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Knee Sports MCQs

Practice Set 3 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 41

Topic: Knee Sports

Which bundle of the anterior cruciate ligament (ACL) is responsible for primarily resisting anterior tibial translation when the knee is in near-full extension?

. Anteromedial (AM) bundle
. Posterolateral (PL) bundle
. Anterolateral (AL) bundle
. Posteromedial (PM) bundle
. Ligament of Wrisberg

Correct Answer & Explanation

. Posterolateral (PL) bundle

Explanation

The posterolateral (PL) bundle of the ACL is tightest in extension. It serves as the primary restraint to both anterior tibial translation and rotatory loads when the knee is near full extension.

Question 42

Topic: Knee Sports

A posterior root tear of the medial meniscus in a 50-year-old patient typically results in biomechanical alterations most closely resembling which of the following scenarios?

. A partial medial meniscectomy
. A bucket-handle meniscus tear
. A total medial meniscectomy
. An anterior horn radial tear
. An intact meniscus under heavy physiological load

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A posterior root tear effectively abolishes the hoop stresses of the meniscus, leading to extrusion under load. Biomechanically, this distributes tibiofemoral contact pressures in a manner nearly identical to a total meniscectomy.

Question 43

Topic: Knee Sports
When performing a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the anatomic femoral attachment (Schöttle's point) is best described radiographically as being located:
. Anterior to the posterior femoral cortical line and distal to Blumensaat's line
. Posterior to the posterior femoral cortical line and proximal to Blumensaat's line
. Between the medial epicondyle and the adductor tubercle
. 10 mm distal to the medial epicondyle
. Directly on the medial epicondyle

Correct Answer & Explanation

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

Explanation

Anatomically, Schöttle's point is located in the saddle between the medial epicondyle and adductor tubercle. Radiographically, it is located roughly 1 mm anterior to the posterior femoral cortical line and 2.5 mm distal to the posterior origin of the medial femoral condyle.

Question 44

Topic: Knee Sports

When using the tibial external rotation test on a patient, increased external rotation at 30° and 90° of knee flexion is indicative of:

. Anterior cruciate ligament injury
. Posterior cruciate ligament injury
. Isolated posterolateral corner injury
. Posterior cruciate and posterolateral corner injury
. Anterior cruciate and posterior cruciate ligament injury

Correct Answer & Explanation

. Posterior cruciate and posterolateral corner injury

Explanation

The tibial external rotation test is performed at 30° and 90° of knee flexion. The degree of foot external rotation with regard to the femur is evaluated. Increased external rotation at 30° is consistent with an isolated posterolateral corner injury. Increased external rotation at 30° and 90° is consistent with a combined posterolateral and posterior cruciate ligament injury.

Question 45

Topic: Knee Sports

The recommended treatment for an acute combined anterior cruciate ligament and complete posterolateral corner disruption in a young athlete is:

. Anterior cruciate ligament reconstruction alone
. Nonoperative treatment emphasizing quadriceps strengthening
. Anterior cruciate ligament reconstruction and posterolateral corner repair
. Anterior cruciate ligament repair and posterolateral corner repair
. Posterolateral corner repair alone

Correct Answer & Explanation

. Anterior cruciate ligament reconstruction and posterolateral corner repair

Explanation

In cases of combined cruciate ligament and posterolateral corner injuries, most surgeons recommend addressing both injuries. In one study, the most common cause of anterior cruciate ligament failure was unrecognized and untreated concomitant posterolateral corner injuries.

Question 46

Topic: Knee Sports

The ideal timing for repair of an acute posterolateral corner knee injury is:

. In the first 3 weeks
. 4 to 6 weeks
. 8 to 12 weeks
. Acute repair is unsuccessful, and late reconstruction is recommended.
. Surgery is rarely needed for complete posterolateral corner injuries.

Correct Answer & Explanation

. In the first 3 weeks

Explanation

Surgical repair of posterolateral corner injuries is recommended within the first several weeks because dissection can be difficult and can result in the need for a reconstruction with longer delays. Results of chronic posterolateral corner injury repairs are inferior to those for acute posterolateral corner injuries.

Question 47

Topic: Knee Sports

Which of the following exercises must be delayed for up to 3 months after posterolateral corner repair or reconstruction of the knee:

. Range of motion exercises
. Isometric quadriceps exercises
. Closed chain quadriceps exercises
. Hamstring exercises
. All of the above answers should be started immediately

Correct Answer & Explanation

. Hamstring exercises

Explanation

Postoperative rehabilitation for posterolateral corner repair or reconstruction involves early protected or nonweight bearing, early range of motion exercises, and quadriceps exercises. Avoidance of hamstring exercises for up to 12 weeks is recommended to decrease external rotational torque and posterior subluxation forces at the knee joint.

Question 48

Topic: Knee Sports

Which of the following structures constitute the primary static stabilizers of the posterolateral corner (PLC) of the knee?

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament
. Biceps femoris, lateral collateral ligament, and iliotibial band
. Popliteus tendon, arcuate ligament, and fabellofibular ligament
. Lateral collateral ligament, anterolateral ligament, and popliteus tendon
. Coronary ligament, lateral collateral ligament, and popliteofibular ligament

Correct Answer & Explanation

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

The primary static stabilizers of the PLC are the lateral collateral ligament (LCL), the popliteus tendon, and the popliteofibular ligament (PFL). These structures primarily resist varus stress and external rotation of the tibia.

Question 49

Topic: Knee Sports

During the tibial external rotation (dial) test, a patient exhibits 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side, but normal external rotation at 90 degrees. This finding is most indicative of an isolated injury to which of the following?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Posterolateral corner
. Posteromedial corner
. Medial collateral ligament

Correct Answer & Explanation

. Posterolateral corner

Explanation

Increased external rotation at 30 degrees of flexion only indicates an isolated posterolateral corner (PLC) injury. If increased rotation is present at both 30 and 90 degrees, a combined PLC and PCL injury is suspected.

Question 50

Topic: Knee Sports

Which of the following clinical tests is most specific for diagnosing a posterolateral corner (PLC) deficiency in the knee?

. Pivot shift test
. Reverse pivot shift test
. Lachman test
. Anterior drawer test
. Quadriceps active test

Correct Answer & Explanation

. Reverse pivot shift test

Explanation

The reverse pivot shift test evaluates PLC instability. The knee is brought from flexion to extension with a valgus and external rotation force; a palpable clunk occurs as the posteriorly subluxated lateral tibial plateau reduces.

Question 51

Topic: Knee Sports

The posterior cruciate ligament (PCL) consists of two main functional bundles. Which of the following statements regarding the anterolateral (AL) bundle is correct?

. It is the smaller of the two bundles.
. It is tightest in knee extension.
. It is tightest in knee flexion.
. It primarily resists valgus stress.
. It originates on the lateral femoral condyle.

Correct Answer & Explanation

. It is tightest in knee flexion.

Explanation

The PCL is composed of a larger anterolateral (AL) bundle and a smaller posteromedial (PM) bundle. The AL bundle is tight in flexion and loose in extension, whereas the PM bundle is tight in extension.

Question 52

Topic: Knee Sports
A 25-year-old soccer player sustains an acute combined Grade III femoral-sided medial collateral ligament (MCL) tear and an anterior cruciate ligament (ACL) rupture. What is the most widely accepted treatment strategy for this injury pattern?
. Acute repair of both ACL and MCL
. Acute repair of MCL followed by delayed ACL reconstruction
. ACL reconstruction with nonoperative management of the MCL using a hinged brace
. Nonoperative management of both ligaments
. Acute ACL reconstruction with staged MCL reconstruction

Correct Answer & Explanation

. ACL reconstruction with nonoperative management of the MCL using a hinged brace

Explanation

The standard treatment for a combined ACL tear and a femoral-sided Grade III MCL tear is ACL reconstruction with conservative management of the MCL in a hinged brace, as the MCL has excellent healing potential.

Question 53

Topic: Knee Sports

Which of the following arteries provides the primary blood supply to the anterior cruciate ligament (ACL)?

. Lateral inferior genicular artery
. Medial inferior genicular artery
. Middle genicular artery
. Descending genicular artery
. Superior medial genicular artery

Correct Answer & Explanation

. Middle genicular artery

Explanation

The middle genicular artery, a branch of the popliteal artery, pierces the posterior capsule to provide the primary blood supply to the cruciate ligaments and the synovial fold.

Question 54

Topic: Knee Sports

During the evaluation of a patient with a suspected knee ligament injury, the quadriceps active test is performed. The knee is flexed to 90 degrees, and the patient is asked to slide their foot forward against resistance. An anterior shift of the tibia is noted. This finding indicates a deficiency of the:

. Anterior cruciate ligament
. Posterior cruciate ligament
. Medial collateral ligament
. Posterolateral corner
. Posteromedial corner

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

The quadriceps active test assesses for a PCL tear. In a PCL-deficient knee flexed to 90 degrees, the tibia sags posteriorly. Contraction of the quadriceps pulls the tibia anteriorly into its reduced anatomical position.

Question 55

Topic: Knee Sports

A 24-year-old male sustains a traumatic knee dislocation resulting in a combined ACL, PCL, and posterolateral corner (PLC) injury. He is noted to have foot drop on the affected side. Injury to which of the following nerves is most likely?

. Tibial nerve
. Femoral nerve
. Obturator nerve
. Common peroneal nerve
. Sural nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve is the most frequently injured nerve in knee dislocations, particularly those involving disruption of the posterolateral corner and lateral side structures. It typically presents as a foot drop.

Question 56

Topic: Knee Sports

A clinical examination of a knee shows increased external rotation of the tibia at 30 degrees of flexion that normalizes at 90 degrees.

To reconstruct the primary deficient structures in this specific injury pattern, grafts should be routed to replicate the functions of which anatomical structures?

. LCL, popliteus tendon, and PCL
. LCL, popliteus tendon, and popliteofibular ligament
. POL, semimembranosus, and MCL
. ACL, LCL, and popliteus tendon
. Popliteus tendon, ALL, and IT band

Correct Answer & Explanation

. LCL, popliteus tendon, and popliteofibular ligament

Explanation

The described examination indicates an isolated PLC injury. Anatomical reconstruction of the PLC aims to replicate the functions of the lateral collateral ligament, popliteus tendon, and popliteofibular ligament.

Question 57

Topic: Knee Sports
According to the Schenck classification of knee dislocations (KD), a patient who sustains tears to both the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL), with intact collateral ligaments, is classified as:
. KD I
. KD II
. KD III
. KD IV
. KD V

Correct Answer & Explanation

. KD II

Explanation

In the Schenck classification, KD II refers to tears of both the ACL and PCL, with intact collateral ligaments. KD III involves both cruciates plus one collateral, and KD IV involves all four major ligaments.

Question 58

Topic: Knee Sports
A patient presents with a knee injury. The dial test shows >10 degrees of external rotation asymmetry at 30 degrees of knee flexion, but symmetric rotation at 90 degrees. Which structure is most likely injured?
. Isolated anterior cruciate ligament
. Isolated posterior cruciate ligament
. Isolated posterolateral corner
. Combined posterior cruciate ligament and posterolateral corner
. Isolated lateral collateral ligament

Correct Answer & Explanation

. Isolated posterolateral corner

Explanation

Isolated asymmetry at 30 degrees of flexion indicates an isolated posterolateral corner (PLC) injury. If asymmetry is present at both 30 and 90 degrees, it suggests a combined PLC and PCL injury.

Question 59

Topic: Knee Sports

A 35-year-old male presents with chronic posterolateral knee instability and varus malalignment following an old injury. He is scheduled for a posterolateral corner (PLC) reconstruction. What is the most appropriate initial surgical management?

. Isolated anatomic PLC reconstruction
. High tibial osteotomy
. Distal femoral osteotomy
. ACL reconstruction followed by PLC reconstruction
. Total knee arthroplasty

Correct Answer & Explanation

. High tibial osteotomy

Explanation

In patients with chronic PLC instability and varus mechanical alignment, a high tibial osteotomy (HTO) should be performed first or concurrently. Performing a soft tissue reconstruction without correcting the bony varus alignment will predictably lead to graft stretching and failure.

Question 60

Topic: Knee Sports

Which of the following nerves is most frequently injured in the setting of a severe posterolateral corner (PLC) injury or knee dislocation?

. Tibial nerve
. Common peroneal nerve
. Saphenous nerve
. Sural nerve
. Deep peroneal nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve is uniquely tethered around the fibular neck and is highly susceptible to traction injury during a varus and hyperextension mechanism typical of PLC injuries. It occurs in up to 15-30% of knee dislocations.

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