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Knee Sports MCQs

Practice Set 33 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 641

Topic: Knee Sports

A 24-year-old football player sustains a contact injury to his right knee. Physical examination reveals a positive dial test with 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 between both knees. Which of the following injury patterns is most consistent with these findings?

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

Correct Answer & Explanation

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

Explanation

The dial test is used to evaluate combined or isolated posterolateral corner (PLC) and posterior cruciate ligament (PCL) injuries. Asymmetry of >10 degrees of external rotation at 30 degrees of knee flexion, but symmetric rotation at 90 degrees, is indicative of an isolated PLC injury. If the asymmetry is present at both 30 and 90 degrees of flexion, it indicates a combined PCL and PLC injury. The primary restraint to external rotation at 30 degrees is the popliteofibular ligament and fibular collateral ligament.

Question 642

Topic: Knee Sports

A 15-year-old skeletally mature gymnast presents with chronic anterior knee pain and mechanical catching. MRI demonstrates a 2 x 2 cm osteochondritis dissecans (OCD) lesion with subchondral fluid indicative of instability, but the articular cartilage overlying it is intact. Where is the most common anatomical location for an OCD lesion in the knee?

. Central aspect of the medial femoral condyle
. Lateral aspect of the medial femoral condyle
. Central aspect of the lateral femoral condyle
. Medial aspect of the lateral femoral condyle
. Anterior aspect of the lateral femoral condyle

Correct Answer & Explanation

. Central aspect of the medial femoral condyle

Explanation

The most common location for osteochondritis dissecans (OCD) in the knee is the lateral aspect of the medial femoral condyle (often remembered by the mnemonic LAME: Lateral Aspect Medial Epicondyle/Condyle). It accounts for roughly 70-80% of all knee OCD lesions. Surgical fixation is indicated in skeletally mature patients with unstable lesions.

Question 643

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon inadvertently places the femoral tunnel too proximal and anterior to the anatomic footprint (Schöttle point). What is the primary kinematic consequence of this technical error?
. The graft will tighten in extension and become lax in flexion.
. The graft will tighten in flexion and cause loss of knee flexion.
. The graft will be lax throughout the entire range of motion.
. The graft will cause obligate patella alta.
. The graft will cause excessive medial translation of the patella in full extension only.

Correct Answer & Explanation

. The graft will tighten in flexion and cause loss of knee flexion.

Explanation

The anatomic femoral origin of the MPFL is crucial for proper graft kinematics. If the femoral tunnel is placed too proximal and anterior, the distance between the patellar attachment and the femoral attachment increases as the knee flexes. This causes the graft to become inappropriately tight in flexion, leading to restricted knee flexion, increased medial patellofemoral contact pressures, and potential early graft failure or osteoarthritis.

Question 644

Topic: Knee Sports

A 40-year-old active patient with medial compartment osteoarthritis and varus alignment is scheduled for a medial opening wedge high tibial osteotomy (HTO). Which of the following is an expected sagittal plane biomechanical alteration associated with this specific procedure?

. Decreased posterior tibial slope, which unloads an anterior cruciate ligament (ACL) graft.
. Decreased posterior tibial slope, which increases strain on the posterior cruciate ligament (PCL).
. Increased posterior tibial slope, which increases strain on the anterior cruciate ligament (ACL).
. Increased posterior tibial slope, which unloads the anterior cruciate ligament (ACL).
. No predictable change in tibial slope occurs with a medial opening wedge HTO.

Correct Answer & Explanation

. Decreased posterior tibial slope, which unloads an anterior cruciate ligament (ACL) graft.

Explanation

A medial opening wedge HTO characteristically increases the posterior tibial slope due to the triangular anatomy of the proximal tibia (the medial aspect is narrower anteriorly than posteriorly). An increase in posterior tibial slope promotes anterior tibial translation, which functionally acts as a PCL agonist (unloading the PCL) but acts as an ACL antagonist by increasing strain on the ACL or an ACL graft.

Question 645

Topic: Knee Sports

A 55-year-old female presents with sudden onset medial knee pain after squatting. MRI confirms a posterior root tear of the medial meniscus with 4 mm of meniscal extrusion. What is the biomechanical consequence of this specific injury on the knee joint?

. Loss of hoop stresses, resulting in contact mechanics equivalent to a totally intact meniscus
. Loss of hoop stresses, resulting in contact mechanics equivalent to a total medial meniscectomy
. Increased anterior translation of the tibia, increasing load on the anterior cruciate ligament
. Decreased medial compartment contact pressures by redirecting loads to the lateral compartment
. No significant change in peak contact pressures if meniscal extrusion is less than 5 mm

Correct Answer & Explanation

. Loss of hoop stresses, resulting in contact mechanics equivalent to a totally intact meniscus

Explanation

A posterior root tear of the medial meniscus disconnects the meniscal attachment to the tibial plateau. This failure disrupts the circumferential hoop stresses that the meniscus normally converts axial loads into. Biomechanical studies have shown that a meniscal root tear leads to a complete loss of hoop stresses, causing meniscal extrusion and resulting in peak tibiofemoral contact pressures that are biomechanically equivalent to those of a total meniscectomy.

Question 646

Topic: Knee Sports

The anterior cruciate ligament (ACL) consists of two functional bundles: the anteromedial (AM) and posterolateral (PL) bundles. During the physical examination of an ACL-deficient knee, which bundle's primary function is evaluated by the pivot shift test?

. Anteromedial bundle, which is tightest in flexion
. Anteromedial bundle, which is tightest in extension
. Posterolateral bundle, which is tightest in flexion
. Posterolateral bundle, which is tightest in extension
. Posterolateral bundle, which acts primarily as a restraint to varus stress

Correct Answer & Explanation

. Anteromedial bundle, which is tightest in flexion

Explanation

The PL bundle of the ACL is tightest in extension and is the primary restraint to rotatory instability (anterolateral subluxation of the tibia), which is clinically evaluated by the pivot shift test. The AM bundle is tightest in flexion and is the primary restraint to anterior tibial translation (evaluated by the anterior drawer test).

Question 647

Topic: Knee Sports

During the surgical reconstruction of an isolated posterior cruciate ligament (PCL) injury utilizing a single-bundle technique, the graft is typically positioned to recreate the function of the dominant bundle. Which bundle is reconstructed, and at what angle is it maximally tensioned?

. Anteromedial bundle; tightest in flexion
. Anteromedial bundle; tightest in extension
. Anterolateral bundle; tightest in flexion
. Posteromedial bundle; tightest in flexion
. Posteromedial bundle; tightest in extension

Correct Answer & Explanation

. Anteromedial bundle; tightest in flexion

Explanation

The PCL consists of the anterolateral (AL) and posteromedial (PM) bundles. The AL bundle is larger, stronger, and tightest in knee flexion, making it the primary restraint to posterior tibial translation in the flexed knee. Single-bundle PCL reconstruction aims to recreate the AL bundle. The PM bundle is tightest in extension.

Question 648

Topic: Knee Sports

A 50-year-old female presents with acute posterior medial knee pain after squatting. MRI reveals an isolated complete tear of the medial meniscus posterior root. The biomechanical consequence of leaving this injury untreated is most equivalent to which of the following conditions?

. Anterior cruciate ligament (ACL) deficiency
. Total medial meniscectomy
. Partial lateral meniscectomy
. Posterior cruciate ligament (PCL) deficiency
. Isolated medial collateral ligament (MCL) sprain

Correct Answer & Explanation

. Anterior cruciate ligament (ACL) deficiency

Explanation

A complete tear of the medial meniscal root disrupts the meniscal hoop stresses entirely, leading to meniscal extrusion. Biomechanical studies have proven that a posterior root tear effectively renders the meniscus nonfunctional, altering contact pressures identically to a total medial meniscectomy.

Question 649

Topic: Knee Sports
According to the Schenck classification system for knee dislocations, an injury resulting in complete tears of the ACL, PCL, and medial collateral ligament (MCL), with an intact posterolateral corner (PLC), is classified as:
. KD I
. KD II
. KD III-M
. KD III-L
. KD IV

Correct Answer & Explanation

. KD III-M

Explanation

The Schenck classification: KD I = single cruciate + collaterals; KD II = ACL + PCL (intact collaterals); KD III-M = ACL + PCL + MCL; KD III-L = ACL + PCL + LCL/PLC; KD IV = ACL + PCL + MCL + LCL/PLC. Since the MCL is involved, it is KD III-M.

Question 650

Topic: Knee Sports

A 25-year-old male is evaluated for a knee injury. On physical examination, the 'dial test' reveals 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. However, at 90 degrees of knee flexion, the external rotation is symmetric bilaterally. This examination finding is most indicative of an isolated injury to the:

. Posterior cruciate ligament (PCL)
. Posterolateral corner (PLC)
. Anterior cruciate ligament (ACL)
. Medial collateral ligament (MCL)
. Posteromedial corner (PMC)

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

The dial test assesses combined PLC and PCL injuries. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion indicates an isolated Posterolateral Corner (PLC) injury. If external rotation is increased at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 651

Topic: Knee Sports

A 19-year-old female sustains a traumatic lateral patellar dislocation. Which of the following structures is the primary soft-tissue restraint to lateral patellar translation at 0 to 20 degrees of knee flexion?

. Medial patellofemoral ligament (MPFL)
. Medial collateral ligament (MCL)
. Lateral retinaculum
. Quadriceps tendon
. Vastus medialis obliquus (VMO)

Correct Answer & Explanation

. Medial patellofemoral ligament (MPFL)

Explanation

The Medial Patellofemoral Ligament (MPFL) is the primary static restraint to lateral translation of the patella, particularly in early flexion (0-20 degrees) before the patella fully engages in the trochlear groove. It contributes 50-60% of the restraining force.

Question 652

Topic: Knee Sports
In anatomic reconstruction of the medial patellofemoral ligament (MPFL), establishing the correct femoral attachment (Schöttle's point) is critical. On a strict lateral radiograph, Schöttle's point is located:
. Anterior to the posterior femoral cortical line and proximal to Blumensaat's line
. 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
. Posterior to the posterior femoral cortical line and distal to Blumensaat's line
. Anterior to the posterior femoral cortical line and exactly on Blumensaat's line

Correct Answer & Explanation

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

Explanation

According to Schöttle et al., the radiographic landmark for the femoral origin of the MPFL on a true lateral x-ray is: 1 mm anterior to the posterior femoral cortical extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior point of Blumensaat's line.

Question 653

Topic: Knee Sports
A 24-year-old male presents with a KD-III (ACL, PCL, and PMC torn) knee dislocation after a fall from height. The knee is grossly reduced. Pulses are symmetrically palpable in the dorsalis pedis and posterior tibial arteries. The Ankle-Brachial Index (ABI) is measured at 0.85. What is the most appropriate next step in management?
. Immediate surgical exploration of the popliteal artery
. CT angiography of the lower extremity
. Observation and serial ABIs every 4 hours
. MRI of the knee to evaluate ligamentous injury
. Duplex ultrasound of the superficial femoral artery

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

In the setting of a knee dislocation, an ABI < 0.9 is a strong indicator of a potential occult arterial injury, even if palpable pulses are present. A CT angiogram (CTA) is indicated to definitely evaluate the popliteal artery. Immediate surgical exploration is reserved for hard signs of vascular injury (e.g., active hemorrhage, absent pulses, expanding hematoma, or obvious ischemia).

Question 654

Topic: Knee Sports

A 25-year-old male sustains an isolated, displaced bony avulsion fracture of the posterior cruciate ligament (PCL) from its tibial footprint (dashboard injury). Open reduction and internal fixation is planned via a direct posterior approach to the knee. Which surgical interval is used for this classic Burks and Schaffer approach?

. Between the lateral head of the gastrocnemius and the biceps femoris
. Between the plantaris and the lateral head of the gastrocnemius
. Between the medial head of the gastrocnemius and the semimembranosus
. Through the midline of the gastrocnemius aponeurosis
. Between the popliteus and the posterior capsule

Correct Answer & Explanation

. Between the lateral head of the gastrocnemius and the biceps femoris

Explanation

The Burks and Schaffer approach (a modified posteromedial approach) provides excellent exposure to the tibial PCL attachment. The interval is between the medial head of the gastrocnemius (which is retracted laterally, protecting the midline neurovascular structures) and the semimembranosus (retracted medially).

Question 655

Topic: Knee Sports

During a routine anterior cruciate ligament (ACL) reconstruction, an unrecognized posterior root tear of the medial meniscus is left unrepaired. Biomechanically, what is the consequence of leaving a meniscal root tear unrepaired?

. Decreased peak contact pressures in the medial compartment
. Increased joint space width of the medial compartment under load
. Joint contact pressures and hoop stress loss equivalent to a total meniscectomy
. Medial compartment gapping during terminal extension
. Increased resistance to anterior tibial translation

Correct Answer & Explanation

. Decreased peak contact pressures in the medial compartment

Explanation

The meniscal roots anchor the meniscus to the tibial plateau, allowing the meniscus to convert axial loads into circumferential hoop stresses. A radial tear at the root disrupts this continuous ring, rendering the meniscus completely non-functional under load. Biomechanically, an unrepaired posterior root tear is equivalent to a total meniscectomy in terms of peak contact pressures and loss of hoop stress.

Question 656

Topic: Knee Sports

A 19-year-old female presents with recurrent lateral patellar dislocations. Advanced imaging reveals a tibial tubercle-trochlear groove (TT-TG) distance of 23 mm and minimal patellofemoral arthritis. Which of the following surgical interventions is most appropriate in addition to a medial patellofemoral ligament (MPFL) reconstruction?

. Medializing tibial tubercle osteotomy
. Anteromedializing tibial tubercle osteotomy (Fulkerson osteotomy)
. Lateralizing tibial tubercle osteotomy
. Distalizing tibial tubercle osteotomy
. Trochleoplasty

Correct Answer & Explanation

. Medializing tibial tubercle osteotomy

Explanation

A normal TT-TG distance is less than 15 mm. A TT-TG distance > 20 mm is a pathologic lateralized pull of the extensor mechanism and is a primary indication for a medializing tibial tubercle osteotomy (Elmslie-Trillat) to correct the anatomic tracking anomaly. Anteromedialization (Fulkerson) is preferred if there is concurrent distal/lateral patellofemoral arthritis to offload the joint, but pure medialization is standard for isolated instability without arthritis.

Question 657

Topic: Knee Sports

During a retrograde intramedullary nailing of a supracondylar distal femur fracture, the surgeon is selecting the ideal intra-articular starting point to avoid damaging the cruciate ligaments and to ensure proper axial alignment. What is the correct starting point in the intercondylar notch?

. Just posterior to the origin of the posterior cruciate ligament (PCL)
. At the top of the intercondylar notch, just anterior to the origin of the PCL
. In the exact center of the trochlear groove
. Directly at the femoral attachment of the anterior cruciate ligament (ACL)
. 2 cm proximal to Blumensaat's line within the medullary canal

Correct Answer & Explanation

. Just posterior to the origin of the posterior cruciate ligament (PCL)

Explanation

The proper starting point for a retrograde femoral nail is located in the top (anterior apex) of the intercondylar notch, perfectly in line with the medullary canal in both AP and lateral planes. On the lateral view, this corresponds to a point just anterior to Blumensaat's line (the roof of the notch and origin of the PCL). A start point too far posterior will damage the PCL, while a start point too far anterior will damage the patellofemoral articular surface.

Question 658

Topic: Knee Sports

A patient complains of a lack of terminal knee extension six months after an ACL reconstruction. Lateral radiographs show that the tibial tunnel is positioned entirely anterior to Blumensaat's line with the knee in full extension. What is the mechanism of this patient's extension loss?

. The graft becomes excessively taut in flexion, preventing full extension.
. The graft impinges posteriorly against the PCL.
. The graft impinges anteriorly against the intercondylar notch roof during extension.
. The graft acts as a physical block within the trochlear groove.
. The patella tracks laterally causing a mechanical block.

Correct Answer & Explanation

. The graft impinges anteriorly against the intercondylar notch roof during extension.

Explanation

Anterior placement of the tibial tunnel is a classic technical error in ACL reconstruction. If the tibial tunnel is placed anterior to the slope of the intercondylar roof (Blumensaat's line in full extension), the graft will impinge against the roof of the notch as the knee extends (notch impingement). This leads to a mechanical loss of terminal extension, graft abrasion, and eventual graft failure.

Question 659

Topic: Knee Sports

A patient undergoes surgical reconstruction of a severe posterolateral corner (PLC) injury. Postoperatively, the patient is noted to have a foot drop and numbness over the dorsum of the foot. During the dissection, which three major static stabilizing structures of the PLC were identified and reconstructed, placing the peroneal nerve at highest risk during exposure?

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament
. Lateral collateral ligament, biceps femoris tendon, and iliotibial band
. Popliteus tendon, anterolateral ligament, and arcuate ligament
. Lateral collateral ligament, anterior cruciate ligament, and oblique popliteal ligament
. Popliteofibular ligament, lateral gastrocnemius tendon, and fabellofibular ligament

Correct Answer & Explanation

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

The three major static stabilizing structures of the posterolateral corner (PLC) of the knee are the Lateral Collateral Ligament (LCL), the Popliteus tendon, and the Popliteofibular ligament (PFL). Reconstruction of these structures requires dissection near the fibular head and neck, which places the common peroneal nerve at high risk of iatrogenic injury.

Question 660

Topic: Knee Sports

A 22-year-old professional soccer player undergoes an ACL reconstruction and concurrent repair of a longitudinal tear in the red-white zone of the medial meniscus. It is well-documented that meniscal repairs performed concurrently with ACL reconstruction have a higher healing rate than isolated meniscal repairs. What is the primary biological reason for this phenomenon?

. The ACL reconstruction restricts post-operative range of motion more rigidly.
. The reconstruction immediately restores native tibiofemoral contact mechanics to decrease shear.
. Notch osteoplasty and tunnel drilling release marrow-derived stem cells and growth factors into the joint.
. The graft completely eliminates all rotational forces on the healing meniscus.
. The vascularity of the white-white zone is directly re-established by the infrapatellar fat pad.

Correct Answer & Explanation

. Notch osteoplasty and tunnel drilling release marrow-derived stem cells and growth factors into the joint.

Explanation

Concurrent ACL reconstruction significantly enhances meniscal healing. The biologic rationale is that the osseous trauma from tunnel drilling and notch preparation releases a bone marrow-rich 'hemarthrosis' into the joint space. This fluid is packed with mesenchymal stem cells (MSCs) and growth factors (e.g., PDGF, TGF-beta) which provide a potent biologic stimulus that augments the healing of the meniscal repair.

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