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Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC.
A 30-year-old active-duty woman presents to your clinic with right knee pain and without any history of trauma. She is an avid runner and is part of the Army 10-miler team. Her pain is located directly over her medial femoral condyle (MFC). Additionally, she describes intermittent episodes of an inability to fully extend her knee. Her clinical mechanical alignment, patellar tracking, meniscal examination, and ligamentous examination are all equivocal on physical examination. Your diagnostic imaging workup with pertinent findings is represented in Figures A through E. You perform a diagnostic arthroscopy to confirm that the pathology is isolated to the medial compartment and you note that there is not any evidence of ligamentous or meniscal pathology. Based on your findings which definitive surgical options would you recommend to the patient?
Proximal tibia valgus osteotomy, microfracture to the MFC, and removal of loose osteochondral bodies
Distal femur varus osteotomy and autologous chondrocyte implantation to the MFC
Osteochondral autograft transplantation to the MFC
Removal of loose osteochondral bodies and osteochondral allograft transplantation to the MFC
Patellofemoral realignment osteotomy, removal of loose osteochondral bodies, and autologous chondrocyte implantation to the MFC
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Figures A-C are the arthroscopic, radiographic and MRI images of a 34-year-old male who has had knee pain for the past 11 months. He has failed conservative and arthroscopic management under the care of another physician. He comes to you for a second opinion. The decision is made to proceed with osteochondral allograft transplantation to the medial femoral condyle. All of the following are contraindications for this surgery except:
Osteochondral defect measuring > 2 cm2
Uncorrectable limb malalignment
Ligamentous instability of the knee
A 35-year-old man presents with mechanical knee pain after a fall. An arthroscopic picture taken during diagnostic arthroscopy is shown in Figure A. His surgeon considers treatment with Technique B and Technique C, which are shown in Figures B and C, respectively. Which of the following statement is true with respect to Technique B and C?
A diminished immune response to transplanted chondrocytes is seen in Technique C because the dense cartilage matrix acts as a barrier that limits antigen exposure.
In Technique C, healing is initiated by mesenchymal stem cell migration from subchondral bone. In Technique B, healing is initiated by allogeneic chondrocytes reimplanted beneath a periosteal patch.
Grafts in Technique C are transferred to an antibiotic solution to kill microorganisms and stored at 4°C until use.
A biopsy of the repair site at 3 months will reveal more Type I collagen in Technique B than in Technique C.
Technique C is a 2-stage procedure. Technique B is a single-stage procedure.
A 25-year-old patient undergoes the procedure seen in Figure A. Which of the following statements best describes the incorporation of the graft and biopsy results of the graft at one year?
The transplanted chondrocytes are viable and articular cartilage heals. Biopsy shows type I collagen.
The transplanted chondrocytes are viable and articular cartilage heals. Biopsy shows type II collagen.
The transplanted chondrocytes are nonviable and cartilage is used as a scaffold for growth of new articular cartilage. Biopsy shows type II collagen.
The transplanted chondrocytes are nonviable and articular cartilage is gradually replaced by fibrocartilage. Biopsy shows type I collagen.
The transplanted chondrocytes are nonviable and articular cartilage is gradually replaced by fibrocartilage. Biopsy shows mixture of type I and II collagen.
What type of tissue is formed by the activation of marrow mesenchymal cells following subchondral drilling of an 8x7 mm osteochondral defect?
A 24-year-old female has moderate arthrosis of the medial facet of the patella and the medial femoral condyle. Which of the following procedures is contraindicated?
Anterior (Maquet) tibial tubercle osteotomy
Anteromedial (Fulkerson) tibial tubercle osteotomy
Anterolateral tibial tubercle osteotomy
Medial opening wedge high tibial osteotomy
Lateral closing wedge high tibial osteotomy
Following a medial femoral condyle osteochondral autograft mosaicplasty, which of the following statements best describes the fixation of the graft?
Graft fixation strength increases linearly with time until subchondral union at 3 months
Graft fixation strength initially decreases during the early healing phase, and then increases with subchondral bone healing
Graft fixation strength does not change during the first 3 months following surgery
Graft fixation strength is enhanced by early weight bearing
Graft fixation strength initially increases over the first 6 weeks, then recedes with bony remodeling
A 32-year-old female is referred to you for definitive treatment of a symptomatic focal chondral defect on her medial femoral condyle. A photograph from a recent diagnostic arthroscopy shows the defect (Figure A), which measured 25 x 25mm after debridement. What surgical treatment would you recommend?
Osteochondral autograft with 1-2 plugs
A patient with a symptomatic chondral defect undergoes the arthroscopic procedure seen in Figure A. The reparative tissue would best be described as which of the following?
All of the following are acceptable scenarios for the use of autologous chondrocyte implantation (ACI) in the patellofemoral joint EXCEPT:
Grade 4 lesion of the medial femoral condyle
Grade 4 lesion of the trochlea
Joint space narrowing on Merchant view
Varus mechanical axis on standing full length radiograph
Concomitant anteromedial tibial tubercle transfer osteotomy (Fulkerson's)