Menu

Knee Sports MCQs

Practice Set 102 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 2021

Topic: Knee Sports

An 18-year-old football player sustains a knee injury with immediate hemarthrosis after decelerating and pivoting. Examination reveals a positive Lachman test. The injured structure consists of two distinct bundles. Which of the following statements regarding the biomechanics of these bundles is correct?

. The anteromedial bundle is tight in extension and controls rotatory stability.
. The posterolateral bundle is tight in flexion and controls anterior translation.
. The anteromedial bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees of flexion.
. The posterolateral bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees of flexion.
. Both bundles are equally tight throughout the entire range of motion.

Correct Answer & Explanation

. The anteromedial bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees of flexion.

Explanation

Correct Answer: The anteromedial bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees of flexion.The anterior cruciate ligament (ACL) consists of two main bundles: the anteromedial (AM) bundle and the posterolateral (PL) bundle. The AM bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees of flexion (tested via the anterior drawer test). The PL bundle is tight in extension and is the primary restraint to rotatory loads and anterior translation in near-extension (tested via the Lachman and pivot shift tests). Understanding this anatomy is crucial for anatomic ACL reconstruction.

Question 2022

Topic: Knee Sports

An 18-year-old football player sustains an acute anterior cruciate ligament (ACL) tear with a large hemarthrosis. He currently has a knee range of motion from 15 degrees of extension to 90 degrees of flexion. What is the most significant risk of performing an immediate ACL reconstruction before he regains full range of motion?

. Graft rupture
. Arthrofibrosis
. Deep vein thrombosis
. Infection
. Patellar tendon rupture

Correct Answer & Explanation

. Arthrofibrosis

Explanation

Correct Answer: BPerforming an ACL reconstruction in the acute phase when the knee is swollen, inflamed, and lacks full range of motion significantly increases the risk of postoperative arthrofibrosis (stiffness). Current standard of care involves a period of "prehabilitation" to allow the acute hemarthrosis to resolve, restore normal gait mechanics, and achieve full range of motion (especially full extension) prior to surgical reconstruction. This approach drastically reduces the incidence of postoperative motion complications.

Question 2023

Topic: Knee Sports

An 18-year-old football player develops an immediate, tense hemarthrosis following a pivoting injury to his knee. Aspiration yields 60 mL of frank blood. He is subsequently diagnosed with an anterior cruciate ligament (ACL) tear. The primary blood supply to the ruptured ligament, which is responsible for the rapid hemarthrosis, is derived from which of the following arteries?

. Lateral inferior genicular artery
. Medial inferior genicular artery
. Middle genicular artery
. Descending genicular artery
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Middle genicular artery

Explanation

Correct Answer: CThe primary blood supply to the anterior and posterior cruciate ligaments is the middle genicular artery. This artery originates from the popliteal artery, pierces the posterior joint capsule, and supplies the synovial fold that envelops the cruciate ligaments. Rupture of the ACL tears these vascular structures, leading to the rapid accumulation of blood in the joint (immediate hemarthrosis). The medial and lateral inferior genicular arteries primarily supply the menisci and peripheral joint capsule.

Question 2024

Topic: Knee Sports

An 18-year-old high school football player sustains a non-contact deceleration and pivoting injury to his knee. He develops an immediate, tense hemarthrosis. Examination reveals a 2+ Lachman test, no joint line tenderness, and a range of motion from 15 to 90 degrees. Radiographs are negative for fracture. What is the most appropriate initial management to optimize his outcome prior to definitive surgical reconstruction?

. Immediate anterior cruciate ligament (ACL) reconstruction
. Aspiration of the hemarthrosis followed by immediate ACL reconstruction
. Immobilization in full extension for 4 weeks followed by ACL reconstruction
. Physical therapy to restore full range of motion and resolve the effusion prior to ACL reconstruction
. Diagnostic arthroscopy and meniscal repair

Correct Answer & Explanation

. Physical therapy to restore full range of motion and resolve the effusion prior to ACL reconstruction

Explanation

Correct Answer: DThe patient has sustained an acute anterior cruciate ligament (ACL) tear, evidenced by the mechanism of injury, immediate hemarthrosis, and positive Lachman test. Performing an ACL reconstruction in an acutely inflamed knee with limited range of motion significantly increases the risk of postoperative arthrofibrosis (stiffness). The standard of care is to delay surgical reconstruction until the acute inflammatory phase has passed, the effusion has resolved, normal gait is restored, and full range of motion (especially full extension) is achieved. This process typically takes 3 to 6 weeks and is facilitated by "prehabilitation" physical therapy. Immediate reconstruction or prolonged immobilization would both unacceptably increase the risk of permanent knee stiffness.

Question 2025

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, the surgeon must accurately identify the native femoral footprint to ensure proper graft placement. The ACL consists of two main bundles: the anteromedial (AM) and posterolateral (PL) bundles, named according to their tibial insertions. Where does the AM bundle originate on the femur?

. High and deep on the medial wall of the lateral femoral condyle
. Low and shallow on the medial wall of the lateral femoral condyle
. High and deep on the lateral wall of the medial femoral condyle
. Low and shallow on the lateral wall of the medial femoral condyle
. Central portion of the intercondylar notch roof

Correct Answer & Explanation

. High and deep on the medial wall of the lateral femoral condyle

Explanation

Correct Answer: AThe anterior cruciate ligament (ACL) originates on the medial wall of the lateral femoral condyle and inserts on the anterior intercondylar area of the tibia. The two functional bundles, the anteromedial (AM) and posterolateral (PL), are named for their tibial insertion sites. On the femoral side (with the knee in extension), the AM bundle originates high and deep (proximal and posterior) on the medial wall of the lateral femoral condyle. The PL bundle originates lower and more shallow (distal and anterior). The AM bundle is tight in flexion and controls anterior translation, while the PL bundle is tight in extension and primarily controls rotatory stability.

Question 2026

Topic: Knee Sports

An 18-year-old football player sustains a twisting knee injury resulting in an immediate hemarthrosis. Examination reveals a 2+ Lachman test and a range of motion from 15 to 90 degrees. If an anterior cruciate ligament (ACL) reconstruction is performed immediately, the patient is at the highest risk for developing which of the following postoperative complications?

. Patellar tendon rupture
. Arthrofibrosis
. Recurrent instability
. Deep vein thrombosis
. Complex regional pain syndrome

Correct Answer & Explanation

. Arthrofibrosis

Explanation

Correct Answer: BPerforming an anterior cruciate ligament (ACL) reconstruction in the acute setting, when the knee is swollen, inflamed, and lacks full range of motion, significantly increases the risk of postoperative arthrofibrosis. Arthrofibrosis is characterized by the proliferation of scar tissue within the joint, leading to a painful restriction of motion. To minimize this risk, the standard of care is to delay ACL reconstruction until the acute inflammatory phase has resolved, the effusion has subsided, and the patient has regained full extension and at least 120 degrees of flexion. This typically takes 2 to 4 weeks of preoperative physical therapy ("prehab").

Question 2027

Topic: Knee Sports

An 18-year-old athlete undergoes evaluation for an acute anterior cruciate ligament (ACL) tear after a non-contact pivoting injury. He has a large effusion and a positive Lachman test. Which of the following meniscal tear patterns is most commonly associated with this specific acute injury?

. Medial meniscus bucket-handle tear
. Lateral meniscus posterior horn root tear
. Medial meniscus horizontal cleavage tear
. Lateral meniscus posterior horn tear
. Medial meniscus radial tear

Correct Answer & Explanation

. Lateral meniscus posterior horn tear

Explanation

Correct Answer: DMeniscal tears are highly associated with ACL injuries. In the setting of an acute ACL tear, lateral meniscus tears are more common than medial meniscus tears, occurring in up to 60-70% of cases. The most frequent location is the posterior horn of the lateral meniscus. This occurs due to the mechanism of injury, where the lateral femoral condyle subluxates posteriorly and impacts the posterior aspect of the lateral tibial plateau, trapping the lateral meniscus. Conversely, in chronic ACL deficiency, medial meniscus tears become more common. This is because the medial meniscus acts as a secondary stabilizer to anterior tibial translation; over time, the repetitive anterior shear forces lead to failure of the posterior horn of the medial meniscus.

Question 2028

Topic: Knee Sports
An 11-year-old boy sustains a Meyers and McKeever Type III fracture of the tibial eminence during a bicycle fall. Which ligamentous structure is directly involved in this avulsion injury?
. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Medial collateral ligament (MCL)
. Lateral collateral ligament (LCL)
. Patellar tendon

Correct Answer & Explanation

. Anterior cruciate ligament (ACL)

Explanation

A tibial eminence fracture in the pediatric population is a bony avulsion of the anterior cruciate ligament (ACL) insertion. A Type III fracture is completely displaced and requires surgical reduction and internal fixation.

Question 2029

Topic: Knee Sports

A 12-year-old male with open physes presents with knee pain. MRI reveals an intact, stable osteochondritis dissecans (OCD) lesion. What is the most common anatomical location for this lesion?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central portion of the trochlea
. Inferior pole of the patella
. Medial aspect of the medial femoral condyle

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The lateral aspect of the medial femoral condyle is the classic and most common location for osteochondritis dissecans (OCD) lesions in the knee. Stable lesions in patients with open physes generally heal with conservative activity modification.

Question 2030

Topic: Knee Sports
A 10-year-old boy falls off his bicycle and sustains a closed knee injury. Radiographs show a completely displaced fracture of the tibial eminence (Meyers and McKeever Type III). What is the primary anatomic structure attached to this avulsed fragment, and what is the standard treatment?
. Anterior cruciate ligament; arthroscopic or open reduction and internal fixation
. Posterior cruciate ligament; cast in extension
. Medial meniscus; arthroscopic partial meniscectomy
. Patellar tendon; tension band wiring
. Anterior cruciate ligament; cast in 90 degrees of flexion

Correct Answer & Explanation

. Posterior cruciate ligament; cast in extension

Explanation

The tibial eminence is the distal attachment site of the anterior cruciate ligament (ACL). A completely displaced (Type III) tibial spine fracture requires arthroscopic or open reduction and internal fixation to restore ACL competence and prevent mechanical block from meniscal entrapment.

Question 2031

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two distinct functional bundles. Which of the following statements correctly describes the biomechanical role of the anteromedial (AM) bundle?

. It is tightest in extension and primarily resists rotatory loads.
. It is tightest in flexion and primarily resists anterior tibial translation.
. It is tightest in extension and primarily resists anterior tibial translation.
. It is tightest in flexion and primarily resists rotatory loads.
. It remains isometric throughout the entire range of knee motion.

Correct Answer & Explanation

. It is tightest in flexion and primarily resists anterior tibial translation.

Explanation

Correct Answer: It is tightest in flexion and primarily resists anterior tibial translation.The ACL consists of the anteromedial (AM) and posterolateral (PL) bundles, named for their tibial insertion sites. The AM bundle is tightest in knee flexion and is the primary restraint to anterior tibial translation. The PL bundle is tightest in knee extension and is the primary restraint to rotatory loads (pivot shift). Understanding this anatomy is crucial for anatomic ACL reconstruction techniques.

Question 2032

Topic: Knee Sports

The anterior cruciate ligament (ACL) is the primary restraint to anterior tibial translation. It is composed of two distinct functional bundles. Which of the following statements correctly describes the biomechanical behavior of these bundles during knee range of motion?

. The anteromedial bundle is tight in extension, while the posterolateral bundle is tight in flexion
. The anteromedial bundle is tight in flexion, while the posterolateral bundle is tight in extension
. Both bundles are equally tight throughout the entire range of motion
. The posterolateral bundle primarily resists varus stress, while the anteromedial bundle resists valgus stress
. The anteromedial bundle is the primary restraint to internal rotation in full extension

Correct Answer & Explanation

. The anteromedial bundle is tight in flexion, while the posterolateral bundle is tight in extension

Explanation

Correct Answer: BThe ACL consists of the anteromedial (AM) and posterolateral (PL) bundles. Biomechanically, the AM bundle is tight in knee flexion and is the primary restraint to anterior translation at 90 degrees of flexion. The PL bundle is tight in knee extension and is the primary restraint to rotatory loads and anterior translation in near-full extension.

Question 2033

Topic: Knee Sports

The anterior cruciate ligament (ACL) is the primary restraint to anterior tibial translation. It is composed of two distinct functional bundles. Which of the following statements accurately describes the biomechanical behavior of these bundles during knee range of motion?

. The anteromedial bundle is tight in extension, while the posterolateral bundle is tight in flexion.
. The anteromedial bundle is tight in flexion, while the posterolateral bundle is tight in extension.
. Both bundles are equally tight throughout the entire range of motion.
. The posterolateral bundle primarily resists varus stress, while the anteromedial bundle resists valgus stress.
. The anteromedial bundle is the primary restraint to internal rotation in full extension.

Correct Answer & Explanation

. The anteromedial bundle is tight in flexion, while the posterolateral bundle is tight in extension.

Explanation

Correct Answer: BThe ACL consists of the anteromedial (AM) and posterolateral (PL) bundles, named for their tibial insertion sites. Biomechanically, the AM bundle tightens during knee flexion, providing primary restraint to anterior translation in the flexed position. Conversely, the PL bundle tightens during knee extension and is the primary restraint to rotatory loads (such as those tested during a pivot shift) when the knee is near full extension.

Question 2034

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, placing the femoral tunnel too anteriorly will result in which of the following postoperative biomechanical issues?

. Graft laxity in extension and tightness in flexion
. Graft tightness in extension and laxity in flexion
. Unrestricted physiological knee kinematics
. Decreased anterior translation at 30 degrees of flexion
. Premature graft rupture during pivot-shift testing

Correct Answer & Explanation

. Graft tightness in extension and laxity in flexion

Explanation

Proper femoral tunnel placement is critical in ACL reconstruction. A tunnel placed too anteriorly on the femur results in a graft that is tight in flexion and loose in extension, often leading to restricted knee flexion or eventual graft stretching.

Question 2035

Topic: Knee Sports

During an arthroscopic posterior cruciate ligament (PCL) reconstruction, the surgeon prepares the femoral footprint targeting the anterolateral bundle. Where is the anatomical insertion of this specific bundle located on the femur?

. High and deep in the medial intercondylar notch
. Low and deep in the medial intercondylar notch
. High and deep in the lateral intercondylar notch
. Low and shallow in the lateral intercondylar notch
. High and shallow in the medial intercondylar notch

Correct Answer & Explanation

. High and deep in the medial intercondylar notch

Explanation

The PCL inserts on the lateral aspect of the medial femoral condyle. The larger anterolateral bundle inserts high (superior/roof) and shallow (anterior), whereas the posteromedial bundle inserts low and deep.

Question 2036

Topic: Knee Sports

A 22-year-old female soccer player sustains a twisting knee injury. Radiographs reveal an avulsion fracture of the lateral tibial plateau (Segond fracture). This radiographic finding is most highly associated with a tear of which of the following structures?

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

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion of the anterolateral ligament complex from the lateral tibial plateau. It is considered a pathognomonic radiographic sign for an anterior cruciate ligament (ACL) tear.

Question 2037

Topic: Knee Sports

In a patient with TRPS1, progressive joint deformities in the hands most often occur due to which of the following mechanisms?

. Synovial hypertrophy and pannus formation
. Premature fusion of the cone-shaped epiphyses
. Recurrent microfractures of osteopenic bone
. Deposition of monosodium urate crystals
. Ligamentous laxity and spontaneous subluxation

Correct Answer & Explanation

. Premature fusion of the cone-shaped epiphyses

Explanation

The cone-shaped epiphyses in TRPS1 frequently undergo premature fusion. This abnormal growth plate arrest leads to shortened phalanges, angular deformities like clinodactyly, and early secondary osteoarthritis.

Question 2038

Topic: Knee Sports

During a cruciate-retaining total knee arthroplasty, the surgeon finds that the knee is well balanced and symmetric in full extension, but tight symmetrically in 90 degrees of flexion. Which of the following is the most appropriate intervention to balance the knee?

. Recut the distal femur with 2 degrees more valgus
. Recut the distal femur to remove 2 mm more bone
. Downsize the femoral component and use a thicker polyethylene insert
. Release the posterior cruciate ligament (PCL)
. Release the superficial medial collateral ligament (sMCL)

Correct Answer & Explanation

. Release the posterior cruciate ligament (PCL)

Explanation

A knee that is symmetric in extension but tight symmetrically in flexion in a cruciate-retaining implant often has a tight PCL. Releasing the PCL, increasing the posterior tibial slope, or downsizing the femoral component will increase the flexion gap without affecting the extension gap.

Question 2039

Topic: Knee Sports

A 22-year-old female collegiate soccer player sustains a non-contact rotational knee injury. Examination reveals a positive Lachman test and a positive pivot shift test, and MRI confirms an isolated, complete rupture of the anterior cruciate ligament (ACL). Regarding the native biomechanical anatomy of the ACL, which of the following statements is most accurate regarding its distinct bundles?

. The posterolateral bundle is tight in flexion and is the primary restraint to anterior translation.
. The anteromedial bundle is tight in flexion and is the primary restraint to anterior tibial translation.
. The anteromedial bundle is tight in extension and primarily controls rotatory stability.
. The posterolateral bundle originates on the medial wall of the lateral femoral condyle and inserts on the medial meniscus.
. Both bundles maintain equal tension throughout the entire range of knee motion.

Correct Answer & Explanation

. The anteromedial bundle is tight in flexion and is the primary restraint to anterior tibial translation.

Explanation

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

Question 2040

Topic: Knee Sports

During a medial opening wedge high tibial osteotomy (HTO) for a varus knee, the anterior gap is inadvertently opened significantly more than the posterior gap. What is the expected biomechanical effect on the knee?

. Increased posterior tibial slope leading to an anterior tibial translation force during weight-bearing.
. Decreased posterior tibial slope leading to a posterior tibial translation force during weight-bearing.
. Increased posterior tibial slope leading to a posterior tibial translation force during weight-bearing.
. Decreased posterior tibial slope leading to an anterior tibial translation force during weight-bearing.
. Unchanged sagittal mechanics, but increased patellofemoral tracking laterally.

Correct Answer & Explanation

. Increased posterior tibial slope leading to an anterior tibial translation force during weight-bearing.

Explanation

Opening the anterior cortex more than the posterior cortex increases the posterior tibial slope. Biomechanically, an increased posterior slope shifts the tibia anteriorly under axial load, placing increased strain on the anterior cruciate ligament (ACL).

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page