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Knee Sports MCQs

Practice Set 100 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 1981

Topic: Knee Sports

During a posterior cruciate ligament (PCL) reconstruction, the surgeon identifies the meniscofemoral ligaments to aid in anatomic orientation. The ligament of Wrisberg passes in which relation to the PCL?

. Anterior to the PCL
. Posterior to the PCL
. Lateral to the PCL
. Medial to the PCL
. Superior to the PCL

Correct Answer & Explanation

. Posterior to the PCL

Explanation

The meniscofemoral ligaments connect the posterior horn of the lateral meniscus to the lateral aspect of the medial femoral condyle. The ligament of Wrisberg passes posterior to the PCL, while the ligament of Humphrey passes anterior to the PCL.

Question 1982

Topic: Knee Sports

A 45-year-old male sustains a distal third femoral shaft fracture.

If the surgeon opts for retrograde intramedullary nailing, what is the ideal entry point?

. At the true center of the intercondylar notch, posterior to Blumensaat's line
. Anterior to Blumensaat's line and medial to the center of the notch
. In line with the medullary canal, just anterior to the origin of the posterior cruciate ligament (PCL)
. Lateral to the center of the intercondylar notch, anterior to the ACL
. Distal to the inferior pole of the patella, purely extra-articular

Correct Answer & Explanation

. In line with the medullary canal, just anterior to the origin of the posterior cruciate ligament (PCL)

Explanation

The ideal starting point for a retrograde femoral nail is intra-articular: in the center of the intercondylar notch (medial-lateral), directly in line with the anatomic axis of the femur, and just anterior to the origin of the posterior cruciate ligament (PCL). An entry point that is too anterior increases the risk of damaging the patellofemoral joint cartilage, and too posterior risks damaging the PCL or missing the diaphyseal axis.

Question 1983

Topic: Knee Sports

A patient undergoes a Dial test during a knee examination. There is 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side, but symmetric external rotation at 90 degrees of flexion. This finding is most indicative of an isolated injury to which of the following structures?

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

Correct Answer & Explanation

. Posterolateral corner

Explanation

The Dial test evaluates external rotation of the tibia. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion, but not at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. If increased external rotation is present at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 1984

Topic: Knee Sports

During an ACL reconstruction, a surgeon accidentally places the femoral tunnel too anteriorly relative to the native footprint. What is the most likely biomechanical consequence of this error during postoperative knee range of motion?

. The graft will be tight in extension and loose in flexion
. The graft will be tight in flexion and loose in extension
. The graft will be tight throughout the entire range of motion
. The graft will be loose throughout the entire range of motion
. The graft will impinge on the PCL during extension

Correct Answer & Explanation

. The graft will be tight in flexion and loose in extension

Explanation

An anteriorly placed femoral tunnel (relative to the native footprint) causes the ACL graft to be relatively loose in extension and excessively tight in flexion. This often leads to restricted knee flexion and potential graft stretching or failure.

Question 1985

Topic: Knee Sports

During a posterior cruciate ligament (PCL) reconstruction, the surgeon is tensioning the anterolateral (AL) bundle of the graft. In a normal knee, the anterolateral bundle of the PCL is under maximum tension in which of the following positions?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 degrees of flexion
. 120 degrees of flexion

Correct Answer & Explanation

. 90 degrees of flexion

Explanation

The PCL consists of two main bundles: the anterolateral (AL) bundle and the posteromedial (PM) bundle. The AL bundle is larger, stiffer, and is tightest in 90 degrees of flexion. The PM bundle is tightest in extension. Single-bundle PCL reconstructions typically attempt to recreate the AL bundle and are therefore tensioned and fixed at 90 degrees of knee flexion.

Question 1986

Topic: Knee Sports

In the kinematics of the native knee joint, 'femoral rollback' allows for increased knee flexion by preventing early posterior impingement of the femur on the posterior tibia. This rollback mechanism is primarily driven by the intact:

. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Medial collateral ligament (MCL)
. Lateral collateral ligament (LCL)
. Popliteofibular ligament

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

Femoral rollback is the posterior translation of the femoral condyles on the tibial plateau as the knee flexes. This is primarily driven by the tension in the posterior cruciate ligament (PCL). In total knee arthroplasty, posterior stabilized (PS) designs use a cam and post mechanism to artificially recreate this rollback when the PCL is sacrificed.

Question 1987

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two distinct bundles. Which of the following best describes the function of the posterolateral (PL) bundle?

. It is tightest in full flexion and controls anterior translation.
. It is tightest in extension and primarily controls rotatory stability.
. It is the primary restraint to valgus stress.
. It inserts onto the medial meniscus.
. It is tightest in 90 degrees of flexion and controls internal rotation.

Correct Answer & Explanation

. It is tightest in extension and primarily controls rotatory stability.

Explanation

The PL bundle is tight in extension and provides primary rotatory stability to the knee. In contrast, the anteromedial (AM) bundle is tightest in flexion and serves as the primary restraint against anterior tibial translation.

Question 1988

Topic: Knee Sports

Biomechanical studies of the anterior cruciate ligament (ACL) demonstrate distinct functional roles for the anteromedial (AM) and posterolateral (PL) bundles. Which of the following statements is true regarding their biomechanics?

. The AM bundle is tight in extension and primarily controls rotatory stability.
. The PL bundle is tight in flexion and primarily controls anterior translation.
. The AM bundle is tight in flexion and the PL bundle is tight in extension.
. Both bundles maintain equal tension throughout the entire arc of motion.
. The PL bundle is the primary restraint to varus stress in full extension.

Correct Answer & Explanation

. The AM bundle is tight in flexion and the PL bundle is tight in extension.

Explanation

The AM bundle is tight in flexion and serves as the primary restraint to anterior tibial translation at 90 degrees of flexion. The PL bundle is tight in extension and is the primary restraint to rotatory instability.

Question 1989

Topic: Knee Sports

Regarding the functional anatomy of the anterior cruciate ligament (ACL), the anteromedial (AM) and posterolateral (PL) bundles exhibit distinct tension patterns during knee motion. Which statement is most accurate?

. The AM bundle is tight in extension and loose in flexion
. The PL bundle is tight in flexion and loose in extension
. The AM bundle is tight in flexion and the PL bundle is tight in extension
. Both bundles exhibit maximum tension at 45 degrees of flexion
. The PL bundle controls anterior translation primarily at 90 degrees of flexion

Correct Answer & Explanation

. The AM bundle is tight in flexion and the PL bundle is tight in extension

Explanation

The anteromedial (AM) bundle of the ACL is primarily tight in flexion, controlling anterior tibial translation at 90 degrees. The posterolateral (PL) bundle is tight in extension, providing primary rotational stability in early flexion.

Question 1990

Topic: Knee Sports

A 50-year-old female felt a sudden 'pop' in the back of her knee while squatting. MRI reveals a complete tear of the medial meniscus posterior root. If left untreated, this injury results in a biomechanical state most equivalent to which of the following?

. Loss of anterior tibial translation restraint equivalent to an ACL tear
. Complete loss of hoop stresses, equivalent to a total meniscectomy
. Increased lateral compartment contact pressures
. Shift of the mechanical axis into valgus
. Decreased contact area with paradoxically decreased contact pressures

Correct Answer & Explanation

. Complete loss of hoop stresses, equivalent to a total meniscectomy

Explanation

The meniscal roots anchor the meniscus to the tibia, converting axial loads into circumferential 'hoop stresses.' A complete root tear disrupts this mechanism, allowing the meniscus to extrude. Biomechanically, this results in a complete loss of hoop stresses, significantly reducing contact area and increasing peak contact pressures in the medial compartment, functioning identically to a total meniscectomy.

Question 1991

Topic: Knee Sports

A 22-year-old football player sustains a non-contact pivoting knee injury. Radiographs reveal an avulsion fracture of the lateral tibial plateau (Segond fracture). This radiographic finding is virtually pathognomonic for an injury to which of the following structures?

. Posterior cruciate ligament
. Anterior cruciate ligament
. Medial collateral ligament
. Posterolateral corner complex
. Popliteus tendon

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

The Segond fracture is an avulsion of the anterolateral capsular attachments (often involving the anterolateral ligament) from the lateral tibial plateau. Its presence on an AP radiograph is highly specific and virtually pathognomonic for an anterior cruciate ligament (ACL) tear.

Question 1992

Topic: Knee Sports

A 25-year-old athlete sustains a knee injury. On examination, the dial test reveals 15 degrees of increased external rotation on the injured side compared to the normal side when tested at 30 degrees of knee flexion. However, at 90 degrees of knee flexion, the external rotation is symmetrical bilaterally. What is the most likely diagnosis?

. Isolated posterolateral corner (PLC) injury
. Combined PLC and posterior cruciate ligament (PCL) injury
. Isolated PCL injury
. Combined PLC and anterior cruciate ligament (ACL) injury
. Isolated medial collateral ligament (MCL) injury

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

An isolated posterolateral corner (PLC) injury is indicated by increased external rotation at 30 degrees of flexion but not at 90 degrees. If external rotation asymmetry is present at both 30 and 90 degrees, a combined PLC and PCL injury is diagnosed.

Question 1993

Topic: Knee Sports
A 28-year-old professional athlete presents with chronic posterior knee instability and functional limitations due to an isolated Grade II posterior cruciate ligament (PCL) tear, sustained 18 months ago. Non-operative management, including extensive physical therapy, has failed to restore stability or allow return to sport. Which surgical technique is generally considered the most biomechanically advantageous for PCL reconstruction in this patient?
. Single-bundle transtibial PCL reconstruction.
. Double-bundle transtibial PCL reconstruction.
. Single-bundle femoral inlay PCL reconstruction.
. Double-bundle femoral inlay PCL reconstruction.
. Dynamic PCL stabilization with hamstring transfer.

Correct Answer & Explanation

. Single-bundle femoral inlay PCL reconstruction.

Explanation

For a chronic, symptomatic PCL deficiency in an active individual, surgical reconstruction is indicated. Among the options, the femoral inlay technique (both single and double bundle) has been shown to be biomechanically superior to the transtibial technique. The transtibial technique often creates a 'killer turn' or acute angle for the graft as it exits the tibia, which can lead to graft abrasion, lengthening, and failure. The femoral inlay technique avoids this acute turn, providing a more anatomical and biomechanically sound reconstruction. While double-bundle techniques may offer theoretical advantages in some cases, the single-bundle femoral inlay technique is a robust option that avoids the 'killer turn' and is highly effective for isolated Grade II/III tears, making it a strong choice.

Question 1994

Topic: Knee Sports

A 14-year-old active male complains of poorly localized, intermittent knee pain and catching over the past six months. Radiographs reveal osteochondritis dissecans (OCD) of the knee. What is the most common anatomical location for this lesion?

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

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

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

Question 1995

Topic: Knee Sports

A 19-year-old soccer player sustains a twisting injury to his knee. He presents with a locked knee and a large effusion. MRI reveals a complete anterior cruciate ligament (ACL) tear and a displaced bucket-handle tear of the medial meniscus. What is the recommended surgical management?

. Concurrent ACL reconstruction and medial meniscus repair
. ACL reconstruction and partial medial meniscectomy
. Physical therapy for range of motion, followed by delayed ACL reconstruction
. Immediate diagnostic arthroscopy and meniscus repair, followed by staged ACL reconstruction 6 months later
. Non-operative management with a hinged knee brace

Correct Answer & Explanation

. Concurrent ACL reconstruction and medial meniscus repair

Explanation

A locked knee secondary to a displaced bucket-handle meniscal tear requires urgent surgical intervention. Concurrent ACL reconstruction and meniscal repair should be performed, as the bleeding and bone marrow elements from the ACL reconstruction create a favorable biologic environment that improves meniscal healing rates.

Question 1996

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. During knee flexion, which of the following accurately describes the tension pattern of the anteromedial (AM) and posterolateral (PL) bundles?

. AM bundle is tight, PL bundle is loose
. AM bundle is loose, PL bundle is tight
. Both bundles are uniformly tight
. Both bundles are uniformly loose
. Both bundles are tightest at 30 degrees of flexion

Correct Answer & Explanation

. AM bundle is tight, PL bundle is loose

Explanation

The ACL's two functional bundles exhibit reciprocal tension patterns. The anteromedial (AM) bundle tightens in flexion (acting as the primary restraint to anterior translation at 90 degrees), while the posterolateral (PL) bundle is tight in extension (providing rotatory stability) and becomes loose in flexion.

Question 1997

Topic: Knee Sports

A 22-year-old male sustains a direct blow to the anteromedial proximal tibia while his knee is extended. A posterolateral corner (PLC) injury is suspected. Which of the following physical examination findings specifically isolates an injury to the PLC?

. Positive anterior drawer test in neutral rotation
. Increased external rotation of the tibia at 30 degrees of knee flexion
. Significant valgus laxity at 0 degrees of knee flexion
. Positive pivot shift test
. Positive McMurray test with varus stress

Correct Answer & Explanation

. Increased external rotation of the tibia at 30 degrees of knee flexion

Explanation

The dial test assesses for posterolateral corner injury. Increased external rotation at 30 degrees of flexion (but not at 90 degrees) indicates an isolated PLC injury. If it is increased at both 30 and 90 degrees, a combined PLC and PCL injury is present.

Question 1998

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. Which of the following statements correctly describes the tensioning and primary stabilizing function of the posterolateral (PL) bundle?

. Tight in flexion and primarily controls anterior translation
. Tight in extension and primarily controls rotatory stability
. Tight in flexion and primarily controls rotatory stability
. Tight in extension and primarily controls anterior translation
. Exhibits uniform tension throughout the entire arc of motion

Correct Answer & Explanation

. Tight in flexion and primarily controls anterior translation

Explanation

The ACL has an anteromedial (AM) and a posterolateral (PL) bundle. The AM bundle tightens in flexion and is the primary restraint to anterior tibial translation. The PL bundle tightens in extension and is the primary restraint to rotatory loads (pivot shift).

Question 1999

Topic: Knee Sports

A 45-year-old female presents with sudden onset medial knee pain after a deep squat. MRI demonstrates a posterior root tear of the medial meniscus. From a biomechanical perspective, what is the consequence of an untreated medial meniscus posterior root tear?

. It creates an environment identical to a total medial meniscectomy regarding contact pressures
. It primarily leads to isolated anterior knee instability
. It increases patellofemoral joint contact forces by 50%
. It shifts the mechanical axis of the knee into severe valgus
. It leads to healing via fibrocartilage formation within 6 months

Correct Answer & Explanation

. It creates an environment identical to a total medial meniscectomy regarding contact pressures

Explanation

A complete radial tear at the meniscal root destroys the hoop stresses of the meniscus. Biomechanically, this results in meniscal extrusion and alters the tibiofemoral contact mechanics to a state equivalent to that of a total meniscectomy, leading to rapid progression of osteoarthritis if left untreated.

Question 2000

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two distinct functional bundles. Which statement best describes the primary biomechanical role of the posterolateral (PL) bundle?

. It is tightest in deep flexion
. It is the primary restraint to anterior tibial translation at 90 degrees of flexion
. It provides primary rotatory stability in extension
. It originates high and anterior on the femoral footprint
. It inserts directly on the medial tibial spine

Correct Answer & Explanation

. It provides primary rotatory stability in extension

Explanation

The posterolateral (PL) bundle of the ACL is tightest in extension and acts as the primary restraint to rotatory instability, which correlates with the clinical pivot shift test. In contrast, the anteromedial (AM) bundle is tightest in flexion and controls anterior translation.

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