04 ACL 1 Flashcards Preview

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Flashcards in 04 ACL 1 Deck (28):
1

What types of factors contribute to ACL injury?

- modifiable risk factors
- non-modifiable risk factors

2

What are the modifiable risk factors for ACL injury?

- fatigue
- triplanar movements

3

What are the non-modifiable risk factors for ACL injury?

- shape of notch (rounded or a-frame)
- females more susceptible

4

What do we mean by triplanar movements?

- frontal
- sagittal
- transverse

5

What is a risk factor for frontal plane issues? Why?

glut med weakness

hip abductors prevent valgus motion

6

What is a risk factor for transverse plane issues?

- dynamic valgus
- eccentric control of hip external rotators

7

What is a risk factor for sagittal plane issues?

muscle imbalance

unilateral weakness of hamstrings to quads

8

Who has sagittal plane issues most commonly?

women

9

When do ACL injuries occur?

femur and tibia twist in opposite directions under full body weight

10

What does a normal ACL look like on MR?

black

11

What are the options if an athlete has an ACL tear early in the season?

- immediate surgery
- use rehab and bracing to return quickly to sports and operate after the season

12

What is a drawback to immediate surgery for an athlete with an ACL tear early in the season?

end of the season for them

13

What is a drawback to waiting to do surgery until later for an athlete with an ACL tear early in the season?

runs the risk of further injuries to the knee

14

gold standard for ACL repairs

BTB

15

autogenous

from one's own tissue

16

What are the options for ACL grafts?

- autograft
- allograft
- xenograft
- synthetic grafts
- tissue engineering

17

xenograft

bovine

18

synthetic graft

- prosthetic ligament
- ligament augmentation device
- scaffold

19

Which of the ACL graft options is the future of ACL reconstructions?

tissue engineering

20

How many bundles in the ACL?

2

21

What are the two ACL bundles?

- AM: anterior medial
- PL: posterior lateral

22

Why might surgeone choose to do a double bundle ACL reconstruction rather than just one?

- traditional approach addressed anterior translation, but not rotational translation
- double bundle may minimize and/or prevent OA changes that are often seen

23

percentages of normal (single vs. double bundle)

anterior translation

single bundle: 89%
double bundle: 97%

24

percentages of normal (single vs. double bundle)

combined rotary translation

single bundle: 66%
double bundl: 91%

25

What are the surgical portals?

- standard lateral portal
- standard medial portal
- accessory medial portal

26

In addition to the portals, what other surgical landmark is there for ACL repair?

tibial incision

27

standard medial portal advantages

- accurate femoral and tibial tunnel placement
- preservation of AM or PL bundle
- 1x or 2x bundle reconstruction
- compatible with any graft or fixation
- parallel placement of screw fixation through same medial portal as that used for tunnel creation
- decreased tunnel widening

28

risks to medial portal

- short tunnel length
- posterior wall blow-out
- not protective against incorrect tunnel placement
- limited tunnel visualization
- excessive sagittal angulation
- peroneal nerve injury