Ligamentous instability of the knee

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QUESTION 1 OF 5

22.A 19-year-old gymnast attends clinic after an ACL reconstruction using hamstring graft 4 weeks ago. He reports hypersensitivity and numbness at the hamstring graft harvest site related to damage of infrapatellar branch of the saphenous nerve (IPBSN).
Which of the following statements is true regarding this risk of damage to IPBSN?

QUESTION ID: 1186

1. E. Oblique incision has lowest risk of injury compared to vertical and horizontal incisions
2. Risk is higher in female
3. Risk is higher in older age
4. The IPBSN is closer to semitendinosus compared to gracilis tendon
5. Vertical incision is better than horizontal incision for reducing the risk of nerve injury
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QUESTION 2 OF 5

23.A 25-year professional basketball player attends your sports knee clinic to discuss treatment options for ACL deficient right knee.
Which of the following statements is true when counselling about graft options for ACL reconstruction?
BPTB – Bone patella tendon bone graft
HT – Hamstring graft

QUESTION ID: 1187

1. BPTB graft has a lower risk of donor site morbidity compared to HT
2. BPTB graft is useful for double bundle ACL reconstruction
3. BPTB graft requires longer duration for integration compared to HT
4. Irradiated allografts have no donor site morbidity but are more likely to fail
5. Quadrupled HT graft has a higher tensile strength compared to intact native ACL
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QUESTION 3 OF 5

24.A 30-year-old solicitor reports ongoing instability symptoms following a dashboard knee injury sustained 6 months ago. Assessment reveals an isolated ligament injury with posterior tibial sag and positive quadriceps active test.
Which of the following statements is correct regarding the ligament reconstruction technique for this presentation?

QUESTION ID: 1188

1. Acute “killer turn” of the graft is encountered in transtibial technique
2. Direct bone-to-bone healing is seen in transtibial technique
3. Open tibial inlay PCL reconstruction results in the formation of a long oblique tibial tunnel
4. Single bundle PCL reconstruction is tensioned in extension or 20 degrees of flexion
5. Transtibial technique allows for anatomic placement of the PCL graft at its tibial attachment
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QUESTION 4 OF 5

25.A 40-year-old man sustains a direct blow injury to knee (‘dashboard type’) resulting in a painful swollen knee. The knee feels stable on varus and valgus stress test with posterior sag detected on posterior drawer test.
All of the following statements are correct regarding non-operative management of isolated PCL injuries EXCEPT?

QUESTION ID: 1189

1. Early rehabilitation and bracing of isolated PCL injuries can result in successful return to sports
2. Hamstring exercises should be avoided in the early stages
3. Patella mobilisations performed to minimise quadriceps inhibition
4. Quadriceps strengthening exercises should be encouraged
5. Range of movement knee exercise in supine position in early stages
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QUESTION 5 OF 5

A 14-year-old footballer sustained a valgus twisting injury to his knee. His MRI shows an ACL (anterior cruciate ligament) rupture and a bucket handle medial meniscus tear. He still has open physis around his knee and his height is 5 feet. His parents are both 6 feet. What is your management plan?

QUESTION ID: 1265

1. As his physis is open an isolated physiotherapy programme for his ACL deficient knee.
2. As his physis is open, physiotherapy for his ACL deficient knee and a partial medial menisectomy
3. As his physis is open, physiotherapy for his ACL deficient knee and an isolated medial meniscus repair followed by ACL reconstruction once his physis is closed
4. Carry out a transphyseal ACL reconstruction using hamstrings and a partial medial menisectomy
5. Carry out a transphyseal ACL reconstruction using hamstrings and repair his medial meniscus
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