MCQs-sports knee 2
lateral release and VMO advancement
– if you have lateral patellar tilt but otherwise normal tracking, start again with physio, then you can do an arthroscopic lateral release. “LPCS” or lateral patellar compression syndrome is associated with a tight lateral retinaculum and excessive lateral tilt.
– in terms of risk factors for arthrofibrosis after ACL reconstruction – a toss up between MCL repair and reconstruction within 2 weeks. Lots of papers describe increased stiffness when doing ACL plus meniscal repair and ACL plus MCL repair (the latter does worse – ie. doing the MCL leads to more stiffness than the meniscus); lots describe increased stiffness when doing them acutely. But nothing I’ve seen compares the addition of MCL repair versus timing of surgery as risk factors.
– graft placement within the knee is critical in ACL reconstruction – on the femur, placing it too anteriorly makes it too tight in flexion, placing it too posteriorly makes it too tight in extension. On the tibia, placing the hole too anteriorly makes it too tight in flexion and makes it impinge in extension
– the ACL and PCL are extra-synovial
– the tibial attachment of the ACL is stronger than the femoral origin – check this out!
– the saphenous nerve is most in danger when doing outside in mensical repair
– most LCL injuries can be managed non-operatively. This typically causes problems in the varus knee only.
– the best predictor of outcome after HTO is the postop alignment.
– for distal femoral varus osteotomy, you are aiming for a femoral-tibial angle of ZERO (or maybe a tiny bit of valgus at most)
– the Q angle is not increased by externally rotating the femur; it is increased by anteversion of the hip (internal rotation of the femur) and external rotation of the tibia (lateralizes the insertion of the patellar tendon)
– on the function of the meniscus – takes 50% of load in extension, 85% of load in flexion; as a shock absorber, it is decreases shock by 20%. As a stabilizer, it is not very important until the ACL is torn, at which point the medial meniscus becomes a very important stabilizer – it is stressed and often tears with chronic ACL insufficiency.