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Knee Sports MCQs

Practice Set 19 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 361

Topic: Knee Sports

Regarding the anatomy and biomechanics of the native anterior cruciate ligament (ACL), which of the following statements is most accurate?

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

Correct Answer & Explanation

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

Explanation

The ACL consists of two main bundles. The anteromedial (AM) bundle is tight in flexion and provides primary anterior-posterior stability, while the posterolateral (PL) bundle is tight in extension and primarily controls rotational stability.

Question 362

Topic: Knee Sports

A 55-year-old female presents with sudden onset posteromedial knee pain after squatting. MRI demonstrates a radial tear at the meniscal attachment. Which of the following best explains the rapid progression of osteoarthritis often seen with this specific injury?

. Loss of the shock-absorbing properties of the articular cartilage
. Disruption of circumferential hoop stresses leading to meniscal extrusion
. Increased valgus alignment increasing medial compartment contact pressures
. Chronic hemarthrosis causing synovitis and cartilage degradation
. Incompetence of the posterior cruciate ligament

Correct Answer & Explanation

. Disruption of circumferential hoop stresses leading to meniscal extrusion

Explanation

Posterior meniscal root tears completely disrupt the circumferential hoop stresses of the meniscus. This leads to peripheral meniscal extrusion, functionally equivalent to a total meniscectomy, causing rapid articular cartilage degeneration.

Question 363

Topic: Knee Sports

A 19-year-old female presents with recurrent patellar dislocations. Advanced imaging reveals a tibial tubercle-trochlear groove (TT-TG) distance of 24 mm and a normal Patellotrochlear Index. What is the most appropriate surgical management?

. Isolated medial patellofemoral ligament (MPFL) reconstruction
. Lateral retinacular release
. Tibial tubercle anteromedialization (Fulkerson osteotomy) with MPFL reconstruction
. Trochleoplasty
. Proximal realignment (Insall procedure)

Correct Answer & Explanation

. Tibial tubercle anteromedialization (Fulkerson osteotomy) with MPFL reconstruction

Explanation

A TT-TG distance >20 mm is a strict indication for a tibial tubercle osteotomy (medialization) to correct the anatomic malalignment. This is typically combined with an MPFL reconstruction to restore the primary soft-tissue restraint.

Question 364

Topic: Knee Sports

A 30-year-old soccer player sustains a twisting injury to his knee. On examination, the dial test reveals 15 degrees of increased external rotation compared to the contralateral side at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees. What is the diagnosis?

. Isolated posterior cruciate ligament (PCL) injury
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injury
. Isolated anterior cruciate ligament (ACL) injury
. Combined ACL and posteromedial corner injury

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

The dial test assesses for posterolateral corner and PCL injuries. Asymmetry of >10 degrees at 30 degrees of flexion only indicates an isolated PLC injury. If asymmetry is present at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 365

Topic: Knee Sports

A 14-year-old boy presents with vague knee pain and intermittent catching. Radiographs demonstrate an osteochondritis dissecans (OCD) lesion. Which of the following is the most classic anatomic location for this lesion?

. Central weight-bearing dome of the lateral femoral condyle
. Posterolateral aspect of the medial femoral condyle
. Anterior aspect of the medial femoral condyle
. Inferior pole of the patella
. Lateral facet of the trochlea

Correct Answer & Explanation

. Posterolateral aspect of the medial femoral condyle

Explanation

Osteochondritis dissecans (OCD) most commonly affects the knee. The classic location, accounting for about 70% of cases, is the posterolateral aspect of the medial femoral condyle.

Question 366

Topic: Knee Sports

A 55-year-old female presents with acute medial knee pain and a feeling of "giving way" after descending stairs. MRI shows a radial tear adjacent to the posterior horn medial meniscus attachment and 4 mm of medial meniscal extrusion. What is the biomechanical consequence of this injury?

. Increased load on the lateral compartment
. Loss of hoop stresses leading to contact mechanics equivalent to a total meniscectomy
. Decreased anterior tibial translation under load
. Increased patellofemoral contact pressure
. Varus thrust during the swing phase of gait

Correct Answer & Explanation

. Loss of hoop stresses leading to contact mechanics equivalent to a total meniscectomy

Explanation

A meniscal root tear disrupts circumferential hoop stresses, rendering the meniscus functionally incompetent. This increases peak contact pressures to levels equivalent to a total meniscectomy, often leading to rapid progression of osteoarthritis.

Question 367

Topic: Knee Sports

A 19-year-old soccer player sustains a twisting knee injury. Radiographs reveal an avulsion fracture of the anterolateral tibial plateau.

This radiographic finding is virtually pathognomonic for an injury to which of the following structures?

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

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

The image describes a Segond fracture, an avulsion of the anterolateral capsule (anterolateral ligament) from the lateral tibial plateau. It is considered pathognomonic for an anterior cruciate ligament (ACL) tear.

Question 368

Topic: Knee Sports
During reconstruction of the medial patellofemoral ligament (MPFL), identifying the anatomic femoral insertion is critical. Radiographically, the Schöttle point is located:
. Anterior to the posterior cortical line and proximal to the posterior femoral condyle
. Anterior to the posterior cortical line and distal to the posterior femoral condyle
. Anterior to the posterior cortical line, proximal to the Blumensaat line, and distal to the posterior condyle origin
. Posterior to the posterior cortical line, proximal to the Blumensaat line, and distal to the posterior condyle
. At the direct center of the trochlear groove

Correct Answer & Explanation

. Anterior to the posterior cortical line, proximal to the Blumensaat line, and distal to the posterior condyle origin

Explanation

The Schöttle point marks the anatomic femoral origin of the MPFL. Radiographically, it is located just anterior to the posterior cortical line, proximal to the Blumensaat line, and just distal to the origin of the medial femoral condyle.

Question 369

Topic: Knee Sports

A patient presents with knee instability after a hyperextension injury. The dial test demonstrates 15 degrees of increased external rotation of the tibia compared to the contralateral side at 30 degrees of knee flexion, but symmetric rotation at 90 degrees of flexion. What is the most likely injury?

. Isolated posterior cruciate ligament tear
. Isolated posterolateral corner injury
. Combined ACL and PCL tear
. Combined PCL and posterolateral corner injury
. Medial collateral ligament tear

Correct Answer & Explanation

. Isolated posterolateral corner injury

Explanation

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

Question 370

Topic: Knee Sports

A 14-year-old boy presents with vague, activity-related knee pain and mechanical symptoms. Radiographs suggest osteochondritis dissecans (OCD). Which of the following is the most common anatomic location for this lesion?

. Medial aspect of the medial femoral condyle
. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Lateral aspect of the lateral femoral condyle
. Central trochlear groove

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for osteochondritis dissecans of the knee is the lateral aspect of the medial femoral condyle (accounting for about 70% of cases). It is thought to be caused by repetitive microtrauma, such as impingement from the tibial spine.

Question 371

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, identifying the correct femoral attachment (Schöttle point) is crucial. Where is this point located anatomically?
. Anterior to the medial epicondyle and proximal to the adductor tubercle
. In the saddle between the adductor tubercle and the medial epicondyle
. Directly on the medial epicondyle
. Distal to the medial epicondyle and anterior to the MCL origin
. Posterior to the adductor magnus insertion

Correct Answer & Explanation

. In the saddle between the adductor tubercle and the medial epicondyle

Explanation

The anatomic femoral origin of the MPFL is located in the saddle-shaped depression between the adductor tubercle proximally and the medial epicondyle distally. Non-anatomic graft placement is a leading cause of MPFL reconstruction failure.

Question 372

Topic: Knee Sports

A patient presents with lateral knee pain and instability after a hyperextension injury. The dial test shows 15 degrees of increased external rotation on the injured side at 30 degrees of knee flexion, but symmetric external rotation at 90 degrees of knee flexion. What does this examination finding indicate?

. Isolated anterior cruciate ligament (ACL) tear
. Isolated posterior cruciate ligament (PCL) tear
. Isolated posterolateral corner (PLC) injury
. Combined PLC and PCL injury
. Medial collateral ligament (MCL) injury

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

An increase in external rotation >10 degrees at 30 degrees of flexion but symmetric rotation at 90 degrees indicates an isolated posterolateral corner (PLC) injury. Combined PCL and PLC injuries show increased external rotation at both 30 and 90 degrees.

Question 373

Topic: Knee Sports

A 14-year-old boy presents with vague, poorly localized knee pain and intermittent swelling. Radiographs reveal an osteochondritis dissecans (OCD) lesion. In which of the following locations is this lesion most commonly found?

. Lateral aspect of the lateral femoral condyle
. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central trochlear groove

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 (seen in over 70% of cases). This location can be visualized on a notch view radiograph.

Question 374

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two distinct functional bundles: the anteromedial (AM) bundle and the posterolateral (PL) bundle. Which of the following best describes their tensioning behavior during knee range of motion?

. The AM bundle is tightest in flexion, and the PL bundle is tightest in extension.
. The AM bundle is tightest in extension, and the PL bundle is tightest in flexion.
. Both bundles maintain isometric tension throughout the full range of motion.
. The AM bundle is slack in flexion, and the PL bundle is slack in extension.
. Both bundles are tightest at 45 degrees of flexion.

Correct Answer & Explanation

. The AM bundle is tightest in flexion, and the PL bundle is tightest in extension.

Explanation

The AM bundle of the ACL is tense in knee flexion and is the primary restraint to anterior tibial translation at 90 degrees. The PL bundle is tense in knee extension and provides significant rotatory stability.

Question 375

Topic: Knee Sports

A 55-year-old male falls from a ladder, sustaining a bilateral C5-C6 facet dislocation with significant anterior translation. He presents with an ASIA C incomplete spinal cord injury. The provided image illustrates the complex anatomical relationships in the cervical spine during a dislocation event.

Considering the biomechanics of this injury, which of the following structures is most critically compromised, leading to the profound instability observed?

. Anterior Longitudinal Ligament (ALL)
. Posterior Longitudinal Ligament (PLL)
. Ligamentum Flavum (LF)
. Intervertebral Disc Annulus Fibrosus
. Posterior Ligamentous Complex (PLC)

Correct Answer & Explanation

. Posterior Ligamentous Complex (PLC)

Explanation

Correct Answer: EThe Posterior Ligamentous Complex (PLC) is the primary tension band of the cervical spine, comprising the ligamentum flavum, interspinous ligaments, supraspinous ligaments, and the facet joint capsules. In bilateral cervical facet dislocation, the severe hyperflexion and distraction forces cause complete, catastrophic disruption of the PLC. While the Anterior Longitudinal Ligament (ALL), Posterior Longitudinal Ligament (PLL), and Intervertebral Disc Annulus Fibrosus are also frequently compromised (often stripped or torn), the complete failure of the PLC is the hallmark of this injury, leading to the profound instability and anterior translation of the superior vertebral body. The Ligamentum Flavum (C) is a component of the PLC, but the entire complex's disruption is the most critical factor.

Question 376

Topic: Knee Sports

A 16-year-old male presents with recurrent lateral patellar dislocations. Clinical examination reveals a positive J-sign, patellar hypermobility, and a positive apprehension test at 20 degrees of knee flexion. Imaging shows significant trochlear dysplasia, a TT-TG distance of 22 mm, and patella alta. The patient has failed conservative management. Which of the following surgical interventions would be MOST appropriate to address the multiple anatomical risk factors in this patient?

. Isolated MPFL reconstruction with hamstring autograft.
. VMO advancement combined with lateral retinacular release.
. Trochleoplasty and combined MPFL reconstruction with tibial tubercle osteotomy for medialization and distalization.
. Tibial tubercle medialization osteotomy alone.
. Proximal realignment with arthroscopic lateral retinacular release.

Correct Answer & Explanation

. Trochleoplasty and combined MPFL reconstruction with tibial tubercle osteotomy for medialization and distalization.

Explanation

Correct Answer: CThis patient presents with a severe form of patellar instability characterized by multiple significant anatomical risk factors: severe trochlear dysplasia, markedly increased TT-TG distance (normal < 15-20 mm), and patella alta. Isolated MPFL reconstruction would address the medial restraint but not the underlying bony deformities. VMO advancement and lateral retinacular release are typically insufficient for severe bony dysplasia. Tibial tubercle medialization alone would only address the TT-TG and not the trochlear dysplasia or patella alta. Therefore, a comprehensive approach involving trochleoplasty (for the severe dysplasia), MPFL reconstruction (for the medial restraint), and a tibial tubercle osteotomy for both medialization (for TT-TG) and distalization (for patella alta) is indicated for optimal outcomes and recurrence prevention. This combination addresses all major identified risk factors.

Question 377

Topic: Knee Sports

Which of the following is considered the MOST significant risk factor for recurrent patellar instability?

. Generalized ligamentous laxity.
. First dislocation occurring after age 25.
. Absence of a torn MPFL on MRI.
. Severe trochlear dysplasia (Type C or D per Dejour classification).
. Q-angle less than 10 degrees.

Correct Answer & Explanation

. Severe trochlear dysplasia (Type C or D per Dejour classification).

Explanation

Correct Answer: DSevere trochlear dysplasia, especially Dejour Types B, C, or D, is consistently identified as the single most significant anatomical risk factor for recurrent patellar instability. The flattened or convex trochlear groove provides inadequate bony constraint against lateral patellar translation. Generalized ligamentous laxity is a risk factor but less potent than severe dysplasia. Dislocation at a younger age (especially under 15) is associated with higher recurrence rates, not older age. A torn MPFL is characteristic of acute dislocation, but its absence doesn't preclude recurrence if other factors exist; its presenceincreasesrecurrence risk if left untreated. A Q-angle less than 10 degrees would typically be protective or normal, not a risk factor; an increased Q-angle is a risk factor.

Question 378

Topic: Knee Sports

A patient with a history of recurrent patellar instability undergoes an MRI. The report indicates a TTPG (Tibial Tubercle-Trochlear Groove) distance of 20 mm. What is the clinical significance of this finding?

. It is within normal limits and unlikely to contribute to instability.
. It suggests a high likelihood of lateral patellar subluxation due to lateralization of the tibial tubercle.
. It is indicative of severe patella alta.
. It primarily correlates with quadriceps muscle imbalance.
. It necessitates immediate surgical intervention, regardless of symptoms.

Correct Answer & Explanation

. It suggests a high likelihood of lateral patellar subluxation due to lateralization of the tibial tubercle.

Explanation

Correct Answer: BA TT-TG distance of 20 mm is considered significantly elevated. Normal values are typically less than 15-20 mm, with values over 20 mm strongly correlating with patellofemoral instability due to a lateralized pull of the patellar tendon and quadriceps mechanism relative to the trochlear groove. It is a key factor indicating bony malalignment. While patella alta can coexist, TT-TG specifically measures the transverse plane relationship, not patellar height. It's a significant risk factor but doesn't necessarily dictate immediate surgery if asymptomatic or if conservative management is successful. Quadriceps imbalance can contribute but isn't directly measured by TT-TG.

Question 379

Topic: Knee Sports

A 12-year-old male with open physes experiences his second lateral patellar dislocation. X-rays show no fracture. MRI confirms MPFL rupture and normal trochlear morphology. He has no significant patella alta or increased TT-TG distance. What is the most appropriate surgical approach?

. Tibial tubercle distalization osteotomy.
. Trochleoplasty.
. MPFL reconstruction using an all-epiphyseal or transphyseal technique avoiding the growth plate.
. Lateral retinacular release alone.
. Conservative management with bracing and physiotherapy.

Correct Answer & Explanation

. MPFL reconstruction using an all-epiphyseal or transphyseal technique avoiding the growth plate.

Explanation

Correct Answer: CFor skeletally immature patients with recurrent patellar instability, MPFL reconstruction is the preferred procedure. Given the open physes, techniques that avoid or protect the growth plates are critical, such as an all-epiphyseal (transphyseal without violating growth plates) or transphyseal tunnels placed carefully to minimize growth disturbance. Tibial tubercle osteotomies and trochleoplasty are generally avoided in skeletally immature patients due to the risk of growth arrest, unless there are severe underlying bony deformities that supersede this risk (which are explicitly ruled out in this question). Conservative management has failed after the second dislocation, and lateral release alone is insufficient for MPFL rupture.

Question 380

Topic: Knee Sports

A 28-year-old female presents with persistent anterior knee pain and crepitus following an MPFL reconstruction performed 1 year ago for recurrent patellar dislocations. She reports no further dislocations but finds stairs and squatting painful. Physical exam shows no apprehension, but diffuse tenderness around the patellofemoral joint. Patellar height is normal. What is the most likely cause of her symptoms?

. Recurrent patellar instability.
. Infection of the MPFL graft.
. Over-constraining of the patella during MPFL reconstruction.
. Insufficient medialization of the tibial tubercle.
. Rupture of the MPFL graft.

Correct Answer & Explanation

. Over-constraining of the patella during MPFL reconstruction.

Explanation

Correct Answer: CPersistent anterior knee pain, particularly with activities like stairs and squatting, after an MPFL reconstruction that successfully prevented recurrence, strongly suggests patellofemoral overload or over-constraining. This is a common complication if the MPFL graft is tensioned too tightly or fixed in an incorrect position, leading to increased patellofemoral contact pressures. Recurrence is ruled out by the history. Infection would typically present with different symptoms (fever, warmth, redness, systemic signs). Insufficient medialization would lead to continued instability, not just pain without apprehension. Graft rupture would lead to recurrence.

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