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Knee Sports MCQs

Practice Set 29 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 561

Topic: Knee Sports
An 18-year-old football halfback reports that he had immediate right knee pain after being tackled 1 week ago. Examination now reveals moderate tenderness over the proximal medial tibia and lateral joint and normal cruciate stability. In evaluating the integrity of the posterolateral knee structures, what is the most reliable examination finding?
. Excessive varus laxity at 30 degrees of flexion
. Reverse pivot shift
. Posterolateral drawer laxity at 90 degrees of flexion
. Asymmetric tibial external rotation at 30 degrees of flexion
. Positive external rotation/recurvatum test

Correct Answer & Explanation

. Asymmetric tibial external rotation at 30 degrees of flexion

Explanation

DISCUSSION: The most reliable test for a relatively isolated posterolateral complex (PLC) injury is the asymmetric tibial external rotation or “dial test.” It can be performed with the patient prone or supine. When greater than 10 degrees of external rotation at 30 degrees of flexion is present when compared with the opposite knee, it indicates significant damage to the posterolateral structures. Asymmetric external rotation, which is also present at 90 degrees of flexion, indicates injury to the posterior cruciate ligament (PCL) as well. Varus laxity may indicate significant damage to both the PLC and PCL. Approximately 35% of the normal population may have a reverse pivot shift when examined under anesthesia; therefore, it is considered a less specific test. The external rotation/recurvatum and posterolateral drawer tests are adjunctive in assessing isolated posterolateral laxity but are not thought to be as reliable.

Question 562

Topic: Knee Sports
A 24-year-old male presents with a symptomatic 4.5 cm² full-thickness chondral defect on the medial femoral condyle. He has failed conservative management. What is the primary advantage of Autologous Chondrocyte Implantation (ACI) over microfracture for this specific patient?
. ACI is a single-stage procedure allowing faster return to sport
. ACI produces predominantly type II collagen hyaline-like cartilage, whereas microfracture produces type I collagen fibrocartilage
. ACI utilizes a synthetic scaffold that eliminates the need for cartilage harvest
. ACI provides immediate structural support and weight-bearing capability
. ACI has a lower overall cost and lower surgical morbidity

Correct Answer & Explanation

. ACI produces predominantly type II collagen hyaline-like cartilage, whereas microfracture produces type I collagen fibrocartilage

Explanation

For lesions >2 cm², ACI is preferred over microfracture. Microfracture relies on marrow stimulation and results in fibrocartilage repair (predominantly Type I collagen), which is less durable under shear and compressive loads. ACI (a two-stage procedure) results in the formation of hyaline-like cartilage (predominantly Type II collagen and aggrecan), providing superior long-term durability for larger defects.

Question 563

Topic: Knee Sports
What is the primary advantage of Matrix-Induced Autologous Chondrocyte Implantation (MACI) compared to traditional first-generation Autologous Chondrocyte Implantation (ACI) for treating full-thickness chondral defects?
. It can be performed as a single-stage procedure.
. It eliminates the need for a periosteal patch, reducing the risk of graft hypertrophy.
. It stimulates the production of Type I collagen predominantly, making the graft stronger.
. It utilizes allogeneic chondrocytes, eliminating donor site morbidity entirely.
. It does not require adherence to strict postoperative weight-bearing restrictions.

Correct Answer & Explanation

. It eliminates the need for a periosteal patch, reducing the risk of graft hypertrophy.

Explanation

MACI utilizes a type I/III porcine collagen bilayer membrane seeded with the patient's cultured chondrocytes. A major advantage over first-generation ACI is that it does not require harvesting a periosteal patch to cover the defect. The use of a periosteal patch in traditional ACI was associated with a high rate of graft hypertrophy (up to 25%), which MACI significantly avoids.

Question 564

Topic: Knee Sports

In a 14-year-old male with an osteochondritis dissecans (OCD) lesion of the medial femoral condyle, which of the following MRI findings is the most reliable indicator of lesion instability warranting surgical intervention over non-operative management?

. Bone marrow edema confined to the epiphysis
. A hyperintense T2 signal line extending completely behind the osteochondral fragment
. Subchondral sclerosis surrounding the lesion on T1-weighted images
. A lesion size of 1.5 cm in diameter
. Intact overlying articular cartilage visualized on proton density sequences

Correct Answer & Explanation

. Bone marrow edema confined to the epiphysis

Explanation

A high-intensity T2 signal line completely interposing between the OCD fragment and the underlying bone bed indicates that synovial fluid has tracked behind the fragment. This is a definitive sign of instability (a fluid cleft). Unstable lesions in both juveniles and adults generally require surgical stabilization, whereas stable lesions in juveniles with open physes may heal with rest.

Question 565

Topic: Knee Sports
Following a microfracture procedure for a full-thickness chondral defect of the medial femoral condyle, a marrow-stimulating healing response occurs. The resulting repair tissue that fills the defect is predominantly characterized by the presence of which of the following?
. Type II collagen and high proteoglycan content
. Type I collagen and a lack of organized hyaline architecture
. Type X collagen and extensive calcification
. Type III collagen and abundant elastic fibers
. Type IX collagen and stratified squamous epithelium

Correct Answer & Explanation

. Type I collagen and a lack of organized hyaline architecture

Explanation

Microfracture penetrates the subchondral bone plate, releasing marrow elements (MSCs) that form a super-clot. This repairs the defect with fibrocartilage, which is predominantly composed of Type I collagen, unlike native hyaline articular cartilage, which is rich in Type II collagen. Fibrocartilage has inferior biomechanical properties and wear resistance compared to hyaline cartilage.

Question 566

Topic: Knee Sports
A 24-year-old professional athlete undergoes Matrix-induced Autologous Chondrocyte Implantation (MACI) for a symptomatic 4 cm² full-thickness chondral defect on the medial femoral condyle. What histological type of tissue is predominantly expected to form in the defect at 2 years postoperatively?
. Fibrocartilage rich in Type I collagen
. Hyaline-like cartilage rich in Type II collagen
. Fibrocartilage rich in Type X collagen
. Scar tissue lacking collagen network
. Calcified cartilage rich in Type IX collagen

Correct Answer & Explanation

. Hyaline-like cartilage rich in Type II collagen

Explanation

Autologous chondrocyte implantation techniques, including MACI, are designed to generate a repair tissue that closely resembles native hyaline cartilage ('hyaline-like'), which is predominantly composed of Type II collagen. In contrast, bone marrow stimulation techniques like microfracture produce primarily Type I collagen-rich fibrocartilage.

Question 567

Topic: Knee Sports
What is the primary clinical and biological advantage of utilizing Matrix-induced Autologous Chondrocyte Implantation (MACI) compared to first-generation Autologous Chondrocyte Implantation (ACI) for focal full-thickness chondral defects?
. MACI completely eliminates the need for an initial arthroscopic cartilage harvest.
. MACI produces mature type II hyaline cartilage significantly faster than primary ACI.
. MACI utilizes a periosteal patch, increasing the integration rate with native subchondral bone.
. MACI avoids the harvest and suturing of a periosteal patch, significantly reducing the incidence of symptomatic graft hypertrophy.
. MACI relies exclusively on mesenchymal stem cells derived from bone marrow aspirate concentrate.

Correct Answer & Explanation

. MACI avoids the harvest and suturing of a periosteal patch, significantly reducing the incidence of symptomatic graft hypertrophy.

Explanation

First-generation ACI utilized a harvested periosteal patch sutured over the defect to contain the injected cultured chondrocytes. This periosteal patch was highly associated with symptomatic graft hypertrophy, often requiring reoperation for debridement. MACI seeds the cultured chondrocytes onto a biodegradable porcine collagen membrane (Type I/III), which can be glued or sutured into the defect, eliminating the need for periosteal harvest and significantly reducing the risk of graft hypertrophy.

Question 568

Topic: Knee Sports

A 14-year-old male presents with knee pain. MRI reveals an osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. Which of the following MRI findings is the most specific indicator that the OCD lesion is unstable and requires surgical fixation rather than non-operative management?

. Subchondral bone marrow edema surrounding the lesion on T2-weighted imaging.
. A high-signal T2 line completely surrounding the osteochondral fragment.
. Intact overlying articular cartilage on a T1-weighted sequence.
. Sclerotic margins bordering the defect on proton density sequences.
. Presence of multiple small subchondral cysts adjacent to the fragment.

Correct Answer & Explanation

. A high-signal T2 line completely surrounding the osteochondral fragment.

Explanation

The most specific and reliable MRI sign of instability in an OCD lesion is a high T2-signal line that completely surrounds the fragment, indicating fluid interposition between the fragment and the native bone bed (a true non-union/separation). Subchondral cysts and edema can be present in stable lesions, but a complete rim of fluid beneath the fragment confirms mechanical instability requiring surgical intervention.

Question 569

Topic: Knee Sports

The posterior horn of the medial meniscus receives its primary blood supply from what artery? Review Topic

. Middle genicular
. Medial inferior genicular
. Medial superior genicular
. Lateral superior genicular
. Inferior lateral genicular

Correct Answer & Explanation

. Middle genicular

Explanation

The middle genicular artery supplies the posterior capsule and intracapsular structures (anterior cruciate ligament, posterior cruciate ligament, posterior horns of the meniscus). The medial and lateral inferior geniculates anastomose anteriorly to form a capillary network to supply the fat pad, synovial cavity, and patellar tendon. The lateral superior and inferior genicular arteries supply the lateral retinaculum.

Question 570

Topic: Knee Sports
A 16-year-old football player sustains a direct blow to the anterior aspect of his flexed right knee. Examination reveals a contusion over the anterior tibial tubercle and a small effusion. MRI scans are shown in Figures 33a through 33c. What is the most likely diagnosis?
. Partial tear of the patellar tendon
. Osteochondral fracture of the femur
. Anterior cruciate ligament (ACL) tear
. Posterior cruciate ligament (PCL) tear
. Patella fracture

Correct Answer & Explanation

. Posterior cruciate ligament (PCL) tear

Explanation

DISCUSSION: The MRI scans show disruption of the fibers of the PCL. Patients sustaining an isolated acute PCL injury can present with only minimal discomfort and have full range of motion. When examination reveals a contusion over the tibial tubercle and discomfort with the posterior drawer examination, with or without instability, a possible injury to the PCL should be considered. In acute injuries, the reported accuracy of MRI imaging for diagnosing PCL tears ranges from 96% to 100%. REFERENCES: Resnick D, Kang HS: Internal Derangement of Joints: Emphasis on MRI Imaging. Philadelphia, PA, WB Saunders, 1997, pp 699-700. Harner CD, Hoher J: Evaluation and treatment of posterior cruciate ligament injuries. Am J Sports Med 1998;26:471-482. Fischer SP, Fox JM, Del Pizzo W, Friedman MJ, Snyder SJ, Ferkel RD: Accuracy of diagnoses from magnetic imaging of the knee: A multi-center analysis of one thousand and fourteen patients. J Bone Joint Surg Am 1991;73:2-10.

Question 571

Topic: Knee Sports

A lateral extra-articular tenodesis (LET) is frequently added to revision anterior cruciate ligament (ACL) reconstructions to control rotational laxity. The anterolateral ligament (ALL), often the anatomical target of this augmentation, inserts on the tibia at which of the following locations?

. Directly on Gerdy's tubercle
. The apex of the fibular head
. Midway between Gerdy's tubercle and the anterior margin of the fibular head
. Medial to the tibial tuberosity
. The anterior margin of the lateral collateral ligament insertion

Correct Answer & Explanation

. Directly on Gerdy's tubercle

Explanation

The anterolateral ligament (ALL) originates near the lateral epicondyle of the femur and inserts on the proximal lateral tibia, midway between Gerdy's tubercle and the anterior margin of the fibular head, approximately 5 mm distal to the joint line.

Question 572

Topic: Knee Sports

A 45-year-old female undergoes an MRI of her knee, which demonstrates a complete tear of the posterior root of the medial meniscus. If left untreated, biomechanical studies demonstrate that this injury alters knee joint contact pressures to a level most equivalent to which of the following?

. A normal knee with intact menisci
. A knee after a 25% partial meniscectomy
. A knee after a total meniscectomy
. An ACL-deficient knee
. A PCL-deficient knee

Correct Answer & Explanation

. A normal knee with intact menisci

Explanation

A posterior root tear of the medial meniscus disrupts the circumferential hoop stresses of the meniscus, leading to extrusion of the meniscus during axial loading. Biomechanically, this functional loss is equivalent to a total meniscectomy, severely increasing peak articular contact pressures and accelerating osteoarthritis.

Question 573

Topic: Knee Sports

A 16-year-old female is undergoing a medial patellofemoral ligament (MPFL) reconstruction. The surgeon uses intraoperative fluoroscopy to identify Schottle's point for the femoral attachment. Which of the following best describes the location of Schottle's point on a perfect lateral radiograph?

. 1 mm anterior to the posterior femoral cortical extension line, and proximal to Blumensaat's line
. 1 mm posterior to the posterior femoral cortical extension line, and distal to Blumensaat's line
. 5 mm anterior to the posterior femoral cortical extension line, exactly on Blumensaat's line
. 5 mm posterior to the posterior femoral cortical extension line, and proximal to Blumensaat's line
. 1 mm anterior to the posterior femoral cortical extension line, and distal to Blumensaat's line

Correct Answer & Explanation

. 1 mm anterior to the posterior femoral cortical extension line, and proximal to Blumensaat's line

Explanation

Schottle's point anatomically approximates the femoral origin of the MPFL. Radiographically, on a true lateral view, it is located 1 mm anterior to the line extending the posterior femoral cortex, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of Blumensaat's line.

Question 574

Topic: Knee Sports

The posterior cruciate ligament (PCL) consists of two distinct functional bundles. Which of the following statements correctly describes the biomechanical properties of the anterolateral (AL) bundle?

. It is tight in extension and loose in flexion
. It is tight in flexion and loose in extension
. It is the primary restraint to valgus stress at 30 degrees of flexion
. It is the smaller and weaker of the two bundles
. It originates on the lateral aspect of the lateral femoral condyle

Correct Answer & Explanation

. It is tight in extension and loose in flexion

Explanation

The PCL consists of the larger, stiffer anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle is tight in flexion and loose in extension, whereas the PM bundle is tight in extension and loose in flexion. The PCL originates on the lateral aspect of the medial femoral condyle.

Question 575

Topic: Knee Sports

During a routine ACL reconstruction on a 19-year-old soccer player, the surgeon systematically evaluates the menisci and identifies a 'ramp lesion' utilizing a posteromedial portal. A ramp lesion specifically describes a tear at which of the following anatomic locations?

. The meniscocapsular and meniscotibial attachments of the posterior horn of the medial meniscus
. The radial margin of the medial meniscus mid-body
. The true posterior root attachment of the medial meniscus to the tibial plateau
. The attachments of the meniscofemoral ligaments (Wrisberg and Humphrey)
. The meniscocapsular junction of the anterior horn of the lateral meniscus

Correct Answer & Explanation

. The meniscocapsular and meniscotibial attachments of the posterior horn of the medial meniscus

Explanation

A ramp lesion is a peripheral tear involving the meniscocapsular and meniscotibial attachments of the posterior horn of the medial meniscus. It is highly associated with acute ACL ruptures and is often missed if a systematic evaluation of the posteromedial compartment (via the intercondylar notch or a dedicated posteromedial portal) is not performed.

Question 576

Topic: Knee Sports
A 28-year-old male sustains a multiligamentous knee injury. Which of the following injury patterns (Schenck classification) carries the highest risk of associated common peroneal nerve injury?
. Anterior knee dislocation without rotatory instability
. Posterior knee dislocation without rotatory instability
. KD-III-M (ACL, PCL, Medial side disrupted)
. KD-III-L (ACL, PCL, Lateral side disrupted)
. KD-I (Isolated ACL or PCL with dislocation)

Correct Answer & Explanation

. KD-III-L (ACL, PCL, Lateral side disrupted)

Explanation

Multiligament knee injuries involving the posterolateral corner (PLC) and lateral side (KD-III-L) are most highly associated with common peroneal nerve palsies. This is often due to the traction mechanism (varus and hyperextension) that injures both the lateral structures and the tethered peroneal nerve.

Question 577

Topic: Knee Sports

When performing a posterior cruciate ligament (PCL) reconstruction, the tibial inlay technique was developed primarily to avoid which of the following phenomena associated with the transtibial technique?

. Popliteal artery injury during tunnel reaming
. Anterior knee pain from graft harvest
. The "killer turn" effect on the graft
. Postoperative extension deficit
. Iatrogenic damage to the medial meniscus root

Correct Answer & Explanation

. Popliteal artery injury during tunnel reaming

Explanation

The tibial inlay technique avoids the acute sharp angle (the "killer turn") that the graft must negotiate when passed through a transtibial tunnel and over the posterior proximal tibia. This acute angle is theorized to lead to graft abrasion, attenuation, and eventual failure over time.

Question 578

Topic: Knee Sports
In medial patellofemoral ligament (MPFL) reconstruction, incorrect femoral tunnel placement is the most common cause of graft failure. If the femoral tunnel is placed erroneously proximal to the anatomic footprint (Schöttle point), how will the graft tension behave during knee range of motion?
. The graft will maintain isometric tension throughout motion.
. The graft will become excessively tight in flexion and loose in extension.
. The graft will become excessively tight in extension and loose in flexion.
. The graft will exclusively limit terminal extension.
. The graft will only be tight between 30 and 60 degrees of flexion.

Correct Answer & Explanation

. The graft will become excessively tight in flexion and loose in extension.

Explanation

The MPFL normally acts as a checkrein primarily in early flexion (0-30 degrees). If the femoral tunnel is placed too far proximal, the distance between the patellar and femoral attachments increases as the knee goes into deeper flexion. This causes the graft to become excessively tight in flexion, leading to medial patellar overload, stiffness, or graft failure.

Question 579

Topic: Knee Sports

A complete radial tear adjacent to the posterior horn medial meniscus root attachment alters the biomechanics of the knee joint. Biomechanical studies have shown that peak contact pressures in this scenario most closely resemble which of the following conditions?

. An intact meniscus
. Total meniscectomy
. Partial meniscectomy
. Peripheral longitudinal tear repaired with inside-out technique
. Bucket-handle meniscal tear

Correct Answer & Explanation

. An intact meniscus

Explanation

A complete radial tear at or near the meniscal root completely disrupts the circumferential hoop fibers of the meniscus. Biomechanically, this leads to extrusion of the meniscus under axial load, effectively eliminating its load-sharing capability. Consequently, the peak contact pressures and contact areas in the medial compartment become essentially equivalent to those seen in a knee following a total meniscectomy.

Question 580

Topic: Knee Sports

A 12-year-old patient presents with vague knee pain and is diagnosed with Osteochondritis Dissecans (OCD) of the medial femoral condyle. Which of the following is the most reliable predictor of spontaneous healing with non-operative management?

. Lesion size greater than 2 cm
. Open distal femoral and proximal tibial physes
. Location on the central weight-bearing aspect of the lateral condyle
. Presence of mechanical symptoms such as catching or locking
. Sclerotic margins surrounding the lesion on plain radiographs

Correct Answer & Explanation

. Lesion size greater than 2 cm

Explanation

The healing potential of OCD lesions in the knee is highly correlated with skeletal maturity. Juvenile OCD (patients with open physes) has a very high rate of spontaneous healing with non-operative management (e.g., rest, activity modification). In contrast, adult OCD (closed physes), larger lesions, cystic changes, or sclerotic margins suggest a poor prognosis for non-operative healing.

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