Lateral Ankle Instability & Achilles Pathology exam questions and answers fully solved

Lateral Ankle Instability & Achilles Pathology exam questions and answers fully solved What is the name of the functional stabilizing tendon that runs behind the lateral malleolus and inserts on the base of the 1st met? - AnswersPeroneus longus What is the name of the functional stabilizing tendon that runs behind the lateral malleolus and inserts on the base of the 5th met? - AnswersPeroneus brevis Which of the peroneal tendons runs anterior to the lateral malleolus and is absent in 25% of people? - AnswersPeroneus tertius What neurovascular structure is at risk in lateral ankle procedures (runs behind lateral mal)? - AnswersSural nerve What neurovascular structure runs on the anterior aspect of the foot? - AnswersSuperficial peroneal nerve What is the function of the ATFL? - AnswersPrevents anterior translation of the talus and internal rotation of the foot Where is the fibular attachment site of the ATFL? - AnswersAttaches 1.4 cm from distal aspect of fibula Where is the talar attachment site of the ATFL? - AnswersAttaches 1.8 cm anterior and medial from the lateral talar process What is the function of the CFL? - AnswersPrevents movement of tibiotalar and subtalar joint When is the PTFL typically injured? - AnswersDue to axial load or traumatic impact (car wreck) What is the mechanism of injury for an ATFL sprain? - AnswersSubtalar inversion and forced plantarflexion Difference between functional and mechanical issues in ATFL - AnswersFunctional: patient complains of pain and difficulty with movement; mechanical: can physically translate the talus Classification of ankle sprains: - AnswersGrade 1: ligament stretched but intact Grade 2: ligament partially torn Grade 3: ligament completely torn CFL instability can be confirmed by: - AnswersVarus stress, talar tilt test, subtalar inversion How does a Brostrom-Gould differ from traditional Brostrom? - AnswersBrostrom-Gould incorporates extensor retinaculum into repair What percent of people with lateral ankle sprain don't return to full prior activity level? - Answers42% What percent of people with lateral ankle sprain abandon athletic activity altogether? - Answers26% What is the strength of the native ATFL? - Answers160N What is the strength of a Brostrom repair? - Answers75N What is the strength of an Internal Brace augmentation? - Answers250N How much sooner can you return to activity with IB v. modified Brostrom? - Answers4.2 weeks sooner DX Fibertak placement for ATFL repair? - Answers1st anchor: 1 cm from distal tip of fibula 2nd anchor: 1 cm proximal from first anchor Where do you position talar offset guide? - Answers2 cm medial from lateral talar process; angle guide 40-45 degrees to sagittal plane and parallel with longitudinal line of 5th met; 7:30 for left, 4:30 for right What percent of all sports injuries are lateral ankle sprains? - Answers15-30% Lateral ankle augmentation with IB is necessary for: - AnswersEarly ROM (ligament elongation will occur without static stabilization) In order for collagen to reorganize properly you need: - AnswersROM and stress during healing What percent of revision rates with modified Brostrom v. IB? - Answers6.5% higher revision rate w/o IB Benefit of collagen-coated suture: - AnswersImproves tenocyte interaction What percent of lateral ankle repairs are augmented? - Answers15% What position should ankle be tensioned in for placement of fibertaks? - AnswersDorsiflexion and eversion What position should ankle be tensioned in for placement of IB? - Answers10-15 degrees plantarflexion and neutral inversion/eversion What is time-zero strength? - AnswersHow strong a construct is as soon as it's put together ATFL is naturally tight in what position? - AnswersPlantarflexion (20 degrees) and inversion What is the longest and strongest tendon in the body? - AnswersAchilles What is the insertion point of the achilles tendon? - AnswersPosterior middle third of the calc tuberosity Function of the gastroc: - AnswersPlantarflexion and knee flexion Function of the soleus: - AnswersPlantarflexion Function of the achilles: - AnswersPlantarflexion Types of insertional achilles pathology: - AnswersHaglund's deformity (10% of patients), painful bone spur, calcification Where does insertional pathology typically occur? - AnswersSubcalc bursa and retrocalc bursa (usually Haglund's) Lateral structures at risk: - AnswersSural nerve, calcaneal branches of fibular artery Medial structures at risk: - AnswersMedial calcaneal branch of tibial nerve, calcaneal branches of posterior tibial artery What is the watershed zone and where is it? - AnswersHypovascularized area where >75% of ruptures occur (about 2-6 cm from distal insertion) Insertional pathology typically seen in - Answersolder patients T or F: Intrinsic risk factors are the same for insertional and midsubstance - AnswersTrue Non-surgical treatment of ruptures results in _______ rate of re-rupture due to hypovascularity - Answershigher Drill angle for PARS midsub anchors? - Answers45 degrees in coronal and sagittal plane What percent of patients return to baseline activity within 5 months after PARS? - Answers98% Must tension PARS in maximal ______ - Answersplantarflexion #1 goal of PARS midsub repair: - AnswersTo restore length and strength of achilles in most minimally invasive and safe way How many times should you cycle PARS suture to take out creep? - Answers10 Where should you make incision for PARS jig? - Answersabout 4 cm from tip of calc Laser line on 3.9 swivelock shows...? - Answers2 mm countersunk How does the new fibertak achilles speedbridge compare to old 4.75 construct? - Answers25% smaller construct with double the strength (600N v. 1117N) Three components of MIS technique: - AnswersPreparation --> resection --> fixation What kind of suture is on DX fibertak? Drill sizes and depth? - Answers1.3 mm suturetape; 1.35 mm and 1.6 mm; 15 mm What kind of suture is on DX knotless fibertak? Drill sizes and depth? - Answers#2 coreless; 1.6 mm and 1.8 mm; 20 mm Lateral ankle stabilizers: - AnswersATFL, CFL, PTFL Mechanism of injury for CFL: - AnswersSupination, inversion, internal rotation Varus stress test: - AnswersInternally rotate and supinate tibial plafond off talar dome Fibertape stretches... - Answers3 mm over 300N Thompson test: - AnswersSqueeze gastroc to see if foot moves, test for achilles competency Native ATFL stretches... - Answers4.5 mm over 300N Rate of achilles tendon rupture - Answers250,000/year; 6% report pain in lifetime Mean age of rupture in men and women: - Answers44.4 - men; 50 - women Fibertak bailouts: - Answers3.0 knotless and regular suturetak What is the name of the structure that houses and protects the achilles tendon? - Answersparatenon What is the #1 structure you want to be wary of when doing midsub repair? - AnswersSural nerve New PARS kit: - Answers1.3 mm collagen-coated suturetapes (white x2, blue x2, black x2), x2 fiberlink, x2 3.9 mm anchors, banana suture lasso, 2.6 mm drill, 3.9 mm tap New Fibertak kit: - Answersx2 2.6 mm fibertak anchors with 1.7 mm collagen-coated fibertape, x2 3.9 mm anchors, 2.6 drill (fibertak), 2.6 drill (swivelocks), 3.9 mm tap, banana suture lasso, 4.3 conical burr, obturator, free needles, nitinol suture passing wire, k wires Why is the fibertak kit different? - Answers25% less material, 2x the strength, knotless ripstop Where should you place drill guide for proximal fibertaks in achilles speedbridge? - AnswersAbout 1 cm proximal to distal insertion of achilles and central to each side of tendon split