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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
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?
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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
Tunnel malposition is thought to be a primary etiology for ACL graft failure. All of the following are true of tunnel position EXCEPT:
Vertical placement of the femoral tunnel can result in rotational instability and impingement against the PCL
Anterior placement of the femoral tunnel can result in elongation of the graft
Tibial tunnel placement should be placed posterior to a line extending from Blumenstaat's line when the knee is in full extension
Transtibial drilling through a tibia tunnel that is too far anterior can result in a vertical (12:00) graft
Transtibial drilling through a tibia tunnel that is too far anterior can result in an oblique (10:30 or 1:30 position) graft
A 31-year-old male is 1 year status post primary anterior cruciate ligament reconstruction. Despite adequate physical therapy, he has been unable to return to sport due to recurrent instability and elects to proceed with revision surgery. What is the most common reason for failure of his primary ACL reconstruction?
Unrecognized varus malalignment preop
Improper bone tunnel placement
Reconstruction with a single bundle
Improper graft selection
Patients may complain of numbness over the anterolateral aspect of the knee following ACL reconstruction. This is most commonly due to injury of which of the following?
Suprapatellar branch of the saphenous nerve
Infrapatellar branch of the saphenous nerve
The common peroneal nerve
The superficial femoral nerve
The lateral femoral cutaneous nerve
A 25-year-old male undergoes an ACL reconstruction with an ipsilateral bone-patella tendon-bone autograft. At his two week followup he is noted to have complete loss of his extensor mechanism on exam, stable Lachman and posterior drawer tests, and patella alta radiographically. Management should consist of?
Continued standard ACL rehab protocol
Quadraceps tendon repair
WBAT in a cylinder cast
Patellar tendon repair or reconstruction
Revision ACL reconstruction with hamstring autograft
Strategies which focus on increasing patient neuromuscular control are most effective at preventing which of the following female sporting injuries?
Anterior cruciate ligament ruptures
When comparing autologous graft options for ACL reconstruction, a hamstring graft is associated with which of the following findings when compared to a patellar tendon graft?
Decreased tunnel widening
Decreased pivot shift
Decreased incidence of anterior knee pain
Increased knee flexion strength on Cybex testing
Increased stability on KT-1000
A 28-year-old male presents with persistent knee symptoms 6 months following ACL reconstruction. Current radiographs are shown in Figure A. Based on the location of his femoral tunnel, which of the following physical exam findings is likely present?
Positive Lachman's exam
Positive external rotation dial test at 30 degrees
Positive anterior drawer sign
Positive posterior drawer sign
Positive pivot shift sign
Figure 23 shows the postoperative radiograph of a patient who underwent an anterior cruciate ligament (ACL) reconstruction (with bone-patella tendon-bone autograft) that failed. He initially had loss of flexion postoperatively. What is the most likely cause of this failure?
Fixation in the tibial tunnel
Fixation in the femoral tunnel
Posterior placement of the tibial tunnel
Anterior placement of the femoral tunnel
Size of the patellar autograft
What is the effect on knee kinematics following placement of an anterior cruciate ligament (ACL) graft at the 12 o’clock position?
Decreased rotational stability