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Knee Sports MCQs

Practice Set 30 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 581

Topic: Knee Sports

During a physical examination of a knee following acute trauma, the dial test (tibial external rotation) demonstrates 15 degrees of increased external rotation at 30 degrees of flexion compared to the contralateral side. At 90 degrees of flexion, the external rotation is identical to the normal side. What is the most likely diagnosis?

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

Correct Answer & Explanation

. Isolated anterior cruciate ligament (ACL) injury

Explanation

The dial test assesses injury to the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of knee flexion but NOT at 90 degrees indicates an isolated PLC injury. If increased external rotation is present at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 582

Topic: Knee Sports

A 30-year-old football player sustains a posterolateral corner (PLC) knee injury. Which physical exam finding best differentiates an isolated PLC injury from a combined PCL and PLC injury?

. Positive dial test at 30 degrees only
. Positive dial test at both 30 and 90 degrees
. Positive pivot shift
. Positive Lachman test
. Varus gapping at 0 degrees

Correct Answer & Explanation

. Positive dial test at 30 degrees only

Explanation

An isolated PLC injury typically presents with increased external rotation (positive dial test) at 30 degrees of knee flexion but not at 90 degrees. Increased external rotation at both 30 and 90 degrees indicates a combined PCL and PLC injury.

Question 583

Topic: Knee Sports

During a medial patellofemoral ligament (MPFL) reconstruction, the femoral tunnel is being localized. According to Schottle's radiographic criteria on a true lateral radiograph, where should the anatomic femoral footprint be positioned?

. Anterior to the posterior cortical line and distal to the posterior aspect of Blumensaat's line
. Posterior to the posterior cortical line and proximal to the posterior aspect of Blumensaat's line
. Anterior to the posterior cortical line and proximal to the posterior aspect of Blumensaat's line
. Posterior to the posterior cortical line and distal to the posterior aspect of Blumensaat's line
. Directly on the medial epicondyle

Correct Answer & Explanation

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

Explanation

Schottle's point defines the anatomic femoral footprint of the MPFL. On a strict lateral radiograph, it is located 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the posterior aspect of Blumensaat's line.

Question 584

Topic: Knee Sports

A 45-year-old woman undergoes repair of a posterior medial meniscal root tear. Biomechanically, complete avulsion of the posterior horn of the medial meniscus root alters the peak contact pressures of the medial compartment to be most comparable to which of the following conditions?

. Total meniscectomy
. A bucket-handle meniscal tear
. A horizontal cleavage tear
. An isolated ACL tear
. A radial tear of the lateral meniscus

Correct Answer & Explanation

. Total meniscectomy

Explanation

A complete posterior medial meniscal root tear eliminates the hoop stresses of the meniscus, causing it to extrude. Biomechanically, this failure causes peak contact pressures in the medial compartment to approximate those seen in a totally meniscectomized knee.

Question 585

Topic: Knee Sports

In a double-bundle posterior cruciate ligament (PCL) reconstruction, the two distinct bundles are tensioned at different angles of knee flexion to restore native biomechanics. In the native knee, the anterolateral bundle is tightest in which of the following positions?

. Full extension
. 30 degrees of flexion
. 90 degrees of flexion
. Full external rotation
. Full internal rotation

Correct Answer & Explanation

. Full extension

Explanation

The PCL consists of the anterolateral (AL) and posteromedial (PM) bundles. The larger AL bundle is tightest in knee flexion (around 90 degrees), while the smaller PM bundle is tightest in extension.

Question 586

Topic: Knee Sports

A 28-year-old male sustains a traumatic knee dislocation with a high-grade posterolateral corner (PLC) injury. He has a profound foot drop on presentation. Which component of the PLC is most closely associated anatomically with the injured nerve?

. Popliteus tendon
. Lateral collateral ligament
. Popliteofibular ligament
. Biceps femoris tendon
. Iliotibial band

Correct Answer & Explanation

. Popliteus tendon

Explanation

The common peroneal nerve is highly susceptible to stretch injuries during PLC disruptions. Anatomically, it courses directly posterior and inferior to the biceps femoris tendon as it wraps around the fibular neck.

Question 587

Topic: Knee Sports

When performing a medial patellofemoral ligament (MPFL) reconstruction, accurate femoral tunnel placement is critical to avoid abnormal graft tension. Radiographically, Schottle's point is located:

. Anterior to the posterior cortical line and proximal to Blumensaat's line
. Posterior to the posterior cortical line and distal to Blumensaat's line
. Anterior to the anterior cortical line and proximal to Blumensaat's line
. Distal to the medial epicondyle and anterior to Blumensaat's line
. Proximal to the adductor tubercle and posterior to the posterior cortical line

Correct Answer & Explanation

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

Explanation

Schottle's point defines the radiographic femoral origin of the MPFL. It is located 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line.

Question 588

Topic: Knee Sports
  • The lateral fragment of bone (Segond fracture) associated with an injury of the anterior cruciate ligament is the result of an avulsion of the
. Oblique popliteal ligament
. Lateral capsule
. Popliteal tendon
. Fibular collateral ligament
. Posterior oblique ligament

Correct Answer & Explanation

. Oblique popliteal ligament

Explanation

The segond fragment is avulsed by three fibers which are under tension to this area at proximal lateral aspect of tibia. These fibers are intimate with lateral capsule consisting of 1) posterior fibers of anterolateral femoratibial ligament 2) the anterior expansion of arcuate ligament 3) biceps tendon expansions from posteriolateral direction.

Question 589

Topic: Knee Sports
Figure A is the lateral view of a left knee cadaveric specimen that has the extensor mechanism removed. Which two structures labeled provide the most rotational stability in knee flexion?
. A + C
. B + C
. B + D
. C + D
. C + E

Correct Answer & Explanation

. C + D

Explanation

The popliteus tendon (C) and the popliteofibular ligament (D) are the lateral knee structures that provide the most rotational stability in knee flexion. The lateral collateral ligament (B) provides varus stability and rotational stability in knee extension. The PT and PFL serve as restraints to rotational instability, the highest forces occurring at knee flexion (60°-90°).

Question 590

Topic: Knee Sports

Figure 1 is an arthroscopic view of the intercondylar notch of a right knee from an anterolateral portal. What is the main function of the structure delineated by the black asterisks?

. Resist anterior translation during knee flexion
. Resist posterior translation during knee flexion
. Resist rotatory loads during knee flexion
. Resist rotatory loads during knee extension

Correct Answer & Explanation

. Resist anterior translation during knee flexion

Explanation

The structure shown is the posterolateral bundle of the anterior cruciate ligament (ACL). This bundle is optimally positioned in the knee to resist rotatory forces during terminal knee extension. "Resist anterior translation during knee flexion" best describes the anteromedial bundle. "Resist rotatory loads during knee flexion" is unlikely because the posterolateral bundle is tightest during knee extension. The posterior cruciate ligament, not the ACL, functions to resist posterior translation.

Question 591

Topic: Knee Sports

Figures 23a through 23h are the radiographs and MR images of a 32-year-old man with worsening left knee pain. A 3-foot hip-to-ankle radiograph shows a 13-degree varus knee deformity. The patient sustained a major left knee injury 5 years ago and a confirmed complete anterior cruciate ligament (ACL) tear. He managed this injury nonsurgically with a functional brace but experienced worsening pain. He was seen by an orthopaedic surgeon 18 months ago and a medial meniscus tear was diagnosed; the tear was treated with an arthroscopic partial medial meniscectomy. Since then, his knee has been giving way more often and he no longer feels safe working on a pitched roof. The patient received 6 months of formal physical therapy and was fitted for a new functional ACL brace, but he still has pain and instability symptoms. He believes he has exhausted his nonsurgical options and would like to undergo surgery. What is the most appropriate treatment at this time?

. ACL reconstruction and subsequent proximal tibial osteotomy
. ACL reconstruction alone
. Distal femoral osteotomy with simultaneous ACL reconstruction
. Proximal tibial osteotomy with subsequent ACL reconstruction

Correct Answer & Explanation

. ACL reconstruction and subsequent proximal tibial osteotomy

Explanation

DISCUSSIONProximal tibial osteotomy is the most appropriate intervention to correct varus malalignment and to decrease stress on the ACL. In some cases, proximal tibial osteotomy alone may address both pain and instability, but, if instability persists, particularly in the setting in which instability can be dangerous, subsequent ACL reconstruction can further stabilize the knee with less stress on the graft after correction of malalignment. Varus alignment places increased stress on the native or reconstructed ACL. ACL reconstruction should only be performed at the same time as or following proximal tibial osteotomy to correct alignment in the setting of varus malalignment. It is not appropriate to perform ACL reconstruction prior to proximal tibial osteotomy in this setting. Distal femoral osteotomy is not indicated to correct varus malalignment. Varus alignment places increased stress on the native or reconstructed ACL, and ACL reconstruction alone is not indicated for this patient.

Question 592

Topic: Knee Sports

During anatomic medial patellofemoral ligament (MPFL) reconstruction, the surgeon notes that the graft is becoming too tight with greater knee flexion. What is the most likely cause?

. Femoral attachment placed too distal
. Femoral attachment placed too proximal
. Patellar attachment placed too distal
. Patellar attachment placed too proximal

Correct Answer & Explanation

. Femoral attachment placed too distal

Explanation

If the graft becomes tighter with knee flexion, the femoral attachment is too proximal. This error is referred to as “high and tight,” meaning that a high or proximal femoral attachment produces a graft that is too tight with knee flexion. If graft tension increases with increasing knee flexion, the result is loss of knee flexion or graft failure, increased contact forces resulting in patella femoral chondrosis, and possibly medial subluxation.

Question 593

Topic: Knee Sports

Figure 80a shows an arthroscopic view from an infralateral portal of a right knee. Figure 80b shows a coronal MRI scan, and Figures 80c through 80e show consecutive sagittal images of the knee. The images show what anatomic finding? Review Topic

. Loose body
. Discoid lateral meniscus
. Transverse meniscal ligament
. Displaced lateral meniscus tear
. Displaced medial meniscus tear

Correct Answer & Explanation

. Loose body

Explanation

The arthroscopic view and the coronal MRI scan show a discoid lateral meniscus covering almost the entire lateral tibial plateau. The sagittal views show a contiguous meniscus or "bow tie" sign on three consecutive images, pathognomonic for a discoid meniscus. Lateral discoid menisci are much more common than medial. There is no evidence of abnormal signal to indicate meniscal tearing. A transverse meniscal ligament is best seen anterior to the anterior horn of the lateral meniscus on multiple views. There is no evidence of a loose body on the arthroscopic or MRI images.

Question 594

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon uses fluoroscopy to identify Schöttle's point. Which of the following describes the correct anatomic landmarks for the femoral attachment of the MPFL on a lateral radiograph?
. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior notch.
. 5 mm posterior to the posterior cortex extension line, 5 mm proximal to the Blumensaat line.
. At the intersection of the Blumensaat line and the anterior cortex of the femur.
. Directly on the medial epicondyle, distal to the adductor tubercle.
. 3 mm anterior to the medial epicondyle and 3 mm distal to the adductor tubercle.

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior notch.

Explanation

Schöttle's point is a validated radiographic landmark for the anatomic femoral attachment of the MPFL. On a strictly true lateral radiograph, it is located 1 mm anterior to a 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 the posterior point of the Blumensaat line.

Question 595

Topic: Knee Sports
A 22-year-old female presents with recurrent patellar dislocations. Examination reveals a positive J-sign. Imaging shows a TT-TG distance of 22 mm, normal patellar height, and grade III chondromalacia isolated to the distal/inferior patellar pole. Which of the following is the most appropriate surgical intervention?
. MPFL reconstruction alone
. Lateral release alone
. Anteromedialization (Fulkerson) osteotomy of the tibial tubercle
. Straight medialization (Elmslie-Trillat) of the tibial tubercle
. Distalization of the tibial tubercle

Correct Answer & Explanation

. Anteromedialization (Fulkerson) osteotomy of the tibial tubercle

Explanation

Anteromedialization of the tibial tubercle (Fulkerson osteotomy) is indicated for patients with patellofemoral instability, an elevated TT-TG distance (>20 mm), and associated distal/inferior or lateral patellar chondral lesions. The anterior translation component offloads the distal and lateral patella, while medialization corrects the tracking vector. Straight medialization does not offload the patellofemoral joint.

Question 596

Topic: Knee Sports

In a single-bundle posterior cruciate ligament (PCL) reconstruction, the graft is designed to recreate the primary functional bundle of the PCL. Which bundle is being reconstructed, and in what position is it tightest?

. Posteromedial bundle; tightest in extension
. Posteromedial bundle; tightest in flexion
. Anterolateral bundle; tightest in flexion
. Anterolateral bundle; tightest in extension
. Meniscofemoral ligament; tightest in mid-flexion

Correct Answer & Explanation

. Anterolateral bundle; tightest in flexion

Explanation

The PCL consists of two main bundles: the anterolateral (AL) and posteromedial (PM). The AL bundle is the larger, stiffer bundle and is tightest in knee flexion. Single-bundle PCL reconstruction typically aims to reconstruct the AL bundle to control posterior translation at higher flexion angles.

Question 597

Topic: Knee Sports

A 26-year-old male presents for revision ACL reconstruction after re-rupturing his graft. CT scan demonstrates significant tunnel widening with the femoral tunnel measuring 16 mm and tibial tunnel measuring 15 mm. What is the most appropriate management?

. Single-stage revision with a larger diameter bone-patellar tendon-bone graft
. Single-stage revision using a suspension cortical button on the femur and interference screw on the tibia
. Two-stage revision with initial bone grafting of the tunnels, followed by revision ACL reconstruction after graft incorporation
. Single-stage revision with extra-articular lateral extra-articular tenodesis (LET) only
. Conservative management with bracing

Correct Answer & Explanation

. Two-stage revision with initial bone grafting of the tunnels, followed by revision ACL reconstruction after graft incorporation

Explanation

In the setting of significant tunnel widening (>14 mm), a two-stage revision is indicated to ensure adequate graft fixation. The first stage involves hardware removal and bone grafting of the expanded tunnels (e.g., using iliac crest bone graft, allograft dowels, or synthetic bone substitutes). Once incorporated (usually 4-6 months later), the second stage involves the definitive revision ACL reconstruction.

Question 598

Topic: Knee Sports

Which of the following structures constitutes the primary static stabilizer against external rotation of the tibia at 30 degrees of knee flexion?

. Popliteus tendon
. Lateral collateral ligament (LCL)
. Popliteofibular ligament (PFL)
. Iliotibial band
. Biceps femoris tendon

Correct Answer & Explanation

. Popliteofibular ligament (PFL)

Explanation

The posterolateral corner (PLC) of the knee consists primarily of the LCL, popliteus tendon, and popliteofibular ligament (PFL). The primary static stabilizers to external rotation at 30 degrees of knee flexion are the popliteus complex (specifically the popliteofibular ligament) and the LCL. The PFL plays a crucial role in resisting external tibial rotation.

Question 599

Topic: Knee Sports

During an ACL reconstruction, a systematic arthroscopic evaluation is performed. A 'ramp lesion' is identified. Which of the following best describes this pathology?

. A radial tear in the anterior horn of the medial meniscus
. A tear at the meniscocapsular junction of the posterior horn of the medial meniscus
. A cleavage tear of the lateral meniscus body
. A root tear of the lateral meniscus
. An avulsion of the posterior cruciate ligament

Correct Answer & Explanation

. A tear at the meniscocapsular junction of the posterior horn of the medial meniscus

Explanation

A ramp lesion refers to a tear at the peripheral meniscocapsular attachment of the posterior horn of the medial meniscus. It is commonly associated with ACL injuries. These lesions can be easily missed if the posteromedial compartment is not thoroughly visualized (e.g., via a posteromedial portal or trans-notch view).

Question 600

Topic: Knee Sports

During the terminal 30 degrees of knee extension, the tibia externally rotates relative to the femur. Which of the following anatomic features is primarily responsible for this 'screw home' mechanism?

. The lateral femoral condyle is longer and projects further anteriorly than the medial condyle.
. The medial femoral condyle has a larger articular surface area than the lateral condyle.
. The tension in the anterior cruciate ligament forces the tibia into external rotation.
. The popliteus muscle actively contracts to externally rotate the tibia.
. The lateral meniscus translates more posteriorly than the medial meniscus.

Correct Answer & Explanation

. The lateral femoral condyle is longer and projects further anteriorly than the medial condyle.

Explanation

The 'screw home' mechanism refers to the obligatory external rotation of the tibia during terminal knee extension. This is primarily driven by the asymmetry of the femoral condyles; the articular surface of the medial femoral condyle is longer and curves further anteriorly than that of the lateral condyle. As the lateral side stops gliding during extension, the medial side continues, resulting in external rotation of the tibia.

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