138. Which of the following tests correlates most closely with outcome after an ACL tear?

1. 9. Based on the findings shown in the sagittal T1-weighted MRI scan seen in Figure 2, what is the most likely diagnosis? • Ganglion cyst • PCL tear • Medial Meniscus tear • Osteochondral defect • Normal Findings

2. 32. During normal knee flexion from 0 to 100 degrees, which if the following kinematic motions occurs? • Both the lateral and medial femoral condyles move posteriorly an equal distance 2. The lateral condyle moves posteriorly more than the medial condyle 3. The medial condyle moves posteriorly more than the lateral condyle 4. The lateral condyle moves anteriorly 5. The medial condyle moves anteriorly

3. Which of the following “alphabet soup” lesions of the shoulder will more likely require open rather than arthroscopic repair? • Anterior labroligamentous periosteal sleeve avulsion (ALPSA) • Partial articular supraspinatus tendon avulsion (PASTA) • Superior labrum anterior and posterior (SLAP) • Humeral avulsion of the glenohumeral igament (HAGL) • Glenolabral articular disruption (GLAD)

4. 55. Which of the following mechanisms of injury is most likely to result in an isolated posterior cruciate ligament injury? • External rotation – valgus knee injury 2. Internal rotation – varus knee injury • Direct blow to the posterior knee • Fall on the knee with the foot plantar flexed • Fall on the knee with the foot dorsiflexed

5. 56. A 14-year-old male athlete sustains a twisting, valgus stress injury to his knee. Radiographs are shown in Figures 17a and 17b. The analogous knee injury in the adult would include • Anterior and posterior cruciate ligament tears • An ACL tear and a posterolateral capsule avulsion • A PCL tear and a deep MCL tear • A PCL tear and posterolateral capsule avulsion • A PCL tear and a posteromedial capsule avulsion

6. 59. A 21-year-old football player reports recurrent anterior dislocation of the glenohumeral joint despite undergoing three surgeries to stabilize the shoulder. Radiographs of the affected shoulder are shown in Figures 18a and 18b. What is the most likely reason for the failure of the surgical procedures? • Large, engaging Hill-Sachs lesion • Significant defect of the anterior inferior glenoid • Unrecognized lateral capsular avulsion • Labral nonunion • Subscapularis deficiency

7. 68. What is the most predictive factor associated with successful healing of a medial collateral ligament tear? • Proximal rupture • Midsubstance rupture • Distal rupture • Concomitant ACL tear • Concomitant PCL tear

8. 69. An 18-year-old high school football player has bilateral shoulder pain associated with bench and military press activities. He does not recall any acute injuries but reports that since age 10 years he has actively caused his shoulders to “pop” out of joint. Examination bilaterally shows posterior instability with jerk testing, 1 cm of inferior sulcus testing, and 1+ anterior instability with load and shift testing. Anterior apprehension and relocation tests are negative. An MRI arthrogram shows no discrete labral or capsular injury, and the glenoid is intact. Management should consist of • Open posterior capsular shift • Arthroscopic posterior capsular plication • Rotator cuff interval closure • Thermal capsulorrhaphy • Physical therapy

9. 88. A 17-year-old male hockey player twists his knee and is now unable to passively extend it beyond 20 degrees. An MRI scan sows a displaced bucket-handle tear of the lateral meniscus, and arthroscopy confirms a displaced bucket-handle tear of the normally configured lateral meniscus with a 3-mm peripheral rim. What is the best course of action at this time? • Partial meniscectomy • Reduction of the meniscus and an inside-out repair with vertical mattress sutures • Reduction of the meniscus and an outside-in repair using mulberry knots • Reduction of the meniscus and repair with bioabsorbable arrows • Reduction of the meniscus and repair with nonabsorbable horizontal mattress sutures

10. 112. A 21-year-old man sustained a pivoting injury to his left knee in a flag football game 3 days ago. Examination reveals an effusion, and he is unable to reach terminal extension or flex past 45 degrees. MRI scans are shown in Figures 36a thru 36c. Initial management should consist of • Immobilization with a long leg splint • Acute surgical reconstruction • Preoperative physical therapy for mobilization • Prophylactic bracing and a return to normal activity • Arthrocentesis and rest

11. 122. After repair of a torn quadriceps tendon, which of the following rehabilitation protocols provides range of motion and minimal stress on the repair? • Active open chain extension and active open chain flexion • Active open chain extension and active closed chain flexion • Active-assisted extension and active open chain flexion • Passive extension and active open chain flexion • Passive extension and active closed chain flexion

12. 128. A 21-year-old college football player reports a history of feeling his shoulder “pop in and out” during play. Examination reveals mild apprehension with a significant anterior shift and a positive sulcus examination. Physical therapy has failed to provide relief. A current T1-weighted MRI scan is shown in Figure 43. Based on these finding, what is the most likely diagnosis • Supraspinatus tendon tear of the anterior portion • Humeral avulsion of the inferior glenohumeral ligament • Superior labral tear (SLAP lesion) • Inferior labral tear • Osteochondral injury of the humeral head

13. 138. Which of the following tests correlates most closely with outcome after an ACL tear? • Lachman’s • Anterior drawer • Pivot shift • Quadriceps active • KT-1000

14. 177. With a surgical approach to the pes insertion for harvest of the semitendinosis and gracilis tendons, what nerve is at risk as it emerges between the sartorius and gracilis tendons? • Common peroneal • Superficial peroneal • Medial femoral cutaneous • Terminal branch of the saphenous • Medial retinacular

15. 179. The structure at the tip of the arrow shown in Figure 68 is attached to a muscle that is innervated by which of the following nerves? • Axillary • Subscapular • Suprascpaular • Pectoral • Musculocutaneous

16. 181. A 42-year-old carpenter has had pain and has been unable to lift his dominant arm overhead for the past few months. Examination reveals atrophy of the supraspinatus fossa with grade 2/5 function of the supraspinatus. Radiographs are normal. A sagittal T1-weighted MRI scan is shown in Figure 70. Management consisting of physical therapy and two cortisone injections has failed to provide relief. Treatment should now consist of • Implantation of an oversize humeral head component • Glenohumeral arthrodesis • Reverse total shoulder arthroplasty • Bipolar shoulder arthroplasty • Latissimus dorsi transfer

17. 186. Autologous chondrocyte implantation has been applied to isolated patellofemoral arthritic conditions. Its use is contraindicated in which of the following situation? • Worker’s compensation claim • Findings of joint collapse on a skyline radiograph • Grade IV chondral lesions • Concurrent realignment procedure • Young patient

18. 192. A 45-year-old man reports pain and instability of the right shoulder with activities of daily living. History reveals that he underwent two previous surgeries: one arthroscopic and one open Bankart repair. A CT scan is shown in Figure 73. What is the next most appropriate step in management? • Physical therapy program with emphasis on strengthening of the rotator cuff and scapular stabilizers • Arthroscopic stabilization with repair of the anterior labrum and capsular plication • Open inferior capsular shift for circumferential capsular tightening • Coracoid osteotomy and transfer with conjoint tendon to the anterior glenoid • Pectoralis major transfer under the coracoid

19. 200. A skeletally immature 12-year-old boy has recurrent atraumatic knee pain associated with repetitive sports activities. A radiograph is shown in Figure 77. Initial management should consist of • Application of a bone stimulator • Non-weight bearing for 6 weeks • Arthroscopic excision of loose fragments • Open reduction and internal fixation • Autologous chondrocyte implantation

20. 235. A 35-year-old runner who has had intermittent calf pain for the past 4 months now reports cramping, coolness of the leg, and occasional parasthesias of the foot. Symptoms are worse with walking and relieved with running. Examination reveals that dorsiflexion and plantar flexion of the ankle accentuate the patient’s symptoms. What diagnostic study will best confirm the diagnosis? • Electromyography and nerve conduction velocity studies • Vacular studies • Compartment pressure measurement • Noncontrast MRI • Noncontrast CT

21. A healthy human knee contains approximately how many milliliters of synovial fluid? • 0 • 2 • 10 • 25 • 50

22. 256. Which of the following associated injuries is most commonly noted during arthroscopy after acute shoulder dislocation? • Anterior labral tears • Posterior labral tears • Complete rotator cuff tear • Hill-Sach lesions • Superior labrum anterior and posterior (SLAP) lesions