Knee

Question 1

ACL All-inside Graftlink Technique provides what?

Answer 1

provides ultimate and anatomic minimally invasive an reproducable ACL reconstruction

Question 2

ACL sprain: Grade 1

Answer 2

• mild (ligament mildly damaged)

- stretched but stable

Question 3

ACL Sprain: Grade 2

Answer 3

• Moderate (stretched ligament becomes loose)

- partial tear

Question 4

ACL Sprain: Grade 3

Answer 4

• severe (complete tears of ligament)

- unstable knee

Question 5

ACL Helical Double Bundle
Origin:
Insertion:

Answer 5

origin- posterior medial aspect of lateral femoral condyle

insertion- anterior lateral aspect of medial tibial spine

Question 6

Anterior medial and anterior lateral portal is used for ______.

Answer 6

working and viewing portals
EX) arthroscope - camera and light source
and an arthroscopic instrument

Question 7

Superior medial and superior lateral portal are used for ______..

Answer 7

fluid outflow (cannula)

Question 8

Posterior medial and posterior lateral portal are used for ______.

Answer 8

• gain access to back of knee

- used in PCL reconstruction and meniscal root repair

Question 9

In knee arthroscopy surgeons typically have 2 options for portal placement, _____.

Answer 9

1. horizontal portal- allows camera movement medial and laterally
2. vertical portal- allows for camera to move up and down

Question 10

Arteries

Answer 10

carry oxygenated blood

Question 11

Veins

Answer 11

carry deoxygenated blood

Question 12

PES Anserine

Answer 12

• area where 3 tendons of the sartorius, gracilis, semi-tendenosus (Semi-T), all merge together and insert onto tibia
• common location where any of these ligaments can be harvested for a graft

Question 13

Knee Flexors

Answer 13

(hamstring)

• semitendonosus
• semimembranosus
• biceps femoris
  - origin of all 3: pelvis
  - inserts of all 3: distally on proximal tibia
• there are many other knee flexors

Question 14

Knee Extendors

Answer 14

(quadriceps) : quadriceps femoris

Question 15

what are the 4 muscles of the quadriceps femoris and where is their origin and insertion?

Answer 15

1. rectus femoris
2. vastus mediallus
3. vastus laterallis
4. vastus intermedius

ALL originate @ the pelvis
ALL insert distally @ tibial tubercle

Question 16

LCL

origin-
insertion-
role-

Answer 16

-Lateral Collateral Ligament

origin- attaches to lateral epicondyle of femur

insert- onto anterior lateral aspect of fibula head

role- protect against varus forces to knee

Question 17

Superficial MCL

Answer 17

• 2 attachment sites on tibia
• proximal attachment is approx 1 cm below tibial joint line
• distal segment attaches approx 6 cm below tibial joint
• superficial MCL plays major role in protecting against Valgus forces`

Question 18

Deep MCL

Answer 18

-directly attaches to medial meniscus and is broken into 2 segments
1. meniscal femoral attachment
2 . meniscal tibial attachment

-tibial attachment of deep MCL: edge of tibial plateau

Question 19

MCL

Answer 19

• Medial Collateral Ligament
• has 2 components (deep and superficial MCL)
• tibial attachments differ, but BOTH attach to medial epicondyle of femur

Question 20

PCL double bundle structure

Femoral Attachment:
Tibial Attachment:

Answer 20

-named for attachment on femur
- Anterior Lateral (AL)
- Posterior Medial (PM)
Femoral Attachment- attaches to medial femoral condyle
Tibial Attachment- locates on posterior facet of tibia

Question 21

PCL

Role:

Answer 21

-Posterior Cruciate

role- prevent tibia from dislocation posteriorly to femur

Question 22

Double bundle structures of ACL (AM & PL) have ______, meaning :

Answer 22

• reciprocal functions
• meaning when 1 is tight, the other is loose
• in any position of the knee, a portion of the ACL remains under constant tension, providing sufficient knee stability throughout ROM

Question 23

ACL
role
attachment

Answer 23

-Anterior Cruciate Ligament
-double bundle structure connects femur to tibia
-Anterior Medial (AM)
- Posterior Lateral (PL)
Role- stop tibia from dislocation anteriorly on femur
-attaches to the lateral femoral condyle

Question 24

Gerdy’s Tubercle (anterior surface)

Answer 24

• on proximal end of tibia
• anterior lateral tibia
• attachment site of the IT band

Question 25

"Lighthouse of the knee"

Answer 25

Gerdy's Tubercle

Question 26

what is Articular Cartilage?

Answer 26

- specialized cells, provides protection, covers the ENDS of bones - anural and avascular

Question 27

Articular cartilage covering allows _______.

Answer 27

-allows bones to glide over one another with little friction

Question 28

Anural

Answer 28

-meaning without nerves

Question 29

Avascular

Answer 29

-meaning with out blood supply

Question 30

Cancellous bone

Answer 30

-spongy bone, soft/flexible

Question 31

where are blood cells made in bones?

Answer 31

cancellous bone

Question 32

Cortical Bone

Answer 32

- hard, compact portion of bone | - gives strength to hollow bone

Question 33

Periosteum

Answer 33

- entire portion of bone is covered in periosteum | - thin, tough layer covering entire bone, EXCEPT the articular surface and attachments of ligaments/tendons

Question 34

Structure of bone: | Diaphysis-

Answer 34

-long "shaft" of bone

Question 35

Structure of bone: | Metaphysis-

Answer 35

"wide" portion of bone between epiphysis and diaphysis

Question 36

Structure of bone: | Epiphysis-

Answer 36

- rounded end of a long bone @ joint covered with articular cartilage

Question 37

Valgus

Answer 37

-outward angulation of distal segment of bone/joint (knock kneed)

Question 38

If a distal segment is lateral to a proximal segment then it is _______.

Answer 38

valgus

Question 39

Varus

Answer 39

-inward angulation of distal segment of a bone or joint ( bow legged)

Question 40

if a distal segment of a bone is medial to a proximal segment of bone then it is _______.

Answer 40

varus

Question 41

What is the normal ROM of the knee?

Answer 41

- Flexion: 145-155 degrees | - Extension: minus 10 degrees

Question 42

When the knee hyperextends it is called _______?

Answer 42

-Recurvatum | (internal/external rotation is approximately 10-15 degrees)

Question 43

Ligament

Answer 43

attaches a BONE TO ANOTHER BONE | - made of fibrous connective tissue compromised of collagen fibers

Question 44

Tendon

Answer 44

-fibrous connective tissue attaches a MUSCLE TO A BONE

Question 45

Collagen Fibers

Answer 45

- flexible/strong, arranged in parallel bundles - helps multiply strength of individual fibers - collagen bundles attached to outer coverings of bones (periosteum)

Question 46

The knee consists of :

Answer 46

2 articulations - femur and tibia - femur and patella 3 compartments - medial - lateral - patellofemoral

Question 47

What is the standard equipment needed for a knee arthroscopy?

Answer 47

- arthroscope 30 (most common) or 70 degrees -hand instrument (biters, scissors, forceps) - motorized shavers and burs -probe

Question 48

Typical knee arthroscopy position

Answer 48

patient lying supine, w/ knee flexed at 90 degrees inside of a tourniquet

Question 49

another option for knee arthroscopy positioning

Answer 49

have leg hanging off edge of bed. while using a pivot post allows surgeon to place a valgus(internal rotation) force on knee and open tight medial compartment for better view of posterior medial structures

Question 50

what portal is the main working portal?

Answer 50

anterior medial portal

Question 51

what are the ACL double bundles called?

Answer 51

- double bundle structure connects femur to tibia - Anterior Medial (AM) - Posterior Lateral (PL)