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Knee Sports MCQs

Practice Set 34 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 661

Topic: Knee Sports

A surgeon opts to perform a posterior cruciate ligament (PCL) reconstruction using the tibial inlay technique rather than the traditional transtibial tunnel technique. What is the primary biomechanical and clinical advantage proposed for the tibial inlay technique?

. It completely eliminates the need for femoral tunnel drilling.
. It allows for immediate post-operative full weight-bearing.
. It avoids the 'killer turn' and subsequent graft abrasion at the posterior tibial aperture.
. It preserves the posterior horn of the medial meniscus anatomically.
. It reliably prevents iatrogenic popliteal artery injury during drilling.

Correct Answer & Explanation

. It avoids the 'killer turn' and subsequent graft abrasion at the posterior tibial aperture.

Explanation

In the traditional transtibial PCL reconstruction, the graft must make an acute angle as it exits the posterior tibial tunnel and courses towards the medial femoral condyle. This acute angle is known as the 'killer turn' and is a known site for graft abrasion, stretching, and eventual failure. The tibial inlay technique secures the graft directly to the anatomic tibial footprint via a posterior approach, completely avoiding the killer turn and minimizing graft attenuation.

Question 662

Topic: Knee Sports

During a posterior cruciate ligament (PCL) reconstruction, the surgeon aims to accurately recreate the native biomechanics of the knee. Which specific bundle of the native PCL is tight in flexion and serves as the primary restraint to posterior tibial translation at 90 degrees of knee flexion?

. Anterolateral bundle
. Posteromedial bundle
. Anteromedial bundle
. Posterolateral bundle
. Central meniscofemoral bundle

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The native PCL consists of two main bundles: the anterolateral bundle (ALB) and the posteromedial bundle (PMB). The ALB is larger, tightens in flexion, and is the primary restraint to posterior translation at 90 degrees of knee flexion.

Question 663

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction, the popliteofibular ligament must be addressed. This ligament originates from the popliteus musculotendinous junction and inserts onto the fibular styloid. It primarily resists which abnormal tibiofemoral motion?

. Anterior tibial translation
. Posterior tibial translation
. Valgus gapping
. External tibial rotation
. Internal tibial rotation

Correct Answer & Explanation

. External tibial rotation

Explanation

The popliteofibular ligament is a key static stabilizer of the posterolateral corner of the knee. It provides significant restraint to external tibial rotation, particularly at higher degrees of knee flexion.

Question 664

Topic: Knee Sports

A 24-year-old athlete undergoes reconstruction of the posterolateral corner (PLC) of the knee. To correctly recreate the normal anatomic footprints on the lateral femur, what is the spatial relationship of the lateral collateral ligament (LCL) attachment relative to the popliteus tendon attachment?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly anterior

Correct Answer & Explanation

. Proximal and posterior

Explanation

On the lateral femoral epicondyle, the LCL footprint is located slightly proximal and posterior to the popliteus tendon footprint. Accurately reproducing this relationship is crucial for restoring proper isometry and kinematics during PLC reconstruction.

Question 665

Topic: Knee Sports

During a medial patellofemoral ligament (MPFL) reconstruction, placing the femoral tunnel proximal to the true anatomic footprint (Schottle point) will result in which of the following kinematic abnormalities?

. The graft will be overly tight in deep flexion
. The graft will be overly tight in full extension
. The graft will remain entirely isometric throughout range of motion
. The patella will dislocate medially in full extension
. The graft will be completely lax during the entire range of motion

Correct Answer & Explanation

. The graft will be overly tight in deep flexion

Explanation

A femoral tunnel placed too proximal during MPFL reconstruction causes the graft to act non-isometrically, becoming overly tight in knee flexion. This can lead to restricted flexion, increased patellofemoral contact pressures, and accelerated arthrosis.

Question 666

Topic: Knee Sports

A 26-year-old male presents with recurrent instability 3 years after primary ACL reconstruction. Radiographs and CT show malpositioned, expanded femoral and tibial tunnels. What is the accepted threshold of tunnel widening that generally necessitates a two-stage revision with initial bone grafting?

. 8 mm
. 10 mm
. 14 mm
. 18 mm
. Any measurable tunnel widening requires two stages

Correct Answer & Explanation

. 14 mm

Explanation

Tunnel widening greater than 14-15 mm typically compromises fixation in a single-stage revision ACL reconstruction. A two-stage procedure with initial bone grafting of the defects followed by reconstruction months later is recommended.

Question 667

Topic: Knee Sports

What do the T2-weighted, fat-saturated MRI scans shown in Figures 76a through 76d reveal? Review Topic

. Posterior cruciate ligament (PCL) tear, isolated
. PCL tear and medial meniscus tear
. Anterior cruciate ligament (ACL) tear, isolated
. ACL tear and medial meniscus tear

Correct Answer & Explanation

. Posterior cruciate ligament (PCL) tear, isolated

Explanation

The MRI scans show that edema is noted on the femoral insertion of the ACL consistent with a high-grade or complete ACL tear. The ACL is not visualized on the sagittal view, although the torn meniscus can be seen in the notch. On the coronal image, there is an empty lateral wall sign indicating proximal disruption of the ACL. The medial meniscus images show a disruption of normal meniscus morphology consistent with a bucket handle medial meniscus tear. Note the appearance on the sagittal MRI scan of what appears to be a second soft-tissue density in line with the PCL. This "double PCL" sign is highly indicative of a displaced medial meniscus tear rather than a displaced lateral meniscus tear.

Question 668

Topic: Knee Sports

The function of which of the following structures is to resist internal tibial rotation with the knee in full extension? Review Topic

. Anterior cruciate ligament
. Iliotibial band
. Popliteus tendon
. Popliteofibular ligament
. Posterior oblique ligament

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

The primary function of the posterior oblique ligament is to resist internal tibial rotation with the knee in full extension.The posterior oblique ligament is a structure within the posteromedial corner of the knee, with attachments proximally to the adductor tubercle of the femur and distally to the tibia/posterior knee capsule. The posterior oblique ligament and posteromedial capsule play a significant role in the prevention of additional posterior tibial translation in the knee in the setting of posterior cruciate ligament injury. They also act to resist internal tibial rotation with the knee in full extension.Griffith et al. reports that the posterior oblique ligament provides significant resistance to valgus and internal rotation forces with knee extension. They used a cadaver model and demonstrated that the superficial MCL resists valgus and external rotation forces more than the posterior oblique ligament, while the posterior oblique ligament is more involved in resisting internal rotation.Tibor et al. reviews the anatomy of the posteromedial corner of the knee. They report that failing to recognize injury to these structures may cause failure of cruciate ligament reconstruction surgery, and that reconstruction or repair of the posteromedial corner may be indicated in the face of multiple ligament injuries.Illustration A shows the posteromedial corner of the knee, including the posterior oblique ligament.Incorrect answers:1-4: These structures are not primary restraints to internal tibial rotation in full extension.

Question 669

Topic: Knee Sports
A 32-year-old man with worsening left knee pain has a 13-degree varus knee deformity and a history of a complete anterior cruciate ligament (ACL) tear treated nonsurgically. He previously underwent an arthroscopic partial medial meniscectomy. He continues to experience pain and instability. 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

. Proximal tibial osteotomy with subsequent ACL reconstruction

Explanation

Proximal tibial osteotomy is the most appropriate intervention to correct varus malalignment and to reduce stress on the ACL. In some cases, proximal tibial osteotomy alone may address both pain and instability, but if instability persists, subsequent ACL reconstruction can further stabilize the knee with less stress on the graft after the correction of malalignment. ACL reconstruction should be performed only at the same time as or following proximal tibial osteotomy to correct alignment in the setting of varus malalignment.

Question 670

Topic: Knee Sports
Figures below depict the AP and lateral radiographs obtained from a 64-year-old man with long-standing right knee osteoarthritis and pain that is unresponsive to nonsurgical treatment. The patient undergoes navigated cruciate-retaining right total knee arthroplasty. After surgery, this patient continues to experience pain and swelling of the knee with recurrent effusions. He returns to the office reporting continued pain 2 years after surgery. He describes instability, particularly when descending stairs. On examination, range of motion of 0° to 120° is observed, with no extensor lag. Slope of the tibial component is 7°. The knee is stable to varus and valgus stress in extension, but flexion instability is present in both the anterior-posterior direction and the varus-valgus direction. Bracing leads to a slight decrease in symptoms but is not well tolerated. Isokinetic testing demonstrates decreased knee extension velocity at mid push. Radiographs demonstrate well-aligned and fixed knee implants. An infection work-up is negative. What is the most appropriate surgical intervention at this time?
. Tibial polyethylene exchange
. Revision of the femoral and tibial components and conversion to a posterior stabilized insert
. Revision of the femoral and tibial components to a constrained rotating hinge prosthesis
. Isolated femoral component revision and upsizing of the femoral implant with a new posterior cruciate ligament (PCL)-retaining polyethylene insert

Correct Answer & Explanation

. Revision of the femoral and tibial components and conversion to a posterior stabilized insert

Explanation

The patient’s symptoms at follow-up—pain, swelling, and difficulty descending stairs—suggest knee flexion instability. Considering his history, an incompetent PCL must be considered. Revision of the knee to a posterior stabilized or nonlinked constrained condylar implant (depending on the condition of the ligaments) likely is needed to address his symptoms. The difference in extension stability and flexion stability makes polyethylene exchange a poor option. A constrained rotating hinge design is not necessary. Repeat use of a PCL-retaining insert is not recommended. Tibial and femoral revision both are required. Correction of excessive slope will be attained with tibial revision, femoral component revision is required to convert to a PCL-substituting design. There is also an opportunity to increase posterior condylar offset if needed.

Question 671

Topic: Knee Sports

A 52-year-old female presents with acute medial knee pain after a squatting maneuver. MRI demonstrates a complete radial tear at the posterior root of the medial meniscus, with 4 mm of meniscal extrusion. If left untreated, what is the primary biomechanical consequence of this specific meniscal injury?

. Increased anterior tibial translation during the Lachman test
. Loss of circumferential hoop stresses leading to contact mechanics akin to a total meniscectomy
. Severe rotatory instability during the pivot-shift maneuver
. Excessive lateral joint space opening during varus stress
. Development of patellofemoral tracking disorders

Correct Answer & Explanation

. Increased anterior tibial translation during the Lachman test

Explanation

The meniscal roots anchor the meniscus to the tibial plateau, allowing it to convert axial loads into circumferential hoop stresses. A root tear disrupts these fibers, resulting in meniscal extrusion and a complete loss of hoop stresses. Biomechanically, the peak contact pressures and contact area in the compartment become nearly identical to a knee that has undergone a total meniscectomy, rapidly predisposing the joint to osteoarthritis.

Question 672

Topic: Knee Sports

A 13-year-old gymnast presents with vague, activity-related knee pain and a sensation of catching. Radiographs reveal an osteochondritis dissecans (OCD) lesion. Where is the classic and most frequent anatomical location for an OCD lesion in the knee?

. Central weight-bearing dome of the lateral femoral condyle
. Posterolateral aspect of the medial femoral condyle
. Inferior pole of the patella
. Anterior aspect of the lateral tibial plateau
. Trochlear groove

Correct Answer & Explanation

. Central weight-bearing dome of the lateral femoral condyle

Explanation

The classic location for osteochondritis dissecans (OCD) in the knee is the posterolateral aspect of the medial femoral condyle (often remembered by the acronym LAME: Lateral Aspect of the Medial Epicondyle/Condyle). This accounts for approximately 70-80% of knee OCD lesions.

Question 673

Topic: Knee Sports

A 55-year-old female experiences a sudden 'pop' in the posterior aspect of her knee while squatting. MRI reveals a medial meniscus posterior root tear. Biomechanical studies demonstrate that this injury alters tibiofemoral contact pressures most similarly to which of the following conditions?

. Total medial meniscectomy
. 50% partial medial meniscectomy
. Anterior cruciate ligament rupture
. Medial collateral ligament sprain
. Chondral defect of the medial femoral condyle

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus disrupts the hoop stresses of the meniscus, causing it to extrude. Biomechanically, this results in peak contact pressures and contact areas that are equivalent to those seen following a total medial meniscectomy, predisposing the joint to rapid articular cartilage degeneration.

Question 674

Topic: Knee Sports

The primary restraint to posterior tibial translation at 90 degrees of knee flexion is the posterior cruciate ligament (PCL). Which of the following bundles of the PCL is tightest in this position?

. Anterolateral bundle
. Posteromedial bundle
. Anteromedial bundle
. Posterolateral bundle
. Meniscofemoral ligament of Wrisberg

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The PCL consists of two main bundles: the anterolateral (AL) and posteromedial (PM) bundles. The anterolateral bundle is the larger of the two and is tightest in knee flexion (particularly around 90 degrees). The posteromedial bundle is tightest in knee extension.

Question 675

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon uses intraoperative fluoroscopy to identify Schöttle's point for the femoral tunnel. Due to a technical error, the femoral tunnel is placed 8 mm strictly proximal to the true anatomic footprint. What is the expected kinematic effect of this non-anatomic tunnel placement on the patellofemoral joint?
. The graft will be overly tight in knee flexion and loose in knee extension
. The graft will be overly tight in knee extension and loose in knee flexion
. The graft will maintain isometric tension throughout the entire range of motion
. The patella will dislocate medially during terminal extension
. The patella will experience decreased medial restraint solely between 0 and 30 degrees of flexion

Correct Answer & Explanation

. The graft will be overly tight in knee flexion and loose in knee extension

Explanation

The MPFL acts as the primary soft-tissue restraint to lateral patellar translation from 0 to 30 degrees of knee flexion. Correct femoral tunnel positioning is critical for near-isometric graft behavior. If the femoral tunnel is placed too proximal, the distance between the femoral attachment and patellar attachment increases as the knee goes into flexion. Consequently, the graft will be loose in extension (when it should be restraining the patella) and become excessively tight in flexion, causing increased medial patellofemoral cartilage contact pressures and potentially restricting flexion.

Question 676

Topic: Knee Sports

A 19-year-old running back lands directly on his anterior knee after being tackled. He has mild anterior knee pain, a trace effusion, a 2+ posterior drawer, a grade 1+ stable Lachman, no valgus laxity, and negative dial tests at 30° and 90°. What is the best treatment strategy at this time?

. Physical therapy with a focus on quadriceps strengthening
. Physical therapy and delayed posterior cruciate ligament (PCL) reconstruction
. PCL reconstruction
. PCL and posterolateral corner reconstruction

Correct Answer & Explanation

. Physical therapy with a focus on quadriceps strengthening

Explanation

This patient has likely sustained an isolated PCL injury. The examination is consistent with a grade II injury to the PCL. In this scenario, the best initial option is nonsurgical treatment and return to play as symptoms subside and strength improves. Physical therapy with a focus on quadriceps strengthening and delayed PCL reconstruction is not the answer because this patient can likely be treated without surgery. The absence of valgus laxity and negative dial testing findings suggest that an injury to the posteromedial and posterolateral corners has not occurred. Initial nonsurgical treatment is indicated for this patient. If he completes rehabilitation and experiences persistent disability with anterior and/or medial knee discomfort or senses the knee is "loose," PCL reconstruction should be considered at that time.

Question 677

Topic: Knee Sports
A 16-year-old female basketball player suffers recurrent lateral patellar dislocations. An MRI reveals an avulsion of the medial patellofemoral ligament (MPFL) at its femoral origin. In an MPFL reconstruction, correct femoral tunnel placement is critical. Where is the anatomical femoral attachment of the MPFL (Schöttle's point) located radiographically on a true lateral view?
. Distal to Blumensaat's line and anterior to the posterior femoral cortex line.
. Proximal to the adductor tubercle and posterior to the medial epicondyle.
. 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 Blumensaat's line.
. Directly over the center of the medial epicondyle.
. At the junction of the medial collateral ligament and the posterior oblique ligament.

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 Blumensaat's line.

Explanation

Schöttle's point defines the optimal radiographic and anatomic femoral attachment for MPFL reconstruction. On a strictly true lateral radiograph of the knee, Schöttle's point is found 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 posterior point of Blumensaat's line. Anatomically, it is situated between the adductor tubercle (proximal) and the medial epicondyle (distal and anterior).

Question 678

Topic: Knee Sports

A 12-year-old male baseball player presents with vague, activity-related right knee pain. Radiographs demonstrate a classic Osteochondritis Dissecans (OCD) lesion. Assuming the most common anatomic location for this lesion, which of the following best describes its position?

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

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for an Osteochondritis Dissecans (OCD) lesion in the knee is the lateral aspect of the medial femoral condyle (often remembered by the mnemonic LAME: Lateral Aspect Medial Epicondyle/condyle, though technically it's the condyle). It accounts for roughly 70-80% of all knee OCD lesions. These lesions are thought to result from repetitive microtrauma and vascular insufficiency to the subchondral bone.

Question 679

Topic: Knee Sports
A 19-year-old football player sustains a complex knee injury involving an acute grade III medial collateral ligament (MCL) tear and a complete ACL rupture. Based on current literature and sports medicine guidelines, what is the most broadly accepted initial treatment strategy for this combined injury?
. Immediate surgical repair of both the ACL and MCL.
. Conservative management with a hinged knee brace for the MCL for 4-6 weeks, followed by ACL reconstruction.
. Primary ACL reconstruction within 48 hours, leaving the MCL to heal.
. Immediate MCL repair followed by delayed ACL reconstruction after 3 months.
. Non-operative management of both ligaments with a 12-week intensive physical therapy protocol.

Correct Answer & Explanation

. Conservative management with a hinged knee brace for the MCL for 4-6 weeks, followed by ACL reconstruction.

Explanation

The standard of care for a combined ACL and grade III MCL tear is to allow the MCL to heal non-operatively in a hinged knee brace for approximately 4 to 6 weeks, followed by delayed reconstruction of the ACL. Operating on the ACL immediately or repairing the MCL routinely increases the risk of severe post-operative arthrofibrosis. The MCL has an excellent intrinsic healing capacity due to its robust blood supply. If valgus instability persists after 6 weeks of conservative management, an MCL reconstruction or repair can be performed concurrently with the ACL reconstruction.

Question 680

Topic: Knee Sports

When performing a medial patellofemoral ligament (MPFL) reconstruction, identifying the correct anatomic femoral attachment is critical to ensure anisometry is minimized. Radiographically, Schottle's point represents the ideal femoral origin. Which of the following best describes the radiographic location of Schottle's point on a true lateral radiograph of the knee?

. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line
. 3 mm posterior to the posterior cortical line, 5 mm proximal to the posterior articular border, and distal to Blumensaat's line
. On the anterior cortical line, 2.5 mm proximal to the posterior articular border, and proximal to Blumensaat's line
. 5 mm anterior to the posterior cortical line, 5 mm distal to the posterior articular border, and intersecting Blumensaat's line
. 1 mm posterior to the posterior cortical line, 2.5 mm proximal to the posterior articular border, and distal to Blumensaat's line

Correct Answer & Explanation

. 1 mm posterior to the posterior cortical line, 2.5 mm proximal to the posterior articular border, and distal to Blumensaat's line

Explanation

Schottle's point is a radiographic landmark for the femoral origin of the MPFL on a strict lateral radiograph. It is located 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to a line parallel to the posterior articular border of the medial femoral condyle, and proximal to a line extending from Blumensaat's line.

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