Final Review Questions

Microfracture Facts

1. Can be done for OA of the knee when there is an area of bare bone 2. Involves puncturing an area of bare bone on the femoral condyle 3. Allows blood and marror to fill an area of bare bone with the hope of reproducing cartilage cover to reduce pain for patients with OA of the knee Answer: all of the above

Shoulder ligaments fill in the blank answers

1. Coracoacromial 2. Acromioclavicular 3. Trapezoid 4. Conoid 5. Coracohumeral

Name the 4 possible areas of the humerus for biceps tenodesis

1. High in the groove 2. Low in the groove 3. Supra pec 4. Sub pec

Before inserting the tibial screw in an ACL reconstruction, the knee is cycled to accomplish 2 things which are

1. Locking 2. Remove Creep

What is AC joint instability?

1. Separated Shoulder 2. Unstable Acromioclavicular joint

Name the 5 product lines a sports rep would carry in their bag

1. Video/Light Source 2. Pumps 3. RF Wand 4. Shavers 5. Drills

Shoulder bone image answers

1. humerus 2. scapula 3. clavicle 4. glenoid 5. acromion 6. humeral head 7. coroacoid process

Answers to knee arthroscope image

1. tibia 2. probe 3. meniscus 4. femur

What is the target blood pressure value does the surgeon aim to be below in order to have a successful shoulder arthroscopy case with minimal saline extravasation of the surrounding tissue?

100

The transtibial approach to drilling ACL tunnels puts the femoral tunnel at _________ o'clock which is deemed to be incorrect tunnel placement as it is deemed too __________.

12 vertical

Where is the posterior scope portal located on the patient's anatomy?

2 finger breadths inferior and 1 breadth medial to the posterior corner of the acromion

Label the anchor materials below in chronological order: Bio-Absorbable UHMWPE Metal Bio-Composite PEEK

3 Bio-absorbable 5 UHMWPE 1 Metal 4 Bio-composite 2 PEEK

How many major ligaments stabilize the knee?

4

AC joint instability accounts for what percentage of shoulder sports injuries?

40%

How many grades of AC Joint instability are there according to the Rockwood Classification?

6

A rep tells a surgeon that his irrigation pump will be able to better control the pressure inside the joint, and will virtually eliminate joint collapse when using a shaver compared to the current irrigation pump on contract. What additional device must the reps pump utilize in order for this to be true, and how does it accomplish this?

A sensor or switch that connects to the shaver so when the shaver is turned on, the pump knows to push fluid into the joint at the same time

The mechanism of injury for AC joint instability includes

A. Direct impact on the tip of the shoulder with the arm adducted C. Indirect fall on an outstretched hand

Possible AC joint complications include:

A. Shoulder Pain B. Clavicle fracture C. Infection D. Corocoid Fracture

Answer to previous image

ACCR and Dog Bone

The ACL has two bundles, Antero-medial (AM) and Postero-lateral (PL). Which of the following is true?

AM tight in flexion, PL tight in extension

List the correct 4 main AO principals of bone healing

Align and approximate, internal fixation, restore blood flow, early mobilization

Use of meniscal fixation devices such as the Smith & Nephew FastFix 360 is an example of what technique?

All-Inside

Define ACCR

Anatomic coraclavicular reconstruction

Define ACR

Anatomic coraclavicular reconstruction

The ligament of Humphrey inserts where on the femur, relative to the PCL?

Anterior

Bankart lesions are usually located on which area of the Glenohumeral joint?

Anterior Inferior

Roof impingement in ACL Reconstruction is caused by which of the following

Anterior tibial tunnel placement

What portal is established first in hip arthroscopy?

Anterolateral

Answer to implant system image

Arthrex Biotenodesis

Name 3 possible techniques for PCL reconstruction

Arthroscopic, Transtibial, Tibial Inlay

The knee is the largest joint in our body and relies on many structures to allow it to function properly. What is the role of a ligament?

Attach bone to bone

List the possible ACL graft harvest choices for the two following type of grafts

Autograft: 1. BTB 2. Hamstring 3. Quad Allowgraft: 1. BTB 2. Hamstring 3. Quad 4. Achilles 5. Anterior Tibialis 6. Posterior tibialis

Advanced X-ray answer

Axillary

Answer to which knee graft image

BTB

The gold standard repair for ACL tears is still considered to be

BTB Autograft and Interference Screws

What procedure is a Remplissage typically done in conjuction with?

Bankhart

The dividing wall of the AM and PL bundles of the ACL is called the

Bifurcate ridge

What is the best X-ray view utilized to view grade V AC joint dislocation?

Bilateral Zanca

An RF system that doesn't require a grounding pad is considered to be _________, which means the electrical current has a return path built into the device to exit the body

Bipolar

Which is a mattress suture technique?

Both limbs of suture are passed through tissue and tied

What shown image answer

Bufford's complex

What instrument do we use to remove bone? E.G. Acromioplasty

Burr

What are mature cartilage cells found in healthy cartilage?

Chondrocytes

Color blue for surgical electrocautery

Coag

A growing concern in ACL repair surgery is the use of allograft tissues. These tissue are very useful, however, they can present which of the following concerns

Contamination

What ligament is transferred in the Weaver Dunn Procedure?

Coracoacromial

Non-invasive treatment option for joint preservation

Corticosteroid injections

Which type of RC tear is theoretically the easiest to fix?

Crescent

Which is not a treatment option for Osteochondral defects?

Debridement

The little triangle on the edge of the circular scope picture indicates

Direction the scope is pointing

The tibial insertion of the ACL is _________

Directly medial to the anterior horn of the lateral meniscus

Allograft tissue has benefits and controversies. Which of the following is a benefit of using an allograft tissue in an ACL procedure?

Donor Site Morbidity

Chuck for burr

Drill chuck

An acellular dermal matrix provides these advantages:

Excellent scaffold for revascularization by the recipient

True or False - A pump with a single spinner thing allows independent control of pressure and flow of fluid in the joint

FALSE

True or False - A sports med surgeon should tie all the knots he wants in the glenohumeral joint to prevent the possibility of any knots flipping into the joint and damaging the cartilage

FALSE

True or False - In tendon repair, one of the benefits of using tendon autograft is reduced donor site morbidity

FALSE

True or False - PRP separates whole blood into 3 components: Red Blood Cells, Stem Cells, and Plasma

FALSE

True or False - RANKL is secreted by osteoclasts, bind to receptors on OPC, which differentiate into osteoblasts

FALSE

True or False - Synthetic bone grafts try to mimic the porosity of cortical bone

FALSE

True or False - A Bankart lesion is the same thing as a SLAP Lesion

False

True or False - A graft that preserves the MSC component gives the graft the biologic property of osteoconduction

False

True or False - AC Joint reconstruction can only be done open

False

True or False - An acute wound is defined as a wound that does not improve after four weeks or does not heal in eight weeks

False

True or False - Aseptically processed grafts are considered terminally sterile

False

True or False - BMC is a concentration of allograft stem cells

False

True or False - In degenerative tendinopathy, the tendon can appear thickened and nodular, but there is no risk of tendon rupture with advanced degeneration

False

True or False - Operative management of type III AC injuries is always recommended?

False

True or False - Synthetics are typically only osteoinductive

False

True or False - The OATS system can be utilized on chondral defects over 25mm in diameter

False

True or False - The Rockwood classification of AC injury says operative management is controversial for type IV and V?

False

True or False - Under Wolff's Law, Stress Shielding is far superior for bone that Load Sharing implants

False

What does FAI stand for?

Femoral Acetabular impingement

In an attempt to repair damaged hyaline cartilage in the joints, the body with try to produce what type of cartilage

Fibrocartilage

The meniscus is made up of what tissue?

Fibrocartilage

For preparation of a femoral allograft for transplantation, it is imperative that the allograft be __________ in order to achieve the best outcome

Fresh

Define Arthrodesis

Fusion of a joint

This describes the way the product functions in the surgeon's hands, or describes the ease of use outside the body, on the back table and in the grafting area

Handling characteristics

What lesion on the posterior humeral head is indicative of a multiple dislocator and is the first thing you see when you enter the glenohumeral joint with the scope?

Hill-Sachs

The acromioclavicular ligaments and capsule restrain?

Horizontal instability

Define Woven Bone

Immature, disorganized collagen structure

Explain the role of the body's natural bone morphogenetic proteins in the bone formation process:

Induces and stimulates MSC differentiation

In order, the FOUR steps of bone healing are as follows

Inflammation, Soft Callus, Hard Callus, Remodeling

Choose the best answer regarding the anterior cruciate ligament's orientation

Inserts on the anterior tibia and originates on the lateral condyle

What is the gold standard surgical option for treatment of meniscal tears?

Inside-Out

Which diagnostic test is most sensitive in evaluating an ACL injury

Lachman test

Which side of the meniscus is more mobile?

Lateral mediscus

Explain the role of Osteoblasts in the bone formation process

Lays new bone matrix

What attaches to the lens and scope that allows a bright picture to be transmitted to a high definition viewing screen?

Light cord

The labrum shares a footprint with which of the following?

Long head of the biceps

What diagnostic tool is typically used to confirm a rotator cuff tear?

MRI

Explain the role of mesenchymal stem cells in the bone formation cascade

MSC's are summoned to the site, thanks to the chemotaxic signals, and some differentiate into osteoblasts, which lay new osteoid

How might a large meniscal flap tear be surgically treated?

Meniscectomy

Which of the following is a negative in using allograft tissue for ACL reconstruction surgery?

Method of preservation

When the patient's own bone marrow is exposed to create a "superclot" that forms fibrocartilage, this is called

Microfracture

3 possible treatment options for Osteochondral defects

Microfracture, OATS, Autologous Chondrocyte Implantation

Answer to previous image

Mosaicplasty

The most common mechanism of injury for a PCL injury is?

Motor Vehicle Accident

Define Chemotaxis

Movement of cells thanks to chemical signal

What is the primary advantage that a DBM biologic might offer over an autograft?

No donor site morbidity

The majority of ACL injuries are usually the result of which of the following?

Non-Contact

Chuck for Saw Blade

Oscillating Chuck

What does PEEK stand for?

Poly Ether Ether Ketone

The primary function of the _____________ bundle of the ACL is to prevent forward translation of the tibia, and the primary function of the ______________ bundle of the ACL is to prevent excessive internal rotation

Posteriolateral, Anteromedial

The ligament of Wrisberg inserts where on the femur, relative to the PCL?

Posterior

Define Apoptosis

Programmed cell death

The biceps tendon travels up the humeral shaft, through the bicipital grove, up and over the humeral head through the __________________ and attaches to the ________________ position on the glenoid.

RC Interval 12 o'clock

What pathology is a Laterjet procedure intended to address?

Recurrent anterior shoulder dislocations

Which meniscal zone is most likely to result in a successful repair?

Red-Red

Define Donor Site Morbidity

Risks that may occur after graft harvesting

Answer to which portals image

Rotator cuff

Under the same classification system, what is a type III AC injury described as?

Rupture of the AC ligament, joint capsule, CC ligamend and clavicle elevated as much as 100%

Answer to which shoulder tear image

SLAP

Example of a sliding locking knot

SMC

Define Osteoconduction

Scaffold

Which of the following tendons are not considered for harvest of an autograft in ACL surgery?

Semimenbranosus tendon

When harvesting the hamstring tendons for an autograft ACL, which two tendons do we strip out?

Semitendinosus and Gracilis

What instrument do we use to remove tissue?

Shaver

Shoulder instability is likely the result of which of the following injuries

Shoulder dislocation

Which best explains Osteoinduction

Signal

Why is it important to prepare the graft bed, or bloody up the bone/tissue before laying the graft down?

Signal the body that it is in need for healing in that area

The main advantage of an arthroscopic subacromial decompression (SAD) over an open approach is

Sparing of the deltoid muscle origin

What does SCR stand for?

Superior Capsular Reconstruction

What does SLAP stand for?

Superior Labrum Anterior Posterior

Where is the accessory portal used for fluid outflow located? (ACL)

Suprapatellar pouch

Which sensory nerve innervates the Supraspinatus and is believed by some to be the source of rotator cuff impingement pain?

Suprascapular

What would a surgeon use in an Inside-Out repair?

Suture

Bankart and SLAP tears are typically reattached via which method?

Suture Anchors

In doing a Remplissage procedure, what implant might a surgeon use?

Suture anchors

True or False - In tendon repair, one of the downsides of tendon allografts is risk of re-rupture, but this concern has been greatly reduced, as low-dose gamma irradiation is now used to sterilize the tendon allografts

TRUE

True or False - Tendons attach muscle to bone

TRUE

True or False - The only way to replace defective hyaline cartilage with healthy mature hyaline cartilage is the OATS procedure

TRUE

True or False - The ultimate goal of AC Joint instability treatment is to restore painless function to the injured joint in order to return the athlete safely and quickly to sport

TRUE

True or False - the INFUSE rhBMB-2 liquid is only Osteoinductive

TRUE

Distal biceps technique picture answer

Tension slide technique with button

Which muscle is not a rotator cuff muscle?

Teres Major

Define Creeping Substitution

The process in which the graft material resorbs [or old necrotic bone is eaten] and new bone matrix is laid down

Answer to sheath/screw knee device image/question

The screw expands the sheath in the center of the tunnel allowing 360 degrees of tissue and bone contact

Explain the role of osteoclasts in bone formation

They create an acidic environment called the "sealed zone" which breaks down bone and paves the way for new boney osteoid matrix to be laid down

The Anterior and Posterior horns of the meniscus are attached to which structrues?

Tibial plateau

Define Allograft

Tissue donated from another individual, same species

Define the term Xenograft

Tissue donated from non-human species

What does Angiogenesis mean?

To form new blood vessels

Why might a surgeon need to open a rotator cuff repair?

To lay down a biologic dermal patch

Which of the following is not a technique for PCL reconstruction?

TransFibular

Answer to what type repair image

Transosseous equivalent

What is the name of the ligament that connects the acetabular labrum at the inferior aspect of the socket?

Transverse acetabular ligament

True or False - Human dermis, in the form of an acellular matrix, is a treatment option for a variety of different applications such as, rotator cuff reinforcement, wound graft, tendon augmentation, hernia repair, and breast augmentation.

True

True or False - Majority of ACL graft Failure is due to the graft pulling past the tibial screw

True

True or False - PRP is used as a treatment for OA

True

True or False - The best way to control fluid pressure/flow to minimize joint extravasation and to save on fluid consumption cost is to utilize an inflow-outflow pump where pressure and flow can be independently controlled

True

True or False - The conoid ligament is medial and the trapezoid is lateral on the clavicle

True

True or False - The medial meniscus is shaped like a "C" and the lateral meniscus is shaped like an "O"

True

True or False - The shrug test with bilateral zanca can help define grade V injury

True

True or False - When fixing a large U shape supraspinatus tear, a surgeon will most likely have to do one or more margin convergence stitches to bring two edges of the tendon together before anchoring the tendon or bone

True

True or false - A microfracture procedure can be performed through a scope

True

True or False - A bankart extends from 2-6 o'clock on the glenoid face

True ish... Jeff gave us points for false because he kept saying 3

Answer to Acromion image

Type III

When there is not enough healthy tendon to reconnect, a surgeon may choose an allograft over an autograft because of the following advantage

Using it will reduce time in the OR

In a Stress Shielding environment, the bone may become

Weak, resorbs without healthy stresses

Suspensory fixation of the ACL has been shown to lead to

Windshield wiper effect

Answer to drill attachment image

Wire/Pin Driver

Which population gender has the highest rate of of ACL injuries and why?

Women because of wider hips and narrower notch

A patient that presents to the physician with a meniscal tear will be administered a series of tests to determine the presence and potential extent of the injury. Which of the following answers are correct about tests a patient will encounter to determine a meniscal tear?

X-Ray, McMurray Test, and MRI

What is margin convergence

a large u-shaped tear that requires criss-cross sutures anterior - posterior to make crescent shape tear. From these anchors are used to fix repair to footprint I dont like your answer Kristina

The following products are used to treat wounds

a. Amnion b. Acellular Dermal Matrix c. Platelet-Rich Plasma d. Xenografts Answer - All of the above

Amniotic technologies are becoming more popular in the orthopedic industry, however, it is still considered experimental. What do we know so far about this technology?

a. Anti-Inflammatory b. Creates a barrier against scar tissue c. Enhances tissue handling Answer - All of the Above

In a subacromial decmpression, what three disposables might a surgeon utilize?

a. Burr c. Shaver d. RF wand

The mechanism of injury for a meniscal injury is which of the following?

a. Compression c. Rotation Answer - A & C

The decision to repair or replace cartilage is one in which the surgeon takes into consideration which factors

a. Defect size b. Patient's Age c. Patient's Mobility d. Patient's Health Answer - All of the above

Macrophages

a. Engulf and digest necrotic tissue & debris b. Eat dead cells and foreign particles c. Are part of the White Blood Cell lineage

Bone will not form, or even start to form, if

a. In the presence of infection b. The fracture gap is too large c. 2 osteoblast cells are not within very close proximity to each other (200 - 300 micrometers) d. There is no matrix or scaffold to bind/attach to Answer - All of the above

A chronic ACL-deficient knee may demonstrate which of the following complications?

a. Instability b. Chondral damage c. Irreparable meniscal damage Answer - all of the above

Articular cartilage as a difficult time healing in the body, this is due to:

a. Lack of sufficient stem cells to repair the defect b. Chondrocyte death in surrounding cartilage d. Lack of blood supply Answer: A, B, and D

Which of the following meniscal signs and symptoms does the patient complain of post injury?

a. Locking joint b. Pain c. Joint line tenderness d. Swelling Answer - all of the above

What is the role of the meniscus?

a. Lubricate b. Stabilize c. Mobile d. Weight Distribution Answer - all of the above

There are several cellular allografts on the market that are bone void fillers, such as Trinity Elite Orthofix and OsteoCel Plus by NuVasive, They have retained the viable Mesenchymal Stem cells and Osteoprogenitor Cells in the donated tissues, therefore they have the following properties:

a. Osteogenic b. Osteoconductive c. Osteoinductive Answer - all of the above

What factors may guide your surgeon's decisions and selection process concering orthobiologics?

a. Patient b. Pathology c. Procedure d. Product Features Answer - All of the above

What indications would lead a patient to a hip scope procedure?

a. Snapping hip syndrome b. Loose bodies c. FAI d. Labral tear answer - All of the above

Which specialties are likely targets for biologic sales?

a. Sports medicine specialist b. Neurosurgeon c. Oral surgeon d. podiatrist Answer - All of the above

Color yellow for surgical electrocautery

ablation

Label the Supraspinatus tear image

answer given

a burr is used for resecting

bone

A Laterjet invloves detaching the tip of the ___________, splitting the _________ tendon and attaching the graft to the anterior glenoid with ____________, whereby the _______________ tendon acts as a sling to hold the humeral head

coracoid, subscapularis, screws, conjoined

What is a Mumford?

distal clavicle resection

ECM

extracellular matrix

True or False - The growth plate of bone is in the diaphysis

false

When might a surgeon perform an SCR?

for a massive unrepairable rotator cuff tear

When would you use an allograft for an ACCR?

for chronic issues

Surgical Drill - blue chuck

high speed, low torque

IGF

insulin-like growth factor

Surgical drill - red chuck

low speed, high torque

Osteoclasts are

multi-nucleated cells developed from hemotopoietic stem cells

Chuck for rasp

reciprocating chuck

Tenodesis is

surgical anchoring of a tendon

Example of a sliding knot

tennessee

Relative to a biologic technology that we may sell, when a biologic material is described as having "osteogenic" properties, what does this mean about this product/technology?

this product is claiming it has "viable cells" within the product

A shaver is used for resecting

tissue

Apeture fixation is accomplished by graft fixation _________

using an interference screw