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Knee Sports MCQs

Practice Set 10 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 181

Topic: Knee Sports

In which of the following anatomic locations have authors described a characteristic MRI edema pattern lesion that occurs with an acute anterior cruciate ligament (AC L) injury:

. Posterolateral aspect of the tibia and the middle aspect of the lateral femoral condyle
. Posterolateral aspect of the tibia and the posteriar aspect of the lateral femoral condyle
. Lateral patellar facet and lateral trochlear groove
. Anterolateral aspect of the tibia and the posterolateral aspect of the lateral femoral condyle
. Posteromedial aspect of the tibia and the anteromedial aspect of the lateral femoral condyle

Correct Answer & Explanation

. Posterolateral aspect of the tibia and the posteriar aspect of the lateral femoral condyle

Explanation

During anterior cruciate ligament (AC L) injury, anterior translation of the tibia and the associated valgus force create a compressive load on the articular cartilage in the posterolateral aspect of the tibia and the anterolateral aspect of the lateral femoral condyle. It has been estimated that approximately 80% of acute AC L injuries demonstrate this pattern on magnetic resonance imaging.

Question 182

Topic: Knee Sports

Six days following anterior cruciate ligament (AC L) reconstruction, a patient returns for follow-up with a fever of 102° F, local incisional drainage, painful decreased knee motion, effusion, erythema, and warmth in the knee. Aspiration of the knee reveals cloudy, blood-tinged synovial fluid. A white blood cell count of the aspirate was 60,000 with 85% polymorphonuclear cells. Appropriate management at this time should include:

. Admission to the hospital and administration of IV antibiotics.
. Starting the patient on oral antibiotics followed by careful outpatient observation over the next several days.
. Immediate arthroscopic lavage with incision and drainage of all associated wounds.
. Immediate arthroscopic lavage with incision and drainage of all associated wounds, partial synovectomy, and graft debridement.
. Immediate arthroscopic lavage with incision and drainage of all associated wounds, partial synovectomy, and debridement with graft retention.

Correct Answer & Explanation

. Immediate arthroscopic lavage with incision and drainage of all associated wounds, partial synovectomy, and debridement with graft retention.

Explanation

Although reported infection rates following anterior cruciate ligament (AC L) reconstruction are as low as 0.3%, the treatment of septic arthritis in the early postoperative period can be challenging. In a patient with a suspected infection, immediate arthroscopic lavage with debridement of necrotic tissue and partial synovectomy is paramount. In a recent review of 831 arthroscopically guided AC L reconstructions, McAllister and associates reported complete resolution of all four infected cases with early lavage, debridement, and graft retention followed by IV, then oral antibiotics. However, the clinical outcome of these patients was inferior to that of patients who had undergone uncomplicated AC L reconstruction due to the damage of the articular cartilage as a result of the infection.

Question 183

Topic: Knee Sports

Which of the following statements correctly describes the relationship of screw length to pull-out strength in anterior cruciate ligament (AC L) fixation using hamstring tendon graft fixation with soft tissue interference screws:

. Use of a longer screw provides stronger fixation strength.
. A small diameter screw provides stronger fixation strength.
. Fixation strength has not been shown to be affected by screw length.
. The best fixation is achieved with a long screw and aperture fixation.
. Better fixation is achieved with larger bone tunnel diameter.

Correct Answer & Explanation

. Fixation strength has not been shown to be affected by screw length.

Explanation

A recent study compared the cyclic and time-zero pull-out forces of 7 25 mm and 7 40 mm blunt-threaded metal interference screws for hamstring graft tibial fixation in 8 paired human cadaveric specimens. There were no measurable differences in the mean cyclic failure strength, pull-out strength, or stiffness between the 2 sizes of screws. One potential advantage of using a longer screw is the relative ease with which it can be removed compared with a shorter screw should revision surgery become necessary.

Question 184

Topic: Knee Sports
Which of the following anatomic landmarks of the knee represents the contact area between the lateral femoral condyle and the anterior horn of the lateral meniscus when the knee is in full extension?
. Outerbridge's ridge
. Blumensaat's line
. Notch of Grant
. David's point
. Sulcus terminalis

Correct Answer & Explanation

. Sulcus terminalis

Explanation

The indentation on the lateral femoral condyle often seen on the lateral radiograph of the knee represents the contact area between the femoral condyle and the anterior portion of the lateral meniscus and is often referred to as the sulcus terminalis. After an acute anterior cruciate ligament (ACL) injury or recurrent giving way episode in a chronically ACL deficient knee, the sulcus terminalis is the region in which a bone contusion is typically seen on a magnetic resonance image.

Question 185

Topic: Knee Sports

Which of the following initial treatment regimens is most appropriate for a 12-year-old boy with osteochondritis dissecans and no effusion or mechanical symptoms:

. Arthroscopic fixation of the lesion
. Arthroscopic drilling of the lesion
. Moderation of activities
. Arthroscopic removal of loose bodies
. Arthroscopic synovectomy and debridement

Correct Answer & Explanation

. Moderation of activities

Explanation

Arthroscopic treatment of osteochondritis dissecans is limited to those patients with mechanical symptoms, effusion, and/or radiographic evidence of loose bodies in the joint. Osteochondritis of the femoral condyle may well heal with moderation of activities.

Question 186

Topic: Knee Sports

A 25-year-old male sustains a twisting knee injury. Examination reveals a positive dial test at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees compared to the contralateral knee. Which structure is most likely isolated in this injury?

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

Correct Answer & Explanation

. Posterolateral corner

Explanation

An increase in external rotation of >10 degrees at 30 degrees of flexion, but not at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. Combined PLC and PCL injuries show increased external rotation at both 30 and 90 degrees.

Question 187

Topic: Knee Sports

A 50-year-old woman hears a "pop" in her knee while squatting. MRI demonstrates a medial meniscus posterior root tear with 4 mm of meniscal extrusion. Biomechanically, this injury is most equivalent to which of the following?

. Normal knee biomechanics
. Partial medial meniscectomy
. Total medial meniscectomy
. Anterior cruciate ligament tear
. Chondral defect of the medial femoral condyle

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus severely disrupts hoop stresses, rendering the meniscus functionally incompetent. Biomechanically, contact pressures and areas are equivalent to those seen after a total meniscectomy.

Question 188

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, the femoral attachment is identified fluoroscopically using Schöttle's point. Where is this point located anatomically?
. Anterior to the posterior femoral cortical line and distal to the Blumensaat line
. Anterior to the posterior femoral cortical line and proximal to the Blumensaat line
. Posterior to the posterior femoral cortical line and distal to the Blumensaat line
. Posterior to the posterior femoral cortical line and proximal to the Blumensaat line
. Centered on the medial epicondyle

Correct Answer & Explanation

. Anterior to the posterior femoral cortical line and proximal to the Blumensaat line

Explanation

Schöttle's point is located 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the Blumensaat line. Proper placement is critical to maintain graft isometry.

Question 189

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. Which of the following best describes the tensioning pattern of the anteromedial (AM) and posterolateral (PL) bundles during normal knee range of motion?

. AM is tight in extension, PL is tight in flexion
. AM is tight in flexion, PL is tight in extension
. Both are equally tight throughout the entire range of motion
. Both are loose in extension and tight in flexion
. AM controls varus stability, PL controls valgus stability

Correct Answer & Explanation

. AM is tight in flexion, PL is tight in extension

Explanation

The AM bundle is primarily tight in knee flexion and controls anterior translation, whereas the PL bundle is tight in extension and provides rotational stability.

Question 190

Topic: Knee Sports

The primary static stabilizers of the posterolateral corner (PLC) of the knee include the fibular collateral ligament (FCL), the popliteus tendon (PT), and which other major structure?

. Biceps femoris tendon
. Arcuate ligament
. Popliteofibular ligament (PFL)
. Fabellofibular ligament
. Oblique popliteal ligament

Correct Answer & Explanation

. Popliteofibular ligament (PFL)

Explanation

The three major static stabilizers of the posterolateral corner are the FCL, popliteus tendon, and popliteofibular ligament (PFL). Surgical reconstruction of the PLC specifically aims to recreate these three core structures.

Question 191

Topic: Knee Sports

A 32-year-old male complains of a palpable, tender mass over the lateral joint line of his knee. MRI reveals a large parameniscal cyst. This finding is most strongly associated with which underlying meniscal pathology?

. Vertical longitudinal tear
. Horizontal cleavage tear
. Radial tear
. Bucket-handle tear
. Meniscal root avulsion

Correct Answer & Explanation

. Horizontal cleavage tear

Explanation

Meniscal cysts are almost exclusively associated with horizontal cleavage tears, which allow synovial fluid to be pumped out of the joint space into the parameniscal tissue. They are more commonly found on the lateral meniscus.

Question 192

Topic: Knee Sports

What is the most common anatomical location for osteochondritis dissecans (OCD) lesions in the adolescent knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Lateral aspect of the lateral femoral condyle
. Inferior pole of the patella
. Central trochlear groove

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for osteochondritis dissecans (OCD) of the knee is the lateral aspect of the medial femoral condyle. This location accounts for approximately 70-80% of all knee OCD lesions.

Question 193

Topic: Knee Sports

A 26-year-old male sustains a dashboard injury during a motor vehicle collision. Examination reveals a positive posterior tibial sag. The dial test shows 20 degrees of external rotation asymmetry at both 30 and 90 degrees of knee flexion. This indicates injury to which of the following?

. Isolated PCL
. Isolated PLC
. Combined PCL and PLC
. Combined ACL and PLC
. Isolated MCL

Correct Answer & Explanation

. Combined PCL and PLC

Explanation

Increased external rotation asymmetry at both 30 degrees and 90 degrees of knee flexion on the dial test indicates a combined injury to both the posterior cruciate ligament (PCL) and the posterolateral corner (PLC).

Question 194

Topic: Knee Sports
Which nerve injury is most commonly associated with a severe varus and hyperextension multiligamentous knee injury (KD-III)?
. Tibial nerve
. Saphenous nerve
. Common peroneal nerve
. Femoral nerve
. Obturator nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve is highly vulnerable to traction injuries during severe varus and hyperextension trauma, especially in posterolateral corner injuries or frank knee dislocations.

Question 195

Topic: Knee Sports

A 24-year-old male presents with chronic knee instability after a hyperextension injury. Physical examination reveals a positive posterior drawer test. A dial test is performed, which demonstrates 15 degrees of increased external rotation compared to the contralateral knee at both 30 degrees and 90 degrees of knee flexion. Which of the following injury patterns is most consistent with these findings?

. Isolated anterior cruciate ligament tear
. Isolated posterolateral corner injury
. Combined anterior cruciate ligament and posterolateral corner injury
. Combined posterior cruciate ligament and posterolateral corner injury
. Isolated posterior cruciate ligament tear

Correct Answer & Explanation

. Combined posterior cruciate ligament and posterolateral corner injury

Explanation

A positive dial test (asymmetric external rotation >10 degrees) at both 30 and 90 degrees of knee flexion indicates a combined posterior cruciate ligament (PCL) and posterolateral corner (PLC) injury. An isolated PLC injury shows increased external rotation at 30 degrees but not at 90 degrees.

Question 196

Topic: Knee Sports

In an anterior cruciate ligament (ACL) reconstruction, if the surgeon places the femoral tunnel too vertically (in the 12 o'clock position in the notch), which of the following clinical outcomes is most likely?

. Restoration of both anterior and rotatory stability
. Failure to control anterior tibial translation (positive Lachman)
. Loss of terminal knee extension
. Failure to control rotatory instability (positive pivot shift)
. Increased risk of intercondylar notch impingement

Correct Answer & Explanation

. Failure to control rotatory instability (positive pivot shift)

Explanation

A vertical femoral tunnel placement in ACL reconstruction may control straight anterior tibial translation but fails to restore the native biomechanics needed to control rotatory forces. Consequently, the patient is likely to demonstrate a persistent positive pivot shift test.

Question 197

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, anatomic placement of the femoral tunnel is critical to ensure proper graft tension throughout the range of motion. According to Schöttle's anatomical studies, where is the optimal femoral origin of the MPFL located?
. Between the medial epicondyle and adductor tubercle
. Anterior and distal to the medial epicondyle
. Proximal and posterior to the adductor tubercle
. Directly over the center of the medial epicondyle
. Distal to the medial collateral ligament origin

Correct Answer & Explanation

. Between the medial epicondyle and adductor tubercle

Explanation

Schöttle's point, identifying the anatomic femoral origin of the MPFL, is located radiographically and anatomically in the saddle between the medial epicondyle distally and the adductor tubercle proximally.

Question 198

Topic: Knee Sports

A surgeon is performing an opening wedge high tibial osteotomy (HTO) on a patient with medial compartment osteoarthritis and varus alignment. If the osteotomy gap is opened significantly more anteriorly than posteriorly, what biomechanical alteration will occur to the knee joint?

. Decreased anterior tibial translation
. Decreased posterior tibial slope
. Increased posterior tibial slope
. Decreased patellofemoral contact pressure
. Lateralization of the tibial tubercle

Correct Answer & Explanation

. Increased posterior tibial slope

Explanation

Opening an HTO anteriorly more than posteriorly increases the posterior tibial slope. Increased posterior slope can place excessive strain on the anterior cruciate ligament by increasing anterior tibial translation forces.

Question 199

Topic: Knee Sports

In the setting of chronic anterior cruciate ligament (ACL) deficiency, which of the following structures serves as the primary secondary restraint to anterior tibial translation?

. Posterior horn of the lateral meniscus
. Posterior horn of the medial meniscus
. Medial collateral ligament
. Popliteofibular ligament
. Iliotibial band

Correct Answer & Explanation

. Posterior horn of the medial meniscus

Explanation

The posterior horn of the medial meniscus acts as the primary secondary restraint to anterior translation of the tibia relative to the femur. This wedge effect is why patients with chronic ACL deficiency often go on to develop medial meniscus tears.

Question 200

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction, the surgeon is preparing to drill the femoral tunnel for the fibular collateral ligament (FCL). What is the correct anatomic location of the FCL femoral footprint relative to the lateral epicondyle?

. Anterior and distal
. Anterior and proximal
. Proximal and posterior
. Distal and posterior
. Directly superimposed on the lateral epicondyle

Correct Answer & Explanation

. Proximal and posterior

Explanation

The anatomic footprint of the fibular collateral ligament (FCL) on the lateral femur is situated slightly proximal (1.4 mm) and posterior (3.1 mm) to the prominence of the lateral epicondyle.

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