10.11.12

Questions and Answers

What is the primary challenge in treating cartilage lesions in the knee joint?

Determining the need for complete immobilization of the joint

Finding the optimal method of surgical intervention

Balancing loading and unloading during the healing phase (correct)

Restoring normal blood supply to the cartilage

What unique characteristic distinguishes cartilage from other connective tissues?

Low water content

Presence of a rich blood supply

High nerve innervation

Lack of lymph drainage (correct)

Which component constitutes approximately 10% of cartilage tissue?

Collagen type II

Water

Extracellular matrix

Cells (correct)

What is crucial for enhancing the biological response in the treatment of cartilage lesions?

Progressive mechanical loading Signup and view all the answers

Which statement best reflects an appropriate approach to managing overuse injuries?

Partial rest while exercising other body parts Signup and view all the answers

What percentage of water is typically present in cartilage?

65-80% Signup and view all the answers

In the context of cartilage lesions, which macromolecules significantly contribute to the extracellular matrix?

Proteoglycans and collagens Signup and view all the answers

Which type of collagen is predominantly found in cartilage?

Collagen type II Signup and view all the answers

What is the effect of excessive mechanical loading during the healing phase?

Causes stiffness and complications Signup and view all the answers

Which aspect of cartilage is NOT a characteristic mentioned in the content?

High cellular activity Signup and view all the answers

What is the purpose of finding the optimal loading during the healing phase of cartilage lesions?

To promote effective collagen formation without leading to stiffness Signup and view all the answers

What is a key aspect of addressing overuse injuries in athletes?

Rest the injured site while maintaining activity in other body parts Signup and view all the answers

In cartilage, what percentage of its structure is extracellular matrix?

65-80% Signup and view all the answers

Why is cartilage categorized differently than other connective tissues?

It shows limited cellular activity and no blood supply Signup and view all the answers

What characterizes the collagen present in cartilage?

Collagen type II is the main type present Signup and view all the answers

Which component makes up a significant portion of the extracellular matrix in cartilage?

Collagens Signup and view all the answers

What should be done to the injured area during the rehabilitation of cartilage lesions?

Balance between rest and appropriate loading Signup and view all the answers

How much water can make up the content of cartilage?

Up to 70% Signup and view all the answers

What must be augmented during the treatment of cartilage lesions?

Biological response necessary for healing Signup and view all the answers

What is a major risk associated with inappropriate loading during the healing phase?

Development of joint stiffness Signup and view all the answers

What is a critical factor in managing the balance during the healing phase of cartilage lesions?

Determining the optimal loading to enhance healing without causing complications Signup and view all the answers

How should rest be effectively implemented to manage overuse injuries?

Resting the injured part while exercising the rest of the body Signup and view all the answers

What percentage of cartilage is comprised mainly of water?

70% Signup and view all the answers

What characterizes the cellular activity in cartilage?

Scant cellular count and activity Signup and view all the answers

Which macromolecule constitutes a major part of the extracellular matrix in cartilage?

Collagen type II Signup and view all the answers

What is the role of mechanical loading in the treatment of cartilage lesions?

It enhances the biological response and promotes healing Signup and view all the answers

What happens to the body's overall fitness if an athlete rests too much during an overuse injury?

Weakens other parts and tissues of the body Signup and view all the answers

What should be avoided during the healing phase to prevent complications?

Overloading the injured area with excessive mechanical stress Signup and view all the answers

Which characteristic does NOT apply to cartilage?

It has a rich nerve supply Signup and view all the answers

What is a main component of the extracellular matrix in cartilage besides water?

Proteoglycans and collagens Signup and view all the answers

Cartilage is characterized by a high cellular count and activity.

False Signup and view all the answers

Resting an injured part completely is beneficial for the body during rehabilitation.

False Signup and view all the answers

The extracellular matrix of cartilage consists mostly of water.

True Signup and view all the answers

Optimal loading during the healing phase of cartilage is aimed at reducing stiffness.

True Signup and view all the answers

Collagen type I is the predominant collagen type found in cartilage.

False Signup and view all the answers

Cartilage experiences no blood supply, nerve supply, or lymph drainage.

True Signup and view all the answers

Mechanical loading should always be avoided during the healing phase.

False Signup and view all the answers

Resting injured cartilage includes allowing movement in surrounding tissues.

True Signup and view all the answers

Cartilage has a high blood supply, which aids in its healing process.

False Signup and view all the answers

The optimal loading during the healing phase of cartilage is aimed at enhancing stiffness in the joint.

False Signup and view all the answers

Collagen type II is the main collagen type found in cartilage tissue.

True Signup and view all the answers

Resting an injured part of cartilage completely is recommended to ensure complete local recovery.

False Signup and view all the answers

Cartilage mainly consists of approximately 70% macromolecules and 30% water.

False Signup and view all the answers

Overuse injuries in athletes necessitate a state of complete inactivity to avoid worsening conditions.

False Signup and view all the answers

Mechanical loading can have both positive benefits and negative complications during cartilage healing.

True Signup and view all the answers

The extracellular matrix of cartilage contains a high abundance of cells, constituting about 40% of its structure.

False Signup and view all the answers

Fractures and dislocations of the ankle are part of syndesmotic injuries.

False Signup and view all the answers

The IOC's manual of sports medicine provides extensive coverage on ankle fractures and dislocations.

True Signup and view all the answers

Syndesmotic injuries are common and classified under ankle dislocations.

False Signup and view all the answers

The IOC manual is edited by R., who specializes in fractures and dislocations of the ankle.

True Signup and view all the answers

Fractures and dislocations of the ankle can happen simultaneously in extreme sports.

True Signup and view all the answers

Syndesmotic injuries do not typically require surgical intervention.

False Signup and view all the answers

The management of ankle fractures often involves non-operative techniques only.

False Signup and view all the answers

An ankle dislocation can occur without associated fractures.

True Signup and view all the answers

Fractures and dislocations of the ankle are particularly prevalent in contact sports.

True Signup and view all the answers

The provisions of the IOC manual only cover surgical procedures related to ankle injuries.

False Signup and view all the answers

Transverse fractures typically result from sudden and severe trauma.

True Signup and view all the answers

Stress fractures present symptoms immediately after the initial injury occurs.

False Signup and view all the answers

The second metatarsal is recognized as a problematic site for stress fractures.

True Signup and view all the answers

MRI and scintigraphy are ineffective for the early diagnosis of stress fractures.

False Signup and view all the answers

Ice application is discouraged in first aid management of fractures due to its potential harm.

False Signup and view all the answers

A runner fracture is a type of stress fracture that develops due to prolonged overuse.

True Signup and view all the answers

Bony injuries can only occur due to direct impact trauma.

False Signup and view all the answers

Elevation is not recommended as part of the first aid management for injuries.

False Signup and view all the answers

Stress fractures can lead to acute and insidious patterns of pain.

True Signup and view all the answers

Circulation monitoring is irrelevant in the management of fractures.

False Signup and view all the answers

What component of bones primarily contributes to their hardness and strength?

Bone mineral density Signup and view all the answers

Which component of bone is responsible for its elastic properties?

Collagen Signup and view all the answers

What is the periosteum?

A layer of connective tissue rich in blood and nerve supply Signup and view all the answers

Which part of long bones is primarily involved in growth and lengthening?

Physeal plate Signup and view all the answers

Where is the periosteum more adherent to the bone surface?

Where tendons and ligaments attach Signup and view all the answers

The diaphysis of long bones serves what primary function?

Providing structural support and strength Signup and view all the answers

What role do Sharpey's collagen fibers play in bone structure?

They connect the periosteum to the underlying bone Signup and view all the answers

Which of the following statements best describes the epiphysis of long bones?

It is the site of joint articulation Signup and view all the answers

What property does collagen impart to bone structure?

Relative elasticity Signup and view all the answers

Which type of fracture is often associated with overuse and presents acutely or progressively?

Stress fracture Signup and view all the answers

What diagnostic imaging techniques are primarily utilized for early detection of stress fractures?

MRI and scintigraphy Signup and view all the answers

Which foot bone is commonly known for being affected by problematic stress fractures?

Navicular Signup and view all the answers

In the management of bony injuries, what approach should be taken if one is trained?

Reduce and splint, then refer Signup and view all the answers

Which type of fracture is often referred to as the 'runner fracture' due to repetitive stress?

Stress fracture of the second metatarsal Signup and view all the answers

Which type of trauma is indicated by significant sudden pains and the presence of other clinical signs?

Dramatic trauma Signup and view all the answers

What is the main benefit of applying ice to an injury?

It reduces swelling and pain Signup and view all the answers

Which of the following is NOT a characteristic of stress fractures?

They are primarily caused by acute injury Signup and view all the answers

What should one observe to ensure proper circulation in an injured limb?

Normal color and pulse Signup and view all the answers

What is the primary imaging technique used for diagnosing knee ligament injuries?

MRI Signup and view all the answers

Which graft type is rarely used and typically indicated for extra-articular tenodesis?

Ileotibial graft Signup and view all the answers

In the context of knee rehabilitation, what should be the primary focus immediately post-injury?

Full extension and muscle power Signup and view all the answers

What is a significant complication that may arise from acute ACL injuries?

Chondral damage Signup and view all the answers

Which surgical technique is now considered obsolete for knee ligament reconstruction?

Open surgery Signup and view all the answers

What role does aspiration of haemarthrosis play in the management of knee injuries?

Reduces intra-articular pressure Signup and view all the answers

What is a primary concern when performing anterior drawer tests on a knee with suspected instability?

Comparison to the unaffected side Signup and view all the answers

What is the expected outcome for a young athlete undergoing ACL reconstruction surgery if rehabilitation is done correctly?

Complete recovery with high sports return rate Signup and view all the answers

What is the primary focus during the initial phase post ACL surgery rehabilitation?

Maintaining full extension of the joint Signup and view all the answers

Which of the following is NOT a key component of post-operative rehabilitation for ACL surgery?

Immediate return to competitive sports Signup and view all the answers

In the context of rehabilitation for older recreational athletes, which approach is recommended?

Conservative treatment with lifestyle modifications Signup and view all the answers

What is an essential goal throughout the rehabilitation process after ACL surgery?

Regaining stability and proprioception Signup and view all the answers

When should the rehabilitation process ideally commence after ACL surgery?

Immediately on the day of surgery Signup and view all the answers

What complication can arise from failing to adhere to rehabilitation protocols after ACL surgery?

Increased risk of osteoarthritis Signup and view all the answers

What is a potential outcome of improper loading during the healing phase of rehabilitation?

Delayed recovery and chronic instability Signup and view all the answers

Which strategy should be implemented to support the biological response during ACL rehabilitation?

Respecting the body’s healing timeline Signup and view all the answers

What has improved in modern techniques for anterior cruciate ligament reconstruction?

Anatomic fidelity to the native ACL Signup and view all the answers

Which imaging technique is typically used to assess the integrity of the anterior cruciate ligament?

Magnetic resonance imaging (MRI) Signup and view all the answers

Which option most accurately describes a common complication following ACL reconstruction?

Excessive scar tissue formation Signup and view all the answers

What is a key rehabilitation protocol focus after ACL reconstruction?

Progressive range of motion exercises Signup and view all the answers

Which graft type is commonly used in ACL reconstruction surgeries?

Autologous tendon grafts Signup and view all the answers

What outcome can result from improper surgical technique during ACL reconstruction?

Increased risk of re-injury Signup and view all the answers

What is a common physical therapy goal in the first phase of post-ACL surgery rehabilitation?

Restoring full knee extension Signup and view all the answers

Which factor can negatively influence the outcomes after ACL reconstruction?

Age of the patient Signup and view all the answers

Which graft type is typically known for higher incidence of infection post-surgery?

Synthetic grafts Signup and view all the answers

What is the optimal location for the femoral tunnel in an ACL reconstruction procedure?

At the distal end of the medial wall of the lateral condyle Signup and view all the answers

Which factor is commonly impacted by the choice of fixation device in surgical procedures?

Surgeon's preference Signup and view all the answers

What was identified as a significant drawback of using allografts in ACL reconstruction?

Incidence of special infections Signup and view all the answers

What is a potential consequence of improper tunnel placement during ACL reconstruction?

Increased risk of re-injury Signup and view all the answers

In anatomic ACL reconstruction, where should the tibial tunnel be placed?

In the middle of the insertion area, more medially Signup and view all the answers

What is a primary benefit of using semitendinosus and gracilis grafts in ACL reconstruction?

Less harvest site morbidity Signup and view all the answers

Which characteristic is essential to consider for an ideal fixation tool in surgical procedures?

Stability in varied conditions Signup and view all the answers

What type of tendon graft is known for providing better stability but may lead to higher instances of anterior knee pain post-operatively?

Patellar tendon graft Signup and view all the answers

Which graft type is considered an autograft commonly used in knee surgeries?

Bone-patellar tendon-bone graft Signup and view all the answers

What is a major consideration when choosing between BTB and quadriceps grafts for knee surgery?

Post-operative pain implications Signup and view all the answers

Which of the following grafts is the more resistant to deformation?

Quadriceps tendon grafts Signup and view all the answers

What advantage do flexor tendon grafts primarily offer during rehabilitation?

Reduced risk of anterior knee pain Signup and view all the answers

What is a potential complication associated with using BTB and quadriceps grafts?

Higher occurrence of anterior knee pain Signup and view all the answers

In terms of graft types, which of the following statements is accurate regarding autografts?

They are sourced from the patient's own body. Signup and view all the answers

What should be a primary focus during rehabilitation when using these different graft types?

Promoting joint stabilization and pain management Signup and view all the answers

What is the primary goal of rehabilitation following ACL surgery?

Regaining stability and proprioception Signup and view all the answers

When should post-operative rehabilitation ideally begin?

The day of surgery Signup and view all the answers

What is considered the earliest rehabilitation goal after ACL surgery?

Maintaining full extension Signup and view all the answers

Which factor is critical for ensuring successful rehabilitation in older recreational athletes?

Modifications in lifestyle and sport type Signup and view all the answers

What is a common misconception about the duration of rehabilitation after ACL surgery?

It often takes about 6 months Signup and view all the answers

Which approach should be taken regarding the biological response during rehabilitation?

Respecting and supporting the biological response Signup and view all the answers

What aspect is critical when deciding to return to sports after rehabilitation?

Full recovery of range, proprioception, and strength Signup and view all the answers

What is essential to ensure during the rehabilitation process for ACL surgery?

Supervision and strict adherence to instructions Signup and view all the answers

Which type of graft is considered an autograft commonly used in knee surgeries?

Flexor tendon graft Signup and view all the answers

What is a common disadvantage associated with using BTB and quadriceps grafts?

More anterior knee pain post-operatively Signup and view all the answers

What characteristic of autografts makes them preferable compared to allografts?

Reduced risk of graft rejection Signup and view all the answers

When considering graft choice, which type is known for being stiffer?

BTB graft Signup and view all the answers

Which graft option is categorized as a flexor tendon graft?

Gracilis tendon Signup and view all the answers

Which surgical technique might be considered based on the graft choice?

Graft fixation Signup and view all the answers

What factor can significantly affect the outcomes of surgical grafting in the knee?

Post-operative rehabilitation protocol Signup and view all the answers

What is a common complication following the use of stiffer grafts like BTB?

Chronic pain or discomfort Signup and view all the answers

Which type of graft is derived from the patient's own body?

Autograft Signup and view all the answers

What is the most reliable diagnostic imaging technique for detecting ligament discontinuity?

MRI Signup and view all the answers

Which surgical technique is aimed at preserving ligament remnants during reconstruction?

Single bundle reconstruction Signup and view all the answers

What is the primary goal during the rehabilitation phase following ACL surgery?

Achieving full extension of the knee Signup and view all the answers

Which condition is commonly associated with a sudden knee injury, characterized by pop sound and swelling?

ACL rupture Signup and view all the answers

What complication may arise after an acute ACL injury if not promptly addressed?

Lateral condyle contusion Signup and view all the answers

What is a potential drawback of using synthetic grafts for ACL reconstruction?

Poor integration with native tissue Signup and view all the answers

What is a common sign that indicates an acute knee injury involving blood accumulation?

Haemarthrosis Signup and view all the answers

What is a primary disadvantage of using allografts for ACL reconstruction?

Less available than synthetic grafts Signup and view all the answers

Which statement accurately describes the placement of the femoral tunnel in anatomic ACL reconstruction?

Situated at the distal end of the medial wall of the lateral condyle Signup and view all the answers

What is a critical characteristic of an ideal fixation device for ACL reconstruction?

Ease of application should be prioritized Signup and view all the answers

Why are synthetic grafts often considered unreliable for ACL reconstruction?

High incidence of graft failure and infection Signup and view all the answers

What is the recommended location for the tibial tunnel in ACL reconstruction?

In the middle of the insertion area, more medially than laterally Signup and view all the answers

In terms of graft types, which of the following is NOT a drawback of using synthetic grafts?

Higher surgical complexity Signup and view all the answers

Which patient population might benefit most from the use of semi-tendinosus and gracilis tendons for ACL reconstruction?

Hypermobile individuals Signup and view all the answers

What factor is primarily taken into consideration when selecting graft types for ACL reconstruction?

Patient's activity level and needs Signup and view all the answers

What is the primary foundation for orthopaedic surgery?

Anatomy Signup and view all the answers

What has led to the development of improved modern reconstruction techniques for the anterior cruciate ligament (ACL)?

Advancing knowledge of ACL anatomy Signup and view all the answers

What is the primary goal of modern ACL reconstruction techniques?

To approach the anatomy of the native ACL Signup and view all the answers

What is essential for orthopaedic surgeons to understand when performing ACL reconstruction?

The anatomy of the ACL Signup and view all the answers

How do modern ACL reconstruction techniques differ from traditional methods?

They aim to replicate the native ACL anatomy Signup and view all the answers

What is the significance of understanding ACL anatomy in orthopaedic surgery?

It leads to the development of improved reconstruction techniques Signup and view all the answers

What is the primary focus of modern ACL reconstruction techniques?

To approach the anatomy of the native ACL Signup and view all the answers

How has the understanding of ACL anatomy impacted orthopaedic surgery?

It has enabled the creation of more effective reconstruction techniques Signup and view all the answers

Scopic surgery has become the preferred method for ACL reconstruction due to its minimally invasive nature.

True Signup and view all the answers

MRI is essential for diagnosing ACL injuries as it provides absolute certainty in all cases.

False Signup and view all the answers

The primary goal of early rehabilitation post-injury is to achieve full extension of the affected limb.

True Signup and view all the answers

Autografts used in ACL reconstruction are harvested from a donor body.

False Signup and view all the answers

A common complication following ACL injury is chronic knee effusion.

True Signup and view all the answers

The Lachmann’s test is primarily used to measure lateral instability in the knee.

False Signup and view all the answers

Synthetic grafts, such as LARS, are the most commonly used grafts in ACL reconstruction.

False Signup and view all the answers

The healing potential of the ACL is considered low, making surgical intervention often necessary in young athletes.

True Signup and view all the answers

Rehabilitation after ACL surgery should start at least by the day of surgery.

True Signup and view all the answers

Maintaining full extension is considered a late objective for both the surgeon and therapist.

False Signup and view all the answers

A rehabilitation process after ACL surgery typically spans about 6 weeks.

False Signup and view all the answers

Proprioception and strength should be regained before making a decision about returning to sports.

True Signup and view all the answers

Rehabilitation is a minor aspect of treatment following ACL surgery.

False Signup and view all the answers

Non-operative treatment for older recreational athletes may involve lifestyle modifications.

True Signup and view all the answers

Surgical techniques for ACL injuries do not impact the long-term prevention of osteoarthritis (OA).

False Signup and view all the answers

The contact with your surgeon is irrelevant during the rehabilitation process.

False Signup and view all the answers

BTB and quadriceps grafts have a lower incidence of anterior knee pains post-operative.

False Signup and view all the answers

Autografts from the flexor tendon, such as hamstrings, are also referred to as flexor tendon grafts.

True Signup and view all the answers

The quadriceps tendon is less commonly used due to its high resistance to deformation.

False Signup and view all the answers

Flexor tendon grafts are sourced from the hamstring muscles.

True Signup and view all the answers

Choosing the right graft type can significantly influence the surgical outcomes and recovery process.

True Signup and view all the answers

Allografts have a high incidence of special infections such as AIDS.

True Signup and view all the answers

In surgical procedures, graft choice does not affect the stiffness of the knee post-operation.

False Signup and view all the answers

Recovery protocols may vary depending on the type of graft used during an operation.

True Signup and view all the answers

Synthetic grafts are known for their low incidence of failure and infection.

False Signup and view all the answers

The best results in knee surgeries are always associated with avoiding any form of grafts.

False Signup and view all the answers

The femoral tunnel for ACL reconstruction should be located at the proximal end of the lateral condyle of the femur.

False Signup and view all the answers

The tibial tunnel in ACL reconstruction should be placed more laterally than medially.

False Signup and view all the answers

Semi T and gracilis harvesting techniques result in minimal site morbidity.

True Signup and view all the answers

The ideal fixation device for grafts is universally agreed upon among surgeons.

False Signup and view all the answers

Anatomic reconstruction of the ACL includes a precise placement of the femoral and tibial tunnels.

True Signup and view all the answers

Revision surgeries for ACL injuries often require the same graft sources as the initial operation.

False Signup and view all the answers

Understanding the anatomy of the anterior cruciate ligament (ACL) is essential for effective surgical techniques.

True Signup and view all the answers

Advanced diagnostic imaging is unnecessary when assessing injuries of the anterior cruciate ligament.

False Signup and view all the answers

Different types of grafts may be used in ACL reconstruction based on individual patient needs.

True Signup and view all the answers

Rehabilitation protocols following ACL surgery are uniform across all patient profiles.

False Signup and view all the answers

Complications arising from ACL reconstruction surgery can sometimes lead to further injuries or setbacks during recovery.

True Signup and view all the answers

Outcomes for ACL reconstruction are consistently poor, regardless of surgical technique used.

False Signup and view all the answers

Surgical techniques for ACL injuries have remained static and have not evolved over time.

False Signup and view all the answers

The choice of graft type plays a pivotal role in the success of ACL reconstruction.

True Signup and view all the answers

What is a primary characteristic of cartilage lesions treatment concerning mechanical loading?

Finding an optimal loading amount is essential. Signup and view all the answers

What should be emphasized during rehabilitation for overuse injuries in athletes?

Exercising unaffected body parts. Signup and view all the answers

What type of collagen is predominantly found in cartilage?

Collagen type II Signup and view all the answers

Which characteristic does NOT apply to cartilage?

Presence of blood supply. Signup and view all the answers

Why is it important to balance loading and unloading during the healing phase?

To enhance biological response without complications. Signup and view all the answers

What portion of cartilage consists of extracellular matrix?

Around 65-80% Signup and view all the answers

What element is primarily missing in cartilage structure compared to other connective tissues?

Lymph drainage Signup and view all the answers

What happens if the injured part is completely rested without any activity?

It weakens other parts of the body. Signup and view all the answers

What is the expected outcome of mechanical loading during the rehabilitation of cartilage lesions?

Enhanced biological response. Signup and view all the answers

Which of the following increases the risk of complications during cartilage healing?

Excessive mechanical loading. Signup and view all the answers

Cartilage has a high blood supply that promotes healing.

False Signup and view all the answers

Collagen type II is the predominant collagen type found in cartilage.

True Signup and view all the answers

The extracellular matrix of cartilage consists mainly of cells.

False Signup and view all the answers

Resting during rehabilitation should involve complete inactivity of the injured area.

False Signup and view all the answers

Finding the optimal loading during cartilage healing is important to prevent stiffness.

True Signup and view all the answers

Cartilage can have a cellular count as high as 40% of its structure.

False Signup and view all the answers

Mechanical loading should always be avoided during the healing phase of cartilage.

False Signup and view all the answers

Water content in cartilage can be as high as 70%.

True Signup and view all the answers

Scanty cellular activity is a distinguishing feature of cartilage.

True Signup and view all the answers

The biological responses during treatment should be universally aught.

False Signup and view all the answers

Bone functions in calcium storage, hematopoiesis, and protection.

True Signup and view all the answers

Cortical bone is also known as cancellous bone.

False Signup and view all the answers

Bone remodeling is influenced by calcium levels and mechanical loading.

True Signup and view all the answers

Bone is primarily composed of muscle tissue.

False Signup and view all the answers

Cancellous bone is more dense than cortical bone.

False Signup and view all the answers

When osteoblasts become surrounded by mineralized matrix, they are called osteocytes.

True Signup and view all the answers

Osteocytes do not communicate with osteoblasts and osteoclasts.

False Signup and view all the answers

Osteocytes signal for remodeling through channels in the extracellular matrix.

True Signup and view all the answers

Osteocytes are the least abundant cells in bone tissue.

False Signup and view all the answers

Osteoblasts are responsible for the resorption of bone.

False Signup and view all the answers

Osteocytes are derived from chondrocytes.

False Signup and view all the answers

The extracellular matrix consists of organic and inorganic components.

True Signup and view all the answers

Cartilage is primarily made up of 50% water.

False Signup and view all the answers

Extracellular matrix does not play any role in cartilage structure.

False Signup and view all the answers

All components of the extracellular matrix are biological in nature.

False Signup and view all the answers

Collagen is a major component of the extracellular matrix in cartilage.

True Signup and view all the answers

The inorganic components of the extracellular matrix are solely responsible for providing stability.

False Signup and view all the answers

Cartilage is classified as a connective tissue.

True Signup and view all the answers

The extracellular matrix is primarily made up of lipids.

False Signup and view all the answers

Organic components in the extracellular matrix include proteins and carbohydrates.

True Signup and view all the answers

Inorganic components in the extracellular matrix consist mainly of vitamins and minerals.

False Signup and view all the answers

What is formed when calcium and phosphorus combine?

Hydroxyapatite Signup and view all the answers

Which type of cells are responsible for bone formation?

Osteoblasts Signup and view all the answers

What is NOT a component of bone structure?

Adipose tissues Signup and view all the answers

Which of the following characterizes osteoclasts?

Bone resorbing cells Signup and view all the answers

Which component is part of the bone matrix?

Hydroxyapatite Signup and view all the answers

What is the primary function of bone in the locomotor system?

Acting as a lever Signup and view all the answers

Which type of bone is characterized as spongy?

Cancellous bone Signup and view all the answers

What factor is NOT involved in the remodeling process of bone?

Muscle strength Signup and view all the answers

Which function of bone involves the production of blood cells?

Hematopoiesis Signup and view all the answers

What type of bone has a dense structure, often referred to as compact?

Cortical bone Signup and view all the answers

What is a primary aim of rehabilitation after ACL surgery?

Gaining back stability and proprioception Signup and view all the answers

When should post-operative rehabilitation ideally start?

The day of surgery Signup and view all the answers

What is the role of proprioception in ACL rehabilitation?

To ensure the knee joint remains stable Signup and view all the answers

What is a common recommendation for older recreational athletes experiencing injuries?

Modification of lifestyle and sports type Signup and view all the answers

What is the earliest objective in postoperative rehabilitation of the ACL?

Maintaining full extension Signup and view all the answers

How long is the typical rehabilitation process for ACL surgery?

6 months Signup and view all the answers

What should be emphasized throughout the rehabilitation process?

Strict adherence to instructions Signup and view all the answers

What aspect of recovery must be respected during ACL rehabilitation?

The biological response to treatment Signup and view all the answers

What are the two most common mechanisms of injury to the ACL?

Excessive rotatory movement and excessive valgus with mild flexion Signup and view all the answers

Which test is best for detecting anterior instability of the knee?

Lachmann's test Signup and view all the answers

What is the primary goal during rehabilitation following an ACL injury?

Achieving full extension and muscle power Signup and view all the answers

What is a common symptom following a twisting knee injury associated with ACL damage?

Haemarthrosis and inability to continue activity Signup and view all the answers

Which type of graft is harvested from the same patient for ACL reconstruction?

Autograft Signup and view all the answers

In cases of chronic ACL injuries, which radiological method is primarily used for diagnosis?

MRI Signup and view all the answers

What is the recommended immediate treatment protocol after an ACL injury?

Rehabilitation from day one with POLICE Signup and view all the answers

What is the expected finding in a case of acute knee haemarthrosis?

Variable effusion in chronic cases Signup and view all the answers

Which of the following statements is true regarding the healing capabilities of the ACL?

The ACL requires immediate surgical intervention to heal properly. Signup and view all the answers

What is a common associated injury that could complicate an ACL tear?

Meniscal or chondral damage Signup and view all the answers

What is a characteristic of BTB and quadriceps grafts in ACL treatment?

They have a higher incidence of anterior knee pains post operatively. Signup and view all the answers

Which type of graft is considered an autograft when treating ACL injuries?

BTB graft Signup and view all the answers

What is the main advantage of using flexor tendon grafts in ACL reconstruction?

They result in less post-operative pain. Signup and view all the answers

Where should the femoral tunnel be located in relation to the lateral condyle of the femur?

At the distal end of the medial wall Signup and view all the answers

What is a disadvantage of using allografts for ACL reconstruction?

Higher cost and limited availability Signup and view all the answers

Which of the following is a disadvantage of using BTB grafts?

Increased risk of rupture compared to soft tissue grafts. Signup and view all the answers

Which fixation device characteristic is considered ideal?

Should match surgeon’s preference Signup and view all the answers

What commonly results from using grafts that are stiffer in nature?

Higher resistance to deformation. Signup and view all the answers

In which area should the tibial tunnel be positioned for optimal ACL reconstruction?

More medially than laterally, within the insertion area Signup and view all the answers

What is a key factor to consider when selecting a graft for ACL reconstruction?

The patient's age and activity level. Signup and view all the answers

What is a potential complication of using stiffer grafts?

Anterior knee pain. Signup and view all the answers

Which of the following describes synthetic grafts used in ACL procedures?

They can experience a high incidence of failure and infection Signup and view all the answers

Which component of ACL grafts comes from the hamstring tendons?

Flexor tendon graft Signup and view all the answers

What is the optimal placement for the femoral tunnel in ACL reconstruction?

Distal to the lateral intercondylar ridge Signup and view all the answers

What is a potential risk of using allografts during ACL reconstruction?

Incidence of special infections Signup and view all the answers

In terms of biomechanical properties, how do BTB and quadriceps grafts compare?

BTB grafts are stiffer than quadriceps grafts. Signup and view all the answers

Which factor is a consideration when determining the best graft choice for ACL reconstruction?

The type of sports played by the patient. Signup and view all the answers

In which area is the tibial tunnel located during ACL reconstruction?

Middle of the insertion area, medially oriented Signup and view all the answers

Which aspect of fixation devices is still a matter of evolution in ACL surgeries?

Surgeon's preference for device choice Signup and view all the answers

Post-operative rehabilitation should begin the day of surgery.

True Signup and view all the answers

Maintaining full extension is the last priority for both the surgeon and the therapist.

False Signup and view all the answers

Rehabilitation after ACL surgery is a short process that typically lasts about 2 weeks.

False Signup and view all the answers

Proprioception is a key factor that should be regained during ACL rehabilitation.

True Signup and view all the answers

A conservative approach in treatment should always be used for older recreational athletes.

True Signup and view all the answers

Communication with the surgeon is not important during the rehabilitation process.

False Signup and view all the answers

The aim of ACL surgery is solely to repair the ligament.

False Signup and view all the answers

Proprioception and strength need to be fully restored before deciding to return to sports.

True Signup and view all the answers

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.

True Signup and view all the answers

Allografts for ACL reconstruction are universally available and economically feasible.

False Signup and view all the answers

The tibial tunnel should be placed more laterally than medially in an ACL reconstruction.

False Signup and view all the answers

Synthetic grafts used in ACL reconstruction have a low incidence of failure.

False Signup and view all the answers

Hypermobile patients are considered suitable candidates for ACL reconstruction using specific graft techniques.

True Signup and view all the answers

The concept of anatomical reconstruction focuses on correcting the position of the ACL to its original anatomical site.

True Signup and view all the answers

The ideal fixation device for ACL reconstruction has been firmly established and is universally accepted.

False Signup and view all the answers

Allografts have a risk of special infections, such as AIDS, due to the nature of their sourcing.

True Signup and view all the answers

Tunnel placement in ACL reconstruction does not require consideration of the anatomical features around the knee.

False Signup and view all the answers

It's crucial to locate the femoral tunnel generally at the anatomical ACL attachment during reconstruction.

True Signup and view all the answers

The primary mechanism of injury for the ACL is excessive rotatory movement and excessive valgus with mild degree of flexion.

True Signup and view all the answers

Mediolateral instability indicates a severe injury that requires no further evaluation of associated injuries.

False Signup and view all the answers

Lachmann’s test is used to detect anterior instability in the knee.

True Signup and view all the answers

Rehabilitation after an ACL injury should be started only after surgery has been performed.

False Signup and view all the answers

MRI is regarded as the most accurate method for diagnosing chondral damage.

False Signup and view all the answers

The operative treatment for ACL injuries often involves anatomic reconstruction techniques.

True Signup and view all the answers

In the acute setting, knee haemarthrosis is one of the most common causes of instability.

True Signup and view all the answers

Autografts are grafts taken from a donor who is not the patient receiving the graft.

False Signup and view all the answers

For managing ACL injuries, the goal of rehabilitation includes achieving full extension of the knee before focusing on muscle power.

True Signup and view all the answers

Twisting and stress valgus injuries occur due to quick changes in direction or impact to the knee.

True Signup and view all the answers

Autografts are a type of graft commonly used in ACL surgeries.

True Signup and view all the answers

Flexor tendon grafts are derived from the quadriceps muscle.

False Signup and view all the answers

Quadriceps grafts are associated with a lower incidence of anterior knee pain post-operatively compared to BTB grafts.

False Signup and view all the answers

The patellar tendon is one of the common graft choices for ACL reconstruction.

True Signup and view all the answers

BTB grafts refer to bone-tendon-bone grafts.

True Signup and view all the answers

Higher stiffness in grafts correlates with better performance after ACL surgery.

False Signup and view all the answers

Gracilis is not typically used in ACL grafts.

False Signup and view all the answers

The choice of graft can influence the outcome of ACL surgeries.

True Signup and view all the answers

Hamstring grafts are considered less invasive than patellar tendon grafts.

True Signup and view all the answers

The choice of graft does not affect the rehabilitation protocols post ACL surgery.

False Signup and view all the answers

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.