Questions and Answers
What is the primary challenge in treating cartilage lesions in the knee joint?
What unique characteristic distinguishes cartilage from other connective tissues?
Which component constitutes approximately 10% of cartilage tissue?
What is crucial for enhancing the biological response in the treatment of cartilage lesions?
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Which statement best reflects an appropriate approach to managing overuse injuries?
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What percentage of water is typically present in cartilage?
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In the context of cartilage lesions, which macromolecules significantly contribute to the extracellular matrix?
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Which type of collagen is predominantly found in cartilage?
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What is the effect of excessive mechanical loading during the healing phase?
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Which aspect of cartilage is NOT a characteristic mentioned in the content?
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What is the purpose of finding the optimal loading during the healing phase of cartilage lesions?
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What is a key aspect of addressing overuse injuries in athletes?
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In cartilage, what percentage of its structure is extracellular matrix?
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Why is cartilage categorized differently than other connective tissues?
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What characterizes the collagen present in cartilage?
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Which component makes up a significant portion of the extracellular matrix in cartilage?
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What should be done to the injured area during the rehabilitation of cartilage lesions?
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How much water can make up the content of cartilage?
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What must be augmented during the treatment of cartilage lesions?
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What is a major risk associated with inappropriate loading during the healing phase?
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What is a critical factor in managing the balance during the healing phase of cartilage lesions?
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How should rest be effectively implemented to manage overuse injuries?
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What percentage of cartilage is comprised mainly of water?
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What characterizes the cellular activity in cartilage?
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Which macromolecule constitutes a major part of the extracellular matrix in cartilage?
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What is the role of mechanical loading in the treatment of cartilage lesions?
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What happens to the body's overall fitness if an athlete rests too much during an overuse injury?
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What should be avoided during the healing phase to prevent complications?
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Which characteristic does NOT apply to cartilage?
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What is a main component of the extracellular matrix in cartilage besides water?
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Cartilage is characterized by a high cellular count and activity.
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Resting an injured part completely is beneficial for the body during rehabilitation.
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The extracellular matrix of cartilage consists mostly of water.
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Optimal loading during the healing phase of cartilage is aimed at reducing stiffness.
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Collagen type I is the predominant collagen type found in cartilage.
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Cartilage experiences no blood supply, nerve supply, or lymph drainage.
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Mechanical loading should always be avoided during the healing phase.
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Resting injured cartilage includes allowing movement in surrounding tissues.
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Cartilage has a high blood supply, which aids in its healing process.
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The optimal loading during the healing phase of cartilage is aimed at enhancing stiffness in the joint.
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Collagen type II is the main collagen type found in cartilage tissue.
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Resting an injured part of cartilage completely is recommended to ensure complete local recovery.
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Cartilage mainly consists of approximately 70% macromolecules and 30% water.
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Overuse injuries in athletes necessitate a state of complete inactivity to avoid worsening conditions.
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Mechanical loading can have both positive benefits and negative complications during cartilage healing.
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The extracellular matrix of cartilage contains a high abundance of cells, constituting about 40% of its structure.
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Fractures and dislocations of the ankle are part of syndesmotic injuries.
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The IOC's manual of sports medicine provides extensive coverage on ankle fractures and dislocations.
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Syndesmotic injuries are common and classified under ankle dislocations.
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The IOC manual is edited by R., who specializes in fractures and dislocations of the ankle.
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Fractures and dislocations of the ankle can happen simultaneously in extreme sports.
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Syndesmotic injuries do not typically require surgical intervention.
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The management of ankle fractures often involves non-operative techniques only.
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An ankle dislocation can occur without associated fractures.
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Fractures and dislocations of the ankle are particularly prevalent in contact sports.
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The provisions of the IOC manual only cover surgical procedures related to ankle injuries.
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Transverse fractures typically result from sudden and severe trauma.
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Stress fractures present symptoms immediately after the initial injury occurs.
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The second metatarsal is recognized as a problematic site for stress fractures.
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MRI and scintigraphy are ineffective for the early diagnosis of stress fractures.
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Ice application is discouraged in first aid management of fractures due to its potential harm.
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A runner fracture is a type of stress fracture that develops due to prolonged overuse.
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Bony injuries can only occur due to direct impact trauma.
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Elevation is not recommended as part of the first aid management for injuries.
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Stress fractures can lead to acute and insidious patterns of pain.
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Circulation monitoring is irrelevant in the management of fractures.
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What component of bones primarily contributes to their hardness and strength?
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Which component of bone is responsible for its elastic properties?
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What is the periosteum?
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Which part of long bones is primarily involved in growth and lengthening?
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Where is the periosteum more adherent to the bone surface?
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The diaphysis of long bones serves what primary function?
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What role do Sharpey's collagen fibers play in bone structure?
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Which of the following statements best describes the epiphysis of long bones?
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What property does collagen impart to bone structure?
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Which type of fracture is often associated with overuse and presents acutely or progressively?
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What diagnostic imaging techniques are primarily utilized for early detection of stress fractures?
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Which foot bone is commonly known for being affected by problematic stress fractures?
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In the management of bony injuries, what approach should be taken if one is trained?
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Which type of fracture is often referred to as the 'runner fracture' due to repetitive stress?
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Which type of trauma is indicated by significant sudden pains and the presence of other clinical signs?
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What is the main benefit of applying ice to an injury?
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Which of the following is NOT a characteristic of stress fractures?
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What should one observe to ensure proper circulation in an injured limb?
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What is the primary imaging technique used for diagnosing knee ligament injuries?
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Which graft type is rarely used and typically indicated for extra-articular tenodesis?
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In the context of knee rehabilitation, what should be the primary focus immediately post-injury?
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What is a significant complication that may arise from acute ACL injuries?
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Which surgical technique is now considered obsolete for knee ligament reconstruction?
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What role does aspiration of haemarthrosis play in the management of knee injuries?
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What is a primary concern when performing anterior drawer tests on a knee with suspected instability?
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What is the expected outcome for a young athlete undergoing ACL reconstruction surgery if rehabilitation is done correctly?
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What is the primary focus during the initial phase post ACL surgery rehabilitation?
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Which of the following is NOT a key component of post-operative rehabilitation for ACL surgery?
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In the context of rehabilitation for older recreational athletes, which approach is recommended?
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What is an essential goal throughout the rehabilitation process after ACL surgery?
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When should the rehabilitation process ideally commence after ACL surgery?
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What complication can arise from failing to adhere to rehabilitation protocols after ACL surgery?
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What is a potential outcome of improper loading during the healing phase of rehabilitation?
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Which strategy should be implemented to support the biological response during ACL rehabilitation?
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What has improved in modern techniques for anterior cruciate ligament reconstruction?
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Which imaging technique is typically used to assess the integrity of the anterior cruciate ligament?
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Which option most accurately describes a common complication following ACL reconstruction?
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What is a key rehabilitation protocol focus after ACL reconstruction?
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Which graft type is commonly used in ACL reconstruction surgeries?
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What outcome can result from improper surgical technique during ACL reconstruction?
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What is a common physical therapy goal in the first phase of post-ACL surgery rehabilitation?
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Which factor can negatively influence the outcomes after ACL reconstruction?
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Which graft type is typically known for higher incidence of infection post-surgery?
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What is the optimal location for the femoral tunnel in an ACL reconstruction procedure?
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Which factor is commonly impacted by the choice of fixation device in surgical procedures?
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What was identified as a significant drawback of using allografts in ACL reconstruction?
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What is a potential consequence of improper tunnel placement during ACL reconstruction?
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In anatomic ACL reconstruction, where should the tibial tunnel be placed?
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What is a primary benefit of using semitendinosus and gracilis grafts in ACL reconstruction?
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Which characteristic is essential to consider for an ideal fixation tool in surgical procedures?
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What type of tendon graft is known for providing better stability but may lead to higher instances of anterior knee pain post-operatively?
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Which graft type is considered an autograft commonly used in knee surgeries?
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What is a major consideration when choosing between BTB and quadriceps grafts for knee surgery?
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Which of the following grafts is the more resistant to deformation?
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What advantage do flexor tendon grafts primarily offer during rehabilitation?
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What is a potential complication associated with using BTB and quadriceps grafts?
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In terms of graft types, which of the following statements is accurate regarding autografts?
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What should be a primary focus during rehabilitation when using these different graft types?
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What is the primary goal of rehabilitation following ACL surgery?
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When should post-operative rehabilitation ideally begin?
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What is considered the earliest rehabilitation goal after ACL surgery?
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Which factor is critical for ensuring successful rehabilitation in older recreational athletes?
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What is a common misconception about the duration of rehabilitation after ACL surgery?
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Which approach should be taken regarding the biological response during rehabilitation?
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What aspect is critical when deciding to return to sports after rehabilitation?
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What is essential to ensure during the rehabilitation process for ACL surgery?
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Which type of graft is considered an autograft commonly used in knee surgeries?
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What is a common disadvantage associated with using BTB and quadriceps grafts?
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What characteristic of autografts makes them preferable compared to allografts?
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When considering graft choice, which type is known for being stiffer?
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Which graft option is categorized as a flexor tendon graft?
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Which surgical technique might be considered based on the graft choice?
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What factor can significantly affect the outcomes of surgical grafting in the knee?
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What is a common complication following the use of stiffer grafts like BTB?
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Which type of graft is derived from the patient's own body?
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What is the most reliable diagnostic imaging technique for detecting ligament discontinuity?
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Which surgical technique is aimed at preserving ligament remnants during reconstruction?
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What is the primary goal during the rehabilitation phase following ACL surgery?
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Which condition is commonly associated with a sudden knee injury, characterized by pop sound and swelling?
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What complication may arise after an acute ACL injury if not promptly addressed?
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What is a potential drawback of using synthetic grafts for ACL reconstruction?
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What is a common sign that indicates an acute knee injury involving blood accumulation?
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What is a primary disadvantage of using allografts for ACL reconstruction?
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Which statement accurately describes the placement of the femoral tunnel in anatomic ACL reconstruction?
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What is a critical characteristic of an ideal fixation device for ACL reconstruction?
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Why are synthetic grafts often considered unreliable for ACL reconstruction?
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What is the recommended location for the tibial tunnel in ACL reconstruction?
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In terms of graft types, which of the following is NOT a drawback of using synthetic grafts?
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Which patient population might benefit most from the use of semi-tendinosus and gracilis tendons for ACL reconstruction?
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What factor is primarily taken into consideration when selecting graft types for ACL reconstruction?
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What is the primary foundation for orthopaedic surgery?
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What has led to the development of improved modern reconstruction techniques for the anterior cruciate ligament (ACL)?
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What is the primary goal of modern ACL reconstruction techniques?
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What is essential for orthopaedic surgeons to understand when performing ACL reconstruction?
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How do modern ACL reconstruction techniques differ from traditional methods?
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What is the significance of understanding ACL anatomy in orthopaedic surgery?
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What is the primary focus of modern ACL reconstruction techniques?
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How has the understanding of ACL anatomy impacted orthopaedic surgery?
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Scopic surgery has become the preferred method for ACL reconstruction due to its minimally invasive nature.
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MRI is essential for diagnosing ACL injuries as it provides absolute certainty in all cases.
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The primary goal of early rehabilitation post-injury is to achieve full extension of the affected limb.
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Autografts used in ACL reconstruction are harvested from a donor body.
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A common complication following ACL injury is chronic knee effusion.
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The Lachmann’s test is primarily used to measure lateral instability in the knee.
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Synthetic grafts, such as LARS, are the most commonly used grafts in ACL reconstruction.
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The healing potential of the ACL is considered low, making surgical intervention often necessary in young athletes.
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Rehabilitation after ACL surgery should start at least by the day of surgery.
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Maintaining full extension is considered a late objective for both the surgeon and therapist.
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A rehabilitation process after ACL surgery typically spans about 6 weeks.
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Proprioception and strength should be regained before making a decision about returning to sports.
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Rehabilitation is a minor aspect of treatment following ACL surgery.
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Non-operative treatment for older recreational athletes may involve lifestyle modifications.
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Surgical techniques for ACL injuries do not impact the long-term prevention of osteoarthritis (OA).
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The contact with your surgeon is irrelevant during the rehabilitation process.
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BTB and quadriceps grafts have a lower incidence of anterior knee pains post-operative.
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Autografts from the flexor tendon, such as hamstrings, are also referred to as flexor tendon grafts.
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The quadriceps tendon is less commonly used due to its high resistance to deformation.
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Flexor tendon grafts are sourced from the hamstring muscles.
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Choosing the right graft type can significantly influence the surgical outcomes and recovery process.
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Allografts have a high incidence of special infections such as AIDS.
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In surgical procedures, graft choice does not affect the stiffness of the knee post-operation.
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Recovery protocols may vary depending on the type of graft used during an operation.
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Synthetic grafts are known for their low incidence of failure and infection.
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The best results in knee surgeries are always associated with avoiding any form of grafts.
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The femoral tunnel for ACL reconstruction should be located at the proximal end of the lateral condyle of the femur.
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The tibial tunnel in ACL reconstruction should be placed more laterally than medially.
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Semi T and gracilis harvesting techniques result in minimal site morbidity.
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The ideal fixation device for grafts is universally agreed upon among surgeons.
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Anatomic reconstruction of the ACL includes a precise placement of the femoral and tibial tunnels.
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Revision surgeries for ACL injuries often require the same graft sources as the initial operation.
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Understanding the anatomy of the anterior cruciate ligament (ACL) is essential for effective surgical techniques.
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Advanced diagnostic imaging is unnecessary when assessing injuries of the anterior cruciate ligament.
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Different types of grafts may be used in ACL reconstruction based on individual patient needs.
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Rehabilitation protocols following ACL surgery are uniform across all patient profiles.
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Complications arising from ACL reconstruction surgery can sometimes lead to further injuries or setbacks during recovery.
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Outcomes for ACL reconstruction are consistently poor, regardless of surgical technique used.
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Surgical techniques for ACL injuries have remained static and have not evolved over time.
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The choice of graft type plays a pivotal role in the success of ACL reconstruction.
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What is a primary characteristic of cartilage lesions treatment concerning mechanical loading?
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What should be emphasized during rehabilitation for overuse injuries in athletes?
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What type of collagen is predominantly found in cartilage?
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Which characteristic does NOT apply to cartilage?
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Why is it important to balance loading and unloading during the healing phase?
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What portion of cartilage consists of extracellular matrix?
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What element is primarily missing in cartilage structure compared to other connective tissues?
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What happens if the injured part is completely rested without any activity?
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What is the expected outcome of mechanical loading during the rehabilitation of cartilage lesions?
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Which of the following increases the risk of complications during cartilage healing?
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Cartilage has a high blood supply that promotes healing.
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Collagen type II is the predominant collagen type found in cartilage.
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The extracellular matrix of cartilage consists mainly of cells.
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Resting during rehabilitation should involve complete inactivity of the injured area.
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Finding the optimal loading during cartilage healing is important to prevent stiffness.
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Cartilage can have a cellular count as high as 40% of its structure.
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Mechanical loading should always be avoided during the healing phase of cartilage.
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Water content in cartilage can be as high as 70%.
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Scanty cellular activity is a distinguishing feature of cartilage.
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The biological responses during treatment should be universally aught.
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Bone functions in calcium storage, hematopoiesis, and protection.
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Cortical bone is also known as cancellous bone.
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Bone remodeling is influenced by calcium levels and mechanical loading.
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Bone is primarily composed of muscle tissue.
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Cancellous bone is more dense than cortical bone.
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When osteoblasts become surrounded by mineralized matrix, they are called osteocytes.
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Osteocytes do not communicate with osteoblasts and osteoclasts.
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Osteocytes signal for remodeling through channels in the extracellular matrix.
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Osteocytes are the least abundant cells in bone tissue.
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Osteoblasts are responsible for the resorption of bone.
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Osteocytes are derived from chondrocytes.
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The extracellular matrix consists of organic and inorganic components.
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Cartilage is primarily made up of 50% water.
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Extracellular matrix does not play any role in cartilage structure.
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All components of the extracellular matrix are biological in nature.
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Collagen is a major component of the extracellular matrix in cartilage.
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The inorganic components of the extracellular matrix are solely responsible for providing stability.
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Cartilage is classified as a connective tissue.
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The extracellular matrix is primarily made up of lipids.
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Organic components in the extracellular matrix include proteins and carbohydrates.
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Inorganic components in the extracellular matrix consist mainly of vitamins and minerals.
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What is formed when calcium and phosphorus combine?
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Which type of cells are responsible for bone formation?
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What is NOT a component of bone structure?
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Which of the following characterizes osteoclasts?
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Which component is part of the bone matrix?
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What is the primary function of bone in the locomotor system?
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Which type of bone is characterized as spongy?
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What factor is NOT involved in the remodeling process of bone?
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Which function of bone involves the production of blood cells?
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What type of bone has a dense structure, often referred to as compact?
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What is a primary aim of rehabilitation after ACL surgery?
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When should post-operative rehabilitation ideally start?
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What is the role of proprioception in ACL rehabilitation?
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What is a common recommendation for older recreational athletes experiencing injuries?
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What is the earliest objective in postoperative rehabilitation of the ACL?
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How long is the typical rehabilitation process for ACL surgery?
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What should be emphasized throughout the rehabilitation process?
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What aspect of recovery must be respected during ACL rehabilitation?
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What are the two most common mechanisms of injury to the ACL?
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Which test is best for detecting anterior instability of the knee?
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What is the primary goal during rehabilitation following an ACL injury?
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What is a common symptom following a twisting knee injury associated with ACL damage?
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Which type of graft is harvested from the same patient for ACL reconstruction?
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In cases of chronic ACL injuries, which radiological method is primarily used for diagnosis?
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What is the recommended immediate treatment protocol after an ACL injury?
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What is the expected finding in a case of acute knee haemarthrosis?
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Which of the following statements is true regarding the healing capabilities of the ACL?
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What is a common associated injury that could complicate an ACL tear?
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What is a characteristic of BTB and quadriceps grafts in ACL treatment?
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Which type of graft is considered an autograft when treating ACL injuries?
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What is the main advantage of using flexor tendon grafts in ACL reconstruction?
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Where should the femoral tunnel be located in relation to the lateral condyle of the femur?
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What is a disadvantage of using allografts for ACL reconstruction?
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Which of the following is a disadvantage of using BTB grafts?
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Which fixation device characteristic is considered ideal?
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What commonly results from using grafts that are stiffer in nature?
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In which area should the tibial tunnel be positioned for optimal ACL reconstruction?
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What is a key factor to consider when selecting a graft for ACL reconstruction?
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What is a potential complication of using stiffer grafts?
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Which of the following describes synthetic grafts used in ACL procedures?
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Which component of ACL grafts comes from the hamstring tendons?
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What is the optimal placement for the femoral tunnel in ACL reconstruction?
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What is a potential risk of using allografts during ACL reconstruction?
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In terms of biomechanical properties, how do BTB and quadriceps grafts compare?
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Which factor is a consideration when determining the best graft choice for ACL reconstruction?
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In which area is the tibial tunnel located during ACL reconstruction?
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Which aspect of fixation devices is still a matter of evolution in ACL surgeries?
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Post-operative rehabilitation should begin the day of surgery.
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Maintaining full extension is the last priority for both the surgeon and the therapist.
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Rehabilitation after ACL surgery is a short process that typically lasts about 2 weeks.
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Proprioception is a key factor that should be regained during ACL rehabilitation.
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A conservative approach in treatment should always be used for older recreational athletes.
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Communication with the surgeon is not important during the rehabilitation process.
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The aim of ACL surgery is solely to repair the ligament.
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Proprioception and strength need to be fully restored before deciding to return to sports.
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The femoral tunnel for an ACL reconstruction should be located at the distal end of the medial wall of the lateral condyle of the femur.
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Allografts for ACL reconstruction are universally available and economically feasible.
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The tibial tunnel should be placed more laterally than medially in an ACL reconstruction.
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Synthetic grafts used in ACL reconstruction have a low incidence of failure.
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Hypermobile patients are considered suitable candidates for ACL reconstruction using specific graft techniques.
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The concept of anatomical reconstruction focuses on correcting the position of the ACL to its original anatomical site.
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The ideal fixation device for ACL reconstruction has been firmly established and is universally accepted.
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Allografts have a risk of special infections, such as AIDS, due to the nature of their sourcing.
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Tunnel placement in ACL reconstruction does not require consideration of the anatomical features around the knee.
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It's crucial to locate the femoral tunnel generally at the anatomical ACL attachment during reconstruction.
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The primary mechanism of injury for the ACL is excessive rotatory movement and excessive valgus with mild degree of flexion.
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Mediolateral instability indicates a severe injury that requires no further evaluation of associated injuries.
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Lachmann’s test is used to detect anterior instability in the knee.
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Rehabilitation after an ACL injury should be started only after surgery has been performed.
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MRI is regarded as the most accurate method for diagnosing chondral damage.
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The operative treatment for ACL injuries often involves anatomic reconstruction techniques.
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In the acute setting, knee haemarthrosis is one of the most common causes of instability.
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Autografts are grafts taken from a donor who is not the patient receiving the graft.
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For managing ACL injuries, the goal of rehabilitation includes achieving full extension of the knee before focusing on muscle power.
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Twisting and stress valgus injuries occur due to quick changes in direction or impact to the knee.
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Autografts are a type of graft commonly used in ACL surgeries.
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Flexor tendon grafts are derived from the quadriceps muscle.
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Quadriceps grafts are associated with a lower incidence of anterior knee pain post-operatively compared to BTB grafts.
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The patellar tendon is one of the common graft choices for ACL reconstruction.
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BTB grafts refer to bone-tendon-bone grafts.
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Higher stiffness in grafts correlates with better performance after ACL surgery.
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Gracilis is not typically used in ACL grafts.
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The choice of graft can influence the outcome of ACL surgeries.
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Hamstring grafts are considered less invasive than patellar tendon grafts.
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The choice of graft does not affect the rehabilitation protocols post ACL surgery.
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Study Notes
Cartilage Lesions and Knee Joint Treatment Principles
- Biological responses in cartilage treatment involve both augmentation and inhibition, adjusting for healing processes.
- Progressive mechanical loading assists in healing collagenous tissues while forming movement-oriented tissues.
- Balancing loading and unloading is crucial during the healing phase to avoid complications like stiffness.
- Complete rest in overuse injuries is not advisable; maintaining overall body strength is necessary while focusing on the injured part’s recovery.
Structure and Function of Cartilage
- Cartilage is composed mainly of cells and an extracellular matrix, differing from other connective tissues.
- Key characteristics include the absence of blood supply, nerve supply, and lymph drainage.
- Cellular content is low with around 10% cells, predominantly consisting of type II collagen and a high water content (up to 70%).
- The extracellular matrix comprises 65-80% water, with the remaining portion made up of proteoglycans (4-7%) and collagens (10-20%).
Bone Structure and Function
- Bone is a dynamic connective tissue continuously remodeled by calcium levels, hormonal balance, and mechanical loading.
- Distinguished between cancellous (spongy) and cortical (compact) bone types.
- Functions include locomotion, calcium storage, hematopoiesis, and providing protection.
- Major components include hydroxyapatite formed from calcium and phosphorus, contributing to bone hardness and strength.
Adaptation to Training
- Bone mass and geometry adjust specifically to physical training, with responses evident in loaded bones.
- Effective training requires fast, repetitive loading rather than slow, gentle loads.
- Impact loading is essential for athletes in power and jumping sports, leading to greater strength adaptations.
- Training adaptation is most effective during peripubertal years and is beneficial for maintaining bone density in middle age.
Bone Injuries and Fractures
- Acute fractures can result from direct or indirect trauma with varying degrees of damage influenced by injury amplitude and tissue condition.
- Different fracture types include transverse, comminuted, and oblique, requiring specific diagnostic attention.
- Stress fractures develop from cumulative stress and must be distinguished from other overuse injuries; imaging techniques like MRI are critical for early diagnosis.
Management of Bone Injuries
- Initial management includes reduction (if trained) and splinting, followed by ice application and circulation observation.
- Non-operative treatment is often preferred for older recreational athletes, focusing on lifestyle modifications.
- Post-operative rehabilitation should promote muscle alertness, maintain full extension, and progressively restore range, proprioception, and strength over a prolonged period (approximately six months).### Knee Instability and Mechanism of Injury
- Varus and valgus instability affects the knee, impacted by medial and lateral ligaments.
- Common injury mechanisms include twisting and stress valgus, excessive rotational movement, and excessive valgus under mild flexion.
Diagnosis
- Key indicators of injury are often a popping sound during twisting, accompanied by haemarthrosis and an inability to continue playing.
- Medial and lateral instability may manifest as repetitive giving way, catching, or locking, potentially accompanied by meniscal or chondral damage.
- Knee haemarthrosis is the most common cause of acute swelling; chronic cases show varying degrees of effusion without ecchymosis due to intracasular injury.
Tests for Instability
- Anterior instability is best detected by Lachmann’s test, pivot shift test under anesthesia, and anterior drawer test, although reliability needs comparative assessment with the contralateral side.
- Mediolateral instability presents mild increases, prompting search for other associated injuries.
Imaging and Injury Assessment
- MRI is helpful for diagnosis, revealing ligament discontinuity and detecting other injuries, although it is less accurate for chondral damage.
- Lateral condyle contusion may occur, occasionally leading to a Segond fracture (avulsion of the posterolateral capsule).
Treatment Protocols
- Operative treatment is preferred, often postponed for three weeks in young athletes, coupled with early rehabilitation (POLICE - Protection, Optimal loading, Ice, Compression, Elevation).
- Early surgical intervention is essential for preventing further damage; achieving full extension and restoring muscle power are primary goals.
Graft Options
- Graft types include autografts (patellar tendon, quadriceps tendon, hamstring grafts), allografts, and synthetic grafts.
- Autografts provide the best outcomes, especially for revisions and young athletes, though allografts have risks of infection and higher costs.
Tunnel Placement and Fixation
- Anatomically, the femoral tunnel should be at the distal end of the medial wall of the lateral condyle of the femur for optimal reconstruction.
- The tibial tunnel should be more medially positioned at the level of the back border of the anterior horn of the lateral meniscus.
Rehabilitation Focus
- Rehabilitation begins on the day of surgery, focusing on maintaining muscle alertness and achieving full extension early.
- Recovery processes span approximately six months, with attention to regaining range of motion, proprioception, and strength tailored to individual standards and adherence to structured guidelines.
Non-Operative Management
- Older, recreational athletes may benefit from conservative approaches, modifying activity to prevent further deterioration.
- The overarching goal in both surgical and non-surgical interventions is enhancing knee stability and proprioception to mitigate risks of osteoarthritis.### Cartilage Lesions and Treatment Principles
- Emphasis on cartilage lesions in the knee joint and their biological healing responses.
- Treatment strategy involves managing biological responses that need enhancement and those that should be inhibited.
- Importance of progressive mechanical loading to facilitate collagen tissue healing while forming movement-oriented tissue.
- Striking a balance between loading and unloading during the healing phase is crucial for optimal recovery.
Structure and Function of Cartilage
- Cartilage lacks blood supply, nerve supply, and lymph drainage.
- It has a low cellular count and activity, with an abundant water content of up to 70%.
- Composed primarily of collagen type II and an extracellular matrix (ECM) consisting of 65-80% water and macromolecules such as proteoglycans (4-7%) and collagens (10-20%).
Adaptation to Training
- Physical training induces changes in both bone mass and geometry, which is site-specific.
- Fast, repetitive loading is necessary for bone adaptation; slow loading is less effective.
- Different sports yield varying effects on bone strength:
- Power sports (e.g., weightlifting, gymnastics) show superior strength gains.
- Runners maintain midrange strength, while swimmers exhibit no significant changes.
Mechanism of Bone Injury
- Fractures can be caused by direct or indirect injuries, influenced by the bone's exposure area, injury angle, and soft tissue health.
- Common mechanisms of knee injury include excessive rotational movement and valgus stress.
- Identifying injury requires attention to patient history, often a "pop" sound followed by hemarthrosis and inability to continue activity.
Diagnosis of Injuries
- Acute knee injuries commonly present with haemarthrosis and varying effusion levels in chronic scenarios.
- Lachmann's test effectively identifies anterior instability, while pivot shift tests are more reliable under anesthesia.
- MRI serves as a valuable diagnostic tool to assess ligament discontinuity and other potential injuries.
Operative Treatment Strategies
- Immediate surgery is often necessary for ACL injuries to prevent further damage, ideally within three weeks.
- Surgical options vary, yet most utilize anatomic reconstruction methods.
- Graft choice is critical and includes:
- Autografts: Patellar tendon, quadriceps tendon, or hamstring grafts.
- Allografts: From donors, include BTB or tendoachillis grafts.
- Synthetic grafts: Such as LARS, though they have higher failure rates.
Rehabilitation Post-Surgery
- Rehabilitation begins immediately post-surgery, focusing on maintaining muscle alertness and achieving full extension.
- Recovery spans approximately six months and requires strict adherence to rehabilitation protocols.
- A multi-faceted approach includes strength training, proprioception, and gradual reintroduction to sports activities.
Key Concepts of Knee Stability and Recovery
- Proprioception and stability are supported by medial and lateral ligament integrity alongside proper graft fixation.
- The challenges of managing varus and valgus instability are essential for optimal recovery outcomes.
- The characteristics of ideal fixation devices are stable fixation, biological compatibility, ease of revision, and quick technical feasibility.
Important Considerations for Non-operative Treatment
- Conservative treatment is advised for older athletes, focusing on lifestyle modification and sport adjustments.
- The primary goal of any treatment (operative or non-operative) is to regain knee stability and enhance proprioception.
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Description
This quiz focuses on the principles of treating cartilage lesions, particularly in the knee joint. It covers the biological responses to treatment, the importance of mechanical loading, and the balance required to enhance healing. Test your understanding of these critical concepts related to cartilage injury management.