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 2001
Topic: Knee Sports
The 'Dial test' is utilized to evaluate posterolateral corner (PLC) instability of the knee. Increased external rotation of the tibia at 30 degrees of flexion, but normal external rotation at 90 degrees of flexion, indicates an isolated injury to which of the following structures?
Correct Answer & Explanation
. Posterolateral corner (PLC) alone
Explanation
A positive Dial test (>10 degrees of asymmetry in external rotation compared to the contralateral knee) at 30 degrees of flexion with a normal test at 90 degrees indicates an isolated injury to the posterolateral corner (PLC). If the test is positive at both 30 degrees and 90 degrees, it suggests a combined injury to the PLC and the PCL.
Question 2002
Topic: Knee Sports
In a posterior-stabilized (PS) total knee arthroplasty, the interaction between the cam on the femoral component and the post on the tibial polyethylene insert is designed to substitute for the function of which native structure?
Correct Answer & Explanation
. Poster cruciate ligament
Explanation
In a posterior-stabilized (PS) TKA design, the posterior cruciate ligament (PCL) is sacrificed. The cam-and-post mechanism engages during knee flexion to enforce femoral rollback, effectively substituting for the function of the resected PCL.
Question 2003
Topic: Knee Sports
During a physical examination of a knee, a posterior drawer test is performed. The posterior cruciate ligament (PCL) is the primary restraint to posterior tibial translation. Which bundle of the PCL is the tightest in 90 degrees of knee flexion?
Correct Answer & Explanation
. Anterolateral bundle
Explanation
The PCL consists of two main functional bundles: the anterolateral (AL) and posteromedial (PM) bundles. The AL bundle is the larger of the two and is tightest in knee flexion (which is why the posterior drawer is tested at 90 degrees). The PM bundle is tightest in knee extension.
Question 2004
Topic: Knee Sports
During an anatomical single-bundle ACL reconstruction, the surgeon must properly place the femoral tunnel. The center of the native ACL footprint is positioned anatomically in relation to which two osseous landmarks on the medial aspect of the lateral femoral condyle?
Correct Answer & Explanation
. Lateral intercondylar ridge and lateral bifurcate ridge
Explanation
The lateral intercondylar ridge (resident's ridge) represents the anterior margin of the ACL footprint, and the lateral bifurcate ridge separates the anteromedial and posterolateral bundle footprints.
Question 2005
Topic: Knee Sports
The anterior cruciate ligament (ACL) provides crucial stability to the knee and is composed of two primary bundles. Which of the following statements correctly describes their varying tension during knee motion?
Correct Answer & Explanation
. The anteromedial bundle is tight in flexion, and the posterolateral bundle is tight in extension.
Explanation
The ACL has two distinct functional bundles based on their tibial insertions. The anteromedial (AM) bundle is the primary restraint to anterior translation and is tightest in flexion, while the posterolateral (PL) bundle provides rotational stability and is tightest in extension.
Question 2006
Topic: Knee Sports
The Anterior Cruciate Ligament (ACL) is composed of two primary bundles. Which of the following accurately describes the tension pattern and primary function of the anteromedial (AM) bundle?
Correct Answer & Explanation
. It is tight in flexion and provides primary restraint to anterior tibial translation in flexion
Explanation
The ACL consists of the Anteromedial (AM) and Posterolateral (PL) bundles. The AM bundle is tight in flexion and acts 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 loads.
Question 2007
Topic: Knee Sports
During reconstruction of the anterior cruciate ligament (ACL), placing the femoral tunnel too far anteriorly will result in which of the following kinematic abnormalities?
Correct Answer & Explanation
. Tightness in flexion and laxity in extension
Explanation
An anteriorly placed femoral tunnel in ACL reconstruction causes the graft to be overly tight in knee flexion and loose in extension. This error often results in restricted terminal knee flexion or graft stretching over time.
Question 2008
Topic: Knee Sports
A 14-year-old male presents with vague anterior knee pain and intermittent catching. Radiographs reveal an osteochondral lesion consistent with osteochondritis dissecans (OCD). Based on the most common location for this pathology, which specific anatomical site is most likely affected?
Correct Answer & Explanation
. Lateral aspect of the medial femoral condyle
Explanation
Correct Answer: A. Lateral aspect of the medial femoral condyleOsteochondritis dissecans (OCD) of the knee most commonly affects the lateral aspect of the medial femoral condyle (accounting for approximately 70-80% of cases). It is thought to result from repetitive microtrauma leading to subchondral bone ischemia and subsequent fragmentation of the overlying articular cartilage and bone. The classic radiographic finding is a crescent-shaped radiolucency. The lateral femoral condyle is the second most common site.
Question 2009
Topic: Knee Sports
A 22-year-old female soccer player sustains a non-contact pivoting injury to her right knee. MRI confirms a complete anterior cruciate ligament tear alongside a displaced bucket-handle tear of the medial meniscus. What is the primary vascular supply to the peripheral third (red-red zone) of the menisci?
Correct Answer & Explanation
. Inferior and superior medial/lateral genicular arteries
Explanation
The peripheral 10-30% of the menisci is vascularized by a capillary plexus originating from the superior and inferior branches of the medial and lateral genicular arteries. The middle genicular artery primarily supplies the cruciate ligaments.
Question 2010
Topic: Knee Sports
A 24-year-old collegiate football player sustains a multi-ligament knee injury. During the surgical reconstruction of the posterolateral corner (PLC), the surgeon must be careful to protect a peripheral nerve that courses around the fibular neck. Which of the following clinical findings would result from an iatrogenic transection of this nerve?
Correct Answer & Explanation
. Inability to actively dorsiflex the ankle
Explanation
The common peroneal nerve courses around the fibular neck and is at high risk during PLC reconstruction. Injury results in a foot drop due to weakness in ankle dorsiflexion and loss of sensation over the first dorsal web space.
Question 2011
Topic: Knee Sports
A 45-year-old male presents with chronic anterior knee pain, worse with climbing stairs and prolonged sitting. Physical examination reveals patellar grind tenderness, pain with patellar compression, and a positive J-sign. Imaging shows lateral patellar tilt and increased tibial tubercle-trochlear groove (TTTG) distance of 18mm. He has failed conservative management. Which of the following surgical interventions is most appropriate?
Given the increased TTTG distance (normal < 15mm) indicating significant lateralization of the extensor mechanism, a tibial tubercle anteromedialization (Fulkerson osteotomy) is the most appropriate surgical intervention. This procedure moves the patellar tendon insertion medially and anteriorly, decreasing the Q-angle and patellofemoral contact pressures, thereby addressing both patellar maltracking and chondromalacia. MPFL reconstruction is primarily for recurrent patellar instability due to medial restraint insufficiency, though it can be combined with osteotomy for severe cases. Lateral retinacular release alone is often insufficient for significant maltracking. Trochleoplasty is reserved for severe trochlear dysplasia, and total knee arthroplasty is excessive for isolated patellofemoral pain in a 45-year-old.
Question 2012
Topic: Knee Sports
What is the primary function of the meniscofemoral ligaments (ligament of Wrisberg and ligament of Humphry)?
Correct Answer & Explanation
. Connect the lateral meniscus to the posterior cruciate ligament (PCL) and medial femoral condyle.
Explanation
The meniscofemoral ligaments (MFLs) are typically two ligaments: the anterior meniscofemoral ligament (ligament of Humphry) and the posterior meniscofemoral ligament (ligament of Wrisberg). Both arise from the posterior horn of the lateral meniscus and insert onto the medial femoral condyle, specifically joining the posterior cruciate ligament (PCL). Their primary function is to stabilize the posterior horn of the lateral meniscus, particularly in relation to the PCL, and to a lesser extent, contribute to PCL function. They do not primarily stabilize the patella, reinforce the ACL, or provide varus stability.
Question 2013
Topic: Knee Sports
What is the primary mechanical function of the ACL?
Correct Answer & Explanation
. Preventing anterior translation of the tibia on the femur.
Explanation
The primary mechanical function of the anterior cruciate ligament (ACL) is to prevent anterior translation of the tibia on the femur. It also plays a significant role in limiting internal rotation of the tibia and to a lesser extent, hyperextension. The posterior cruciate ligament (PCL) prevents posterior translation. The medial collateral ligament (MCL) resists valgus stress, and the lateral collateral ligament (LCL) resists varus stress. While the ACL contributes to rotational stability, its primary role is sagittal plane stability against anterior tibial translation.
Question 2014
Topic: Knee Sports
The MRI scans shown demonstrate a lipohemarthrosis in the knee. Which of the following is the most common underlying etiology for this specific MRI finding?
Correct Answer & Explanation
. Intra-articular fracture
Explanation
Correct Answer: CLipohemarthrosis is characterized by the layering of fat and blood within a joint cavity. The most common cause is an intra-articular fracture, which allows marrow fat to escape into the joint space. On MRI, it typically shows a superior layer of fat, a central layer of serum, and an inferior layer of red blood cells. While an ACL tear causes a hemarthrosis, it does not typically cause a lipohemarthrosis unless accompanied by an osteochondral fracture.
Question 2015
Topic: Knee Sports
During anterior cruciate ligament (ACL) reconstruction, the surgeon inadvertently places the femoral tunnel too anteriorly (superficially) within the intercondylar notch. What is the most likely clinical consequence of this error?
Correct Answer & Explanation
. The graft will be tight in flexion and lax in extension.
Explanation
An anteriorly placed femoral tunnel misses the isometric point, causing the distance between the tibial and femoral attachments to increase as the knee flexes. This results in graft tightness during flexion and laxity during extension, potentially limiting flexion or stretching the graft out.
Question 2016
Topic: Knee Sports
A 24-year-old soccer player sustains a non-contact pivoting knee injury.
Radiographs reveal a small elliptical avulsion fracture of the anterolateral proximal tibia. This pathognomonic finding is most closely associated with an injury to which of the following structures?
Correct Answer & Explanation
. Anterior cruciate ligament
Explanation
The Segond fracture is an avulsion of the anterolateral ligament (ALL) or lateral capsular complex from the proximal tibia. It is considered highly pathognomonic for an anterior cruciate ligament (ACL) tear.
Question 2017
Topic: Knee Sports
A neonate presents with an anteromedial bowing of the tibia, a shortened leg, and an absent lateral ray of the foot. Radiographs confirm fibular hemimelia. Which associated ligamentous deficiency is most commonly seen in the knee of this patient?
Correct Answer & Explanation
. Anterior cruciate ligament (ACL) deficiency
Explanation
Fibular hemimelia is frequently associated with congenital anterior cruciate ligament (ACL) deficiency, leading to anteroposterior knee instability. Ball-and-socket ankle joint and tarsal coalitions are also common associations.
Question 2018
Topic: Knee Sports
The posterolateral corner of the knee is a complex arrangement of static and dynamic stabilizers. Biomechanical studies have shown that the primary function of the popliteofibular ligament is to resist which of the following motions?
Correct Answer & Explanation
. Posterolateral rotation of the tibia on the femur
Explanation
Correct Answer: DThe primary function of the popliteofibular ligament is to resist posterolateral rotation of the tibia on the femur. It also acts as a secondary restraint to varus angulation and posterior displacement of the tibia. The posterior cruciate ligament is the primary restraint to posterior tibial displacement, and the lateral collateral ligament is the primary restraint to varus displacement at 30 degrees of flexion.
Question 2019
Topic: Knee Sports
The popliteofibular ligament is a critical stabilizer of the posterolateral corner of the knee. What is its primary biomechanical function?
Correct Answer & Explanation
. Resisting posterolateral rotation of the tibia on the femur
Explanation
Correct Answer: DThe primary function of the popliteofibular ligament is to resist posterolateral rotation of the tibia on the femur. While it provides secondary restraint to varus angulation and posterior displacement, the lateral collateral ligament is the primary restraint to varus at 30 degrees, and the posterior cruciate ligament is the primary restraint to posterior translation at 90 degrees.
Question 2020
Topic: Knee Sports
A 40-year-old man sustains a traumatic high-energy knee dislocation (KD III) resulting in multiligamentous injury. During the initial neurological assessment, he exhibits a foot drop and decreased sensation over the dorsum of the foot. Which nerve is injured?
Correct Answer & Explanation
. Common peroneal nerve
Explanation
The common peroneal nerve is the most frequently injured nerve in high-energy knee dislocations, particularly those involving disruption of the posterolateral corner. Injury results in foot drop (loss of dorsiflexion) and numbness over the dorsum of the foot.
Test Yourself
Switch to an interactive, timed exam simulation to truly master this topic.
