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Knee Sports MCQs

Practice Set 15 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 281

Topic: Knee Sports
The patient's clinical presentation, including a high-grade pivot shift and a Segond fracture, strongly suggested profound anterolateral rotatory instability. This finding significantly influenced the surgical decision-making process. What is the primary rationale for adding a Lateral Extra-articular Tenodesis (LET) to the primary ACL reconstruction in this specific patient?
. To provide additional static stability against posterior tibial translation.
. To prevent recurrent patellar dislocation in a high-risk athlete.
. To significantly reduce the risk of graft rupture and persistent rotatory laxity in young, high-risk patients.
. To augment the healing of the medial collateral ligament and prevent valgus instability.
. To address a concomitant lateral meniscal tear and improve meniscal healing.

Correct Answer & Explanation

. To significantly reduce the risk of graft rupture and persistent rotatory laxity in young, high-risk patients.

Explanation

Recent biomechanical and clinical outcome studies, including the STABILITY trial, have demonstrated that adding a LET to a primary anterior cruciate ligament reconstruction in young, high-risk patients significantly reduces the risk of graft rupture and persistent rotatory laxity.

Question 282

Topic: Knee Sports

The anterior cruciate ligament consists of two functionally distinct bundles. The anteromedial (AM) bundle is most responsible for resisting anterior tibial translation at which of the following degrees of knee flexion?

. 0 degrees
. 15 degrees
. 30 degrees
. 60 degrees
. 90 degrees

Correct Answer & Explanation

. 90 degrees

Explanation

The AM bundle is tensioned primarily in flexion and is the primary restraint to anterior tibial translation at 90 degrees. The posterolateral (PL) bundle is tensioned in extension and controls rotatory stability.

Question 283

Topic: Knee Sports

A 45-year-old female experiences acute posterior medial knee pain after squatting to lift a heavy box. MRI reveals a complete posterior root tear of the medial meniscus. Biomechanically, this injury most closely mimics the contact pressures of which of the following conditions?

. An intact meniscus
. A partial meniscectomy
. A total meniscectomy
. A bucket handle meniscus tear
. A radial tear of the anterior horn

Correct Answer & Explanation

. A total meniscectomy

Explanation

A complete posterior root tear disrupts the circumferential hoop stresses of the meniscus. Biomechanically, this results in a loss of load-sharing capability, increasing peak contact pressures to levels equivalent to a total meniscectomy.

Question 284

Topic: Knee Sports

The medial meniscus is injured more frequently than the lateral meniscus. This is largely attributed to its decreased mobility. Which anatomical structure firmly anchors the medial meniscus, limiting its excursion during knee motion?

. Anterior cruciate ligament
. Transverse intermeniscal ligament
. Deep medial collateral ligament
. Oblique popliteal ligament
. Popliteus tendon

Correct Answer & Explanation

. Deep medial collateral ligament

Explanation

The medial meniscus is firmly attached to the joint capsule and the deep fibers of the medial collateral ligament (MCL), known as the coronary ligament. This firm attachment severely restricts its mobility, making it more susceptible to tearing.

Question 285

Topic: Knee Sports

During arthroscopic repair of a meniscal tear in the avascular "white-white" zone, the surgeon elects to perform an abrasion of the intercondylar notch (trephination/notch microfracture). What is the primary biological rationale for this adjunct procedure?

. Introduction of marrow elements, growth factors, and fibrin clot
. Upregulation of matrix metalloproteinases in the synovial fluid
. Decrease in synovial fluid viscosity to reduce shear stress
. Release of intra-articular pressure to prevent suture pull-out
. Denervation of the posterior capsule to reduce postoperative pain

Correct Answer & Explanation

. Introduction of marrow elements, growth factors, and fibrin clot

Explanation

Notch abrasion or microfracture releases bone marrow, mesenchymal stem cells, and a fibrin clot into the joint. This biologic augmentation enhances the healing potential of meniscal tears in the avascular zone.

Question 286

Topic: Knee Sports



During the femoral tunnel preparation for ACL reconstruction, the surgeon identifies the lateral intercondylar ridge (resident's ridge). What is the critical anatomical significance of this landmark when placing the femoral tunnel?

. It marks the anterior border of the native ACL footprint, and the tunnel must be placed posterior to it.
. It marks the posterior border of the native ACL footprint, and the tunnel must be placed anterior to it.
. It serves as the precise center for the anteromedial (AM) bundle.
. It divides the footprints of the anterior and posterior cruciate ligaments.
. It indicates the safe zone to avoid the popliteus tendon insertion.

Correct Answer & Explanation

. It marks the anterior border of the native ACL footprint, and the tunnel must be placed posterior to it.

Explanation

The lateral intercondylar ridge (resident's ridge) represents the anterior margin of the native ACL attachment on the lateral femoral condyle. The femoral tunnel must be placed posterior to this ridge to avoid anterior graft malposition.

Question 287

Topic: Knee Sports

Which bundle of the anterior cruciate ligament (ACL) is primarily responsible for rotational stability and is tightest when the knee is in extension?

. Anteromedial bundle
. Posterolateral bundle
. Anterolateral ligament
. Posteromedial bundle
. Central meniscofemoral bundle

Correct Answer & Explanation

. Posterolateral bundle

Explanation

The ACL is composed of two primary bundles. The posterolateral bundle is tightest in extension and primarily controls rotational stability, whereas the anteromedial bundle is tightest in flexion and controls anterior-posterior translation.

Question 288

Topic: Knee Sports

A 50-year-old female experiences a pop in the back of her knee while squatting. MRI reveals a complete radial tear adjacent to the posterior horn medial meniscus root. Biomechanically, if left untreated, this injury is most equivalent to which of the following?

. Normal knee biomechanics due to capsular restraint
. Partial medial meniscectomy
. Total medial meniscectomy
. Isolated anterior cruciate ligament deficiency
. Isolated posterior cruciate ligament deficiency

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus completely disrupts the hoop stresses of the meniscus. Biomechanically, this failure of load distribution is equivalent to a total medial meniscectomy, leading to rapid compartmental chondrolysis.

Question 289

Topic: Knee Sports
Following an ACL reconstruction, a patient complains of recurrent knee giving way. On exam, the Lachman test is grade I with a firm endpoint, but the pivot shift is grade III. Radiographs show the femoral tunnel positioned at the 12 o'clock position in the intercondylar notch. What is the primary cause of this patient's instability?
. Inadequate graft tensioning at the time of fixation
. Femoral tunnel placed too anteriorly
. Femoral tunnel placed too vertically
. Tibial tunnel placed too medially
. Missed medial collateral ligament injury

Correct Answer & Explanation

. Femoral tunnel placed too vertically

Explanation

A vertically placed femoral tunnel (12 o'clock position) fails to reconstruct the posterolateral bundle's function. This results in restored anterior-posterior stability (negative Lachman) but persistent rotational instability (positive pivot shift).

Question 290

Topic: Knee Sports

The healing potential of a meniscus tear is largely dependent on its blood supply. Which of the following vascular structures are the primary source of blood supply to the peripheral aspect of the menisci?

. Descending genicular artery
. Middle genicular artery
. Medial and lateral superior and inferior genicular arteries
. Sural artery
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Medial and lateral superior and inferior genicular arteries

Explanation

The peripheral 10-30% of the meniscus (the red-red zone) is vascularized by the perimeniscal capillary plexus. This plexus is supplied predominantly by the medial and lateral branches of the superior and inferior genicular arteries.

Question 291

Topic: Knee Sports

A 28-year-old female presents with recurrent instability 2 years post-ACL reconstruction. Imaging shows a vertical femoral tunnel positioned anterior to the native footprint.

What is the most likely clinical consequence of this specific femoral tunnel malposition?

. The graft will be overly tight in extension and loose in flexion
. The graft will be overly tight in flexion, resulting in a loss of knee flexion
. The graft will cause impingement against the posterior cruciate ligament (PCL)
. The graft will lead to early isolated patellofemoral arthritis
. The graft will undergo rapid remodeling and hypertrophy

Correct Answer & Explanation

. The graft will be overly tight in flexion, resulting in a loss of knee flexion

Explanation

A femoral tunnel placed too anteriorly (high in the notch with the knee flexed) results in an ACL graft that is tight in flexion and loose in extension. Clinically, this typically presents as a significant loss of terminal knee flexion and recurrent instability.

Question 292

Topic: Knee Sports

During acute ACL reconstruction, the surgeon evaluates the menisci. A peripheral longitudinal tear at the meniscocapsular junction of the posterior horn of the medial meniscus is suspected but not clearly visualized from the standard anterolateral viewing portal. What is the best step to evaluate this lesion?

. Obtain a stat intraoperative MRI
. Establish a posteromedial portal and view with a 30- or 70-degree arthroscope
. Perform a medial arthrotomy
. Probe the anterior horn forcefully to subluxate the meniscus
. Assume the meniscus is intact and proceed with ACL reconstruction

Correct Answer & Explanation

. Establish a posteromedial portal and view with a 30- or 70-degree arthroscope

Explanation

Ramp lesions are tears at the meniscocapsular junction of the posterior horn of the medial meniscus, highly associated with ACL tears. They are frequently "blind spots" from the anterior viewing portals and require a posteromedial portal or a trans-notch view for accurate diagnosis and repair.

Question 293

Topic: Knee Sports

Which of the following blood vessels provides the primary arterial supply to the peripheral 10-30% of the medial and lateral menisci?

. Middle genicular artery
. Medial and lateral inferior genicular arteries
. Descending genicular artery
. Popliteal artery branches directly
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Medial and lateral inferior genicular arteries

Explanation

The peripheral blood supply to the menisci (the red-red zone) is provided by the perimeniscal capillary plexus, which arises predominantly from the medial and lateral inferior genicular arteries. The middle genicular artery supplies the ACL, PCL, and the synovial fold.

Question 294

Topic: Knee Sports

A surgeon is performing an ACL reconstruction using an anteromedial portal technique for femoral tunnel drilling. To minimize the risk of a critically short femoral tunnel or posterior wall blowout, at what degree of knee flexion should the knee ideally be positioned during drilling?

. 0 degrees (full extension)
. 30 degrees
. 60 degrees
. 90 degrees
. 120 degrees or greater

Correct Answer & Explanation

. 120 degrees or greater

Explanation

When using an independent anteromedial portal to drill the femoral tunnel, the knee must be hyperflexed (typically 120 degrees or more) to ensure adequate tunnel length and avoid posterior cortical blowout of the lateral femoral condyle.

Question 295

Topic: Knee Sports

During an ACL reconstruction, the surgeon evaluates the native footprints. The native anterior cruciate ligament consists of two distinct bundles. The anteromedial (AM) bundle is best described by which of the following kinematic characteristics?

. It is tightest in extension and serves as the primary restraint to rotation
. It is tightest in flexion and serves as the primary restraint to anterior tibial translation
. It is tightest in mid-flexion and serves as a secondary restraint to varus stress
. It is tightest in extension and serves as the primary restraint to anterior tibial translation
. It remains isometric throughout the entire arc of motion

Correct Answer & Explanation

. It is tightest in extension and serves as the primary restraint to anterior tibial translation

Explanation

The ACL is composed of the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle is tightest in flexion and provides the primary restraint to anterior tibial translation, whereas the PL bundle is tightest in extension and provides primary rotational stability.

Question 296

Topic: Knee Sports

During an arthroscopic ACL reconstruction, the surgeon probes the posterior aspect of the medial compartment and identifies a 'ramp lesion'. This pathology represents a tear involving which of the following specific structures?

. The meniscofemoral ligaments of Humphry and Wrisberg
. The meniscotibial (coronary) ligament at the posterior horn of the medial meniscus
. The anterior root insertion of the lateral meniscus
. The transverse intermeniscal ligament
. The popliteomeniscal fascicles

Correct Answer & Explanation

. The meniscotibial (coronary) ligament at the posterior horn of the medial meniscus

Explanation

A 'ramp lesion' is a peripheral longitudinal tear of the posterior horn of the medial meniscus located at the meniscocapsular junction. It specifically involves a disruption of the meniscotibial (coronary) ligament and is highly associated with ACL ruptures.

Question 297

Topic: Knee Sports

Which of the following describes the most common mechanism of injury for an anterior cruciate ligament (ACL) rupture?

. Direct blow to the anterior tibia with the knee in flexion
. Hyperextension injury with a varus force
. Non-contact deceleration with a rotational (valgus and external rotation) force
. Posteriorly directed force to the proximal tibia with the knee flexed
. Landing from a jump with the knee in full extension

Correct Answer & Explanation

. Non-contact deceleration with a rotational (valgus and external rotation) force

Explanation

Correct Answer: CThe most common mechanism for ACL rupture is a non-contact injury involving deceleration, cutting, or pivoting maneuvers, typically with the knee in slight flexion, valgus, and external rotation of the tibia on the femur. This creates significant tension on the ACL. A direct blow to the anterior tibia (dashboard injury) can cause a posterior cruciate ligament (PCL) injury. Hyperextension with varus force might stress the posterolateral corner, while a direct posterior force to the tibia causes PCL injury. Landing in full extension is less common than dynamic valgus loading for ACL rupture.

Question 298

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, the surgeon inadvertently places the femoral tunnel too anteriorly. What is the most likely clinical consequence?

. Laxity in extension and tightness in flexion
. Tightness in extension and laxity in flexion
. Increased rotational laxity only
. Graft impingement in the intercondylar notch during extension
. Premature osteoarthritis of the patellofemoral joint

Correct Answer & Explanation

. Tightness in extension and laxity in flexion

Explanation

An anteriorly placed femoral tunnel in ACL reconstruction results in increased distance between the attachments in flexion, causing the graft to be tight in flexion and loose in extension. A properly placed tunnel should maintain relatively isometric tension throughout motion.

Question 299

Topic: Knee Sports

Which meniscal root attachment is considered stronger and has a higher load-to-failure threshold?

. Posterior horn of the lateral meniscus.
. Anterior horn of the medial meniscus.
. Posterior horn of the medial meniscus.
. Anterior horn of the lateral meniscus.
. The transverse meniscal ligament.

Correct Answer & Explanation

. Posterior horn of the medial meniscus.

Explanation

Correct Answer: CThe posterior horn of the medial meniscus root attachment is biomechanically the strongest, resisting high loads and contributing significantly to posterior stability. Disruption of this root attachment effectively renders the medial meniscus non-functional, leading to biomechanical consequences similar to a total meniscectomy.

Question 300

Topic: Knee Sports

Loss of meniscal function due to injury or meniscectomy is most directly linked to an increased incidence of:

. Patellofemoral pain syndrome.
. Osteochondritis dissecans.
. Anterior cruciate ligament ruptures.
. Osteoarthritis of the tibiofemoral joint.
. Popliteal artery entrapment syndrome.

Correct Answer & Explanation

. Osteoarthritis of the tibiofemoral joint.

Explanation

Correct Answer: DThe menisci play a crucial role in load transmission, distributing axial loads over a larger surface area, and thereby reducing peak contact stresses on the articular cartilage. Loss of meniscal function, whether from injury or surgical removal, significantly increases peak contact pressures on the tibial and femoral condyles, leading to progressive degeneration and an increased incidence of tibiofemoral osteoarthritis.

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