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Knee Sports MCQs

Practice Set 1 of 102

This practice set contains high-yield board review questions covering key concepts in Knee Sports. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 1

Topic: Knee Sports

The anterior cruciate ligament is composed of which of the following bundles:

. Anterolateral, posteromedial
. Anteromedial, posterolateral
. Mediolateral, posteromedial
. Anterior, posterior
. Medial, lateral

Correct Answer & Explanation

. Anteromedial, posterolateral

Explanation

The anterior cruciate ligament consists of two bundles. The anteromedial bundle is tight in flexion, and the posterolateral bundle is tight in extension.

Question 2

Topic: Knee Sports

The anterior cruciate ligament (AC L) provides what percent of the stability to anterior tibial translation with the knee flexed 30°:

. 10%
. 25%
. 50%
. 65%
. 85%

Correct Answer & Explanation

. 85%

Explanation

The AC L functions as the primary stabilizer to anterior tibial translation providing more than 85% of stability with the knee in 30° of flexion.

Question 3

Topic: Knee Sports

Which of the following positions of knee flexion produces the greatest strain in the anterior cruciate ligament with anterior loading of the tibia:

. 30° (Lachman test)
. 45°
. 55°
. 75°
. 90° (anterior drawer test)

Correct Answer & Explanation

. 30° (Lachman test)

Explanation

Clinical and biomechanical studies show that anterior loading of the tibia in 30° of knee flexion produces greater strain and elongation of the normal anteromedial bundle than loading in 90° of knee flexion.

Question 4

Topic: Knee Sports

Anterior cruciate ligament (AC L) injuries are almost _ in women than in their male counterparts in collegiate basketball players:

. Four times less common
. One and a half times more common
. Eight times more common
. Equal in prevalence
. Half as common

Correct Answer & Explanation

. Eight times more common

Explanation

Female collegiate basketball players are almost eight times as likely to sustain AC L injuries as their male counterparts.

Question 5

Topic: Knee Sports

Which of the following is not considered an intrinsic risk factor for anterior cruciate ligament (AC L) injury:

. Narrow notch width index
. Altered neuromuscular control
. All of the above
. Increased laxity
. Male gender

Correct Answer & Explanation

. All of the above

Explanation

Intrinsic risk factors for AC L injury include a narrow notch width index, a weak or small native AC L, knee joint anteroposterior laxity, malalignment of the lower extremity, pelvic position, navicular drop, and subtalar joint pronation. Male gender is not a risk factor for AC L injury.

Question 6

Topic: Knee Sports

Anterior cruciate ligament (AC L) injury is most commonly the result of:

. A valgus load as a result of contact
. A hyperextension as a result of contact
. A varus load as a result of contact
. A noncontact injury
. Penetrating trauma

Correct Answer & Explanation

. A noncontact injury

Explanation

An AC L injury is commonly the result of a noncontact mechanism. Two common mechanisms that have been described include a valgus force to a flexed knee with the leg in external rotation and knee hyperextension with the leg internally rotated.

Question 7

Topic: Knee Sports

The incidence of meniscal injury with a concomitant AC L tear is reported to be nearly _, with the __ meniscus more commonly injured in the acute setting:

. 30%, medial
. 70%, medial
. 30%, lateral
. 50%, lateral
. 70%, lateral

Correct Answer & Explanation

. 70%, medial

Explanation

The incidence of meniscal tear after acute anterior cruciate ligament (AC L) injury is reported to be approximately 70%. The lateral meniscus is more often injured in the acute setting, and the medial meniscus is more often injured in the chronically AC L-deficient knee.

Question 8

Topic: Knee Sports

The healing rate of meniscal repairs in association with acute anterior cruciate ligament (AC L) reconstruction is_ that reported for isolated meniscal repairs:

. Higher than
. Lower than
. Equal to
. Meniscal repairs are not recommended in this situation
. Unknown

Correct Answer & Explanation

. Higher than

Explanation

The results with respect to healing of meniscal repairs in the association of an acute AC L injury are reported to be better than in other situations (92% vs 67%).

Question 9

Topic: Knee Sports

The optimal timing for performing anterior cruciate ligament reconstruction after an acute injury is:

. Within 24 hours
. Within the first 3 weeks
. After 4 to 6 weeks
. After return of full knee range of motion
. Timing has not been shown to effect outcomes

Correct Answer & Explanation

. After return of full knee range of motion

Explanation

Shelbourne noted a decrease in the incidence of postoperative stiffness to less than 1% and faster return of strength when surgery is performed after obtaining full knee range of motion including hyperextension of the knee.

Question 10

Topic: Knee Sports

The most common technical errors when performing anterior cruciate ligament reconstruction are:

. Excessively anterior tunnels
. Intraoperative fracture
. Iatrogenic posterior cruciate ligament injury
. Excessively posterior tunnels
. Excessively medial tunnels

Correct Answer & Explanation

. Excessively anterior tunnels

Explanation

The most common technical errors involve excessively anterior placement of the tunnels. Anterior tibial tunnel and femoral tunnel placement can result in graft impingement, inability to fully extend the knee, and eventual failure. Excessively anterior femoral tunnel placement can also result in capturing the knee with difficulty in gaining full flexion and eventual stretching or rupture of the graft with attempts at gaining full flexion.

Question 11

Topic: Knee Sports

All of the following is used to identify the appropriate position for anterior cruciate ligament (AC L) tibial tunnel placement except:

. Inner rim of the anterior horn and lateral meniscus
. 7 mm anterior to the posterior cruciate ligament (PC L)
. Medial tibial spine
. AC L stump/footprint
. Inner rim of the anterior horn of the medial meniscus

Correct Answer & Explanation

. Inner rim of the anterior horn and lateral meniscus

Explanation

Tibial tunnel misplacement can be avoided by using the appropriate landmarks (inner rim of the anterior horn of the lateral meniscus, referencing off of the PC L, the medial tibial spine, and the ACL stump).

Question 12

Topic: Knee Sports

Adequate bone plug length for interference screw fixation during bone- tendon-bone anterior cruciate ligament reconstruction is:

. At least 5 mm in length
. At least 10 mm in length
. At least 15 mm in length
. No less than 20 mm in length
. Bone plug length is not related to fixation strength.

Correct Answer & Explanation

. At least 10 mm in length

Explanation

Graft fixation is the weak point in the early postoperative period. Researchers have reported that the optimal bone plug length is at least 1 cm. Bone plugs of shorter lengths have decreased peak load to failure, but bone plugs of greater length did not have significantly increased peak loads to failure.

Question 13

Topic: Knee Sports

A 13-year-old male gymnast complains of insidious onset, progressive lateral elbow pain and catching. Radiographs demonstrate a radiolucent defect in the capitellum with a sclerotic margin. MRI reveals a detached osteochondral fragment. What is the most appropriate definitive management?

. Casting for 6 weeks
. Fragment excision and microfracture
. Corticosteroid injection
. Ulnar collateral ligament reconstruction
. Physical therapy focusing on wrist extensors

Correct Answer & Explanation

. Fragment excision and microfracture

Explanation

Osteochondritis dissecans of the capitellum with an unstable or detached fragment requires surgical intervention. Fragment excision, loose body removal, and marrow stimulation (microfracture) of the base are indicated for symptomatic detached lesions.

Question 14

Topic: Knee Sports

With regard to the meniscofemoral ligaments, the ligament of Humphrey runs ___ to the posterior cruciate ligament (PC L) and the ligament of Wrisberg runs _____ to the PC L.

. Posterior, anterior
. Anterior, posterior
. Anterior, anterior
. Posterior, posterior
. Medial, lateral

Correct Answer & Explanation

. Posterior, anterior

Explanation

The anterior meniscofemoral ligament of Humphrey runs from the femur to the posterior horn of the lateral meniscus anterior to the PC L. The ligament of Wrisberg runs posterior to the PCL. It is occasionally the only posterior horn attachment site for a discoid lateral meniscus and can result in excessive motion and posterior horn instability.

Question 15

Topic: Knee Sports

The ligament that has an association with an unstable lateral discoid meniscus is:

. Ligament of Humphrey
. Medial collateral ligament
. Lateral collateral ligament
. Ligament of Wrisberg
. Anterior cruciate ligament

Correct Answer & Explanation

. Ligament of Wrisberg

Explanation

The anterior meniscofemoral ligament of Humphrey runs from the femur to the posterior horn of the lateral meniscus anterior to the posterior cruciate ligament (PC L). The ligament of Wrisberg runs posterior to the PC L. It is occasionally the only posterior horn attachment site for a discoid lateral meniscus and can result in excessive motion and posterior horn instability. The medial and lateral collateral ligaments are not the attachment sites for the posterior horn of some lateral discoid meniscal variants.

Question 16

Topic: Knee Sports

The most important structure that resists anterior tibial translation in the anterior cruciate ligament (AC L)-deficient knee is the:

. Anterior horn medial meniscus
. Anterior horn lateral meniscus
. Posterior horn medial meniscus
. Posterior horn lateral meniscus
. Lateral collateral ligament

Correct Answer & Explanation

. Posterior horn medial meniscus

Explanation

One study evaluated the role of the meniscus in anteroposterior stability of the AC L-deficient knee. The researchers found that the posterior horn of the medial meniscus was the most important structure resisting an applied anterior tibial force in an AC Ldeficient knee. The peripheral portion of the meniscus is essential for both load transmission and stability.

Question 17

Topic: Knee Sports

All of the following are either primary or secondary stabilizers of the knee to posterior translation except:

. Posterior cruciate ligament
. Anterior cruciate ligament
. Medial collateral ligament
. Lateral collateral ligament
. Posterolateral corner

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

The posterior cruciate ligament is the primary stabilizer to posterior translation of the knee. Secondary stabilizers include the medial and lateral collateral ligaments and the posterolateral corner.

Question 18

Topic: Knee Sports

Which of the following is the most accurate clinical examination tool in detecting disruption of the posterior cruciate ligament:

. Posterior drawer test
. Quadriceps active drawer test
. Posterior sag test
. Reverse pivot shift test
. Reverse Lachman test

Correct Answer & Explanation

. Posterior drawer test

Explanation

The posterior drawer test is the most accurate method of clinically diagnosing posterior cruciate ligament disruption. Although the quadriceps active drawer test and the posterior sag test are useful, their reported accuracy is less than that of the posterior drawer test. The reverse pivot shift test evaluates posterolateral corner injuries.

Question 19

Topic: Knee Sports

The anteromedial (AM) bundle of the anterior cruciate ligament (ACL) is tightest in which position, and what is its primary biomechanical function?

. Tightest in extension; controls rotational stability
. Tightest in flexion; controls rotational stability
. Tightest in flexion; controls anterior tibial translation
. Tightest in extension; controls anterior tibial translation
. Tightest in mid-flexion; controls varus angulation

Correct Answer & Explanation

. Tightest in flexion; controls anterior tibial translation

Explanation

The AM bundle of the ACL is tightest in flexion and serves as the primary restraint to anterior tibial translation. Conversely, the posterolateral (PL) bundle is tightest in extension and primarily controls rotatory stability.

Question 20

Topic: Knee Sports

During a posterior cruciate ligament (PCL) reconstruction using a transtibial tunnel technique, what is the anatomical structure at greatest risk during drilling of the tibial tunnel?

. Popliteal artery
. Common peroneal nerve
. Anterior tibial artery
. Tibial nerve
. Middle genicular artery

Correct Answer & Explanation

. Popliteal artery

Explanation

The popliteal artery is located directly posterior to the posterior capsule of the knee. Over-penetration of the guide pin or drill during transtibial PCL tunnel creation places the popliteal artery at significant risk of catastrophic injury.

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