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Knee Sports MCQs

Practice Set 14 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 261

Topic: Knee Sports

A 24-year-old soccer player sustains an acute knee injury with an audible "pop." Plain radiographs reveal a small, elliptic bony avulsion fragment just distal to the lateral tibial plateau. This radiographic finding is pathognomonic for a tear of which anatomical structure?

. Posterior cruciate ligament
. Medial collateral ligament
. Anterior cruciate ligament
. Lateral collateral ligament
. Popliteofibular ligament

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

The described radiographic finding is a Segond fracture, which is an avulsion of the anterolateral ligament/capsule. It is highly pathognomonic for an anterior cruciate ligament (ACL) tear.

Question 262

Topic: Knee Sports

The magnetic resonance imaging signs that suggest instability of an osteochondral dissecans lesion include all the following except:

. The presence of a low signal intensity line at the interface between the lesion and the underlying bone.
. Cartilaginous fractures.
. Focal cartilaginous defects.
. Cysts underlying the osteochondritis dissecans lesion.
. Fluid signal between lesion and bone

Correct Answer & Explanation

. Fluid signal between lesion and bone

Explanation

The presence of a high signal intensity line at the interface between the lesion and the underlying bone suggests instability of an osteochondritis dissecans lesion.

Question 263

Topic: Knee Sports

A 45-year-old male sustains an acute twisting injury to his knee. MRI demonstrates a complete anterior cruciate ligament (ACL) tear and a medial meniscus posterior root tear with 3 mm of meniscal extrusion. What is the recommended surgical treatment?

. ACL reconstruction and partial medial meniscectomy
. ACL reconstruction and meniscal root repair
. Nonoperative management with physical therapy
. Meniscal root repair alone without ACL reconstruction
. High tibial osteotomy

Correct Answer & Explanation

. ACL reconstruction and meniscal root repair

Explanation

Medial meniscus posterior root tears result in a loss of hoop stresses, functioning biomechanically like a total meniscectomy. Transtibial pull-out repair at the time of ACL reconstruction restores joint kinematics and delays the onset of osteoarthritis.

Question 264

Topic: Knee Sports

During the surgical reconstruction of a torn posterior cruciate ligament (PCL), the surgeon must accurately reproduce the native anatomy. Which of the following best describes the anatomical femoral footprint and tensioning pattern of the anterolateral (AL) bundle of the PCL?

. It attaches to the medial femoral condyle and is tightest in extension.
. It attaches to the lateral femoral condyle and is tightest in flexion.
. It attaches to the medial femoral condyle and is tightest in flexion.
. It attaches to the lateral femoral condyle and is tightest in extension.
. It attaches to the tibial plateau and is tight in all degrees of flexion.

Correct Answer & Explanation

. It attaches to the medial femoral condyle and is tightest in flexion.

Explanation

The PCL originates on the anterolateral aspect of the medial femoral condyle. The larger anterolateral (AL) bundle is tightest in knee flexion, whereas the smaller posteromedial (PM) bundle is tightest in knee extension.

Question 265

Topic: Knee Sports

In an anterior cruciate ligament (ACL) reconstruction, positioning the femoral tunnel is critical for restoring rotational stability. For a right knee, placing the tunnel at which clock face position optimally mimics the native anatomical footprint?

. 10 o'clock
. 12 o'clock
. 2 o'clock
. 8 o'clock
. 6 o'clock

Correct Answer & Explanation

. 10 o'clock

Explanation

For a right knee, placing the femoral tunnel at the 10 o'clock position (or 2 o'clock for a left knee) optimally addresses the native ACL footprint. Vertical placement at 12 o'clock restores AP stability but fails to control rotational translation.

Question 266

Topic: Knee Sports

During a physical examination of a patient with a suspected anterior cruciate ligament (ACL) injury, a positive pivot shift test is elicited. This test primarily evaluates the competency of which functional bundle of the ACL?

. Anteromedial bundle
. Anterolateral bundle
. Posteromedial bundle
. Posterolateral bundle

Correct Answer & Explanation

. Posterolateral bundle

Explanation

The posterolateral (PL) bundle of the ACL is tight in extension and is the primary restraint to rotatory instability. The pivot shift test specifically evaluates this rotatory stability provided by the PL bundle.

Question 267

Topic: Knee Sports

A 25-year-old athlete sustains a twisting knee injury. MRI reveals a full-thickness anterior cruciate ligament (ACL) tear and a displaced bucket-handle tear of the medial meniscus. What is the most appropriate management?

. Isolated ACL reconstruction
. Partial meniscectomy followed by ACL reconstruction 6 weeks later
. Concurrent ACL reconstruction and meniscal repair
. Non-operative management with bracing
. Meniscal repair only

Correct Answer & Explanation

. Concurrent ACL reconstruction and meniscal repair

Explanation

Concurrent ACL reconstruction and meniscal repair provides optimal knee stability and protects the meniscal repair. The hemarthrosis generated by the ACL reconstruction also enhances the biological environment for meniscal healing.

Question 268

Topic: Knee Sports

A 45-year-old female experiences a sudden pop in her posterior knee while squatting. MRI reveals a complete radial tear of the posterior horn of the medial meniscus at its bony attachment. Biomechanically, this injury is most equivalent to:

. A partial meniscectomy
. A total meniscectomy
. An ACL rupture
. A chondral shear injury
. An intact meniscus due to the supporting coronary ligaments

Correct Answer & Explanation

. A total meniscectomy

Explanation

A complete meniscal root tear disrupts the hoop stresses of the meniscus, resulting in radial extrusion under load. Biomechanically, this alters peak articular contact pressures equivalently to a total meniscectomy, predisposing to rapid cartilage degeneration.

Question 269

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, if the femoral tunnel is inadvertently placed too far anteriorly (shallow), what is the most likely clinical consequence during 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 arc of motion
. The graft will impinge on the posterior cruciate ligament (PCL)
. The graft will be excessively lax throughout the entire arc of motion

Correct Answer & Explanation

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

Explanation

An anteriorly placed femoral tunnel places the graft anterior to the isometric axis of rotation. This causes the ACL graft to be pathologically tight in flexion, potentially limiting knee flexion, and excessively loose in extension.

Question 270

Topic: Knee Sports

During a physical examination of a patient with a suspected multiligament knee injury, the dial test is performed. The test shows 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. Which structure is most likely injured?

. Posterior cruciate ligament only
. Posterolateral corner only
. Both posterior cruciate ligament and posterolateral corner
. Anterior cruciate ligament and medial collateral ligament
. Popliteofibular ligament and anterior cruciate ligament

Correct Answer & Explanation

. Posterolateral corner only

Explanation

The dial test measures external rotation of the tibia. Increased external rotation at 30 degrees but not at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If increased external rotation is present at both 30 and 90 degrees, a combined PLC and posterior cruciate ligament (PCL) injury is suspected.

Question 271

Topic: Knee Sports

Which of the following best describes the biomechanical consequence of an untreated posterior medial meniscal root tear?

. Minimal change in contact pressure if the peripheral rim remains intact
. Increased contact area leading to decreased peak articular contact pressures
. Biomechanical equivalent of a total meniscectomy with significantly increased peak contact pressures
. Increased tension isolated only to the anterior cruciate ligament
. Decreased hoop stresses with no change in overall joint reaction forces

Correct Answer & Explanation

. Biomechanical equivalent of a total meniscectomy with significantly increased peak contact pressures

Explanation

A posterior meniscal root tear disrupts the ability of the meniscus to convert axial loads into hoop stresses, resulting in a biomechanical state equivalent to a total meniscectomy and leading to rapid articular degeneration.

Question 272

Topic: Knee Sports

A 22-year-old soccer player sustains a twisting injury to his knee. Radiographs demonstrate an avulsion fracture of the anterolateral tibial plateau (Segond fracture). Which of the following structures is most likely injured in association with this radiographic finding?

. 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 of the anterolateral capsular complex from the proximal lateral tibia. It is considered a pathognomonic radiographic sign of an anterior cruciate ligament (ACL) tear.

Question 273

Topic: Knee Sports

Which of the following bundles of the anterior cruciate ligament (ACL) is the primary restraint to anterior tibial translation when the knee is in 90 degrees of flexion?

. Anteromedial bundle
. Posterolateral bundle
. Anterolateral bundle
. Posteromedial bundle
. Intermediate bundle

Correct Answer & Explanation

. Anteromedial bundle

Explanation

The anteromedial (AM) bundle of the ACL is tight in flexion and is the primary restraint to anterior translation at 90 degrees. The posterolateral (PL) bundle is tight in extension and primarily resists rotatory loads.

Question 274

Topic: Knee Sports

An MRI of an L2 fracture demonstrates complete disruption of the interspinous ligaments, ligamentum flavum, and facet capsules. According to the Thoracolumbar Injury Classification and Severity Score (TLICS), how many points does this posterior ligamentous complex (PLC) status contribute to the total score?

. 0 points
. 1 point
. 2 points
. 3 points
. 4 points

Correct Answer & Explanation

. 3 points

Explanation

In the TLICS system, an intact PLC is 0 points, suspected/indeterminate injury is 2 points, and a definitively disrupted PLC is assigned 3 points.

Question 275

Topic: Knee Sports
Following the initial clinical assessment, an MRI of the right knee was obtained. Review the provided sagittal T2-weighted image. Which of the following findings is most accurately depicted in this image and is consistent with the patient's presentation?
. Complete rupture of the posterior cruciate ligament with posterior tibial sag.
. A bucket-handle tear of the lateral meniscus with displacement into the intercondylar notch.
. A complete mid-substance rupture of the anterior cruciate ligament with associated bone bruising.
. A Grade III sprain of the medial collateral ligament with significant gapping.
. An osteochondral fracture of the patella with a large hemarthrosis.

Correct Answer & Explanation

. A complete mid-substance rupture of the anterior cruciate ligament with associated bone bruising.

Explanation

The provided sagittal T2-weighted MRI image, combined with the case description, clearly demonstrates a complete rupture of the anterior cruciate ligament (ACL). The ligament fibers are discontinuous, edematous, and appear amorphous. Furthermore, the image shows areas of hyperintensity (bone bruising) in the middle portion of the lateral femoral condyle and the posterior aspect of the lateral tibial plateau, which are characteristic osteochondral impaction injuries resulting from the pivot-shift mechanism.

Question 276

Topic: Knee Sports

Given the patient's age, activity level, and the presence of a high-grade pivot shift with a Segond fracture, the surgical team decided to augment the intra-articular ACL reconstruction with a Lateral Extra-articular Tenodesis (LET). Which of the following best describes the technique for the modified Lemaire LET performed in this case?

. A strip of the semitendinosus tendon is harvested, passed deep to the LCL, and fixed to the lateral femoral epicondyle and Gerdy's tubercle.
. A 1-cm wide strip of the posterior third of the iliotibial band is harvested, leaving its distal attachment at Gerdy's tubercle intact, passed deep to the fibular collateral ligament, and secured into a femoral socket proximal and posterior to the lateral epicondyle.
. The entire iliotibial band is detached proximally and distally, rerouted, and reattached to the lateral femoral condyle and fibular head.
. A synthetic graft is used to reconstruct the anterolateral ligament, fixed to the lateral femoral epicondyle and the anterolateral tibia.
. A portion of the biceps femoris tendon is harvested, passed superficial to the LCL, and fixed to the lateral femoral epicondyle.

Correct Answer & Explanation

. A 1-cm wide strip of the posterior third of the iliotibial band is harvested, leaving its distal attachment at Gerdy's tubercle intact, passed deep to the fibular collateral ligament, and secured into a femoral socket proximal and posterior to the lateral epicondyle.

Explanation

Correct Answer: BThe case explicitly details the technique for the modified Lemaire lateral extra-articular tenodesis: 'A 1-centimeter wide by 8-centimeter long strip of the posterior third of the iliotibial band was harvested, leaving its distal attachment at Gerdy's tubercle intact. The proximal end was whipstitched. The femoral attachment site was identified slightly proximal and posterior to the lateral epicondyle. A guide pin was placed, and a small socket was drilled. The iliotibial band strip was passed deep to the fibular collateral ligament. With the knee held in 30 degrees of flexion and neutral rotation, the graft was tensioned and secured into the femoral socket using a 6-millimeter bioabsorbable interference screw.'Option A is incorrectas it describes using the semitendinosus and an incorrect fixation pattern for a Lemaire.Option C is incorrectas it describes a more extensive and less common ITB tenodesis, not the modified Lemaire.Option D is incorrectas it describes an ALL reconstruction using a synthetic graft, which is not what was performed in this case.Option E is incorrectas it describes using the biceps femoris tendon and an incorrect passage relative to the LCL.

Question 277

Topic: Knee Sports

The patient's postoperative rehabilitation protocol includes specific restrictions due to the combined ACL reconstruction and meniscal repair. In Phase I (Weeks 0 to 4), what is the most critical initial weight-bearing and range of motion restriction, and what is its primary rationale?

. Full weight-bearing as tolerated with the brace locked in extension to promote quadriceps activation.
. Non-weight-bearing with crutches and unrestricted range of motion to prevent arthrofibrosis.
. Touch-down weight-bearing with crutches, brace locked in full extension, and range of motion restricted to 0-90 degrees to protect the healing meniscal repair.
. Partial weight-bearing with crutches, brace unlocked for ambulation, and full range of motion to restore gait mechanics.
. Non-weight-bearing with crutches, brace locked at 30 degrees of flexion, and range of motion restricted to 30-90 degrees to protect the ACL graft.

Correct Answer & Explanation

. Touch-down weight-bearing with crutches, brace locked in full extension, and range of motion restricted to 0-90 degrees to protect the healing meniscal repair.

Explanation

Correct Answer: CThe case explicitly states the Phase I rehabilitation goals: 'The primary goals in the immediate postoperative phase are to control inflammation, protect the graft and meniscal repair, and restore terminal extension.' It further specifies: 'Due to the all-inside repair of the posterior horn of the medial meniscus, weight-bearing was restricted. The patient was allowed touch-down weight-bearing with crutches with the brace locked in full extension. Passive and active-assisted range of motion was initiated early but restricted to 0 to 90 degrees for the first four weeks to prevent excessive shear stress on the healing meniscus.' The primary rationale for these restrictions is to protect the delicate meniscal repair during its initial healing phase, as excessive load or motion can disrupt the repair.Option A is incorrectbecause full weight-bearing is contraindicated with a meniscal repair in the early phase.Option B is incorrectbecause unrestricted range of motion would jeopardize the meniscal repair.Option D is incorrectbecause full weight-bearing and an unlocked brace are too aggressive for the initial phase of a meniscal repair.Option E is incorrectbecause locking the brace at 30 degrees of flexion would promote a flexion contracture and is not standard for ACL/meniscal repair. The ROM restriction is also not optimal.

Question 278

Topic: Knee Sports

During the arthroscopic portion of the surgery, the medial meniscus was addressed. Review the provided arthroscopic image.

Based on the image and the case description, what type of meniscal tear was identified, and what repair technique was utilized?

. A radial tear of the lateral meniscus, treated with partial meniscectomy.
. A horizontal cleavage tear of the medial meniscus, treated with an outside-in repair.
. A complex tear of the medial meniscus, treated with a meniscal root repair.
. A longitudinal vertical tear in the posterior horn of the medial meniscus, treated with an all-inside repair.
. A bucket-handle tear of the medial meniscus, treated with an inside-out repair.

Correct Answer & Explanation

. A longitudinal vertical tear in the posterior horn of the medial meniscus, treated with an all-inside repair.

Explanation

Correct Answer: DThe case description states: 'Attention was turned to the medial meniscus. Probing confirmed a 1.5-centimeter longitudinal vertical tear in the posterior horn, situated in the vascularized red-white zone. The tear was unstable, easily displacing anteriorly into the joint space. An all-inside meniscal repair technique was selected. The meniscal edges and the adjacent synovium were aggressively rasped using an arthroscopic rasp and shaver to stimulate a bleeding bed and promote a healing response. Two all-inside meniscal repair devices (suture anchors) were deployed sequentially, capturing the superior and inferior leaflets of the meniscus and reducing the tear anatomically.'Option A is incorrectbecause the tear was in the medial meniscus, not lateral, and was repaired, not partially meniscectomized.Option B is incorrectbecause it was a longitudinal vertical tear, not a horizontal cleavage tear, and an all-inside technique was used.Option C is incorrectbecause it was a longitudinal vertical tear, not described as complex, and not a root tear.Option E is incorrectbecause it was a longitudinal vertical tear, not a bucket-handle tear, and an all-inside technique was used.

Question 279

Topic: Knee Sports

The timing of ACL reconstruction is crucial to optimize outcomes and minimize complications. In this case, surgery was scheduled for four weeks post-injury. What was the primary rationale for delaying the surgical intervention, and how was the concomitant Grade II MCL sprain managed during this period?

. To allow for spontaneous healing of the ACL and MCL, potentially avoiding surgery.
. To reduce the risk of postoperative arthrofibrosis by allowing resolution of acute inflammation and restoration of knee range of motion, while managing the MCL non-operatively with bracing.
. To perform a staged repair of the MCL first, followed by ACL reconstruction.
. To allow for complete resolution of the hemarthrosis and initiation of full weight-bearing before surgery.
. To obtain additional imaging studies to rule out other injuries, while the MCL was surgically repaired.

Correct Answer & Explanation

. To reduce the risk of postoperative arthrofibrosis by allowing resolution of acute inflammation and restoration of knee range of motion, while managing the MCL non-operatively with bracing.

Explanation

Correct Answer: BThe case explicitly addresses the timing of surgery: 'Historically, acute reconstruction within the first few days of injury was associated with a high incidence of postoperative joint stiffness. Current evidence-based protocols advocate for a period of "pre-habilitation." The patient was placed in a hinged knee brace and initiated on a strict physical therapy regimen aimed at resolving the acute effusion, restoring normal gait mechanics, and achieving full, symmetric range of motion, particularly terminal extension. Surgery was scheduled for four weeks post-injury, at which point his knee was quiet, the effusion had resolved, and he had regained full extension and 125 degrees of flexion. The concomitant Grade II medial collateral ligament sprain was managed non-operatively during this waiting period. Grade I and II medial collateral ligament injuries have excellent healing potential with bracing and rarely require surgical intervention, even in the setting of anterior cruciate ligament reconstruction.'Option A is incorrectbecause spontaneous healing of a complete ACL rupture is rare, and the goal was pre-habilitation, not avoiding surgery.Option C is incorrectbecause Grade I/II MCL sprains are typically managed non-operatively, not with staged surgical repair.Option D is incorrectbecause while effusion resolution is a goal, full weight-bearing is not necessarily achieved or required before surgery, especially with a meniscal tear.Option E is incorrectbecause additional imaging was not the primary reason for delay, and the MCL was managed non-operatively.

Question 280

Topic: Knee Sports

During the surgical procedure, anatomic femoral tunnel placement is critical for successful ACL reconstruction. Which of the following describes the approach and key anatomical landmark used for femoral tunnel creation in this case?

. Transtibial drilling, aiming for the anterior aspect of the lateral femoral condyle.
. Accessory anteromedial portal, with the knee in hyperflexion, targeting the lateral bifurcate ridge and lateral intercondylar ridge on the medial wall of the lateral femoral condyle.
. Outside-in drilling, targeting the posterior aspect of the medial femoral condyle.
. Anterolateral portal, with the knee in full extension, aiming for the anterior aspect of the intercondylar notch.
. Posteromedial portal, targeting the PCL footprint on the medial femoral condyle.

Correct Answer & Explanation

. Accessory anteromedial portal, with the knee in hyperflexion, targeting the lateral bifurcate ridge and lateral intercondylar ridge on the medial wall of the lateral femoral condyle.

Explanation

Correct Answer: BThe case details the femoral tunnel preparation: 'To achieve independent and anatomic femoral tunnel placement, an accessory anteromedial portal was utilized. The knee was hyperflexed to 120 degrees. A guide pin was placed in the center of the native footprint on the medial wall of the lateral femoral condyle, specifically mentioning the lateral bifurcate ridge and the lateral intercondylar ridge (resident's ridge) as landmarks. A 10-millimeter reamer was used to drill the femoral socket to a depth of 25 millimeters.'Option A is incorrectbecause transtibial drilling often leads to a more vertical femoral tunnel, which is non-anatomic and can compromise rotational stability. The case specifies an accessory anteromedial portal.Option C is incorrectbecause the femoral tunnel is placed on the lateral femoral condyle for ACL reconstruction, not the medial.Option D is incorrectbecause the anterolateral portal is typically used for visualization, and the knee is hyperflexed for anatomic femoral tunnel drilling, not full extension.Option E is incorrectbecause the posteromedial portal is used for posterior compartment pathology or PCL reconstruction, not ACL femoral tunnel placement.

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