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Knee Sports MCQs

Practice Set 18 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 341

Topic: Knee Sports

A 19-year-old female presents with persistent knee instability 1 year after ACL reconstruction. Exam demonstrates a 1A Lachman but a grade 3 pivot shift.

What is the most likely technical cause for this specific failure pattern?

. Tibial tunnel placed too posteriorly
. Tibial tunnel placed too anteriorly
. Femoral tunnel placed too vertically
. Unrecognized posterolateral corner injury
. Failure of graft incorporation

Correct Answer & Explanation

. Femoral tunnel placed too vertically

Explanation

A vertically placed femoral tunnel (e.g., high in the notch at the 12 o'clock position) may adequately restore anteroposterior translation (yielding a negative Lachman test). However, it fails to control rotational forces, clinically manifesting as a persistent, high-grade pivot shift.

Question 342

Topic: Knee Sports

A 30-year-old male sustains a high-energy multiligamentous knee dislocation involving the ACL, PCL, and posterolateral corner (PLC). He presents with a complete foot drop. Which nerve is most likely injured, and what is the typical mechanism?

. Tibial nerve; stretch injury
. Common peroneal nerve; traction/stretch injury
. Saphenous nerve; direct laceration
. Deep peroneal nerve; compartment syndrome
. Sural nerve; direct contusion

Correct Answer & Explanation

. Common peroneal nerve; traction/stretch injury

Explanation

The common peroneal nerve is the most frequently injured nerve in multiligament knee injuries, particularly those with a PLC disruption. The pathomechanism is typically a stretch or traction injury (neuropraxia or axonotmesis) secondary to severe varus and hyperextension forces.

Question 343

Topic: Knee Sports

During physical examination of a patient with a suspected multiligament knee injury, the Dial test demonstrates 15 degrees of increased external rotation compared to the contralateral side at 30 degrees of knee flexion. However, there is no difference at 90 degrees of flexion. What is the diagnosis?

. Isolated PCL injury
. Isolated PLC injury
. Combined PCL and PLC injury
. Combined ACL and PLC injury
. Posteromedial corner injury

Correct Answer & Explanation

. Isolated PLC injury

Explanation

An increase of >10 degrees in external rotation at 30 degrees of flexion, with normal rotation at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. If increased external rotation is present at both 30 and 90 degrees, it signifies a combined PLC and PCL injury.

Question 344

Topic: Knee Sports

A patient presents with anterior knee pain and a sudden loss of terminal extension 4 months following an ACL reconstruction.

MRI reveals a localized soft-tissue nodule situated immediately anterior to the ACL graft in the notch. What is the most appropriate management?

. Manipulation under anesthesia
. Arthroscopic excision of the mass
. Revision ACL reconstruction
. Prolonged physical therapy and oral corticosteroids
. Ultrasound-guided aspiration

Correct Answer & Explanation

. Arthroscopic excision of the mass

Explanation

The clinical presentation and MRI findings describe a 'cyclops lesion', which is localized arthrofibrosis anterior to the ACL graft. Arthroscopic excision is the definitive treatment and reliably restores terminal knee extension.

Question 345

Topic: Knee Sports
In anatomic reconstruction of the medial patellofemoral ligament (MPFL), precise placement of the femoral attachment is critical to avoid anisometry. Radiographically (Schöttle's point), where is this isometric point located?
. Anterior to the posterior femoral cortical line and proximal to Blumensaat's line
. Posterior to the posterior femoral cortical line and distal to Blumensaat's line
. On the crest of the medial epicondyle
. At the apex of the adductor tubercle
. 1 cm proximal and 1 cm posterior to the lateral epicondyle

Correct Answer & Explanation

. Anterior to the posterior femoral cortical line and proximal to Blumensaat's line

Explanation

Schöttle's point is the radiographic landmark for the femoral origin of the MPFL. On a strict lateral radiograph, it is found 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line.

Question 346

Topic: Knee Sports

A 45-year-old male presents with chronic medial knee pain and varus malalignment. Radiographs confirm isolated medial compartment osteoarthritis. He is scheduled for a high tibial osteotomy (HTO). Which of the following conditions represents a relative contraindication to an opening wedge HTO?

. Age > 40 years
. Knee flexion contracture > 15 degrees
. Prior ACL reconstruction
. Medial meniscus deficiency
. Patient weight > 80 kg

Correct Answer & Explanation

. Knee flexion contracture > 15 degrees

Explanation

A knee flexion contracture greater than 15 degrees is a significant relative contraindication to a high tibial osteotomy, as the procedure cannot effectively correct sagittal plane deformity and patients do poorly. Other contraindications include tricompartmental OA and inflammatory arthritis.

Question 347

Topic: Knee Sports

What is the primary vascular supply to the anterior cruciate ligament (ACL)?

. Superior medial genicular artery
. Middle genicular artery
. Inferior lateral genicular artery
. Descending genicular artery
. Popliteal artery

Correct Answer & Explanation

. Middle genicular artery

Explanation

The primary blood supply to the ACL is the middle genicular artery, which branches directly off the popliteal artery and pierces the posterior joint capsule to supply the cruciate ligaments and synovial fold.

Question 348

Topic: Knee Sports

A 26-year-old male presents with persistent knee stiffness six months after an anterior cruciate ligament (ACL) reconstruction. Radiographs reveal that the femoral tunnel was placed significantly anterior to the anatomic footprint. Which of the following clinical findings is most likely expected due to this malposition?

. Loss of terminal extension
. Loss of knee flexion
. Recurrent pivot shift
. Patellar tendon rupture
. Lateral meniscus tear

Correct Answer & Explanation

. Loss of knee flexion

Explanation

Anterior placement of the femoral tunnel during ACL reconstruction results in a graft that becomes excessively tight in flexion. This biomechanical mismatch typically causes a loss of knee flexion and can eventually lead to graft stretching or failure.

Question 349

Topic: Knee Sports

A 25-year-old skier sustains a twisting injury to his left knee. He reports hearing a 'pop' and experiencing immediate swelling. A radiograph of the knee is obtained.

What is the most likely associated ligamentous injury?

. Posterior cruciate ligament tear
. Anterior cruciate ligament tear
. Medial collateral ligament tear
. Lateral collateral ligament tear
. Posterolateral corner injury

Correct Answer & Explanation

. Anterior cruciate ligament tear

Explanation

The radiograph demonstrates a Segond fracture, which is an avulsion fracture of the anterolateral proximal tibia. This finding is highly pathognomonic for an anterior cruciate ligament (ACL) tear and represents avulsion of the anterolateral complex.

Question 350

Topic: Knee Sports

A 34-year-old man presents with chronic knee instability. On physical examination, the dial test is performed in the prone position. He demonstrates 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of knee flexion, the external rotation is symmetric bilaterally. What is the most likely diagnosis?

. Isolated anterior cruciate ligament tear
. Isolated posterior cruciate ligament tear
. Combined posterior cruciate ligament and posterolateral corner injury
. Isolated posterolateral corner injury
. Combined anterior cruciate ligament and posteromedial corner injury

Correct Answer & Explanation

. Isolated posterolateral corner injury

Explanation

The dial test evaluates for posterolateral corner (PLC) and PCL injuries. Asymmetry of greater than 10 degrees at 30 degrees of flexion, which normalizes at 90 degrees, indicates an isolated PLC injury. Combined PLC and PCL injuries typically show increased external rotation at both 30 and 90 degrees.

Question 351

Topic: Knee Sports
A 19-year-old gymnast experiences a first-time lateral patellar dislocation. An MRI confirms a full-thickness tear of the medial patellofemoral ligament (MPFL). When considering anatomical reconstruction, where is the femoral origin of the MPFL located?
. Anterior to the medial epicondyle
. Directly on the adductor tubercle
. Between the medial epicondyle and the adductor tubercle
. Posterior and distal to the medial epicondyle
. At the junction of the medial collateral ligament and medial epicondyle

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle

Explanation

The femoral origin of the MPFL is located in the saddle region between the medial epicondyle and the adductor tubercle. Radiographically, Schöttle's point is used to identify this anatomic location to ensure proper graft isometry during reconstruction.

Question 352

Topic: Knee Sports

A surgeon is performing an isolated single-bundle posterior cruciate ligament (PCL) reconstruction to address chronic posterior knee instability. Which functional bundle is being reconstructed, and in what position of knee flexion is this native bundle under the most tension?

. Anterolateral bundle; knee extension
. Anterolateral bundle; knee flexion
. Posteromedial bundle; knee extension
. Posteromedial bundle; knee flexion
. Meniscofemoral bundle; knee extension

Correct Answer & Explanation

. Anterolateral bundle; knee flexion

Explanation

The anterolateral bundle is the larger and biomechanically dominant bundle of the PCL, and it is tightest in knee flexion. Single-bundle PCL reconstructions aim to recreate this anterolateral bundle to restore the primary restraint against posterior tibial translation.

Question 353

Topic: Knee Sports

A 26-year-old female presents after a twisting injury to her knee during a soccer match. Radiographs demonstrate an avulsion fracture of the lateral tibial plateau (Segond fracture). Which of the following structures is most likely injured?

. Posterior cruciate ligament (PCL)
. Popliteofibular ligament
. Medial collateral ligament (MCL)
. Anterior cruciate ligament (ACL) and Anterolateral ligament (ALL)
. Medial patellofemoral ligament (MPFL)

Correct Answer & Explanation

. Anterior cruciate ligament (ACL) and Anterolateral ligament (ALL)

Explanation

A Segond fracture is an avulsion of the anterolateral capsule and the anterolateral ligament (ALL), and it is considered highly pathognomonic for an anterior cruciate ligament (ACL) tear.

Question 354

Topic: Knee Sports

A 26-year-old rugby player sustains a PCL avulsion fracture from its tibial insertion, as depicted in the provided images.

Given the patient's age, activity level, and the nature of the injury (displaced bony avulsion), what is the most appropriate initial surgical management strategy?

. A. Non-operative management with bracing and physical therapy
. B. Arthroscopic debridement of the avulsed fragment
. C. Open reduction and internal fixation (ORIF) of the PCL avulsion via a posterior approach
. D. Primary arthroscopic PCL reconstruction with an allograft
. E. Delayed PCL reconstruction after 6-8 weeks of immobilization

Correct Answer & Explanation

. C. Open reduction and internal fixation (ORIF) of the PCL avulsion via a posterior approach

Explanation

Correct Answer: CThe candidate in the case explicitly states, 'I would offer this patient reattachment of the PCL avulsion through open procedure.' The examiner then probes about the posterior approach, which the candidate confirms. For displaced bony avulsions of the PCL, particularly in active individuals, open reduction and internal fixation (ORIF) is the standard of care to restore anatomical alignment and stability. The posterior approach is well-suited for direct visualization and fixation of these fragments.Option A (Non-operative management)is generally reserved for non-displaced or minimally displaced avulsions, or for mid-substance tears in less active individuals. A displaced fragment in a rugby player warrants surgical intervention.Option B (Arthroscopic debridement)is incorrect. Debridement would remove the fragment, leading to PCL insufficiency. The goal is reattachment and restoration of function.Option D (Primary arthroscopic PCL reconstruction with an allograft)is incorrect. While arthroscopic PCL reconstruction is a valid procedure for mid-substance tears, for a bony avulsion, the primary goal is to reattach the native ligament with its bone fragment, which offers superior healing potential (bone-to-bone) and avoids the need for a full reconstruction with a graft.Option E (Delayed PCL reconstruction)is incorrect. For a displaced bony avulsion, early fixation is crucial to prevent malunion, nonunion, and to facilitate optimal healing and rehabilitation. Delayed reconstruction would be considered for chronic PCL insufficiency, not an acute, fixable avulsion.

Question 355

Topic: Knee Sports

The case describes a posterior approach to the knee for a PCL avulsion fracture, as seen in the images.

Beyond PCL avulsion fixation, which of the following is NOT a recognized indication for a posterior approach to the knee as discussed in the case?

. A. Removal of popliteal cysts
. B. Repair of posterior vascular injuries
. C. Open reduction and internal fixation of posterior tibial plateau shear fractures
. D. Arthroscopic meniscectomy of a lateral meniscal tear
. E. Posterior inlay PCL reconstructions

Correct Answer & Explanation

. D. Arthroscopic meniscectomy of a lateral meniscal tear

Explanation

Correct Answer: DThe candidate lists several indications for the posterior approach: 'The indications include removal of popliteal cysts and neoplasms, posterior synovectomy, open reduction and internal fixation of posterior tibial plateau shear fractures, fixation of bone avulsions associated with a posterior cruciate ligament (PCL) injury, repair of posterior vascular injuries, and more recently, posterior inlay PCL reconstructions.'Option D (Arthroscopic meniscectomy of a lateral meniscal tear)is incorrect because arthroscopic meniscectomy is typically performed through standard anteromedial and anterolateral portals, not a posterior open approach. While posterior portals can be used for posterior horn meniscal pathology, the question specifies an 'open posterior approach' and 'arthroscopic meniscectomy,' which are distinct.Options A, B, C, and Eare all explicitly mentioned as indications for a posterior approach in the provided text.

Question 356

Topic: Knee Sports

Following successful fixation of the PCL avulsion, the same rugby player later sustains an ACL injury to his contralateral knee, requiring single-bundle ACL reconstruction.

For a single-bundle ACL reconstruction in a right knee, what is the optimal femoral tunnel placement, aiming for the footprint of the posterolateral bundle?

. A. 12 o'clock position
. B. 3 o'clock position
. C. 10 to 10:30 o'clock position
. D. 7 to 7:30 o'clock position
. E. 1:30 to 2 o'clock position

Correct Answer & Explanation

. C. 10 to 10:30 o'clock position

Explanation

Correct Answer: CThe candidate states: 'For the femoral tunnel the isometric point lies at about 10 to 10.30 o’clock for right knee and 1.30 to 2 for left knee.' The question specifically asks for a right knee.Option A (12 o'clock position)is generally too anterior and can lead to impingement and restricted flexion.Option B (3 o'clock position)is too anterior and lateral for a right knee, leading to similar issues as 12 o'clock.Option D (7 to 7:30 o'clock position)would be too posterior for a right knee, leading to excessive tightening in extension.Option E (1:30 to 2 o'clock position)is the optimal placement for a left knee, not a right knee, as stated in the text.

Question 357

Topic: Knee Sports

During an ACL reconstruction, a surgeon inadvertently places the femoral tunnel too anteriorly, near the 'resident's ridge,' as described in the case.

What is the most likely clinical consequence of this technical error?

. A. Excessive tightening of the graft when the knee is extended
. B. Increased incidence of patellar fracture
. C. Restriction of knee flexion and potential graft elongation
. D. Increased risk of saphenous nerve injury
. E. Faster graft incorporation due to improved blood supply

Correct Answer & Explanation

. C. Restriction of knee flexion and potential graft elongation

Explanation

Correct Answer: CThe candidate explicitly states: 'The most common mistake is to place femoral tunnel too anterior or ‘resident’s ridge’. This restricts flexion of the knee and may result in elongation of graft.' This directly answers the question.Option A (Excessive tightening of the graft when the knee is extended)is incorrect. This consequence is associated with a femoral tunnel placed too posteriorly, not too anteriorly.Option B (Increased incidence of patellar fracture)is incorrect. Patellar fracture is a potential donor site morbidity associated with BPTB grafts, not a complication of femoral tunnel malpositioning.Option D (Increased risk of saphenous nerve injury)is incorrect. Saphenous nerve injury is a potential donor site morbidity associated with hamstring graft harvest, not a complication of femoral tunnel malpositioning.Option E (Faster graft incorporation due to improved blood supply)is incorrect. Femoral tunnel placement does not directly influence graft incorporation speed in this manner, and an anterior placement is a technical error, not an advantage.

Question 358

Topic: Knee Sports

During an ACL reconstruction, after careful assessment and correct placement of the femoral and tibial tunnels, the surgeon identifies impingement on the lateral femoral condyle.

According to the case discussion, what is the appropriate next step to address this issue?

. A. Reposition the femoral tunnel more anteriorly to avoid impingement
. B. Reposition the tibial tunnel more posteriorly to avoid impingement
. C. Perform a notchplasty of the anterior portion of the lateral femoral condyle
. D. Switch to a smaller diameter graft to reduce impingement
. E. Proceed with graft insertion, as minor impingement is clinically insignificant

Correct Answer & Explanation

. C. Perform a notchplasty of the anterior portion of the lateral femoral condyle

Explanation

Correct Answer: CThe candidate states: 'Careful assessment of notch should be done prior to graft insertion using a pin to ensure no impingement on lateral femoral condyle. The presence of impingement with correct placement of tunnels necessitates notchplasty of the anterior portion of lateral femoral condyle.' This directly indicates notchplasty as the solution when impingement occurs despite correct tunnel placement.Option A (Reposition the femoral tunnel more anteriorly)is incorrect. The case explicitly states that the impingement is occurring 'with correct placement of tunnels.' Repositioning the femoral tunnel anteriorly is a common mistake that leads to other complications like restricted flexion and graft elongation, and would not be the solution if the current placement is already correct.Option B (Reposition the tibial tunnel more posteriorly)is incorrect. Similar to option A, the tunnels are assumed to be correctly placed. Altering tibial tunnel placement could lead to other issues of non-isometricity or impingement elsewhere.Option D (Switch to a smaller diameter graft)is incorrect. Graft diameter is chosen based on patient size and graft strength requirements, not as a primary solution for bony impingement from the intercondylar notch.Option E (Proceed with graft insertion, as minor impingement is clinically insignificant)is incorrect. The case emphasizes that 'abnormally narrow intercondylar notch correlates directly with increased incidence of ACL tears' and that impingement must be assessed and addressed, implying it is clinically significant and can lead to graft failure.

Question 359

Topic: Knee Sports

A 55-year-old female presents with acute medial knee pain and a popping sensation while ascending stairs. MRI demonstrates a complete radial tear of the posterior horn of the medial meniscus near its root, with 4 mm of meniscal extrusion. If left untreated, what is the most likely biomechanical consequence?

. Increased contact pressure equivalent to a total meniscectomy
. Subluxation of the patella due to altered tracking
. Spontaneous healing of the meniscal root over 6 months
. Excessive anterior translation of the tibia
. Development of a symptomatic popliteal cyst without cartilage damage

Correct Answer & Explanation

. Increased contact pressure equivalent to a total meniscectomy

Explanation

A medial meniscal root tear completely disrupts the circumferential hoop stresses of the meniscus. Biomechanically, this is functionally equivalent to a total meniscectomy, leading to exponentially increased peak contact pressures and rapid progression of osteoarthritis.

Question 360

Topic: Knee Sports

When reconstructing the medial patellofemoral ligament (MPFL) for recurrent patellar instability, understanding the native biomechanics is crucial to prevent over-constraining the joint. At which point in the range of motion does the native MPFL provide the greatest restraint to lateral patellar translation?

. From 0 to 30 degrees of flexion
. From 30 to 60 degrees of flexion
. From 60 to 90 degrees of flexion
. Beyond 90 degrees of flexion
. Equally throughout the entire range of motion

Correct Answer & Explanation

. From 0 to 30 degrees of flexion

Explanation

The MPFL is the primary soft-tissue restraint to lateral patellar translation from full extension up to 30 degrees of flexion. Beyond 30 degrees, the patella engages the trochlear groove, and bony geometry dictates stability.

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