Arthroscopy

Arthroscopy Indian Medical PG Question 1: Manoeuvre carried out for diagnosing medial meniscus injury is:

• A. McMurray's test (Correct Answer)
• B. Valgus stress test
• C. Lachmann's test
• D. Varus stress test

Arthroscopy Explanation: ***McMurray's test*** - This test is specifically designed to assess for meniscal tears, particularly the **medial meniscus**. - A positive test involves eliciting a **click or pain** when extending the knee from a fully flexed position while internally and externally rotating the tibia. *Valgus stress test* - This test evaluates the integrity of the **medial collateral ligament (MCL)**. - It involves applying a valgus (outward) force to the knee while stabilizing the thigh, looking for increased gapping or pain. *Lachmann's test* - This is the most sensitive test for assessing the integrity of the **anterior cruciate ligament (ACL)**. - It involves gently pulling the tibia anteriorly with the knee flexed at 20-30 degrees, looking for excessive anterior translation. *Varus stress test* - This test assesses the integrity of the **lateral collateral ligament (LCL)**. - It involves applying a varus (inward) force to the knee while stabilizing the thigh, looking for increased gapping or pain.

Arthroscopy Indian Medical PG Question 2: Pringle's maneuver is mainly used to control bleeding from which site?

• A. IVC
• B. Cystic artery
• C. Hepatic vein
• D. Liver parenchyma (Correct Answer)

Arthroscopy Explanation: ***Liver parenchyma*** - Pringle's maneuver involves **clamping the hepatoduodenal ligament**, which contains the portal triad (hepatic artery, portal vein, and bile duct), to temporarily **reduce blood flow to the liver**. - This maneuver is primarily performed during **liver surgery** to control bleeding from the liver parenchyma itself, allowing for safer resection or repair of liver injuries. *IVC* - Bleeding from the **inferior vena cava (IVC)** is not directly controlled by Pringle's maneuver. The IVC is located posterior to the liver parenchyma and is not part of the hepatoduodenal ligament. - Controlling IVC bleeding typically requires **direct repair** or other specific vascular control techniques, often involving clamps placed directly on the IVC. *Cystic artery* - While the **cystic artery** is a branch of the right hepatic artery (which is occluded during Pringle's maneuver), the maneuver is not *mainly* used to control isolated cystic artery bleeding. - **Cystic artery bleeding** is typically encountered during cholecystectomy and is controlled by ligating or clipping the artery directly, rather than relying on a general liver inflow occlusion. *Hepatic vein* - The **hepatic veins** drain directly into the IVC from the liver parenchyma and are not part of the hepatoduodenal ligament, thus their blood flow is not directly occluded by Pringle's maneuver. - Bleeding from the hepatic veins is a more challenging complication in liver surgery, often requiring **direct compression**, suture repair, or venovenous bypass to manage.

Arthroscopy Indian Medical PG Question 3: What is the most appropriate management option for an intra-articular fracture?

• A. External Fixation
• B. Arthrodesis
• C. Plaster of Paris
• D. Plating (Correct Answer)

Arthroscopy Explanation: ***Plating*** - Plating offers **stable fixation** for intra-articular fractures, allowing for early mobilization and preserving joint function. - It provides **anatomic reduction**, which is crucial for restoring the smooth articular surface and preventing post-traumatic arthritis. *Arthrodesis* - Arthrodesis, or joint fusion, is typically reserved for **severe joint destruction** or failed previous treatments, as it sacrifices joint motion. - It is not the primary approach for acute intra-articular fractures where the goal is to **restore joint function**. *Plaster of Paris* - Plaster of Paris casts often provide **insufficient stability** for complex intra-articular fractures, risking malunion or nonunion. - While it offers immobilization, it can lead to **joint stiffness** and does not allow for early range of motion, which is vital for articular cartilage healing. *External Fixation* - External fixation is usually preferred for **open fractures** with significant soft tissue injury or as a temporary measure in polytrauma patients. - It carries a risk of **pin site infections** and can be cumbersome for the patient, generally not being the definitive treatment for closed intra-articular fractures.

Arthroscopy Indian Medical PG Question 4: Which one of the following statements about Compartment Syndrome is NOT correct?

• A. Pain is on active movement but not on passive movement of muscles (Correct Answer)
• B. Fasciotomy is the treatment of choice
• C. It is commonest in a closed fracture
• D. Volkmann's Ischaemic contracture is a late complication

Arthroscopy Explanation: ***Pain is on active movement but not on passive movement of muscles*** - This statement is incorrect because pain in compartment syndrome is characteristically **out of proportion to the injury** and is **exacerbated by passive stretching of the muscles** within the affected compartment. - While active movement can cause pain, the hallmark sign related to pain is its intensification with passive stretching due to increased pressure. *Fasciotomy is the treatment of choice* - **Fasciotomy** is indeed the definitive surgical treatment for compartment syndrome to relieve pressure and prevent irreversible tissue damage. - It involves incising the fascia to decompress the affected muscle compartment. *It is commonest in a closed fracture* - Compartment syndrome most frequently occurs after a **closed fracture**, particularly in the tibia and forearm, because the intact fascial compartments restrict expansion, leading to increased pressure. - The swelling and hemorrhage associated with the fracture are contained, causing pressure to rise rapidly. *Volkmann's Ischaemic contracture is a late complication* - **Volkmann's ischemic contracture** is a severe and debilitating late complication of unresolved or undertreated compartment syndrome, primarily affecting the forearm muscles. - It results from prolonged ischemia, causing muscle necrosis, fibrosis, and subsequent shortening and contracture.

Arthroscopy Indian Medical PG Question 5: Which of the following is not true about ACL injury?

• A. ACL is important for proprioceptive function
• B. It is a component of the O'Donoghue triad
• C. ACL is intrasynovial
• D. Anterior drawer test is the most sensitive test (Correct Answer)

Arthroscopy Explanation: ***Anterior drawer test is the most sensitive test*** - The **anterior drawer test** has a relatively low sensitivity (around 50-70%) for diagnosing acute ACL tears due to guarding and hamstring spasm. - The **Lachman test** is generally considered the most sensitive clinical test for ACL tears, especially in acute settings. *ACL is important for proprioceptive function* - The ACL contains **mechanoreceptors** (e.g., Pacinian and Ruffini corpuscles) that contribute to joint position sense and kinesthesia, which are crucial for dynamic stability. - Injury to the ACL can impair **proprioception**, increasing the risk of recurrent instability and future injuries. *It is a component of the O'Donoghue triad* - The **O'Donoghue triad** (also known as the "terrible triad" or "unhappy triad") consists of injuries to the **anterior cruciate ligament (ACL)**, medial collateral ligament (MCL), and medial meniscus. - This classic combination of injuries commonly results from a valgus stress with external rotation applied to a flexed knee. *ACL is intrasynovial* - The ACL is paradoxically situated within the knee joint capsule but is **extrasynovial**, meaning it is surrounded by a synovial sheath but not directly bathed in synovial fluid. - This unique anatomical arrangement has implications for its healing potential and response to injury.

Arthroscopy Indian Medical PG Question 6: A 65-year-old lady presented with a swollen and painful knee. On examination, she was found to have grade III osteoarthritic changes. What is the best course of action?

• A. Conservative management
• B. Total knee replacement (Correct Answer)
• C. Arthroscopic washing
• D. Partial knee replacement

Arthroscopy Explanation: ***Total knee replacement*** - For **grade III osteoarthritis** in a 65-year-old, a total knee replacement is the most definitive and effective treatment to relieve pain and restore function in a severely damaged joint. - This procedure addresses widespread cartilage loss and structural changes typical of advanced osteoarthritis. *Conservative management* - This approach is typically favored for **mild to moderate osteoarthritis**, involving physical therapy, NSAIDs, and lifestyle modifications. - For **grade III changes** with significant pain and swelling, conservative measures are unlikely to provide sufficient relief or halt disease progression effectively. *Arthroscopic washing* - **Arthroscopic lavage** and debridement are rarely recommended for osteoarthritis as they have not shown sustained benefits for pain or function. - It is sometimes used for specific mechanical symptoms, but it does not address the underlying cartilage loss and structural damage in severe osteoarthritis. *Partial knee replacement* - A **partial knee replacement** is suitable when osteoarthritis is confined to a single compartment of the knee, and the other compartments are healthy. - Given the indication of "grade III osteoarthritic changes" without specifying a single compartment, a total knee replacement is generally more appropriate for widespread disease.

Arthroscopy Indian Medical PG Question 7: What is the most effective management strategy for hemarthrosis?

• A. Immobilization with a P.O.P. cast
• B. Application of a compression bandage
• C. Needle aspiration to remove excess blood (Correct Answer)
• D. All of the options

Arthroscopy Explanation: ***Needle aspiration to remove excess blood*** - **Aspirating the blood** from the joint effectively reduces intra-articular pressure, pain, and inflammation. - This procedure also helps prevent **synovial hypertrophy** and **cartilage damage** caused by the presence of blood in the joint. *Application of a compression bandage* - While helpful for reducing swelling and providing support, a **compression bandage alone** does not remove the accumulated blood. - It may alleviate some discomfort but does not address the underlying issue of **intra-articular blood accumulation**. *Immobilization with a P.O.P. cast* - **Immobilization** can help rest the joint and reduce pain, but it does not remove the blood from the joint space. - Prolonged immobilization can lead to **joint stiffness** and **muscle atrophy**, which are undesirable outcomes. *All of the options* - While compression and immobilization can be supportive measures, they are not the **most effective primary strategy** for managing hemarthrosis. - The direct removal of blood via **aspiration** is crucial for alleviating pressure and preventing long-term joint damage.

Arthroscopy Indian Medical PG Question 8: Anterior drawer test is done for -

• A. Lateral meniscus
• B. ACL (Correct Answer)
• C. Medial meniscus
• D. PCL

Arthroscopy Explanation: ***ACL*** - The **anterior drawer test** assesses the integrity of the **anterior cruciate ligament (ACL)**. - A positive test involves excessive anterior translation of the tibia relative to the femur, indicating an **ACL tear**. *Lateral meniscus* - Meniscal injuries are typically assessed using tests like the **McMurray test** or **Apley grind test**, which involve specific rotational movements and compression. - The anterior drawer test primarily evaluates ligamentous stability, not meniscal integrity. *Medial meniscus* - Similar to the lateral meniscus, injuries to the **medial meniscus** are evaluated with tests that provoke pain or clicking during specific rotational and compressive maneuvers, such as the **McMurray test**. - The anterior drawer test is not designed to assess meniscal damage. *PCL* - The **posterior cruciate ligament (PCL)** is assessed by the **posterior drawer test**, where the tibia is pushed posteriorly on the femur. - Excessive posterior translation indicates a **PCL injury**, which is opposite to what the anterior drawer test evaluates.

Arthroscopy Indian Medical PG Question 9: Hill-Sach's lesion is seen in:

• A. Anterior dislocation of hip
• B. Posterior dislocation of hip
• C. Recurrent dislocation of shoulder (Correct Answer)
• D. Posterior dislocation of shoulder

Arthroscopy Explanation: ***Recurrent dislocation of shoulder*** - A **Hill-Sach's lesion** is a **compression fracture** of the posterolateral part of the humeral head, occurring as the humeral head impacts the anterior rim of the glenoid during **anterior shoulder dislocation**. - It is particularly associated with **recurrent anterior shoulder dislocations** due to repeated impaction. *Anterior dislocation of hip* - This condition involves the femoral head moving anteriorly out of the acetabulum and is not associated with a Hill-Sach's lesion. - While it causes significant pain and immobility, the specific bone lesion known as Hill-Sach's involves the humerus, not the femur. *Posterior dislocation of hip* - A posterior hip dislocation involves the femoral head moving posteriorly out of the acetabulum and is not linked to a Hill-Sach's lesion. - This type of injury is often seen in high-impact trauma, such as car accidents, and can be associated with acetabular fractures or sciatic nerve injury. *Posterior dislocation of shoulder* - This involves the humeral head dislocating posteriorly relative to the glenoid, and while bone lesions can occur, they are typically **reverse Hill-Sach's lesions** (on the anterior aspect of the humeral head) or **bony Bankart lesions** of the posterior glenoid. - A standard Hill-Sach's lesion specifically refers to the posterolateral humeral head defect seen in **anterior dislocations**.

Arthroscopy Indian Medical PG Question 10: Keinbock's disease is osteochondritis of ?

• A. Scaphoid
• B. Lunate (Correct Answer)
• C. Calcaneum
• D. Tibial tuberosity

Arthroscopy Explanation: ***Lunate*** - **Keinbock's disease** is characterized by avascular necrosis of the **lunate bone** in the wrist. - This condition leads to pain, stiffness, and eventual collapse of the lunate, affecting wrist function. *Scaphoid* - Avascular necrosis of the scaphoid is referred to as **Preiser's disease**, not Keinbock's disease. - The scaphoid is more commonly associated with **fractures** due to its precarious blood supply. *Calcaneum* - The calcaneum (heel bone) is affected by **Sever's disease**, which is osteochondrosis of the calcaneal apophysis, typically seen in children. - This condition is not related to osteonecrosis of a carpal bone. *Tibial tuberosity* - The tibial tuberosity is associated with **Osgood-Schlatter disease**, which is an inflammation of the patellar ligament at its insertion point on the tibia, common in adolescents. - This is an apophysitis, not an osteochondrosis affecting a carpal bone.

Arthroscopy Flashcard 1 of 2

Question: Gold standard investigation for meniscal injury is _____

Answer: arthroscopy

Arthroscopy Flashcard 2 of 2

Question: 2 standard portals are used in arthroscopy:Anteromedial - _____Anterolateral - visualising camera

Answer: instrumentation