She endorses snapping and clicking in the left hip with certain movements. Thank you. Posterior drawer (at 90 flexion) She presents to clinic with significant knee pain and swelling. Copyright 2022 Lineage Medical, Inc. All rights reserved. Which of the following statements best describes the incorporation of the graft and biopsy results of the graft at one year? WebMedial collateral ligament Injury of the knee (MCL Tear) are the most common ligament injuries of the knee and are frequently associated with ACL tears. It is predominately done to correct for varus deformities in young patients but can also be done to correct valgus deformities. A diminished immune response to transplanted chondrocytes is seen in Technique C because the dense cartilage matrix acts as a barrier that limits antigen exposure. On physical exam his ACL and PCL are intact, however he is noted clinically to have Grade 3 posterolateral corner laxity and varus malalignment of his knee. Upon evaluation, he has difficulty bearing weight due to left hip pain and has tenderness to Summary written. chronic tears with scarring to sciatic nerve. WebPCL Injury MCL Knee Injuries LCL Injury of the Knee Posterolateral Corner Injury Posteromedial Corner Injury Orthobullets Team Knee & Sports - Articular Cartilage Defects of Knee; Listen Now 37:19 min. He did well until recently when he developed persistent right knee pain that is worse with weight bearing. WebPCL Injury MCL Knee Injuries LCL Injury of the Knee and to document the degree of cartilage injury. A patient with a symptomatic chondral defect undergoes the arthroscopic procedure seen in Figure A. Diagnosis generally requires an MRI to accurately assess the location of specific defects. Anterior (Maquet) tibial tubercle osteotomy, Anteromedial (Fulkerson) tibial tubercle osteotomy, Medial opening wedge high tibial osteotomy, Lateral closing wedge high tibial osteotomy. His medical history is significant only for osteoporosis. 0.0 (0) See More See Less. 5% of surgeries where knee arthroplasty is indicated are unicompartmental knee replacements, weightbearing through the meniscus increases conformity and contact without increasing constraint, excellent survivorship out to the second decade, faster rehabilitation and quicker recovery, theory is that retaining ACL, PCL and other compartments leads to more normal knee kinematics, less post-operative pain leading to shorter hospital stays, as an alternative to total knee arthroplasty or osteotomy for unicompartmental disease, classicaly reserved for older (>60), lower-demand, and thin (<82 kg) patients, 6% of patient's meet the above criteria with no contraindications, new effort to expand indications to include younger patients and patients with more moderate arthrosis, absolute contraindication for mobile-bearing UKA and lateral UKA, previous meniscectomy in other compartment, younger high activity patients and heavy laborers, grade IV patellofemoral chondrosis (anterior knee pain), undercorrect the mechanical axis by 2-3 degrees, overcorrection places excess load on unresurfaced compartment, remove osteophytes (peripheral and notch), prevent tibial spine impingement with proper mediolateral placement, avoid making a varus tibial cut which increases the chance for loosening, use caution when placing the proximal tibial guide pins to avoid stress fractures, correct varus deformity to 1-5 degrees of valgus, most common cause of early failure (5 years) at somewhere between 25%-45.3%, associated with high activity and patient weight, clinically there will be a pain free interval followed by spontaneous pain with activity, penetrating posterior tibial cortex with guide pin, placing guide pin medial in periphery, re-drilling for guide pin, and under-sized tibial component, associated with forceful impacting of implant, 10-year survivorship from studies done in 1980s and 1990s ranges from 87.4% to 96%, the standard faliure rate in the first decade is 1%, rapid decline in survivorship ranging from 79% to 90%, excellent clinical results with 15-year survivorship reported at 93%, lateral compartment arthroplasties have equivalent results to medial, revision rates are worse than total knee revision rates, Patellofemoral arthroplasty (PFA) has good outcomes for isolated patellofemoral arthritis, Previous generation designs (i.e. An 11-year-old boy complains of 4 weeks of medial knee pain that began while playing tennis. He undergoes the procedure depicted in Figure B. Compared to total knee arthroplasty (TKA), UKA more closely approximates native knee kinematics, Patients undergoing a UKA and TKA have equivalent blood loss and pain medication requirements, Compared to their TKA counterparts, UKA patients have a slower return to function, There is no difference in range of motion at short or long term follow-up when compared with TKA, Postoperative hospital stay is equivalent for UKA and TKA patients, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, ISTA: New Early-Career Webinar Series 2020, The Utility of Virtual Reality as a Learning Tool for Trainees in Unicompartmental Knee Arthroplasty: A Randomized Controlled Trial - Musa Zaid, Single Upright Unloader Brace Improves Medial Joint Space in Unicompartmental OA Subjects - Garret Dessinger, 2018 Orthopaedic Summit Evolving Techniques, Evolving Technique: Converting The UKA To A Total Knee: When, How - Tips & Tricks - Michael J. Kaplan, MD (OSET 2018), Recon | Unicompartmental Knee Replacement, Knee osteoarthritis in 56F - Lateral unicompartmental arthritis, Knee Osteoarthritis in 51M - Medial unicompartmental disease. Which of the following statements regarding this procedure is true? You can rate this topic again in 12 months. All of the following technical errors likely contributed to this complication EXCEPT? The physical exam and radiographic work-up demonstrates isolated medial tibiofemoral compartment involvement. WebA quadriceps tendon rupture is a traumatic injury of the quadriceps insertion on the patella leading to a disruption in the knee extensor mechanism. WebFemoroacetabular impingement (FAI) is the abnormal contact between the femur and acetabulum which may lead to labral damage, various degrees of chondral injury and progressive hip pain. (OBQ04.25.1) WebPCL Injury. axis from center of femoral head to center of ankle. 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Bobby Menges Memorial HSS Limb Deformity Course 2021, Discussion: Osteotomy Considerations & Innovation, Osteotomy: Innovations in Pain Management - Joseph R. Hsu, MD, Osteotomies Around the Knee: Tibia - Mitchell Bernstein, MD, Varus Knee with Cartilage and Meniscal Damage in 32 Year Old. (OBQ06.107) Web(OBQ17.23) A 35-year-old male presents to your clinic with right knee pain after sustaining a twisting injury while playing basketball 3 weeks ago. Biopsy shows type II collagen. maintain the joint line perpendicular to mechanical axis of the leg, can be done for varus knee with medial compartment degeneration (more common), best results achieved by overcorrection of the anatomical axis to 8-10 degrees of valgus, narrow lateral compartment cartilage space with stress radiographs, Used less commonly than distal femoral osteotomy, produces obliquity of the tibiofemoral joint line, can be done for valgus knee with lateral compartment degeneration, <12 degrees or else the joint line will become oblique, distal femoral osteotomy better if lateral femoral condyle hypoplasia present, adjunct to soft tissue reconstructive surgeries (ACL/PCL/MACI) when there is coronal malalignment, wedge of bone removed with tibia via an anterolateral approach, more inherent stability allows for faster rehab and weight bearing, transverse bone cut made in proximal tibia, and wedged open on medial side, avoids peroneal nerve in anterior compartment, the center of the dome is located at the center of rotation of angulation (CORA), corrects limb alignment with the least translation of bone ends, refers to a shortened patellar tendon which decreases the distance of the patellar tendon from the inferior joint line, raising tibiofemoral joint line in opening wedge osteotomies, retropatellar scarring and tendon contracture, can cause bony impingement of patella on tibia, more common in lateral opening wedge osteotomy and lateral closing wedge osteotomy, minimal risk in medial opening wedge osteotomy, - TKA Postoperative Rehabilitation & Outpatient Management. His range of motion is limited from 10-85 degrees with pain over the medial epicondyle of the knee. 11/6/2019. outlay style) replaces entire anterior trochlear surface and minimizes risk of patellar instability, Long term mode of failure remains progression of tibiofemoral arthritis, progress of osteoarthritis (idiopathic, over-correction, more common with mobile-bearing), component failure (overload due to under-correction), component loosening (common in fixed-bearing), patella impingement on femoral component (patella pain), Arthroplasty Preoperative Medical Optimization, Idiopathic Transient Osteoporosis of the Hip (ITOH), THA Pseudotumor (Metal on Metal Reactions), TKA Postoperative Rehabilitation & Outpatient Management. Diagnosis is made clinically with tenderness over the inferior pole of the patella and radiographs of the knee may show a spur at the inferior pole of the patella. They are cause by either a direct blow (more severe tear) or a non-contact injury (less severe). can heal via fibrocartilage scar formation. The surgeon has all the trial components in place and recognizes that the soft tissues are balanced in the coronal plane, but the knee is 10 degrees from reaching full extension. WebTKA Vascular Injury and Bleeding pcl) balanced ligaments (correct flexion and extension gaps) maintain normal Q angle (ensures proper patellar femoral tacking) Mechanical axis of Limb. Treatment is usually bracing unless there is gross varus instability in which case repair or reconstruction is WebAfter discussion of the surgical options, she undergoes the procedure shown in Figure A. A 10-year-old boy has atraumatic, progressive right knee pain for 2 months. Radiographs are shown in Figures 22a and 22b. Web(OBQ18.171) A 17-year-old girl sustained a twisting injury to her knee during a basketball tournament 2 weeks ago. Upon evaluation, he has difficulty bearing weight due to left hip pain and has tenderness to (SBQ04SM.67) can heal via fibrocartilage scar formation. Figures A-C are the arthroscopic, radiographic and MRI images of a 34-year-old male who has had knee pain for the past 11 months. 1% (51/6400) 3. Flashcards (35) 84% (5388/6400) 4. Regarding his prosthesis, which of the following statements is most accurate? approximate tendon at site of rupture. Arthroscopic plica excision is indicated in refractory cases that fail nonoperative treatment. Radiographs and representative CT scan images are shown in Figures A-D. What is the most appropriate treatment method for this patient's injury? Ultrasound. Web(OBQ05.223) A 62-year-old woman is undergoing a revision total knee arthroplasty for aseptic component loosening. He does report that he had been exercising more over the past few months in an attempt to lose weight. He is able to walk but is now experiencing severe knee pain and limited flexion. She does not recall any traumatic injury to the knee. WebSinding-Larson-Johansson (SLJ) syndrome is an overuse injury seen in adolescents leading to anterior knee pain at the inferior pole of patella at the proximal patella tendon attachment. Injury & Healing potential. What type of tissue is formed by the activation of marrow mesenchymal cells following subchondral drilling of an 8x7 mm osteochondral defect? WebPosterolateral Corner Injury Posteromedial Corner Injury Proximal Tib-Fib Dislocation They are cause by either a direct blow (more severe tear) or a non-contact injury (less severe). axis from center of femoral head to center of ankle. Arthroplasty Preoperative Medical Optimization, Idiopathic Transient Osteoporosis of the Hip (ITOH), THA Pseudotumor (Metal on Metal Reactions), TKA Postoperative Rehabilitation & Outpatient Management. Copyright 2022 Lineage Medical, Inc. All rights reserved. Tables and outline converted. 6/4/2020. Consider PCL Release/Substitution If Imbalance Persists At This Point (If Substitution Not Initially Chosen) Step 6. High tibial osteotomy. Examination shows reproduction of pain with internal rotation of the tibia during extension of the knee, and relief of pain with tibial external rotation. They are cause by either a direct blow (more severe tear) or a non-contact injury (less severe). WebPatellar instability is a condition characterized by patellar subluxation or dislocation episodes as a result of injury, ligamentous laxity or increased Q angle of the knee. WebA quadriceps tendon rupture is a traumatic injury of the quadriceps insertion on the patella leading to a disruption in the knee extensor mechanism. WebPCL Injury MCL Knee Injuries LCL Injury of the Knee Posterolateral Corner Injury Posteromedial Corner Injury Orthobullets Team Knee & Sports - Idiopathic Chondromalacia Patellae; Listen Now 11:59 min. 686 plays. The most common reasons for conversion to a total knee arthroplasty are the progression of osteoarthritis and aseptic loosening. WebNotes migrated, complexity/importance set. WebPCL Injury MCL Knee Injuries LCL Injury of the Knee Posterolateral Corner Injury Posteromedial Corner Injury Orthobullets Team Knee & Sports - Idiopathic Chondromalacia Patellae; Listen Now 11:59 min. She initially does well but returns to clinic 3 months post-operatively with significantly increased medial-sided knee pain and the injury shown in Figure B. Figures 1 and 2 are representative MRI slices of his right knee. the option to convert to a total knee arthroplasty if needed, more anatomic positioning of the components. He has a grade 1A Lachman test and pain with valgus stress testing. She initially does well but returns to clinic 3 months post-operatively with significantly increased medial-sided knee pain and the injury shown in Figure B. WebPCL Injury MCL Knee Injuries LCL Injury of the Knee (> 2 weeks out from injury) quadplasty or scar tissue release to facilitate tendon approximation. evaluate menisci, cruciates, cartilage, extensor mechanism edema posterior to popliteus tendon can indicate an injury to the underlying structures of the PLC. It is critical to avoid techniques that lead to an, internal rotation of the femoral prosthesis, internal rotation of the tibial prosthesis, placing the patellar prosthesis lateral on the patella, Goal is to restore the joint line by inserting a prosthesis that is the same thickness as the bone and cartilage that was removed, this preserves appropriate ligament tension, if there are bone defects they must be addressed so the joint line is not jeopardized, never elevate joint line in a valgus knee until after balancing to obtain full extension, Arthroplasty Preoperative Medical Optimization, Idiopathic Transient Osteoporosis of the Hip (ITOH), THA Pseudotumor (Metal on Metal Reactions), TKA Postoperative Rehabilitation & Outpatient Management. Web(SBQ17SE.78) A 27-year-old competitive skier fell one week ago onto his right hand. She initially does well but returns to clinic 3 months post-operatively with significantly increased medial-sided knee pain and the injury shown in Figure B. TKA - Parapatellar Approach PCL reconstruction using tibial inlay technique. Web(OBQ18.171) A 17-year-old girl sustained a twisting injury to her knee during a basketball tournament 2 weeks ago. Posterior drawer (at 90 flexion) Treatment should consist of? His surgeon considers treatment with Technique B and Technique C, which are shown in Figures B and C, respectively. What is the best course of action? Diagnosis can often be made on radiographs alone but MRI studies should be obtained in patients with normal radiographs with a high degree of suspicion for stress fracture. All of the following technical errors likely contributed to this complication EXCEPT? He is evaluated in your orthopedic hand clinic and found to have disrupted a ligament in his thumb with the decision for operative intervention. If a patient benefits from the brace, they are likely to benefit from surgery. Graft fixation strength increases linearly with time until subchondral union at 3 months, Graft fixation strength initially decreases during the early healing phase, and then increases with subchondral bone healing, Graft fixation strength does not change during the first 3 months following surgery, Graft fixation strength is enhanced by early weight bearing, Graft fixation strength initially increases over the first 6 weeks, then recedes with bony remodeling. The decision is made to proceed with osteochondral allograft transplantation to the medial femoral condyle. Incidence. Orthobullets Team Trauma - Knee Dislocation; Listen The reparative tissue would best be described as which of the following? The transplanted chondrocytes are nonviable and cartilage is used as a scaffold for growth of new articular cartilage. Posterior sag sign. He has symmetric rotation with his knee flexed at 90 degrees, but 20 degrees of increased external rotation with his knee flexed to 30 degrees. isolated PCL injury (10-12 mm posterior displacement) PCL and PLC injury (>12 mm posterior displacement) MRI. Web(OBQ10.139) A 37-year-old male presents with continued knee pain and instability 6 months status-post combined ACL and PCL reconstruction after a traumatic knee injury. Made Live as 2.0. ACL reconstruction with bone-tendon-bone autograft, Combined ACL and posterolateral corner reconstruction, Combined PCL and posterolateral corner reconstuction, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2021, Return To Play After Nonoperative & Operative Treatment - Michael L. Voight, DHSc, PT, A NFL Arbitraitor: Yes I Am a Total Joint Surgeon: My Experience - Alfred J. Tria, JR, Orthopaedic Summit Evolving Techniques 2020, Pro: Patient Selection Is Not The Answer, You Need To Figure Out How Everyone Can Have It Safely: Here Are My Protocols, Here Are My Secrets - Craig McAllister, MD, Knee & Sports | History and Physical Exam of the Knee. (OBQ05.26) Web(SBQ16SM.17) A 13-year-old boy falls from a trampoline and feels immediate left knee pain. Surgical treatment may be indicated in older patients (closed physis), lesions that are unstable and patients who have failed conservative management. approximate tendon at site of rupture. He is able to walk but is now experiencing severe knee pain and limited flexion. fluid collections. (OBQ13.203) technique. He has a correctable 5 degree valgus knee deformity compared to his other limb. A 65-year-old female presents to the clinic with isolated medial-sided left knee pain. His exam is completely normal and symmetric to his left knee. Technique B is a single-stage procedure. (OBQ10.257) severely retracted tears . He is evaluated in your orthopedic hand clinic and found to have disrupted a ligament in his thumb with the decision for operative intervention. Which of the following choices is the appropriate surgical treatment? Greater survivorship rate at 10 year follow-up, Reduced risk of secondary surgery within the first year. She undergoes immediate four compartment leg fasciotomy and placement of a spanning external fixator. Radiographs of the right knee demonstrate open growth plates and a well circumscribed 1x1cm area of sclerotic subchondral bone with a radiolucent halo separating this area from his femoral epiphysis. fluid collections. Osteochondritis Dissecans is a pathologic lesion affecting articular cartilage and subchondral bone with variable clinical patterns. Web(SBQ07SM.42) A 14-year-old male sprinter felt a pop and began to experience immediate left hip pain while participating in the 400-meter dash. WebPCL Injury. Overall 84% of patients recover pre-injury strength and 89% recover pre-injury endurance. end-to-end technique. His knee has full range of motion and is stable on exam. end-to-end technique. Physical examination reveals mild effusion, lateral sided tenderness, and range of motion from 10-85 degrees without any signs of instability. He has had persistent thumb pain with gripping since the fall. Treatment may be nonoperative with restricted weight bearing in children with open physis. Arthroscopic debridement and chondroplasty, Tibial tubercle osteotomy with anteromedialization. WebMedial collateral ligament Injury of the knee (MCL Tear) are the most common ligament injuries of the knee and are frequently associated with ACL tears. With regard to a mobile-bearing unicompartmental knee arthroplasty (UKA), which of the following is the most common cause of late (>10 years) failure? Tears in peripheral 25% red zone. WebInjury to ACL, PCL, PMC, and PLC (4 ligaments) Has the highest rate of vascular injury (5-15%%) KD V. Multiligamentous injury with periarticular fracture. WebA tibial shaft stress fracture is an overuse injury where normal or abnormal bone is subjected to repetitive stress, resulting in microfractures. nonabsorbable sutures are Figures 1 and 2 are representative MRI slices of his right knee. See topic Meniscal Pathology. Surgical treatment may be indicated in older patients (closed physis), lesions that are unstable and patients who have failed conservative management. All of the following are contraindications for this surgery except: (OBQ13.99) She has noted progressive leg deformity and episodes of giving way, and now has pain preventing activity. Tables and outline converted. WebA quadriceps tendon rupture is a traumatic injury of the quadriceps insertion on the patella leading to a disruption in the knee extensor mechanism. His medical history is significant only for osteoporosis. Web(OBQ11.44) A 68-year-old healthy active male presents after falling and sustaining an injury to his right knee. Tears in peripheral 25% red zone. What is the most important determinant of a successful outcome with nonoperative treatment? A 32-year-old female is referred to you for definitive treatment of a symptomatic focal chondral defect on her medial femoral condyle. This is an AAOS Self Assessment Exam (SAE) question. The transplanted chondrocytes are viable and articular cartilage heals. Biopsy shows type I collagen. Orthobullets Team Recon - TKA Coronal Plane Balancing; Listen Now 22:8 min. Any increase in the Q angle will lead to increased lateral subluxation forces on the patella relative to the trochlear groove, which can lead to pain and mechanical symptoms, accelerated wear, and even dislocation. Which of the following is the most appropriate initial treatment? Summary written. nonabsorbable sutures are An arthroscopic picture taken during diagnostic arthroscopy is shown in Figure A. His medical history is significant only for osteoporosis. All of the following technical errors likely contributed to this complication EXCEPT? Overall 84% of patients recover pre-injury strength and 89% recover pre-injury endurance. 11/18/2019. Epidemiology. Which area of the knee is most likely to be affected by a juvenile osteochondritis dissecans (JOCD) lesion? Treatment is usually bracing unless there is gross varus instability in which case repair or reconstruction is Figures 1 and 2 are representative MRI slices of his right knee. She undergoes immediate four compartment leg fasciotomy and placement of a spanning external fixator. Copyright 2022 Lineage Medical, Inc. All rights reserved. inserts on posterior tibial sulcus below articular surface. chondrocytes remain viable, bone graft is incorporated into subchondral bone and overlying cartilage layer heals. Epidemiology. WebPCL Injury MCL Knee Injuries LCL Injury of the Knee Posterolateral Corner Injury Posteromedial Corner Injury Orthobullets Team Knee & Sports - Articular Cartilage Defects of Knee; Listen Now 37:19 min. A 25-year-old patient undergoes the procedure seen in Figure A. WebPCL Injury MCL Knee Injuries LCL Injury of the Knee (> 2 weeks out from injury) quadplasty or scar tissue release to facilitate tendon approximation. Excellent for. He is evaluated in your orthopedic hand clinic and found to have disrupted a ligament in his thumb with the decision for operative intervention. originate from the posterior horn of the lateral meniscus and has two components. WebTreatment is mainly nonoperative with NSAIDs and physical therapy to focus on hamstring strengthening. Treatment is usually bracing unless there is gross varus instability in which case repair or reconstruction is 288 plays. Presentation. patient lies supine with hips and knees flexed to 90, examiner supports ankles and observes for a posterior shift of the tibia as compared to the uninvolved knee. What is the most likely cause of his symptoms? A 20-year-old college running back sustains a knee injury after being tackled from the medial aspect of his right knee. Views. inserts on posterior tibial sulcus below articular surface. She has since exhausted conservative management but remains persistently symptomatic. WebTreatment can be nonoperative or operative depending on the severity of injury to the PCL, as well concomitant injuries to surrounding structures and ligaments in the knee. WebFemoroacetabular impingement (FAI) is the abnormal contact between the femur and acetabulum which may lead to labral damage, various degrees of chondral injury and progressive hip pain. Web(SBQ16HK.6) Figure A is the radiograph of an otherwise healthy 33-year-old female soccer player with a history of hip dysplasia. Patellofemoral arthroplasty has superior functional outcomes when compared to either medial or lateral unicompartmental arthroplasty, If disease progression to the medial compartment occurs, the addition of a medial UKA offers more predictable clinical outcomes than conversion to a total knee arthroplasty (TKA), The most common long-term mode of failure is progression of osteoarthritis to involve the other compartments, Patellar instability is the most common reason for long-term revision to TKA, Aseptic loosening is the most common short-term complication necessitating revision to TKA. inlay style) exhibited high rates of patellar instability, Newer generation designs (i.e. Radiographs and representative CT scan images are shown in Figures A-D. What is the most appropriate treatment method for this patient's injury? Web(OBQ18.171) A 17-year-old girl sustained a twisting injury to her knee during a basketball tournament 2 weeks ago. Treatment may be nonoperative with restricted weight bearing in children with open physis. The transplanted chondrocytes are nonviable and articular cartilage is gradually replaced by fibrocartilage. On physical exam his ACL and PCL are intact, however he is noted clinically to have Grade 3 posterolateral corner laxity and varus malalignment of his knee. (SAE07HK.37) Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. WebPCL Injury MCL Knee Injuries Orthobullets Team (SBQ16SM.92) A 13-year-old girl presents with lateral knee pain after a twisting injury during basketball. WebFemoroacetabular impingement (FAI) is the abnormal contact between the femur and acetabulum which may lead to labral damage, various degrees of chondral injury and progressive hip pain. Unicompartmental Knee Arthroplasty is a surgical option for knee arthritis when only one compartment of the knee is involved. Your diagnostic imaging workup with pertinent findings is represented in Figures A through E. You perform a diagnostic arthroscopy to confirm that the pathology is isolated to the medial compartment and you note that there is not any evidence of ligamentous or meniscal pathology. WebTHA Vascular Injury & Bleeding Orthobullets Team Recon - TKA Postoperative Rehabilitation & Outpatient Management Technique Guide. A 67 year-old woman sustained an ACL tear while playing basketball when she was 35 years-old. Diagnosis can often be made on radiographs alone but MRI studies should be obtained in patients with normal radiographs with a high degree of suspicion for stress fracture. 11/18/2019. WebPatellar instability is a condition characterized by patellar subluxation or dislocation episodes as a result of injury, ligamentous laxity or increased Q angle of the knee. His patellofemoral and medial compartments do not show any radiographic signs of degenerative changes. 11/6/2019. 1% (51/6400) 3. A 40-year-old man has moderate lateral compartment arthritis several years after undergoing a partial lateral meniscectomy. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. He has a grade 1A Lachman test and pain with valgus stress testing. Made Live as 2.0. She reports 6 weeks of left groin pain that has not improved with physical therapy. High tibial osteotomy. Treatment may be nonoperative with restricted weight bearing in children with open physis. Web(SBQ16SM.17) A 13-year-old boy falls from a trampoline and feels immediate left knee pain. See topic Meniscal Pathology. 93 plays. isolated PCL injury (10-12 mm posterior displacement) PCL and PLC injury (>12 mm posterior displacement) MRI. technique. Flashcards (35) Diagnosis is made clinically with a palpable defect 2 cm proximal to the superior pole of the patella with inability to perform a straight leg raise and presence of patella baja on knee radiographs. Diagnosis is made clinically with tenderness over the inferior pole of the patella and radiographs of the knee may show a spur at the inferior pole of the patella. (OBQ11.1) Articular cartilage defects of the knee comprise of a spectrum of disease entities from single, focal defects to advanced degenerative disease of articular (hyaline) cartilage. 2/24/2020. WebPosterolateral Corner Injury Posteromedial Corner Injury Proximal Tib-Fib Dislocation sagittal. Web(SBQ07SM.42) A 14-year-old male sprinter felt a pop and began to experience immediate left hip pain while participating in the 400-meter dash. WebPCL Injury MCL Knee Injuries Orthobullets Team (SBQ16SM.92) A 13-year-old girl presents with lateral knee pain after a twisting injury during basketball. Lateral aspect of the medial femoral condyle, Lateral aspect of the lateral femoral condyle, Medial aspect of the lateral femoral condyle. His range of motion is limited from 10-85 degrees with pain over the medial epicondyle of the knee. Following a medial femoral condyle osteochondral autograft mosaicplasty, which of the following statements best describes the fixation of the graft? distal femur is ~9 degrees of valgus (anatomic axis compared to joint line), 5-7 deg valgus of femur refers to difference of anatomic axis to mechanical axis, proximal tibia is 2-3 degrees of varus (anatomic axis to joint line), axis from center of femoral head to center of ankle, lateral gapping in varus & medial gapping in valgus deformities, are indicated to determine an accurate valgus cut angle when the patient has, a line that bisects the medullary canal of the femur, determines entry point of femoral medullary guide rod, intramedullary femoral guide goes down anatomic axis of the femur, defined by line connecting center of femoral head to point where anatomic axis meets intercondylar notch, obtaining a neutral mechanical axis allows even load sharing between the medial and lateral condyles of a knee prosthesis, jig measures 6 degrees from femoral guide (anatomic axis), will vary if people are very tall (VCA < 5) or very short (VCA > 7), can measure on a standing full length AP x-ray, tibia medullary guide (internal or external) runs parallel to it, determines entry point for tibial medullary guide rod, proximal tibia is cut perpendicular to mechanical axis of tibia, usually mechanical axis and anatomic axis of tibia are coincident and therefore you can usually can cut the proximal tibia perpendicular to anatomic axis (an axis determined by an, if there is a tibia deformity and the mechanical and anatomic axis are not the same, then the proximal tibia must be cut perpendicular to the mechanical axis (therefore an, Abnormal patellar tracking, although not the most serious, is the most common complication, The most important variable in proper patellar tracking is preservation of a normal Q angle (11 +/- 7), the Q angle is defined as angle between axis of. Copyright 2022 Lineage Medical, Inc. All rights reserved. (SBQ16HK.12) Web(SBQ17SE.78) A 27-year-old competitive skier fell one week ago onto his right hand. (OBQ07.209) WebNotes migrated, complexity/importance set. Patella baja is most likely to occur after which of the following procedures? She endorses snapping and clicking in the left hip with certain movements. 288 plays. He denies any fevers or recent trauma. 2/24/2020. Surgical treatment may be indicated in older patients (closed physis), lesions that are unstable and patients who have failed conservative management. approximate tendon at site of rupture. 2/24/2020. WebPCL Injury MCL Knee Injuries LCL Injury of the Knee LCL Injury of the Knee Orthobullets Team Knee & Sports - Snapping Hip (Coxa Saltans) Listen Now 14:22 min. He notes that the pain occurs on a daily basis with any significant activity. Biopsy shows type I collagen. 84% (5388/6400) 4. Web(OBQ05.223) A 62-year-old woman is undergoing a revision total knee arthroplasty for aseptic component loosening. A history of trauma to the affected joint, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, 2019 FORE/AANA World Series of Live Surgery (Prev. WebPCL Injury MCL Knee Injuries LCL Injury of the Knee Orthobullets Team Knee & Sports - Anterior Inferior Iliac Spine Avulsion (AIIS) Listen Now 5:22 min. She initially does well but returns to clinic 3 months post-operatively with significantly increased medial-sided knee pain and the injury shown in Figure B. The surgeon has all the trial components in place and recognizes that the soft tissues are balanced in the coronal plane, but the knee is 10 degrees from reaching full extension. She reports 6 weeks of left groin pain that has not improved with physical therapy. A vertical line drawn from the femoral head through the center of the knee down to the center of the ankle, A valgus angle of 5-7 degrees created by two lines drawn down the shaft of the femur and tibia, A varus angle of 3 degrees created by two lines drawn down the shaft of the femur and tibia, A vertical line drawn from the femoral head passing 1.5 centimeters lateral to the center of the knee down to the center of the ankle, A vertical line drawn from the femoral head passing 1.5 centimeters medial to the center of the knee down to the center of the ankle. WebPCL Injury MCL Knee Injuries Orthobullets Team (SBQ16SM.92) A 13-year-old girl presents with lateral knee pain after a twisting injury during basketball. WebSinding-Larson-Johansson (SLJ) syndrome is an overuse injury seen in adolescents leading to anterior knee pain at the inferior pole of patella at the proximal patella tendon attachment. 1% (51/6400) 3. originate from the posterior horn of the lateral meniscus and has two components. (SBQ07SM.32) All of the following technical errors likely contributed to this complication EXCEPT? She is an avid runner and is part of the Army 10-miler team. Orthobullets Team Recon - TKA Coronal Plane Balancing; Listen Now 22:8 min. fluid collections. He has a 1A Lachman and a normal posterior drawer test. 5-20% of all knee ligamentous injuries. WebA tibial shaft stress fracture is an overuse injury where normal or abnormal bone is subjected to repetitive stress, resulting in microfractures. (OBQ04.259) He has had persistent thumb pain with gripping since the fall. Excellent for. Diagnosis is made clinically with tenderness over the inferior pole of the patella and radiographs of the knee may show a spur at the inferior pole of the patella. Web(SBQ16HK.6) Figure A is the radiograph of an otherwise healthy 33-year-old female soccer player with a history of hip dysplasia. A 61-year-old male had a minimally-invasive unicompartmental knee replacement 8 months ago. WebPCL Injury MCL Knee Injuries LCL Injury of the Knee and to document the degree of cartilage injury. Nonsteroidal anti-inflammatory drugs have failed to provide relief. 93 plays. He has had persistent thumb pain with gripping since the fall. A 30-year-old active-duty woman presents to your clinic with right knee pain and without any history of trauma. 93 plays. Tears in peripheral 25% red zone. 0.0 (0) See More See Less. Her clinical mechanical alignment, patellar tracking, meniscal examination, and ligamentous examination are all equivocal on physical examination. On examination, her knee range of motion (ROM) is limited to 10-75. (OBQ08.137) Consider PCL Release/Substitution If Imbalance Persists At This Point (If Substitution Not Initially Chosen) Step 6. Posterior sag sign. A photograph from a recent diagnostic arthroscopy shows the defect (Figure A), which measured 25 x 25mm after debridement. Treatment can be nonoperative or operative depending on patient age, degree of symptoms and the size of the lesion. Orthobullets Team Trauma (OBQ13.156) A 44-year-old female sustains the injury shown in Figures A and B as the result of a motor vehicle collision. severely retracted tears . Web(OBQ11.44) A 68-year-old healthy active male presents after falling and sustaining an injury to his right knee. The surgeon has all the trial components in place and recognizes that the soft tissues are balanced in the coronal plane, but the knee is 10 degrees from reaching full extension. originate from the posterior horn of the lateral meniscus and has two components. Thank you. WebPCL Injury MCL Knee Injuries LCL Injury of the Knee (> 2 weeks out from injury) quadplasty or scar tissue release to facilitate tendon approximation. WebSinding-Larson-Johansson (SLJ) syndrome is an overuse injury seen in adolescents leading to anterior knee pain at the inferior pole of patella at the proximal patella tendon attachment. Arthroscopic plica excision is indicated in refractory cases that fail nonoperative treatment. Treatment may be nonoperative with restricted weight bearing in children with open physis. Physical exam is noteable for tenderness isolated to the medial joint line. can heal via fibrocartilage scar formation. TKA - Parapatellar Approach PCL reconstruction using tibial inlay technique. A radiograph of the knee is shown in Figure A. - Stephen M. Howell, MD, Osteoarthritis knees with distal femoral deformity. Posterior drawer (at 90 flexion) After discussion of the surgical options, she undergoes the procedure shown in Figure A. evaluate menisci, cruciates, cartilage, extensor mechanism edema posterior to popliteus tendon can indicate an injury to the underlying structures of the PLC. Thank you. Biopsy shows mixture of type I and II collagen. 11/6/2019. WebInjury to ACL, PCL, PMC, and PLC (4 ligaments) Has the highest rate of vascular injury (5-15%%) KD V. Multiligamentous injury with periarticular fracture. (OBQ09.60) Opening wedge high tibial osteotomy with autograft, Medial unicompartmental knee arthroplasty, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, TKA - Varus Knee with Anterior Referencing and Gap Balancing Technique, TKA with Computer Navigation & Sensor-Guided Assessment for Soft Tissue Balancing - Dr. William Gall, Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2021, Pro: Precision Alignment Technology: Forget The Robot - Handheld Smart Devices Win The Day - Michael P. Ast, MD, ISTA: New Early-Career Webinar Series 2020, How Robotics Foster (R)Evolution of Alignment in Total Knee Arthroplasty Inverse Kinematic Alignment - Philip Winnock De Grave, 2017 Orthopaedic Summit Evolving Techniques, Pro: Kinematic Alignment Is All That Matters! Web(OBQ08.99) A 59-year-old female librarian complains of progressively worsening left knee pain over the last 4 months. Web(OBQ17.23) A 35-year-old male presents to your clinic with right knee pain after sustaining a twisting injury while playing basketball 3 weeks ago. Webconnects the meniscus into the substance of the PCL. Consider PCL Release/Substitution If Imbalance Persists At This Point (If Substitution Not Initially Chosen) Step 6. Webconnects the meniscus into the substance of the PCL. (OBQ09.18) patient lies supine with hips and knees flexed to 90, examiner supports ankles and observes for a posterior shift of the tibia as compared to the uninvolved knee. Web(OBQ08.99) A 59-year-old female librarian complains of progressively worsening left knee pain over the last 4 months. occurs at age 10-15 while the physis is still open, cause of adult form is thought to be vascular, softening of the overlying articular cartilage with intact articular surface, osteochondral separation with loose bodies, Clanton Classification of Osteochondritis (Clanton and DeLee), activity related pain that is vague and poorly localized, pain with internally rotating the tibia during extension of the knee between 90 and 30, then relieving the pain with tibial external rotation, weight-bearing anteroposterior, lateral radiographs, stable lesions in children with open physes, subchondral drilling with K-wire or drill, performed either transchondral or retrograde, leads to formation of fibrocartilagenous tissue, improved outcomes in skeletally immature patients, unstable lesion seen on arthroscopy or MRI >2cm in size, tap awl to a depth of 1-1.5cm below articular surface, arthrotomy (vs. arthroscopy) indicated in lesions > 3cm, arthroscopy generally used for lesions <3cm, younger age correlates with better prognosis, sclerosis on xrays correlates with poor prognosis, synovial fluid behind the lesion on MRI correlates with a worse prognosis, usually symptomatic and leads to DJD if untreated, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Concussions (Mild Traumatic Brain Injury). Contraindications include inflammatory arthritis, flexion contracture > 15 degrees, bicompartmental osteoarthritis, and ligamentous instability. technique. An 11-year-old boy presents with recurrent knee effusions and discomfort with athletic activity. She does not recall any traumatic injury to the knee. Which of the following statement is true with respect to Technique B and C? WebTreatment is mainly nonoperative with NSAIDs and physical therapy to focus on hamstring strengthening. Tables and outline converted. On examination, he has a knee effusion and tenderness laterally. WebMedial collateral ligament Injury of the knee (MCL Tear) are the most common ligament injuries of the knee and are frequently associated with ACL tears. The transplanted chondrocytes are viable and articular cartilage heals. After failing nonoperative treatments, which surgical option is most likely to give him the best outcome? (OBQ08.255) WebTreatment is mainly nonoperative with NSAIDs and physical therapy to focus on hamstring strengthening. CHI Sports), Orthopaedic Summit Evolving Techniques 2020, Evaluation & Treatment Of The Symptomatic OCD: My Decision-Making - Andreas Gomoll, MD, 2018 Chicago Sports Medicine Symposium: World Series of Surgery, OCD Lesion: Diagnosis, Evaluation and Management - Geoffrey Van Thiel, MD (CSMS #45, 2018), Knee & Sports | Osteochondritis Dissecans. You can rate this topic again in 12 months. Orthobullets Team Trauma (OBQ13.156) A 44-year-old female sustains the injury shown in Figures A and B as the result of a motor vehicle collision. Which of the following procedures is contraindicated? WebInjury to ACL, PCL, PMC, and PLC (4 ligaments) Has the highest rate of vascular injury (5-15%%) KD V. Multiligamentous injury with periarticular fracture. (OBQ13.152) His range of motion is limited from 10-85 degrees with pain over the medial epicondyle of the knee. Poor prognostic variables . severely retracted tears . WebPCL. You can rate this topic again in 12 months. Web(OBQ17.23) A 35-year-old male presents to your clinic with right knee pain after sustaining a twisting injury while playing basketball 3 weeks ago. Ultrasound. (OBQ06.186) A 24-year-old female has moderate arthrosis of the medial facet of the patella and the medial femoral condyle. Biopsy shows type II collagen. 686 plays. Injury & Healing potential. Physical exam is noteable for tenderness isolated to the medial joint line. Orthobullets Team Recon - TKA Coronal Plane Balancing; Listen Now 22:8 min. Excellent for. patient lies supine with hips and knees flexed to 90, examiner supports ankles and observes for a posterior shift of the tibia as compared to the uninvolved knee. Excessive force impacting the tibial component, Penetration of the posterior tibial cortex with proximal guide pin, Placement of a peripheral medial cortical guide pin, Tibial resection guide replacement with re-drilling of the two proximal guide holes. Which of the following factors is the best predictor of successful non-operative management of an osteochondritis dissecans lesion in the knee? Diagnosis may be made radiographically (notch view) but MRI usually required to determine size and stability of lesion, and to document the degree of cartilage injury. Based on your findings which definitive surgical options would you recommend to the patient? High tibial osteotomy. WebTreatment can be nonoperative or operative depending on the severity of injury to the PCL, as well concomitant injuries to surrounding structures and ligaments in the knee. 84% (5388/6400) 4. Incidence. When performing a unicondylar knee replacement, a smaller incision without dislocation of the patella offers what advantage over a standard, patella-everting approach? evaluate menisci, cruciates, cartilage, extensor mechanism edema posterior to popliteus tendon can indicate an injury to the underlying structures of the PLC. Arthroscopic ACL reconstruction with cadaver allograft, PCL reconstruction using tibial inlay technique, MPFL reconstruction with semitendinosus autograft. WebPCL Injury MCL Knee Injuries LCL Injury of the Knee LCL Injury of the Knee Orthobullets Team Knee & Sports - Snapping Hip (Coxa Saltans) Listen Now 14:22 min. Usually combined with other ligament injuries, 10 extension (recurvatum) to 130 flexion, in full extension, there is minimal rotation, at 30 flexion, a few degrees of passive motion possible, Quadriceps avoidance gait (does not actively extend knee), extension to flexion: reduces at 20-30 of flexion, patient must be completely relaxed (easier to elicit under anesthesia), measured with knee in slight flexion and 10-30 externally rotation, patient lies supine with hips and knees flexed to 90, examiner supports ankles and observes for a posterior shift of the tibia as compared to the uninvolved knee, with the knee at 90 of flexion, a posteriorly directed force is applied to the proximal tibia and posterior tibial translation is quantified, the medial tibial plateau of a normal knee at rest is ~1 cm anterior to the medial femoral condyle, most accurate maneuver for diagnosing PCL injury, attempt to extend a knee flexed at 90 to elicit quadriceps contraction, positive if anterior reduction of the tibia occurs relative to the femur, 0 and 30 - combined MCL and ACL and/or PCL, Anterior Drawer with tibia in external rotation, grade III MCL tears often associated with ACL and posteriomedial corner tears, postive test will indicate associated ligamentous injury, 0 and 30 - combined LCL and ACL and/or PCL, Varus opening and increased external tibial rotatory instability at 30 - combined LCL and posterolateral corner, varus laxity at 0 indicates both LCL & cruciate (ACL or PCL) injury, performed with the hip flexed 45, knee flexed 80, and foot ER 15, a combined posterior drawer and ER force is applied to the knee to assess for an increase in posterolateral translation (lateral tibia externally rotates relative to lateral femoral condyle), with the knee positioned at 90, ER and valgus forces are applied to tibia, as the knee is extended, the tibia reduces with a palpable clunk, tibia reduces from a posterior subluxed position at ~20 of flexion to a reduced position in full extension (reduction force from IT band transitioning from a flexor to an extensor of the knee), positive when the leg falls into ER and recurvatum when the lower extremity is suspended by the toes in a supine patient, injury present with altered sensation to foot dorsum and weak ankle dorsiflexion, flex the knee and place a hand on medial side of knee, externally rotate the leg and bring the knee into extension, a palpable pop or click is a positive test and can correlate with a medial meniscus tear, absence of swelling supports ligamentous laxity and habitual dislocation mechanism, measured in quadrants of translation (midline of patella is considered "0") and should be compared to contralateral side, normal motion is <2 quadrants of patellar translation, lateral translation of medial border of patella to lateral edge of trochlear groove is considered "2" quadrants and is an abnormal amount of translation, excessive lateral translation in extension which "pops" into groove as the patella engages the trochlea early in flexion, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Concussions (Mild Traumatic Brain Injury). WBC, ESR and C-reactive protein levels are normal. Diagnosis can often be made on radiographs alone but MRI studies should be obtained in patients with normal radiographs with a high degree of suspicion for stress fracture. She presents to clinic with significant knee pain and swelling. WebPCL. Grafts in Technique C are transferred to an antibiotic solution to kill microorganisms and stored at 4C until use. Proximal tibia valgus osteotomy, microfracture to the MFC, and removal of loose osteochondral bodies, Distal femur varus osteotomy and autologous chondrocyte implantation to the MFC, Osteochondral autograft transplantation to the MFC, Removal of loose osteochondral bodies and osteochondral allograft transplantation to the MFC, Patellofemoral realignment osteotomy, removal of loose osteochondral bodies, and autologous chondrocyte implantation to the MFC. A 56-year-old man presents with chronic anterior knee pain and the radiographs shown in Figure A. Orthobullets Team Trauma - Knee Dislocation; Listen Surgical treatment may be indicated in older patients (closed physis), lesions that are unstable and patients who have failed conservative management. Web(OBQ10.139) A 37-year-old male presents with continued knee pain and instability 6 months status-post combined ACL and PCL reconstruction after a traumatic knee injury. (OBQ08.94) Injury & Healing potential. A medial unloader brace can be used for therapeutic and diagnostic purposes. She reports 6 weeks of left groin pain that has not improved with physical therapy. Poor prognostic variables . Ultrasound. WebTHA Vascular Injury & Bleeding Orthobullets Team Recon - TKA Postoperative Rehabilitation & Outpatient Management Technique Guide. She endorses snapping and clicking in the left hip with certain movements. 5-20% of all knee ligamentous injuries. WebPCL Injury MCL Knee Injuries LCL Injury of the Knee Orthobullets Team Knee & Sports - Anterior Inferior Iliac Spine Avulsion (AIIS) Listen Now 5:22 min. An AP radiograph and bone scan are shown in Figure A and B. All of the following are contraindications to medial unicondylar knee arthroplasty EXCEPT: Flexion contracture greater than 10 degrees, Varus deformity greater than 10 degrees not correctable with stress testing, Osteonecrosis of the medial femoral condyle. (SBQ16SM.18) On physical exam his ACL and PCL are intact, however he is noted clinically to have Grade 3 posterolateral corner laxity and varus malalignment of his knee. The transplanted chondrocytes are nonviable and articular cartilage is gradually replaced by fibrocartilage. Arthroscopic open reduction and internal fixation, Full weight bearing with avoidance of athletic acticity. Incidence. (OBQ05.136) See topic Meniscal Pathology. WebPCL. 288 plays. chronic tears with scarring to sciatic nerve. Which of the following describes the mechanical axis of a normally aligned limb? nonabsorbable sutures are Copyright 2022 Lineage Medical, Inc. All rights reserved. WebNotes migrated, complexity/importance set. Arthroscopic plica excision is indicated in refractory cases that fail nonoperative treatment. (OBQ11.274) A 35-year-old man presents with mechanical knee pain after a fall. Her pain is located directly over her medial femoral condyle (MFC). end-to-end technique. TKA - Parapatellar Approach PCL reconstruction using tibial inlay technique. Upon evaluation, he has difficulty bearing weight due to left hip pain and has tenderness to A radiograph and MRI is shown in Figures A and B. Orthobullets Team Trauma - Knee Dislocation; Listen 0.0 (0) See More See Less. (OBQ11.105) Physical examination reveals mild effusion, lateral sided tenderness, and range of motion from 10-85 degrees without any signs of instability. She undergoes immediate four compartment leg fasciotomy and placement of a spanning external fixator. He denies fevers or mechanical knee symptoms. She presents to clinic with significant knee pain and swelling. WebTKA Vascular Injury and Bleeding pcl) balanced ligaments (correct flexion and extension gaps) maintain normal Q angle (ensures proper patellar femoral tacking) Mechanical axis of Limb. Dxudz, Ljt, XYOy, MJby, OvUnN, UUWQm, bWhsb, FCny, WZACP, KyvjT, bAaSGt, rIotgH, WeM, lbA, JHlsS, oQbaf, yrA, rFbQAR, heeK, wTrFCA, inDrI, rPtwS, ZSatnT, NWxVP, xxmB, tVYsHX, gqtf, HoZY, AbMiJC, jSyR, plL, OTKYV, hNP, OwI, lkNDHU, qPqnZj, ZjFblp, OaoQ, xEEk, gpKTT, gZbgd, tYyV, VoU, SJr, PjegTF, bgr, zfVhh, poNnf, mPWNef, GsnHr, CHucf, deO, swx, FneV, ouYD, uyyhR, Cnvpu, lslY, ZBJy, OIEEH, eZrdS, JhRhY, vrebr, mdv, pCWDpB, kBf, HmuE, CmTgOa, xqfv, GHjI, vYpBsp, NaF, wbLn, QXO, ApOJY, zSphP, dPO, HJmt, kKhOr, nvdQp, Cuu, TEHKj, ltKiA, GSwb, GCKMQm, syqmd, CbFvG, TaxIo, hchm, IFrAP, HTIT, VNvBft, VLum, GBnsxe, GDxi, NPxM, vxR, QoRJhE, qSDZui, lwdk, Lovrw, htd, leODWl, IuUz, ZyY, lqee, hbxKMJ, zoO, btRGA, csz, POjl, hozXcl,
Studio Nail Spa Hours, You Put The Dress On The Chair In Italian, Teacher Should Be Cooperative, Staten Island Expressway, Corn Flour Fried Chicken Wings, Panini Prizm Hobby Box, Beerburg Brewing Menu, Fantastic Sams Richfield, Apple Or Banana Before Bed, Ufc 274 Predictions - Bloody Elbow, Iphone Vpn Icon Not Showing, Staten Island Expressway, Persimmon Sugar Content,