Arthroscopy Practice Questions

Q: Which of the following structures are not normally visualized during arthroscopy of the knee?

Collateral ligaments. ### Explanation **Core Concept:** Knee arthroscopy is an **intra-articular** procedure, meaning the camera (arthroscope) is inserted into the joint capsule to visualize structures within the synovial cavity. The **Collateral Ligaments** (Medial Collateral Ligament and Lateral Collateral Ligament) are **extracapsular** or capsular structures. They lie outside the joint cavity and are covered by the joint capsule and synovium; therefore, they cannot be directly visualized from within the joint during a standard diagnostic arthroscopy. **Analysis of Options:** * **A. Meniscus:** Both the medial and lateral menisci are intra-articular fibrocartilaginous structures. Visualizing and probing them is a primary goal of arthroscopy to check for tears. * **B. Cruciate Ligaments:** The Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL) are intra-articular (though technically extrasynovial). They are clearly visible in the intercondylar notch during arthroscopy. * **D. Patellar Articular Surface:** The posterior surface of the patella is lined with hyaline cartilage and faces the joint cavity. It is easily inspected by looking into the suprapatellar pouch. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Portals:** The most common portals used are the **Anterolateral** (viewing portal) and **Anteromedial** (working portal). * **Structures seen in the Suprapatellar Pouch:** Patellar articular surface, trochlea, and the plica (synovial folds). * **The "Blind Spot":** The posterior horns of the menisci and the posterior capsule are the most difficult areas to visualize and often require specialized maneuvers or accessory portals. * **Triad of O'Donoghue:** Often diagnosed via arthroscopy, involving injury to the ACL, MCL, and Medial Meniscus. Note that while the ACL and meniscus tears are seen directly, the MCL injury is usually inferred by "medial compartment opening" or valgus laxity.

Q: Which is the investigation of choice for a suspected injury of the knee?

Arthroscopy. **Explanation:** The investigation of choice for a suspected internal derangement of the knee (IDK), such as meniscal or cruciate ligament injuries, is **Arthroscopy**. **Why Arthroscopy is the Correct Answer:** Arthroscopy is considered the **Gold Standard** because it serves a dual purpose: it is both diagnostic and therapeutic. It allows for direct visualization of intra-articular structures (menisci, ACL, PCL, and articular cartilage) with 100% accuracy. While MRI is the investigation of choice for *screening* (non-invasive), Arthroscopy remains the definitive investigation of choice for *confirmation* and immediate management. **Analysis of Incorrect Options:** * **Ultrasonography (USG):** While useful for superficial soft tissue pathologies like Baker’s cysts or patellar tendonitis, it has very low sensitivity for deep intra-articular structures like the cruciate ligaments. * **Plain Radiography:** This is the *initial* investigation to rule out fractures or bony avulsions (e.g., Segond fracture), but it cannot visualize soft tissue injuries, which comprise the majority of sports-related knee trauma. * **Arthrography:** This invasive procedure involving dye injection was used historically to detect meniscal tears but has been entirely superseded by MRI and Arthroscopy due to lower accuracy and high complication rates. **Clinical Pearls for NEET-PG:** * **Investigation of Choice (Non-invasive/Screening):** MRI. * **Gold Standard/Definitive Investigation:** Arthroscopy. * **Initial Investigation:** X-ray (AP and Lateral views). * **Unhappy Triad (O'Donoghue):** Injury to the ACL, Medial Collateral Ligament (MCL), and Medial Meniscus (though recent studies suggest Lateral Meniscus involvement is more common in acute phases).

Q: The operative procedure known as "microfracture" is done for the

Osteochondral defect of femur. ***Osteochondral defect of femur*** - **Microfracture** is a surgical technique used to stimulate the growth of **fibrocartilage** in areas of damaged articular cartilage, such as an **osteochondral defect**. - It involves creating small holes in the **subchondral bone** to allow stem cells and growth factors from the bone marrow to form a new reparative tissue. *Delayed union of femur* - **Delayed union** typically involves an extended time for fracture healing, which is often managed through prolonged immobilization, **bone grafting**, or sometimes revision surgery. - Microfracture specifically targets cartilage repair, not the process of **bony union** after a fracture. *Non union of tibia* - **Non-union** refers to the failure of a fractured bone to heal within a reasonable timeframe, often requiring surgical intervention with **bone grafts** or **internal fixation**. - This condition involves bone healing problems, distinct from cartilage defects that microfracture addresses. *Loose bodies of ankle joint* - **Loose bodies** in a joint are typically removed surgically, often arthroscopically, to relieve pain and prevent joint damage. - This procedure does not involve the repair of cartilage defects, which is the primary goal of microfracture.

Q: Loose body in joint: most common site?

Knee. ***Knee*** - The **knee joint** is the most common site for loose bodies due to its high mobility, susceptibility to trauma, and prevalence of conditions like **osteochondritis dissecans** and osteoarthritis. - Loose bodies in the knee can cause symptoms such as **locking**, clicking, pain, and effusion. *Hip* - Loose bodies can occur in the hip, but they are far **less common** than in the knee. - Causes can include **osteochondritis dissecans** and **osteoarthritis**, but the hip's deeper anatomy offers more protection. *Elbow* - The elbow joint can develop loose bodies, particularly in conditions like **osteochondritis dissecans** or following trauma. - However, their incidence is **lower** compared to the knee. *Ankle* - Loose bodies in the ankle are **relatively rare** but can be found, often associated with trauma or **osteochondral lesions**. - They are significantly **less frequent** than in the knee joint.

Q: What is the purpose of anterolateral arthroscopy of the knee?

To see patella femoral articulation. ***To see patella femoral articulation*** - Anterolateral arthroscopy involves inserting the arthroscope through a portal located **anterolaterally to the patella**, providing an excellent direct view of the **patellofemoral joint**. - This position allows for clear visualization of the **articular cartilage** of the patella and femoral trochlea, crucial for assessing conditions like **chondromalacia patellae** or patellar instability. *To see the posterior cruciate ligament* - Visualizing the **posterior cruciate ligament (PCL)** typically requires a more posterior or posteromedial approach, or specific maneuvers within the joint, as its location is deep within the knee. - The anterolateral portal primarily offers views of the anterior compartment and some lateral structures, making PCL visualization challenging with this sole approach. *To see the anterior portion of lateral meniscus* - While the anterolateral portal can give some oblique views of the lateral compartment, a direct and comprehensive view of the **anterior horn of the lateral meniscus** is often achieved more effectively via an anteromedial portal for triangulation or specific maneuvers. - The primary target for an anterolateral entry is often the patellofemoral joint and general anterior compartment assessment. *To see the periphery of the posterior horn of medial* - Viewing the **periphery of the posterior horn of the medial meniscus** generally requires an anteromedial portal for direct visualization, sometimes supplemented by a posteromedial portal for full assessment. - An anterolateral approach is not ideal for this specific area due to the anatomical location and angle required.

Q: An athlete sustained an injury around the knee joint, suspecting cartilage damage. Which of the following is the investigation of choice?

Arthroscopy. ***Arthroscopy*** - **Arthroscopy** is the definitive investigation for **cartilage damage** as it allows for direct visualization of the knee joint's internal structures. - It not only confirms the diagnosis but can also facilitate simultaneous **repair or débridement** of damaged cartilage. *X-ray* - **X-rays** are primarily used to assess **bone structures** and detect fractures or significant joint space narrowing, not soft tissue injuries like cartilage. - They are generally **insufficient** for diagnosing subtle or early cartilage damage. *Clinical examination* - A **clinical examination** is crucial for initial assessment and suspicion of cartilage injury, but it cannot definitively diagnose the extent or type of cartilage damage. - It helps guide further investigations but is **not specific enough** to confirm cartilage integrity. *Arthrotomy* - **Arthrotomy** involves a larger incision to open the joint, which is more **invasive** than arthroscopy and typically reserved for open surgical repairs or complex reconstructions, not as a primary diagnostic tool for cartilage. - It carries a **higher risk of complications**, such as infection and prolonged recovery, compared to arthroscopy.

Question 1

Which of the following structures are not normally visualized during arthroscopy of the knee?

Accepted Answer

Collateral ligaments

Answer

Meniscus

Answer

Cruciate ligaments

Answer

Patellar articular surface

Question 2

Which is the investigation of choice for a suspected injury of the knee?

Accepted Answer

Arthroscopy

Answer

Ultrasonography

Answer

Plain radiography

Answer

Arthrography

Question 3

The operative procedure known as "microfracture" is done for the

Accepted Answer

Osteochondral defect of femur

Answer

Delayed union of femur

Answer

Non union of tibia

Answer

Loose bodies of ankle joint

Question 4

Loose body in joint: most common site?

Accepted Answer

Knee

Answer

Hip

Answer

Elbow

Answer

Ankle

Question 5

What is the purpose of anterolateral arthroscopy of the knee?

Accepted Answer

To see patella femoral articulation

Answer

To see the posterior cruciate ligament

Answer

To see the anterior portion of lateral meniscus

Answer

To see the periphery of the posterior horn of medial

Question 6

An athlete sustained an injury around the knee joint, suspecting cartilage damage. Which of the following is the investigation of choice?

Accepted Answer

Arthroscopy

Answer

Clinical examination

Answer

Arthrotomy

Answer

X-ray

Arthroscopy — MCQs

Arthroscopy — MCQs

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