Chapter 5 – Knee Structured I SBA

Abstract

Knee I Structured SBA Questions

Chapter 5 Knee Structured I SBA

Kiran K. Singisetti

Knee I Structured SBA Questions

1. A 65-year-old man presents to the clinic after initial improvement of knee pain with a knee replacement done 18 months ago. He now reports recent onset of patellar crepitus and jumping of patella. Radiographs show no change in position of the posterior stabilised knee replacement with patella resurfacing.

This presentation could be related to which of the following conditions?

Hypertrophic scar tissue at the inferior pole of the patella impinges on the femoral component during extension

Hypertrophic scar tissue at the inferior pole of the patella impinges on the femoral component during flexion

Hypertrophic scar tissue at the superior pole of the patella impinges on the femoral component during extension

Hypertrophic scar tissue at the superior pole of the patella impinges on the femoral component during flexion

Patellar component loosening

2. During a cruciate retaining knee replacement, the femoral size sagittal measurement comes up in between sizes 4 and 5.

Which of the following statements is correct?

If you are using anterior referencing, a size 5 femoral component may cause flexion instability

If you are using posterior referencing, a size 5 femoral component may cause flexion instability

If you are using anterior referencing, a size 4 femoral component may cause femoral notching

If you are using posterior referencing, a size 4 femoral component may cause femoral notching

If you are using anterior referencing, a size 5 femoral component may cause tightness of patellofemoral joint

3. Component alignment and balancing form a key step in total knee arthroplasty.

Which of the following is a correct guide to optimise tibial component rotation?

Junction of the lateral and medial two-thirds of the tibial tubercle

Achieving optimal posterior medial and anterior lateral cortical contact

Extra-medullary alignment rod overlaying the lateral–middle third junctions of the tibial tubercle, the centre of the ankle mortise and second ray of a neutrally aligned foot

Minimal anterior lateral tibial plateau uncoverage

Trial reduction with absolute congruence of the femoral component and the anterior edge of PE tibial bearing surface

4. A patient attends the arthroplasty knee clinic 2 years following right total knee replacement. In the past year, she has complained of a sense of distrusting the knee without giving way, difficulty with stair descent, recurrent effusions and anterior knee pain.

Possible causes for her symptoms could include which of the following?

Inadequate restoration of the tibial slope

Oversizing of the femoral component

Over-resection of the distal femur

Too little posterior femoral condylar resection

Use of an anterior referencing knee system

5. A 27-year-old female felt a pop during a tackle while playing football.

Which of the following ligament component deficiency causes a positive Pivot shift test?

Anterolateral bundle of ACL

Anteromedial bundle of ACL

Posterolateral bundle of ACL

Posteromedial bundle of ACL

Posteromedial bundle of PCL

6. A patient with a previous ORIF of a lateral tibial plateau is seen in clinic and listed for a total knee replacement.

Regarding the surgical approach for knee replacement, which of the following statements is correct?

Avoid previous incision scars

Dissect superficial to the deep fascia

If longitudinal scars exist, choose the medial-most incision that affords appropriate exposure

Respect the lateral-based vascular anatomy of the skin

Transverse scars may be crossed with an incision in a perpendicular manner

7. A 70-year-old woman with tricompartmental knee osteoarthritis is scheduled to have a total knee replacement.

Which of the following intraoperative steps is not useful in improving patellofemoral tracking during total knee arthroplasty?

External rotation of the femoral component

External rotation of the tibial component

Joint line preservation

Lateralisation of the femoral component

Lateralisation of the patellar component

8. A 56-year-old woman presents with a spontaneous onset of pain in the medial aspect of knee joint.

Which of the following is a false statement regarding spontaneous osteonecrosis of the knee (SONK)?

Bone scan has a low specificity and sensitivity in diagnosis of the condition

Core decompression is a useful treatment following subchondral collapse

Mainstay of initial treatment is non-operative

It is more common in females

MRI is useful in early diagnosis of the condition

9. A retired manual labourer presents with gradual worsening of knee pain with a previous history of high tibial osteotomy (HTO) performed 15 years earlier (Figure 5.1). Radiographs show progressive arthritis of the knee joint and you counsel patient about a total knee arthroplasty (TKA).

Figure 5.1 (a) Anteroposterior (AP) and (b) lateral radiographs knee

Which of the following is a likely issue that you may encounter during TKA following previous HTO?

Bipartite patella

Lateral patella instability

Patella baja

Patella fracture

Patella osteonecrosis

10. A patient with medial compartment knee arthritis attends your clinic. He is keen to consider a medial (partial) unicompartmental arthroplasty on the right knee. His radiographs are shown in Figure 5.2.

Figure 5.2 (a) Anteroposterior (AP) and (b) lateral radiographs right knees

Which of the following is not a contraindication for this procedure?

ACL deficiency

Anterior knee pain

Fixed flexion deformity

Inflammatory arthritis

Uncorrectable varus deformity of more than 15 degrees

11. Which of the following statements is false regarding the surgical approach for primary total arthroplasty in a 62-year-old patient with knee arthritis?

Lateral parapatellar approach is useful in fixed valgus deformity of knee

Midvastus approach is relatively contraindicated in obese patients

Midvastus approach may potentially achieve earlier rehab

Minimally invasive surgical (MIS) approach has no long-term functional advantage

Subvastus approach is an extensile approach

12. Your colleague encourages you to use a knee replacement prosthesis that has the option of using an ‘all-polyethylene tibia component’. It would be prudent to look at the cost, advantage and disadvantages of the implant before considering a change of practice.

Which of the following is false regarding an ‘all-polyethylene tibia component’?

Better functional outcome

Better stability

Less modularity

Less osteolysis

More expensive

13. A patient reports continuing instability following a previous single bundle ACL reconstruction using hamstring graft. MRI suggests intact graft.

Which of the following statements is correct regarding tunnel malposition?

Too anterior femoral tunnel limits flexion of knee

Too anterior femoral tunnel causes rotational instability

Too anterior tibial tunnel limits flexion of knee

Vertical femoral tunnel can risk femoral tunnel blowout

Vertical inclination of femoral tunnel is associated with rotational instability

14. A 20-year-old elite football player sustains an anterior cruciate ligament (ACL) rupture reports instability symptoms despite a focussed exercise plan. He attends a specialist knee clinic. He wants to know the best graft option for a potential ACL reconstruction that would allow early return to sports.

Which of the following graft options would you consider in this situation?

Bone–patella–tendon–bone autograft

Hamstring (four strand) autograft

Quadriceps tendon autograft

Synthetic graft

Tendo-Achilles allograft

15. While performing a total knee arthroplasty, you are faced with a situation of normal extension gap but tight flexion gap.

Which of the following solutions can be useful in this situation for sagittal balancing of the knee?

Cut more proximal tibia

Decrease the size of the femoral component

Use distal femoral augmentation

Use a thicker polyethylene insert

Use a thinner polyethylene insert

16. A 24-year-old male walks into your clinic with a varus thrust at the right knee. He reports right knee pain and instability symptoms following a motorbike accident sustained 3 weeks ago. Dials test reveals increased external rotation of the right foot at 30 degrees flexion but not at 90 degrees flexion of knee.

Which of the following is the most likely ligament injury?

Isolated ACL injury

Isolated MCL injury

Isolated posterolateral corner injury

Isolated PCL injury

Posterolateral corner and PCL injury

17. A 22-year-old female office worker had a previous arthroscopic total medial meniscectomy at a different hospital.

Which of the following situations is a not a contraindication for meniscal transplantation?

Asymptomatic meniscal loss

Chondral changes

Inflammatory arthropathy

Instability

Malalignment

18. A 21-year-old woman presents with recurrent instability of patella following an injury sustained 3 years ago.

How is the isometric point for the femoral tunnel referenced from adductor tubercle when considering a medial patellofemoral ligament (MPFL) reconstruction?

At the adductor tubercle

Distal and anterior to the adductor tubercle

Distal and posterior to the adductor tubercle

Proximal and anterior to the adductor tubercle

Proximal and posterior to the adductor tubercle

19. A 60-year-old male presents at the ED with a sudden onset of knee pain following a twisting incident at home. He underwent a medial unicompartmental knee replacement 5 years ago. His radiographs are shown in Figure 5.3.