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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 17-year-old male presents with left knee pain and swelling after playing football three days ago. On physical exam, he has a large effusion with limited knee flexion due to pain. His radiograph is shown in Figure A. What does the finding in the radiograph represent?
Avulsion fracture of the anterior cruciate ligament
Avulsion fracture of the biceps femoris
Lateral tibial plateau fracture
Avulsion fracture of the anterolateral ligament
Avulsion fracture of the lateral collateral ligament
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A 17-year-old girl sustained a twisting injury to her knee during a basketball tournament 2 weeks ago. She presents to clinic with significant knee pain and swelling. On examination, her knee range of motion (ROM) is limited to 10-75°. A dial test is performed and reveals a 5-degree external rotation asymmetry compared to the contralateral knee. Her radiographs are shown in Figures A and B. What is the likely diagnosis and the best next step in management in order to optimize her outcomes?
Arcuate complex injury; ligament complex repair
Anterior cruciate ligament injury; ligament reconstruction
Anterior cruciate ligament injury; physical therapy to optimize ROM
Posterolateral corner injury; ligament complex repair
Posterolateral corner injury; physical therapy to optimize ROM
An 18-year-old female collegiate athlete sustains the injury seen in Figure A. The patient states that her father had a successful allograft reconstruction for a similar injury and would like to know if she could have the same procedure. Which of the following should be discussed with this patient regarding surgical reconstruction using an allograft?
Increased rate of hamstring weakness
Lower immune reaction compared to autograft
Higher incidence of anterior knee pain
Shorter incorporation time
Increased risk of re-rupture
A 22-year-old soccer player sustained an acute ACL rupture 4 years ago. He underwent an autograft hamstring reconstruction at that time. He presents today with a complaint of a persistent sensation of instability despite having a neutral radiographic mechanical alignment and appropriately placed tibial and femoral tunnels from his previous ACL reconstuction on repeat imaging. He denies any new injury. Figures A-E are clinical examination maneuvers for assessing knee stability. Which figure symbolizes a concomitant injury, that if missed initially, would increase the failure rate of an ACL reconstruction?
A 34-year-old recreational hockey player collides with the goalie during a game and injures his knee. He presents to your clinic for evaluation. A radiograph is shown in Figure A. He is diagnosed with an isolated ligamentous injury. During the pivot shift examination, the iliotibial band contributes to:
Reduction of the medial tibial plateau with knee extension
Reduction of the lateral tibial plateau with knee extension
Reduction of the lateral tibial plateau with knee flexion
Subluxation of the lateral tibial plateau with knee extension
Subluxation of the lateral tibial plateau with knee flexion
Anterior cruciate ligament (ACL) graft failure is most commonly attributed to tunnel malposition. Which physical examination finding is correctly matched to the tunnel malposition??
Positive anterior drawer with a vertical femoral tunnel
Increased knee flexion with an anterior femoral tunnel
Inability to fully extend the knee with an anterior tibial tunnel
Positive pivot shift with an anterior tibial tunnel
Increased anterior tibial translation in knee extension with a posterior femoral tunnel
A patient has persistent instability symptoms one year after ACL reconstruction. Radiographs and MRI show an intact graft with a femoral tunnel that enters the notch at the 12 o'clock position. These clinical findings have been associated with which of the following?
Lachman 2+, negative pivot shift and higher Lysholm scores
Lachman 2+, positive pivot shift and no change in Lysholm scores
Positive pivot shift and lower Lysholm scores
Lachman 1+, negative pivot shift and lower Lysholm scores
Lachman 1+, negative pivot shift and no change in Lysholm scores
A 12-year-old female sustained a right knee injury during a high-level gymnastic competition. Physical examination revealed a significant effusion, positive anterior drawer, and 3+ Lachman. She is a Tanner 3 on the scale of physical development. When considering transphyseal reconstruction techniques, which of the following factors has the greatest potential to cause physeal injury in the tibia?
Vertical transphyseal tunnel position
Slow transphyseal tunnel reaming
Small transphyseal tunnel diameter
Horizontal and oblique transphyseal tunnel position
Which of the following bone bruise patterns seen on magnetic resonance imaging (MRI) is most consistent with an anterior cruciate ligament (ACL) tear?
Medial tibial spine and medial femoral condyle
Medial facet of patella and lateral femoral condyle
Posterolateral tibia and lateral femoral condyle
Posterolateral tibia and medial femoral condyle
Medial tibial spine and lateral femoral condyle
A genotype within the COL5A1 gene is associated with a reduced risk of which of the following injuries in women?
Rotator cuff tear
Lateral patellar dislocation
Anterior cruciate ligament rupture
Torn discoid meniscus
A 23-year-old soccer player suffers an ACL rupture and undergoes reconstruction. Post-operatively she begins a rehabilitation program and her therapist develops a series of knee conditioning exercises to help her regain strength and range of motion. Which of the following exercises places the lowest strain in this patients properly placed ACL graft?
Isometric hamstring contractions at 60 degrees of knee flexion
Isolated quadriceps contractions with the knee at 30 degrees of flexion
Simultaneous quadricep and hamstring contractions at 15 degrees of knee flexion
Isolated quadriceps contractions with the knee at 15 degrees of flexion
Active resisted knee motion from terminal extension to 30 degrees of flexion
A patient develops infrapatellar contracture syndrome after undergoing ACL surgery. All of the following findings are consistent with this diagnosis EXCEPT?
Decreased patellar mobility
Loss of active but not passive flexion
Loss of full extension
Loss of passive flexion
A 25-year-old male is one year status post anterior cruciate ligament (ACL) reconstruction using patellar bone-tendon-bone (BTB) autograft. He complains of persistent instability with certain activities. His operative dictation notes excellent stability intra-operatively with femoral fixation at the 12 o'clock position. Based on his femoral tunnel position, his history and examination are most likely to reveal which of the following?
Positive pivot shift test and instability with cutting activities due to failure to reconstruct the posterolateral bundle of the ACL
Positive Lachman's test and instability with forward running activites due to failure to reconstruct the anteromedial bundle of the ACL
Positive pivot shift test and instability with cutting activities due to failure to reconstruct the anterolateral bundle of the ACL
Positive Lachman's test and instability with forward activites due to failure to reconstruct the posteromedial bundle of the ACL
Positive pivot shift test and instability with forward running activities due to failure to reconstruct the posterolateral bundle of the ACL
A collegiate men's basketball point guard undergoes ACL reconstruction with hamstring autograft. One year following reconstruction, he returns to playing and complains of recurrent instability episodes. He has an acute giving way episode on the court and is found to have an effusion and a positive pivot shift. Which of the following is the most likely cause of his injury?
Improper graft selection
Lack of sufficient physical rehabilitation prior to return to basketball
Overly aggressive physical rehabilitation during the first 3 months following reconstructive surgery
Surgical error in graft tensioning
Surgical error in tunnel position
Which of the following exercises should typically be avoided during the initial therapy following ACL reconstruction?
Light leg press
Use of a stair climbing machine
Vertical squat with light dumbbells in each hand
Seated leg extensions
Use of a stationary bike
A 27-year-old professional rugby player is sprinting down the field during a game and sustains a twisting injury to his right knee with immediate onset of swelling, pain, and difficulty with ambulation. Imaging of his right knee is demonstrated in Figures A, B, and C. Which of the following structures has most likely been injured?
Posterior cruciate ligament
Anterior cruciate ligament
Lateral collateral ligament
Medial collateral ligament