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Knee Sports MCQs

Practice Set 13 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 241

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, placing the femoral tunnel too anteriorly will result in which of the following biomechanical consequences?

. 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 arc of motion
. The graft will be loose throughout the entire arc of motion
. The graft will impinge on the PCL

Correct Answer & Explanation

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

Explanation

An anteriorly placed femoral tunnel in ACL reconstruction causes the graft distance to increase during knee flexion. This results in the graft being overly tight in flexion, causing restricted knee motion and potential graft stretching or rupture.

Question 242

Topic: Knee Sports

The medial patellofemoral ligament (MPFL) is the primary restraint to lateral patellar translation. Where is its anatomic origin on the femur located (Schottle's point)?

. Anterior to the posterior femoral cortex and between the adductor tubercle and medial epicondyle
. Posterior to the posterior femoral cortex and distal to the medial epicondyle
. Directly on the adductor tubercle
. Proximal to the adductor tubercle along the medial supracondylar ridge
. Anterior to the medial epicondyle and distal to the joint line

Correct Answer & Explanation

. Anterior to the posterior femoral cortex and between the adductor tubercle and medial epicondyle

Explanation

Radiographically, Schottle's point defines the femoral footprint of the MPFL. It is located just anterior to a line extending the posterior femoral cortex, between the adductor tubercle proximally and the medial epicondyle distally.

Question 243

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction via an anteromedial portal, placing the knee in hyperflexion (greater than 110 degrees) while drilling the femoral tunnel primarily prevents which complication?

. Anterior cruciate ligament graft impingement against the PCL
. Posterior cortical blowout of the lateral femoral condyle
. Iatrogenic cartilage damage to the medial femoral condyle
. Misplacement of the tibial tunnel
. Fracture of the patellar articular surface

Correct Answer & Explanation

. Posterior cortical blowout of the lateral femoral condyle

Explanation

Hyperflexing the knee when drilling the femoral tunnel through an anteromedial portal directs the drill trajectory more anteriorly. This prevents violating the posterior cortex of the lateral femoral condyle (posterior blowout).

Question 244

Topic: Knee Sports

An 11-year-old girl injures her knee while playing lacrosse and develops a hemarthrosis. The most likely diagnosis is:

. Anterior cruciate ligament tear
. Patellar dislocation
. Physeal injury of the distal femur
. Tibial spine avulsion
. Medial meniscus tear

Correct Answer & Explanation

. Patellar dislocation

Explanation

The most common cause of hemarthrosis of the knee in skeletally immature patients is a patellar dislocation. Anterior cruciate ligament injuries and tibial spine avulsions are less common. Medial meniscus tears are extremely rare in this population.

Question 245

Topic: Knee Sports

In order to see the articular cartilage of the knee in a child who has knee trauma, a magnetic resonance image must include:

. T1-weighted images
. T2-weighted images
. Gradient echo sequences
. Gadolinium contrast
. Flexion and extension images

Correct Answer & Explanation

. Gradient echo sequences

Explanation

Articular cartilage may be injured during trauma to the knee and manifest as either osteochondral fractures or osteochondritis dissecans. The articular cartilage is best visualized using gradient echo sequences. Examples of this technique include fast lowangle shot (FLASH) imaging, fast imaging with steady precession (FISP), and short tau inversion recovery (STIR).

Question 246

Topic: Knee Sports

Which of the following is the most common anatomical location for Osteochondritis Dissecans (OCD) in the pediatric knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central weight-bearing dome of the medial femoral condyle
. Patellar articular surface
. Anterior aspect of the lateral femoral condyle

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.

Question 247

Topic: Knee Sports

A 10-year-old boy with open physes sustains a complete anterior cruciate ligament (ACL) tear. To minimize the risk of growth arrest, a physeal-sparing reconstruction is planned. Which autograft is most commonly used for this specific extra-articular/intra-articular technique?

. Bone-patellar tendon-bone
. Quad tendon with bone block
. Iliotibial band
. Achilles tendon
. Peroneus brevis

Correct Answer & Explanation

. Iliotibial band

Explanation

The iliotibial (IT) band is frequently used in physeal-sparing ACL reconstructions (such as the Micheli or Kocher techniques) in prepubescent children to avoid drilling across the open physes.

Question 248

Topic: Knee Sports
A 14-year-old boy sustains a Meyers-McKeever Type III anterior tibial eminence fracture during a bicycle accident. What is the most appropriate management for this specific injury pattern?
. Cylindrical cast in 20 degrees of flexion
. Hinged knee brace with full range of motion
. Arthroscopic or open reduction and internal fixation
. Excision of the bony fragment and ACL reconstruction
. Immediate physical therapy for range of motion

Correct Answer & Explanation

. Arthroscopic or open reduction and internal fixation

Explanation

Meyers-McKeever Type III fractures are completely displaced tibial eminence avulsions. They require surgical intervention (arthroscopic or open) for anatomical reduction and fixation to restore ACL competence.

Question 249

Topic: Knee Sports
A 10-year-old boy sustains a Meyers and McKeever Type III anterior tibial spine avulsion fracture. Assuming no meniscal entrapment, what is the primary indication for surgical fixation over cast immobilization?
. To prevent premature physeal closure
. To restore anterior cruciate ligament (ACL) tension and prevent laxity
. To minimize the risk of arthrofibrosis
. To address associated collateral ligament tears
. To prevent patellar subluxation

Correct Answer & Explanation

. To restore anterior cruciate ligament (ACL) tension and prevent laxity

Explanation

A Type III tibial spine fracture is completely displaced. Surgical reduction and fixation are indicated to restore proper ACL tension, prevent chronic anterior knee instability, and remove any interposed tissue that blocks anatomic reduction.

Question 250

Topic: Knee Sports

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

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central weight-bearing dome of the medial femoral condyle
. Inferior pole of the patella
. Anterior aspect of the tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for OCD lesions in the knee is the lateral aspect of the medial femoral condyle, accounting for approximately 70-80% of cases. This typically occurs due to repetitive microtrauma and vascular watershed vulnerability.

Question 251

Topic: Knee Sports

Which of the following bundles of the anterior cruciate ligament (ACL) is tightest in full knee extension and provides the primary restraint to anterior tibial translation at 0 to 20 degrees of flexion?

. Posterolateral bundle
. Anteromedial bundle
. Posteromedial bundle
. Anterolateral bundle
. Transverse intermeniscal ligament

Correct Answer & Explanation

. Posterolateral bundle

Explanation

The posterolateral (PL) bundle of the ACL is tight in extension and provides the primary restraint to anterior translation in early flexion. The anteromedial (AM) bundle becomes tight in flexion.

Question 252

Topic: Knee Sports

A 24-year-old female soccer player sustains a non-contact pivoting injury to her left knee. MRI confirms an isolated anterior cruciate ligament (ACL) tear. When performing an anatomic single-bundle ACL reconstruction, where should the femoral tunnel be positioned in relation to the lateral femoral condyle?

. High and anterior on the medial wall
. Low and posterior on the medial wall
. High and anterior on the lateral wall
. Low and posterior on the lateral wall of the notch
. Centered on the intercondylar roof

Correct Answer & Explanation

. Low and posterior on the medial wall

Explanation

The native ACL femoral footprint is located low and posterior on the medial aspect of the lateral femoral condyle within the notch. Anatomic tunnel placement in this location best restores anterior and rotational kinematics.

Question 253

Topic: Knee Sports

A 25-year-old male sustains a severe knee hyperextension injury. Plain radiographs reveal an avulsion fracture of the lateral tibial capsule (Segond fracture). This radiographic finding is most highly associated with an injury to which of the following structures?

. Posterior cruciate ligament
. Medial collateral ligament
. Anterior cruciate ligament
. Posterolateral corner
. Patellar tendon

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion fracture of the anterolateral proximal tibia and is highly pathognomonic for an anterior cruciate ligament (ACL) tear. It represents an avulsion of the anterolateral ligament complex.

Question 254

Topic: Knee Sports

A 22-year-old football player sustains a high-energy varus blow to his knee. Examination reveals significant posterolateral corner (PLC) instability. Which peripheral nerve is most commonly injured in association with this specific injury pattern?

. Tibial nerve
. Deep peroneal nerve
. Superficial peroneal nerve
. Common peroneal nerve
. Saphenous nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve is uniquely susceptible to traction injury during a varus and hyperextension force that disrupts the posterolateral corner (PLC) of the knee. Patients should be assessed for foot drop and numbness in the first web space.

Question 255

Topic: Knee Sports

During an endoscopic anterior cruciate ligament (ACL) reconstruction, the surgeon places the femoral tunnel too anteriorly. What is the expected clinical consequence of this technical error?

. The graft will be tight in flexion and loose in extension
. The graft will be loose in flexion and tight in extension
. The graft will be tight throughout the entire arc of motion
. The graft will be loose throughout the entire arc of motion
. The graft will impinge in the intercondylar notch during extension

Correct Answer & Explanation

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

Explanation

Placing the femoral tunnel too anteriorly (high in the notch) results in an ACL graft that is excessively tight in flexion and loose in extension. This can lead to a loss of full knee flexion and residual laxity in extension.

Question 256

Topic: Knee Sports

A 21-year-old female collegiate soccer player sustains a twisting knee injury, feeling a pop followed by immediate hemarthrosis. An MRI reveals a complete tear of the anterior cruciate ligament (ACL) and a peripheral longitudinal tear of the medial meniscus. Which of the following statements is true regarding meniscal repair performed concurrently with ACL reconstruction?

. Concurrent ACL reconstruction significantly decreases the biological healing rate of the meniscal repair.
. The meniscal repair has a higher healing rate compared to a repair performed in an isolated, ACL-intact knee.
. Only the avascular white-white zone tears should be surgically repaired during ACL reconstruction.
. Partial meniscectomy yields better long-term functional outcomes and less osteoarthritis than meniscal repair in this setting.
. Rehabilitation should strictly prohibit all weight-bearing for 12 weeks to protect the meniscal repair.

Correct Answer & Explanation

. The meniscal repair has a higher healing rate compared to a repair performed in an isolated, ACL-intact knee.

Explanation

Meniscal repairs performed concurrently with ACL reconstruction demonstrate significantly higher healing rates than isolated repairs. The intra-articular bleeding and pluripotent marrow elements released during the bony tunnel reaming enhance the biological healing environment.

Question 257

Topic: Knee Sports

A 24-year-old athlete sustains a severe knee twist. Physical examination reveals an isolated increase in external tibial rotation of 15 degrees compared to the contralateral knee at 30 degrees of flexion, but symmetrical rotation at 90 degrees of flexion. Injury to which of the following structures is most likely responsible?

. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Popliteofibular ligament
. Medial collateral ligament (MCL)
. Posteromedial corner

Correct Answer & Explanation

. Popliteofibular ligament

Explanation

A positive dial test showing increased external rotation at 30 degrees of flexion that reduces at 90 degrees indicates an isolated injury to the posterolateral corner (PLC). The popliteofibular ligament is one of the three primary static stabilizers of the PLC.

Question 258

Topic: Knee Sports

During reconstruction of the anterior cruciate ligament (ACL), drilling the femoral tunnel too anteriorly (shallow in the notch) will result in which of the following biomechanical consequences?

. 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 impinge on the roof of the intercondylar notch
. The graft will lack rotational stability only
. The graft will cause severe anterior knee pain without restriction of motion

Correct Answer & Explanation

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

Explanation

A femoral tunnel placed too anteriorly (high in the notch) results in a graft that becomes excessively tight in flexion, potentially limiting knee flexion. It remains relatively loose in extension, compromising stability.

Question 259

Topic: Knee Sports

A 45-year-old woman falls from a height and sustains an L1 burst fracture. She is neurologically intact. Which of the following radiographic findings is a classic indicator of posterior ligamentous complex (PLC) injury, potentially warranting surgical stabilization?

. Anterior wedge compression of 10%
. Widening of the interspinous distance
. A vertical fracture line through the vertebral body
. Retropulsion of bone into the spinal canal of 20%
. Loss of vertebral body height of 15%

Correct Answer & Explanation

. Widening of the interspinous distance

Explanation

Widening of the interspinous distance on an AP or lateral radiograph suggests tension failure and disruption of the posterior ligamentous complex (PLC). PLC incompetence renders a burst fracture mechanically unstable, often necessitating surgical stabilization.

Question 260

Topic: Knee Sports

Six months after an anterior cruciate ligament (ACL) reconstruction utilizing a bone-patellar tendon-bone autograft, a patient complains of an audible "clunk" and lack of terminal extension. MRI shows a nodular mass anterior to the tibial tunnel. This lesion is predominantly composed of:

. Hyaline cartilage
. Woven bone
. Fibrovascular tissue
. Crystalline deposits
. Foreign body giant cells

Correct Answer & Explanation

. Fibrovascular tissue

Explanation

The patient is presenting with a "Cyclops" lesion, which causes mechanical impingement and loss of terminal extension post-ACL reconstruction. Pathologically, it is a localized nodule of dense fibrovascular tissue.

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