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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
You are reviewing the MRI in Figure A as part of an achilles tendon repair case preparation with your intern. Which of the following structures (A-E) indicates the sural nerve?
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A 35-year-old patient presents with right calf weakness of approximately six weeks duration. The patient noted a pop in the back of their heel when carrying a heavy box up a flight of stairs. In the office, there is an approximately 3 cm palpable defect in the posterior heel cord. When examined in the prone position the foot rests in greater dorsiflexion compared to the contralateral. Which procedure will most likely need to be performed at the time of surgical repair?
Flexor digitorum longus transfer (FDL)
Tibialis posterior transfer
V-Y advancement of the achilles
Synthetic graft augmentation
Peroneal brevis tendon transfer
A 28-year-old male laborer suffered a left ankle injury 4 months ago at work while unloading a dolly. He notes difficulty walking and pain with ambulating. Physical exam shows an inability to toe walk on the left, as well as the finding demonstrated in Figure 1. What other test will be positive and which procedure will likely best result in the restoration of power and function?
Thompson test, primary repair with synthetic graft augmentation
Thomas test, VY advancement
Thompson test, VY advancement with tendon transfer
Thessaly test, VY advancement with tendon transfer
Thompson test, debridement of osseous spur and primary repair
A 58-year-old male with a history of chronic posterior ankle pain feels a "pop" and experiences a sharp pain in the back of his heel after jumping off a step. He is placed in a splint and is subsequently lost to follow-up. Six months later he presents complaining of weakness and pain. Examination reveals weakness to ankle plantarflexion and increased passive ankle dorsiflexion. An MRI of his ankle is shown in Figure A. Intraoperatively, a tendon defect a is measured to be 4cm in length. What is the most appropriate treatment plan:
Equinus casting for 6 to 8 weeks
Surgical repair through an percutaneous approach with plantaris transfer
Surgical reconstruction through an open approach with Achilles allograft
Surgical repair through an open approach with flexor hallucis longus transfer
Surgical repair through an limited open approach with peroneus longus transfer
Which of the following outcomes has been reported with surgical repair of acute Achilles tendon ruptures as compared to non-operative treatment with functional rehabilitation?
Improved ankle dorsiflexion strength at 6 month follow-up
Improved ankle dorsiflexion range-of-motion at 6 month follow-up
Improved mean SMFA scores at 12 months
A statistically significant decrease in re-rupture rates
Increased complication rates
A 55-year-old man has a chronic Achilles tendon rupture. He is scheduled for surgical reconstruction using V-Y advancement of the gastrocnemius-soleus complex aponeurosis with augmentation using a local tendon transfer. What is the native insertion and nerve that innervates the tendon most commonly used to augment this procedure?
1st digit proximal phalanx, Tibial nerve
1st digit distal phalanx, Superficial peroneal nerve
Base of the 5th metatarsal, Superficial peroneal nerve
1st cuneiform and 1st metatarsal, Deep peroneal nerve
1st digit distal phalanx, Tibial nerve
What would be the most appropriate treatment for the sub-acute injury seen in Figures A-C?
Carbon fiber composites synthetic graft
Achilles tendon xenograft with medial and lateral aponeurotic fascial turndown flaps
Posterior tibialis tendon transfer with medial and lateral aponeurotic fascial turndown flaps
Flexor hallucis longus tendon transfer with sliding V-Y advancement of the gastrocnemius-soleus complex aponeurosis
A 56-year old male presents 4 months after injuring his ankle when he misstepped off a curb. Figures A and B are sagittal and coronal MR images taken recently. He undergoes surgery and intra-operatively the surgeon elects to perform a tendon transfer to augment the repair. What deficit would be expected following a transfer of the most common tendon used in this scenario?
Weakness on resisted foot eversion
Weakness on resisted hallux plantarflexion
Weakness on resisted hallux dorsiflexion
Weakness on resisted ankle inversion
Weakness on resisted ankle dorsiflexion
A 36-year-old man presents with fever, pain, and wound drainage 4 months after repair of an acute Achilles tendon rupture. A clinical image is shown in Figure A. Laboratory studies show an ESR of 29 (reference range 0-22 mm/hr). It is decided that he will undergo debridement and irrigation followed by culture specific antibiotic therapy. In the operating room, the Achilles tendon is found to have re-ruptured with a 5 cm defect. What is the most appropriate surgical treatment at this time?
Primary repair of the re-ruptured Achilles tendon
Debridement of necrotic and infected tendon tissue, with no attempt at reconstruction
V-Y plasty of the re-ruptured Achilles tendon
Repair of the re-ruptured Achilles tendon with a turndown procedure
Repair of defect with flexor hallucis longus tendon transfer
A 58-year-old golfer fell stepping into a sand trap and ruptured his Achilles tendon one year ago. He initially chose non-operative treatment, but became unsatisfied with a tender fullness behind his ankle and ankle weakness noticeable during his tee shots. At the time of surgery, a large disorganized fibrous mass is found at the site of rupture. Following extensive debridement there is a 5 cm gap between viable tissue ends. Which of the following surgical techniques provides the greatest likelihood of a successful clinical outcome?
Gastocnemius turndown repair augmented with transfer of the posterior tibial tendon
Gastocnemius turndown repair augmented with transfer of the extensor digitorum longus
Gastocnemius turndown repair augmented with transfer of the flexor hallucis longus
Reconstruction with hamstring autograft
Primary repair with the foot in maximal plantarflexion followed by a gradual stretching program
What is the greatest advantage of surgical repair of an acute Achilles tendon rupture with early range of motion compared to non-operative treatment with immobilization in a short-leg cast for 6 weeks?
Lower rate of infection
Higher rate of normal skin sensation
Better skin cosmesis
Lower rate of dehiscence
Lower rate of re-rupture
A 38-year-old patient has an acute Achilles tendon rupture. He is active in sports and is deciding between operative and nonoperative treatments. Which of the following statements applies to patients undergoing conservative treatment with a cast for 6 weeks followed by a course of physical therapy?
They have lower patient satisfaction scores
They are less likely to return to sport
Their ultimate strength is decreased
They have a higher risk for rerupture
They have a higher risk of skin problems
Which factor increases the chance of wound complications after Achilles tendon repair?
Increased body mass index
Age over 40 years old
A 41-year-old female feels a pop in her ankle while playing tennis. She is diagnosed with an acute Achilles tendon rupture and elects to undergo nonoperative management. Which of the following is the expected outcome seen with nonoperative management with early functional rehabilitation as compared with operative treatment?
Decreased incidence of deep venous thrombosis
No significant difference in functional outcomes
Increased rate of re-rupture
Earlier return to sport
Increased rate of complications