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