 5mm. lateral meniscus. Lateral Ulnar Collateral Ligament Injury (PLRI). 3 months later, the patient presents with pain and a catching sensation in his elbow. to 10mm. Diagnosis is made clinically with tenderness over the inferior pole of the patella and radiographs of the knee may show a spur at the inferior pole of the patella. When comparing mobile-bearing total knee arthroplasty (TKA) to fixed-bearing total condylar arthroplasty, the mobile-bearing procedure provides. Active open chain flexion, active closed chain extension, Passive flexion, active closed chain extension, Active closed chain flexion, active open chain extension, Passive flexion, active open chain extension, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Chronic Patellar Tendon Reconstruction after Failure, Chronic Patellar Tendon Rupture Reconstruction with Hamstring Autograft. 11/8/2019. bony constraint of the patella within the trochlear groove. labrum. He denies any acute traumatic injuries. 10/15/2019. On physical examination, he has pain with flexion, adduction, and internal rotation of the right hip and reports deep-seated groin pain when asked to perform a squat. Web(OBQ05.166) An 8-year-old boy was playing at school and took a direct blow to his knee causing pain and swelling. tibial tubercle. WebAnatomy. Copyright 2022 Lineage Medical, Inc. All rights reserved. WebThese tests evaluate for anterior cruciate ligament (ACL) injury (Table 2 5, 11 and Table 3 4, 6, 11, 34). What is the recommended management? (OBQ11.126) WebAnatomy. age 11y, tubercle is cartilaginous. WebAnatomy. His radiographs are shown in Figures A and B. When performing knee arthroplasty, which of the following procedures provides the most consistent fixation for the tibial component? On physical exam he has medial and lateral joint line tenderness and no instability. anatomy. (SBQ07HK.7) infrapatellar fat pad. Lateral collateral ligament complex consists of 4 components. convex in shape. Hamstrings. is more circular (the horns are closer together and approximate the ACL) covers a larger portion of the articular surface. Simple vs. Complex. has been described as having 2 to 4 distinct layers. fat dark, water bright. Unicompartmental mobile bearing knee arthroplasty, Posterior cruciate retaining total knee arthroplasty, Posterior stabilized total knee arthroplasty, Constrained nonhinged total knee arthroplasty, Constrained hinged total knee arthroplasty. WebAnatomy. Osteology. (SAE07HK.63) On physical examination, he has pain with flexion, adduction, and internal rotation of the right hip and reports deep-seated groin pain when asked to perform a squat. Extends the hip and She is scheduled to undergo right total knee arthroplasty (TKA) after failing nonoperative modalities. Operative repair is indicated if there is disruption of the extensor mechanism. infrapatellar fat pad. Web(OBQ18.106) An ambulatory 57-year-old man with post-polio syndrome presents for follow-up of his right knee pain. Laboratory tests are shown in Figure A. origin. more common in type IV and VI fractures (25%) injury. best for showing anatomy, but not pathology. 11% (680/6268) 5. best for showing anatomy, but not pathology. quadriceps tendon. Anatomy. application of a posterior force will cause posterior subluxation of the radial head, patient lies supine with affected arm extended overhead; forearm is supinated and valgus stress is applied while flexing the elbow, patient cannot do push-ups with forearm supinated, important to rule out associated fractures and confirm concentric reduction in setting of acute dislocation, standard radiographs are often of little value in evaluating PLRI, fluoroscopic imaging during provocative testing (e.g. A 24-year-old male sustains the right elbow injury shown in Figures A and B. Plantar plate. Copyright 2022 Lineage Medical, Inc. All rights reserved. accessory lateral collateral ligament. Distal femur will pivot about a medial axis of the knee, Distal femur will translate anteriorly on the tibia, Distal femur will pivot about a lateral axis of the knee. He has failed all nonoperative measures for his right knee pain. Tendon is a harvest option for autograft ACL reconstruction. 1% WebACL Tear PCL Injury MCL Knee Injuries Anatomy. WebACL Tear PCL Injury MCL Knee Injuries Anatomy. Tibial tubercle is a secondary ossification center. Web(OBQ18.115) A 29-year-old female presents with worsening activity-related groin pain and occasional mechanical symptoms. Simple vs. Complex. The patient was referred to your office for a consultation. She has noted progressive leg deformity and episodes of giving way, and now has pain preventing activity. capsular. T2. to 10mm. - Thomas Carter, MD, Video Spotlight: Meniscal Allograft - Thomas Carter, MD. WebTibial stress syndrome (also known as shin splints) is an overuse injury or repetitive-load injury of the shin area that leads to persistent dull anterior leg pain. broad, crescent-shaped footprint. 1% (66/6400) 2. Extensor mechanism of the knee. WebACL Tear PCL Injury MCL Knee Injuries Anatomy. broad, thick ligamentous structure that spans the plantar aspect of the MTP joint. The patient was referred to your office for a consultation. (OBQ13.88) (OBQ07.28) origin. The Lachman test is the most commonly used technique for assessing the ACL 6, 7 (Figure 2 6). semimembranosus. T2. Web(OBQ05.166) An 8-year-old boy was playing at school and took a direct blow to his knee causing pain and swelling. proximal to the medial plateau. He is unable to perform a pushup. He has a grade 1A Lachman test and pain with valgus stress testing. STIR (Short T1 Inversion Recovery) and cysts within and adjacent to ACL are common findings, and clinically insignificant (no instability) bone bruise. A 57-year-old man complains of knee pain that is exacerbated with weight bearing and ambulation. is the origin of the direct head of the rectus femoris (femoral n.) Orthobullets Team Knee & Sports - biceps femoris. Web(OBQ18.106) An ambulatory 57-year-old man with post-polio syndrome presents for follow-up of his right knee pain. patellar tendon insertion at the inferior pole of the patella, similar to Osgood-Schlatter disease which is at the distal attachment of the patella tendon, Pain present while performing activity and persists after activity, Pain affecting/limiting function during activity, may show spur at inferior pole of patella, debridement of damaged tissue/stimulation of healing response, in some cases refractory to nonoperative treatment, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Concussions (Mild Traumatic Brain Injury). Web(OBQ12.99) A 15-year-old female cross country runner presents with 5 weeks of right knee pain. His body mass index (BMI) is 28kg/m2. long head. horse-shoe shaped structure continuous with transverse acetabular ligament . His exam is completely normal and symmetric to his left knee. is usual site of avulsion of MPFL . Figure A displays the preoperative radiographs of a 67-year-old obese, diabetic woman undergoing total knee arthroplasty. Copyright 2022 Lineage Medical, Inc. All rights reserved. WebAnatomy. Classification. Treatment is closed reduction and casting or open reduction and fixation depending on the degree of displacement and whether it can be Tendon is a harvest option for autograft ACL reconstruction. Ligamentous exam reveals a stable ACL and MCL, but opens to a varus stress and a 3+ posterior drawer and positive dial test at both 30 and 90 degrees of flexion. C-shaped with triangular cross section. Lateral collateral ligament complex consists of 4 components. patella. age 11-14y, apophysis forms. WebNormal anatomy. On exam, he hyperextends to 15 and flexes to 120 with global instability of the knee. Orthobullets Team (OBQ16.51) fibrocartilage. Radiographs are shown in Figures A and B. WebAnatomy. average thickness of 3 to 5mm. Passive stability. Web(OBQ13.257) A 38-year-old man is being considered for medial meniscus transplantation following an arthroscopic subtotal meniscectomy performed at the time of ACL reconstruction. soft tissue constraints including. Which of the following types of prosthetic designs, seen in figures A-E, has been shown to have a high rate of loosening secondary to overconstraint? annular ligament . (OBQ07.46) WebACL Tear PCL Injury MCL Knee Injuries LCL Injury of the Knee Posterolateral Corner Injury Posteromedial Corner Injury Anatomy. to 10mm. osteochondral injury. 11% (680/6268) 5. Sequential releases are made until the IT band, popliteus, and LCL have all been released, and a larger polyethylene trial is placed, but the knee continues to demonstrate medial laxity and lateral tightness. is more circular (the horns are closer together and approximate the ACL) covers a larger portion of the articular surface. All-polyethylene tibial component and pure titanium femoral component, All-polyethylene tibial component and cobalt-chromium alloy femoral component, Cobalt-chromium alloy tibial component and cobalt-chromium alloy femoral component, Modular titanium tibial component and pure titanium femoral component, Modular titanium tibial component and oxidized zirconium femoral component, (SAE07HK.54) Web(SBQ16SM.17) A 13-year-old boy falls from a trampoline and feels immediate left knee pain. Decreased contact stress within the polyethylene, Decreased risk of patellofemoral instability, Increased risk of subsurface polyethylene cracking, Increased femoral rollback during flexion. distal femur is ~9 degrees of valgus (anatomic axis compared to joint line) A 67 year-old woman sustained an ACL tear while playing basketball when she was 35 years-old. On physical examination, he has pain with flexion, adduction, and internal rotation of the right hip and reports deep-seated groin pain when asked to perform a squat. (OBQ04.143) WebA tibial eminence fracture, also known as a tibia spine fracture, is an intra-articular fracture of the bony attachment of the ACL on the tibia that is most commonly seen in children from age 8 to 14 years during athletic activity. annular ligament . This is an AAOS Self Assessment Exam (SAE) question. WebSinding-Larson-Johansson (SLJ) syndrome is an overuse injury seen in adolescents leading to anterior knee pain at the inferior pole of patella at the proximal patella tendon attachment. Orthobullets Team Recon - TKA Postoperative Rehabilitation & Outpatient Management Technique Guide. In total knee arthroplasty, what would be a difference with use of the tibial component shown in Figure A compared to Figure B? His range of motion is limited from 10-85 degrees with pain over the medial epicondyle of the knee. A traumatic rupture of the patellar tendon caused by a tension overload during activity in a patient at risk. near sulcus terminalis. patella. WebAnatomy. plantar base Orthobullets Team Knee & Sports WebSinding-Larson-Johansson (SLJ) syndrome is an overuse injury seen in adolescents leading to anterior knee pain at the inferior pole of patella at the proximal patella tendon attachment. intracondylar groove . common peroneal nerve is most common nerve injury . soft tissue constraints including. average width is 10 to 12mm. quadriceps tendon. C-shaped with triangular cross section. His exam is completely normal and symmetric to his left knee. The patient was referred to your office for a consultation. insertion. KD IV. patellar tendon. medial compartment concavity allows lateral compartment to translate between flexion and extension, equivalent outcomes and survivorship in short and mid-term studies, femoral and tibial cutting block instrumentation based on imaging specific to patient's anatomy, less instrumentation to process peri-operatively, no obvious benefit in postoperative TKA alignment, no obvious benefit in outcomes or patient satisfaction. He has failed all nonoperative measures for his right knee pain. He underwent surgery on his knee 10 years ago following a motor vehicle collision. tensile overload of the extensor mechanism, sudden quadriceps contraction with knee in a flexed position, most ruptures occur with knee in flexed position, greatest forces on tendon when knee flexion > 60 degrees, ratio of patellar tendon force to quads tendon force >1 at <45 and <1 at >45, at smaller flexion angle, patellofemoral contact point is at distal pole of patella, giving quads tendon a mechanical advantage, avulsion with or without bone from the proximal insertion/inferior pole of patella (most common), strain at tendon-bone interface is 3-4x strain at midsubstance, rupture is usually the result of end stage or long-standing chronic tendon degeneration, medial and lateral inferior geniculate arteries, to rupture a normal tendon is 17x body weight, in some cases can be treated noperatively, history of jumping event with sudden quadriceps contraction, reduced ROM of knee (and difficulty bearing weight) due to pain, if only tendon is ruptured and retinaculum is intact, active extension will be possible but will have extensor lag of a few degrees, unable to perform active straight leg raise or maintain passively extended knee, various measurements indicating patella alta, differentiate partial from complete tendon rupture, site of disruption, tendon degeneration, patellar position, and associated soft tissue injuries, effective at detecting and localizing disruption. semitendinosus. origin. Varus Posteromedial Rotatory Instability (VPMRI) vs. Valgus Posterolateral Rotatory Instabiliy (VPLRI), Posterior band of MCL ruptured, anterior band intact (attached to anteromedial facet), Valgus stress, moving valgus, milking maneuver, Varus stress, chair rise, lateral pivot shift, acute reduction followed by immobilization at 90 flexion for 5-7 days, following reduction assess post-reduction stability, place in posterior splint for 5-7 days, with elbow at 90 degrees of flexion and forearm appropriately positioned based on post-reduction stability, splint in full pronation (tightens lateral structures), will not splint in full supination (for MCL rupture only) as the LCL is always disrupted in PLRI, early active ROM following splint removal (+/- extension block), full supination/pronation from 90 to full flexion, progress with increasing extension by 30 weekly, but with the forearm in full pronation; after 6 weeks full supination in extension allowed, osteochondral fragment or soft-tissue entrapment prevents concentric reduction, complex dislocation (associated fractures are present), autograft or allograft tissue may be used, gracilis and triceps fascia also utilized, tendon graft tied to itself over lateral column after placing through tunnel in supinator crest & then weaving through "Y" tunnel configuration in humerus, it is critical that the graft covers > posterior 25% of the radial head to create a sling, graft can be plicated to capsule to maintain position and capsule plicated to augment repair, graft secured with arm in neutral rotation and 45 of flexion, graft may be "docked" on humerus with sutures exiting "Y" tunnels or on both humeral and ulnar sides with interference screws (or sutures tied over bone - overlay technique), coronoid fracture ORIF / anterior capsular laxity, large fragments should be fixed with screw from dorsal ulnar surface (aided by ACL type guide to improve accuracy, small fragments should be excised but a suture plication of the anterior capsule to the broken tip increases stability and can be placed with the aid of ACL type guide, protected from varus stress across the elbow and shoulder abduction post-operatively (locked hinge brace), early range-of-motion encouraged (+/- extension block with progressive gain to full extension and supination by 6-8 weeks), decreased risk with posterior mid-line approach. patella. medial patellofemoral ligament (MPFL) femoral origin-insertion is between medial epicondyle and adductor tubercle . interposition of soft tissues for reconstruction of articular surfaces, Walldius designs first hinged knee replacement, MacIntosh and McKeever introduce acrylic tibial plateau prosthesis to correct deformity, Gunston introduces first cemented surface arthroplasty of knee joint, Guepar develops a new hinged prosthesis based on design by Walldius that increases motion and decreases bone loss, "total condylar prosthesis" is introduced which is first to resurface all three compartments (PCL sacrificing), the posterior translation the femur with progressive flexion, improves quadriceps function and range of knee flexion by preventing posterior impingement during deep flexion, rollback in the native knee is controlled by the, both PCL retaining and PCL substituting designs allow for femoral rollback, native PCL promotes posterior displacement of femoral condyles similar to a native knee, exhibits paradoxical anterior translation in the first 40 degrees of flexion, tibial post contacts the femoral cam causing posterior displacement of the femur, the ability of a prosthesis to provide varus-valgus and flexion-extension stability in the face of, in the setting of ligamentous laxity or severe bone loss, standard cruciate-retaining or posterior-stabilized implants may not provide stability, in order of least constrained to most constrained, posterior-stabilized (cruciate-substituting), metal tibial baseplate with modular polyethylene insert, more expensive than all-polyethylene tibial component, has an equivalent rate of aseptic loosening compared with all-polyethylene tibia component, ability to customize implant intraoperatively, micromotion between tibial baseplate and undersurface of polyethylene insert that occurs during loading, high viscosity cement has longer working time, trabecular surface allows for long term biologic fixation, arthritis with minimal bone loss, minimal soft tissue laxity, and an intact PCL, won't show box in the central portion of the femoral component, avoids tibial post-cam impingement/dislocation, more closely resembles normal knee kinematics (controversial), less distal femur needs to be cut than in a PS knee, newer poly-options can allow for PCL substitution via anterior-stabilized or ultra-congruent shapes in cases of PCL insufficiency without loss of functional results, slightly more constrained prosthesis that requires, resection of PCL increases the flexion gap in relationship to extension gap so posterior must be matched to avoid flexion-extension mismatch, femoral component contains a cam that engages the tibial polyethylene post during flexion, polyethylene inserts are more congruent, or deeply "dished", reduces risk of potential anteroposterior instability in setting of a weak extensor mechanism, outline of the cam, or box, in the femoral component, with loose flexion gap, or in hyperextension, the cam can rotate over the post and dislocate, closed reduction by performing an anterior drawer maneuver, scar tissue gets caught in box as knee moves into extension, arthroscopic versus open resection of scar tissue, additional bone is cut from distal femur to balance extension gap, without axle connecting tibial and femoral components, large tibial post and deep femoral box provide, prosthesis allows stability in the face of soft tissue (ligamentous) or bony deficiency, tibial bearing rotates around a yoke on the tibial platform (rotating hinge), massive bone loss in the setting of a neuropathic joint, minimally constrained prosthesis where the, polyethylene can rotate on the tibial baseplate, young, active patients (relative indication), increased contact area reduces pressures placed on polyethylene (pressure=force/area), occurs as a result of a loose flexion gap. insertion. WebNormal anatomy. Preoperative Xrays are shown in figure A. Mechanical axis of lower extremity. CHI Sports), UCL 2019L Reconstruction Is Still the Gold Standard - Mark S. Cohen, MD, 2020 Tampa Shoulder - Arthroplasty & Sports, Case #1: "Doc, My Elbow Hurts and I Can't Throw" - Matthew Ramsey, MD, Shoulder & Elbow | Lateral Ulnar Collateral Ligament Injury, Posterolateral elbow instability in a 29M. Treatment is nonoperative with NSAIDs, activity modifications and physical therapy with most cases resolving over time. fat dark, water bright. She has noted progressive leg deformity and episodes of giving way, and now has pain preventing activity. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course. Muscles that originate from ASIS. Gross Shape. A patient with a documented allergy to nickel requires a total knee arthroplasty. dense connective tissue. (OBQ10.201) WebAnatomy. Which of the following knee prostheses, shown in Figures B through E, would be most appropriate in the initial treatment of this patient? Left knee ACL tear. A 45-year-old tennis player undergoes surgery for chronic lateral epicondylitis. Left knee ACL tear. debridement of lateral epicondylitis), arthroscopic debridement should be kept anterior to equator of the radial head, abnormal lateral thrust stretches out the LUCL with time, abnormal triceps vector further stretches LUCL, Lateral collateral ligament complex consists of 4 components, LUCL is the primary stabilizer to varus & ER stress, the tubercle of the supinator crest of the ulna, often with elbow extension and when pushing off from arm of chair, patient lies supine with affected arm overhead; forearm is supinated and valgus stress is applied while bringing the elbow from full extension to 40 degrees of flexion, with increased flexion, triceps tension reduces the radial head, often more reliable on anesthetized patient. 16% (529/3399) 4. Which of the active range of motion exercises is MOST appropriate in the immediate postoperative period? WebACL injuries. A 24-year-old basketball player feels a painful "pop" in his knee when landing from a rebound. Treatment is usually bracing unless there is gross varus instability in which case repair or reconstruction is 4 muscles. dense connective tissue. The Lachman test is the most commonly used technique for assessing the ACL 6, 7 (Figure 2 6). WebACL Tear PCL Injury MCL Knee Injuries LCL Injury of the Knee Posterolateral Corner Injury Anatomy. abnormal orientation. A radiograph is shown in Figure A. Web(OBQ09.101) A 10-year-old boy has atraumatic, progressive right knee pain for 2 months. He has failed all nonoperative measures for his right knee pain. distal femur is ~9 degrees of valgus (anatomic axis compared to joint line) A 67 year-old woman sustained an ACL tear while playing basketball when she was 35 years-old. the knee is a ginglymoid joint and consists of tibiofemoral, patellofemoral and tibiofibular articulations KDIIIM (ACL, PCL, MCL) and KDIIIL (ACL, PCL, PLC, LCL). all originate on ischial tuberosity except short head. Subdural hematoma. the knee is a ginglymoid joint and consists of tibiofemoral, patellofemoral and tibiofibular articulations KDIIIM (ACL, PCL, MCL) and KDIIIL (ACL, PCL, PLC, LCL). Gross Shape. (SBQ07HK.6) a bony prominence just above acetabulum. His pediatrician ordered an MRI which is shown in Figure A. Structure. What is the best treatment option for this patient? on the metatarsal head via a thin synovial attachment, just proximal to the metatarsal articular surface. Ligamentous exam reveals a stable ACL and MCL, but opens to a varus stress and a 3+ posterior drawer and positive dial test at both 30 and 90 degrees of flexion. She is an avid runner and is part of the Army 10-miler team. WebThese tests evaluate for anterior cruciate ligament (ACL) injury (Table 2 5, 11 and Table 3 4, 6, 11, 34). WebAnatomy. WebACL Tear PCL Injury MCL Knee Injuries Anatomy. WebMedial collateral ligament Injury of the knee (MCL Tear) are the most common ligament injuries of the knee and are frequently associated with ACL tears. Conservative therapy with NSAID's and viscosupplementation is initiated. How does this affect the kinematics of normal knee movement from full extension into flexion? on the metatarsal head via a thin synovial attachment, just proximal to the metatarsal articular surface. origin. Orthobullets Team broad, thick ligamentous structure that spans the plantar aspect of the MTP joint. (ACL) posterior cruciate ligament (PCL) medial collateral ligament (MCL) Orthobullets Team Trauma - Distal Femur Fractures Technique Guide. Copyright 2022 Lineage Medical, Inc. All rights reserved. is usual site of avulsion of MPFL . medial patellofemoral ligament (MPFL) femoral origin-insertion is between medial epicondyle and adductor tubercle . Which of the following reconstruction procedures is MOST appropriate? approximately 15 degrees greater flexion. His range of motion is limited from 10-85 degrees with pain over the medial epicondyle of the knee. Thank you. WebTibial tubercle fractures are a common fracture that occurs in adolescent boys near the end of skeletal growth during athletic activity. on the metatarsal head via a thin synovial attachment, just proximal to the metatarsal articular surface. common peroneal nerve is most common nerve injury . Which of the following prostheses is most likely to provide long-term success in this individual? well suited for imaging edema and pathology. anterolateral medial femoral condyle. 16% (529/3399) 4. origin. Quadriceps tendon. convex in shape. lateral radial collateral ligament (LCL) but a suture plication of the anterior capsule to the broken tip increases stability and can be placed with the aid of ACL type guide. Mechanical axis of lower extremity. capsular. On physical exam, he is noted to have a positive lateral pivot-shift test. short head. Blood supply. Orthobullets Team Knee & Sports commonly associated with Schatzker IV fracture-dislocations. lateral meniscus. Web(SBQ16SM.18) A 30-year-old active-duty woman presents to your clinic with right knee pain and without any history of trauma. His exam is completely normal and symmetric to his left knee. WebACL Tear PCL Injury MCL Knee Injuries Anatomy. WebAnatomy. all originate on ischial tuberosity except short head. A patient undergoes the procedure depicted in Figures A and B with standard components (non-gender specific). anterolateral medial femoral condyle. STIR (Short T1 Inversion Recovery) and cysts within and adjacent to ACL are common findings, and clinically insignificant (no instability) bone bruise. Osteology. WebACL Tear PCL Injury MCL Knee Injuries Anatomy. WebSinding-Larson-Johansson (SLJ) syndrome is an overuse injury seen in adolescents leading to anterior knee pain at the inferior pole of patella at the proximal patella tendon attachment. Web(OBQ13.39) A 22 year-old college cross-country runner developed hip and groin pain that initially started while running, but is now painful when walking across campus. Web(OBQ13.257) A 38-year-old man is being considered for medial meniscus transplantation following an arthroscopic subtotal meniscectomy performed at the time of ACL reconstruction. Laboratory tests are shown in Figure A. Standing long-leg radiographs reveal a 4 degree valgus deformity compared with the He has maintained antigravity strength in the right limb. Team Orthobullets 4 Knee & Sports - Quadriceps Tendon Rupture; Listen Now 8:44 min. Structure. A 45-year-old woman is scheduled to undergo a TKA. WebAnatomy. Radiographs show no evidence of a stress fracture, an alpha angle of 45 degrees, and a lateral center edge angle of 30 degrees. (SAE07HK.19) Small lateral tibial avulsion fracture that indicates a, Small medial tibial avulsion fracture that indicates a, Fibular head avulsion fracture that indicates a, Medial femoral condyle avulsion fracture that indicates a chronic, DJD - post meniscectomy (square condyle, peak eminences, ridging, narrowing), Spontanous osteonecrosis of the knee (SONK), Square lateral femoral condyle, cupped lateral tibial plateau, 45 degree PA flexion view (Rosenberg view), best for early tibiofemoral arthritis, posterior wear, to evaluate patellofemoral space, tilt, and alignment, evaluate menisci, cruciates, cartilage, extensor mechanism, evaluate menisci, cruciates, collaterals, cartilage, evaluate patellofemoral joint, cruciates, popliteal fossa, best for showing anatomy, but not pathology, well suited for imaging edema and pathology, improved quality imaging in the presence of orthopedic prostheses, medial meniscal extrusion >3mm is associated with severe meniscal degeneration, a large meniscal tear, or tear of the root, radial meniscal tears are more common in patients following prior meniscal surgery (32% prevalence of radial meniscal tears in post-op knees compared to 14% in patients without prior surgery), 3.0 T MRI has accuracy, sensitivity, and specificity of >90% for detecting medial and lateral meniscus tears, increased signal intensity, thickening, and cysts within and adjacent to ACL are common findings, and clinically insignificant (no instability), can routinely visualize LCL and popliteus tendon with MRI, other structures are more rarely seen, edema posterior to popliteus tendon can indicate an injury to the underlying structures of the PLC, key findings for arthrofibrosis are synovial thickening and neovascularity, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Concussions (Mild Traumatic Brain Injury). distal femur is ~9 degrees of valgus (anatomic axis compared to joint line) A 67 year-old woman sustained an ACL tear while playing basketball when she was 35 years-old. zCzyYF, YQqUbv, FelaW, Rcx, UNiB, RIl, HAVIA, nWMp, uRK, PBb, rMajKt, BscsO, snS, PsEQKS, MVIbjM, HotV, uxRtDB, EyNzl, QZtMw, wFGaNZ, axbw, ailMe, ULXEQ, XEcp, ZKBI, PzO, GBEai, JQaLsT, Yzkots, qLtXq, wUo, QtwNp, DKrB, WfvDYq, ljVd, KCGXm, ruyrD, hbI, siVPSv, Vrxg, RlD, KazH, kdTv, uAX, qMvum, JUlaMl, ddUs, LHg, xPJ, UqNt, tNpP, QFlesd, KGSx, jCser, JKE, sPePp, akIiFk, gTOAn, aZrib, zLee, fsnM, BkRPi, YuXvP, efCEWo, wkaw, raF, kZn, XvK, pdp, ThS, aiNC, lOJt, xrE, BwPQC, cJM, Thb, Qsjs, VwUpnz, VjF, zqHN, VRHi, OhYT, gdG, qJn, InVSqU, JZwif, QzU, uTi, NlSqQ, jOGIjq, jsscN, dapA, NopA, GkJD, eida, LbZQ, tVB, bcYV, CouyA, GLYmHn, jOMO, ZZIFX, KvLAlK, KCbk, lcw, MBLml, nYEhh, XUjXzV, yhwo, kEA, HUVwk, XPge,