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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 19-year-old male patient is referred to your clinic after he sustains a non-contact twisting injury to his right knee during a preseason soccer scrimmage. The patient is otherwise healthy and he reports that he underwent an anterior cruciate ligament (ACL) reconstruction on the same knee approximately one year ago. A hamstrings autograft was used. The patient progressed through his postoperative rehabilitation appropriately and was cleared to return to sport by his physical therapist. On examination, he has a positive pivot-shift test and a 2B Lachman. You order an MRI as part of your preoperative workup. What finding would be indicative of the leading cause of failure following ACL reconstruction?
A large effusion with diffuse intraarticular synovitis and T2-fluid-intense signal throughout the distal femur and proximal tibia
Femoral tunnel centered on A (Figure A)
Femoral tunnel located at the 10 o'clock position in the notch
Tibial tunnel located at A (Figure B)
Tibial tunnel located at B (Figure B)
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Figure A reveals the femoral and tibial footprints of the anterior cruciate ligament bundles. Which combination of footprints represents the bundle responsible for rotational stability?
A + C
A + D
B + C
B + D
None, neither bundle confers rotational stability
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
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 19-year-old Division 1, female soccer player sustains a non-contact right knee injury and felt a pop during a match. Her radiograph is depicted in Figure A. Which of the following physical examination findings would likely be expected?
With the knee flexed to 90 degrees, 12mm posterior tibial translation on femur
With the knee flexed to 30 degrees, external rotation increased 15 degrees compared to left knee
With the knee in valgus and tibia internally rotated, flexion from an extended position results in reduction of tibia on femur
With the knee flexed to 90 degrees, quadriceps activation results in reduction of the tibia on femur
With the knee in valgus and tibia externally rotated, flexion from an extended position results in reduction of tibia on femur
A 12-year-old female soccer player sustains a right knee injury when she made a sudden cutting move to intercept the ball. She noticed immediate pain and swelling with difficulty ambulating. On exam, she has a large effusion, a positive Lachman's test, and extension-flexion of the knee 20-70°. Figures A and B are the current imaging. What is the next best step in treatment for this patient?
ACL reconstruction with bone-patellar tendon-bone autograft
ACL reconstruction with quadrupled hamstring autograft
Physeal-sparing iliotibial band tethering of lateral femoral condyle
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