4.0 of 109 Ratings
Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 22-year-old personal trainer presents with pain and feelings of instability in her left knee following a fall. Physical exam shows an effusion and painful range of motion from 0-110 degrees. Her imaging is shown in Figures A-D. What is the best next step in treatment?
ACL reconstruction and delayed meniscal allograft transplantation
ACL reconstruction and meniscectomy
ACL reconstruction and an all-inside meniscal repair in a horizontal mattress fashion
ACL reconstruction and a staged inside-out meniscal repair
ACL reconstruction and meniscal root repair
Select Answer to see Preferred Response
A 26-year-old patient presents with knee pain associated with catching and locking several weeks after playing rugby. Figures A and B demonstrate the MRI of the patient's knee. The patient opts to undergo a surgical repair of the meniscus. An inside-out technique is performed. What is the approach interval and the neurovascular structure at greatest risk?
Between the semimembranosus and medial head of the gastrocnemius; inferior medial genicular artery
Between the joint capsule and the medial head of the gastrocnemius; saphenous nerve
Between the sartorius and the gracilis; saphenous nerve
Between the lateral head of the gastrocnemius and joint capsule; peroneal nerve
Between the lateral head of the gastrocnemius and the biceps femoris; inferior lateral genicular artery
A 35-year-old male presents to your clinic with right knee pain after sustaining a twisting injury while playing basketball 3 weeks ago. He is able to walk but is now experiencing severe knee pain and limited flexion. Figures 1 and 2 are representative MRI slices of his right knee. The patient undergoes the appropriate surgical treatment. Which of the following is a positive prognostic indicator for his outcome following surgery?
Unaddressed ACL insufficiency
Large rim width
Tear at red-white junction
Vertical and longitudinal tear
A 22-year-old professional volleyball player presents with acute knee pain following an awkward landing. She feels that her knee is locked and ROM is limited to 20-90 degrees. Figure A shows an arthroscopic image from her surgery. Which of the following MRI's most closely correlates with the intraoperative findings?
A 26-year-old elite female swimmer underwent a left medial meniscal allograft transplantation. She returns to clinic 3 years later with knee pain. What is the most likely cause for late presenting knee pain in this patient population?
Late immune rejection of the meniscal graft
Loss of graft fixation
Graft tear due to acellularity
Late-onset graft infection
A 38-year-old man is being considered for medial meniscus transplantation following an arthroscopic subtotal meniscectomy performed at the time of ACL reconstruction. His body mass index (BMI) is 28kg/m2. Laboratory tests are shown in Figure A. Standing long-leg radiographs reveal a 4 degree valgus deformity compared with the contralateral side, with the weightbearing line running through the lateral tibial spine. His arthroscopic photos also revealed a 1.7cm wide Outerbridge II chondral lesion over the lateral femoral condyle and synovitis. What factor in this patient is an absolute contraindication to meniscal transplantation?
Previous anterior cruciate ligament reconstruction with allograft tissue
Body mass index
A 34-year-old active high-school football coach presents with chronic right medial knee pain that worsens with prolonged standing. He shares that he underwent a right knee arthroscopic procedure several years ago but is unable to recall any further details regarding the indication and operative findings. He has trialed multiple sessions of rest, physical therapy, and three corticosteroid injections. Knee examination is unremarkable except for medial joint line tenderness. Plain radiographs and MRI scans are depicted in Figures A through D. He wishes to remain active and asks whether he would be a candidate for isolated meniscus allograft transplantation. You advise against an isolated meniscal allograft transplantation for him because:
The current literature does not support allograft meniscal transplantation in isolation
He is beyond the age where the procedure will provide lasting benefits
He has yet to try a course of viscosupplementation
His limb alignment and articular cartilage loss will likely result in increased failure of the procedure
Based on his age and limb alignment, an isolated medial closing wedge tibial osteotomy is all that he needs
The meniscal injury pattern of the left knee seen in the arthroscopic video shown in Figure A is best described as which of the following?
Medial horizontal cleavage tear
Lateral radial tear
Medial parrot beak-type tear
Medial displaced bucket-handle tear
Lateral cyclops tear
An 18-year-old football player sustained a twisting injury to his knee approximately 1 month ago. He complains of continued knee pain with occasional locking and catching. Figure A demonstrates the injury on a T1 sagittal MRI. What physical exam finding is classically seen with this injury?
No endpoint with valgus stressing of the knee
Positive apprehension sign with passive lateral patellar translation
Painful click is elicited as the knee is brought from flexion to extension with internal or external rotation
No endpoint with varus stressing of the knee
A positive posterior drawer and quadriceps active test
Which of the following complications is more likely with an inside-out repair technique compared to an all-inside techniques for a medial meniscus tear?
Peroneal nerve injury
Saphenous nerve injury
When performing an inside-out lateral meniscal repair, capsule exposure is provided by developing the
iliotibial band and biceps tendon interval, then retracting the lateral head of the gastrocnemius anteriorly.
iliotibial band and biceps tendon interval, then retracting the lateral head of the gastrocnemius posteriorly.
iliotibial band and biceps tendon interval, then retracting the lateral collateral ligament posteriorly.
iliotibial band and biceps tendon interval, then splitting the lateral head of the gastrocnemius.
lateral head of the gastrocnemius and biceps tendon interval, then retracting the biceps tendon anteriorly.
Splitting between the iliotibial band and biceps tendon, then retracting the gastrocnemius posteriorly provides exposure for which of the following procedures?
Two-incision ACL reconstruction
Tibial-inlay PCL reconstruction
Peroneal nerve exploration
Inside-out medial meniscus repair
Inside-out lateral meniscus repair
Which of the following is NOT a contra-indication to isolated medial meniscal transplantation?
Patient age over thirty
Grade IV chondromalacia
All of the following variables have a negative impact on the outcomes of isolated meniscal allograft transplantation EXCEPT?
Anterior cruciate ligament insufficiency
The use of a fresh frozen graft
Femoral condyle flattening
Graft size mismatch of 15%
An 18-year-old competitive tennis player sustains a twisting injury to his knee. He develops pain and swelling and is unable to straighten his knee. The MRI is shown in the Figure A. What is the most approriate treatment?
Arthroscopic medial meniscectomy or repair
Arthroscopic lateral meniscectomy or repair
Physical therapy with gradual stretching exercises
Corticosteroid injection for acute inflammation
Following meniscal repair, saphenous nerve injury is more common with which of the following techniques?
Inside-out lateral repair
All-inside lateral repair
Inside-out medial repair
All-inside medial repair
Equal rates for both lateral and medial
A 16-year-old female field hockey player sustains a twisting injury to her knee. On exam, she cannot extend the knee past 30 degrees. Arthroscopy confirms a displaced bucket-handle tear of the lateral meniscus with a 3-mm peripheral rim. What is the most appropriate treatment?
Meniscal repair using all-inside bioabsorbable arrows/darts
Meniscal repair using inside-out horizontal mattress sutures
Meniscal repair using inside-out vertical mattress sutures
A "double PCL sign" seen on a sagittal MRI image of a knee is indicative of which of the following conditions?
Combined ACL and PCL tear
Bucket-handle meniscal tear
Tears in the peripheral one-third of the meniscus have higher healing rates following meniscal repair than those in a more central location. This clinical observation is explained by which of the following anatomic factors?
Increased blood supply
Increased type II collagen
Increased type I collagen
Increased glycosaminoglycan content
A young athlete sustains an isolated meniscal tear and undergoes arthroscopy. The surgeon performs a meniscal repair. Which of the following factors is most important in determining healing rates?
Days from injury to repair
Medial versus lateral meniscus
Width of the meniscal rim
Use of growth hormone
Dominant versus non-dominant leg
A 19-year-old male is playing football and hears a pop in his left knee during a tackle 12 days ago. He was unable to return to the game and reports a large amount of swelling in the knee. On examination today he lacks full extension. A coronal and sagittal MRI is shown in Figures A and B, respectively. Which of the following is the best next step in management.
Rest and icing followed by physical therapy for definitive management
Arthroscopic removal of osteochondral loose body
Arthroscopic meniscus repair followed by immediate joint mobilization
Physical therapy for immediate joint mobilization followed by delayed arthroscopic PCL reconstruction once ROM is near normal
Immediate ACL reconstruction