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Knee Sports MCQs

Practice Set 35 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 681

Topic: Knee Sports

A 25-year-old male presents with a chief complaint of profound loss of knee flexion 8 months following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. He states the knee feels 'locked' whenever he tries to bend it past 80 degrees.

Based on the radiographic principles of ACL graft placement, what is the most likely technical error leading to this specific complication?

. The femoral tunnel was placed too far posterior
. The tibial tunnel was placed too far posterior
. The femoral tunnel was placed too far anterior
. The tibial tunnel was placed too far anterior
. The graft was tensioned in 90 degrees of flexion

Correct Answer & Explanation

. The femoral tunnel was placed too far anterior

Explanation

Placement of the femoral tunnel too far anteriorly is a classic error in ACL reconstruction that results in the graft becoming excessively tight as the knee goes into flexion. This leads to restricted knee flexion and a feeling of 'locking' or extreme tightness when attempting to bend the knee. Conversely, if the femoral tunnel is placed too far posterior, the graft will be tight in extension, resulting in an extension deficit. Tibial tunnel malpositioning typically leads to roof impingement (if too anterior) or PCL impingement (if too posterior).

Question 682

Topic: Knee Sports
A 28-year-old male sustains a high-energy multi-ligament knee injury following a motorcycle collision. Clinical and MRI evaluation reveals a Schenck KD III-L injury (disruption of the ACL, PCL, and the posterolateral corner/LCL). He has intact pulses with normal ABIs. Which associated neurologic injury is most frequently seen with this specific ligamentous injury pattern?
. Saphenous nerve palsy
. Sural nerve palsy
. Tibial nerve palsy
. Common peroneal nerve palsy
. Femoral nerve palsy

Correct Answer & Explanation

. Common peroneal nerve palsy

Explanation

The Schenck KD III-L classification denotes a multi-ligament knee injury involving the anterior cruciate ligament, posterior cruciate ligament, and the lateral/posterolateral structures. Due to the severe varus and internal rotation forces required to disrupt the posterolateral corner, traction on the common peroneal nerve is highly likely. Common peroneal nerve palsy occurs in approximately 15-25% of KD III-L and KD IV knee dislocations, representing the most common neurologic deficit in this setting.

Question 683

Topic: Knee Sports

A 19-year-old female presents with recurrent episodes of lateral patellar dislocation. Conservative management with physical therapy and bracing has failed. Advanced imaging is obtained to assess risk factors for patellofemoral instability. Which of the following anatomic parameters is a primary indication for adding a tibial tubercle medialization osteotomy (e.g., Fulkerson osteotomy) to a medial patellofemoral ligament (MPFL) reconstruction?

. Caton-Deschamps index of 0.8
. Tibial Tubercle-Trochlear Groove (TT-TG) distance of 22 mm
. Trochlear dysplasia Type A according to the Dejour classification
. Q angle of 12 degrees
. Patellar tilt angle of 5 degrees

Correct Answer & Explanation

. Caton-Deschamps index of 0.8

Explanation

A Tibial Tubercle-Trochlear Groove (TT-TG) distance greater than 20 mm is pathologically elevated and represents significant lateralization of the tibial tubercle. This abnormal extensor mechanism vector strongly pulls the patella laterally. In the setting of recurrent patellar instability with a TT-TG > 20 mm, an MPFL reconstruction alone is at high risk of failure due to excessive tension on the graft. Therefore, a tibial tubercle medialization osteotomy (anterior-medialization or AMZ) is indicated to correct the underlying bony malalignment.

Question 684

Topic: Knee Sports
When performing a medial patellofemoral ligament (MPFL) reconstruction, anatomic femoral tunnel placement is critical to prevent graft anisometry. According to Schöttle, where is the ideal radiographic femoral attachment point?
. Anterior to the posterior femoral cortical line and distal to Blumensaat's line
. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line
. Distal to the adductor tubercle and anterior to the medial epicondyle
. Posterior to the posterior cortical line and distal to Blumensaat's line
. At the center of the medial femoral condyle articular surface

Correct Answer & Explanation

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

Explanation

Schöttle's point is radiographically defined on a true lateral knee radiograph as 1 mm anterior to the posterior cortical line extension, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line. Proper placement prevents graft overtensioning in flexion.

Question 685

Topic: Knee Sports
A 24-year-old male sustains a multiligament knee injury resulting in a KD-III L classification (ACL, PCL, and posterolateral corner disruption). He is at highest risk for injury to which of the following neurovascular structures?
. Femoral nerve
. Popliteal artery
. Common peroneal nerve
. Tibial nerve
. Saphenous nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

KD-III L injuries involve the posterolateral corner (PLC). The common peroneal nerve anatomically courses around the fibular neck and is highly susceptible to traction injury during varus-hyperextension mechanisms that disrupt the PLC.

Question 686

Topic: Knee Sports

When evaluating an osteochondritis dissecans (OCD) lesion of the medial femoral condyle, which of the following factors is the most reliable predictor of successful healing with non-operative management?

. Lesion size greater than 400 mm squared
. Location on the weight-bearing aspect of the lateral femoral condyle
. Open distal femoral physes
. Presence of a high signal rim behind the lesion on T2-weighted MRI
. Patient age over 18 years

Correct Answer & Explanation

. Lesion size greater than 400 mm squared

Explanation

Juvenile OCD (patients with open physes) has a significantly higher rate of spontaneous healing with non-operative management compared to adult OCD. Open physes are the strongest predictor of non-operative success.

Question 687

Topic: Knee Sports

Compared to traditional first-generation Autologous Chondrocyte Implantation (ACI), what is the primary technical advantage of Matrix-induced Autologous Chondrocyte Implantation (MACI)?

. It can be performed as a single-stage procedure
. It eliminates the need for a sutured periosteal patch by using a seeded collagen scaffold
. It does not require prior cartilage biopsy and cell expansion
. It utilizes mesenchymal stem cells directly harvested from the iliac crest
. It is primarily indicated for diffuse, severe osteoarthritis rather than focal defects

Correct Answer & Explanation

. It can be performed as a single-stage procedure

Explanation

MACI uses cultured chondrocytes seeded onto a porcine collagen membrane, which is then secured into the defect with fibrin glue. This avoids the technical morbidity of harvesting and suturing a periosteal patch used in first-generation ACI.

Question 688

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. Which of the following statements correctly describes their biomechanical behavior during knee range of motion?

. The anteromedial (AM) bundle is tightest in extension and controls rotatory stability
. The posterolateral (PL) bundle is tightest in deep flexion
. The anteromedial (AM) bundle is tightest in flexion and is the primary restraint to anterior tibial translation at 90 degrees
. The posterolateral (PL) bundle is the primary restraint to anterior translation at 90 degrees of flexion
. Both bundles maintain isometric tension throughout the full arc of motion

Correct Answer & Explanation

. The anteromedial (AM) bundle is tightest in extension and controls rotatory stability

Explanation

The ACL's anteromedial (AM) bundle is tightest in flexion and primarily restricts anterior tibial translation at 90 degrees. The posterolateral (PL) bundle is tightest in extension and provides critical rotatory stability.

Question 689

Topic: Knee Sports

A 30-year-old male sustains a high-energy traumatic knee dislocation.

Following reduction, he presents with a foot drop and numbness over the dorsum of the foot. Which specific ligamentous injury pattern is most highly associated with this neurologic deficit?

. Isolated ACL tear
. Posteromedial corner injury
. Isolated PCL tear
. Posterolateral corner injury
. MCL and ACL tear

Correct Answer & Explanation

. Isolated ACL tear

Explanation

Common peroneal nerve injury is a frequent complication of knee dislocations, occurring in up to 25-30% of cases. It is most highly associated with injuries to the posterolateral corner (PLC) and lateral collateral ligament (LCL) because the mechanism of injury (varus stress and hyperextension) strongly stretches the nerve as it wraps around the fibular neck.

Question 690

Topic: Knee Sports
A 31-year-old female sustains an anterior knee dislocation (KD-III) following a trampoline injury. Vascular exam is normal, but she has a complete foot drop and cannot actively extend her toes. Where is the most likely anatomic site of nerve tethering causing this injury?
. Popliteal fossa
. Fibular neck
. Anterior compartment of the lower leg
. Sciatic notch
. Medial malleolus

Correct Answer & Explanation

. Fibular neck

Explanation

Knee dislocations have a high rate of common peroneal nerve injury (especially posterolateral corner injuries). The nerve is firmly tethered at the fibular neck as it wraps around the bone, making it highly susceptible to traction.

Question 691

Topic: Knee Sports

In the native knee, femoral rollback (the posterior translation of the contact point of the femur on the tibia during flexion) is primarily driven by the tension of which of the following ligaments?

. Anterior cruciate ligament
. Poster cruciate ligament
. Medial collateral ligament
. Lateral collateral ligament
. Anterolateral ligament

Correct Answer & Explanation

. Poster cruciate ligament

Explanation

Femoral rollback is primarily driven by the tension in the posterior cruciate ligament (PCL) as the knee flexes. This kinematic mechanism allows for increased knee flexion by clearing the posterior femoral condyles from impinging on the posterior tibia.

Question 692

Topic: Knee Sports

A 55-year-old female presents with acute knee pain after performing a deep squat. MRI demonstrates a complete radial tear of the medial meniscus posterior root.

Biomechanically, this injury pattern most closely mimics which of the following conditions?

. Partial meniscectomy
. Total meniscectomy
. Anterior cruciate ligament rupture
. Posterior cruciate ligament rupture
. Medial collateral ligament rupture

Correct Answer & Explanation

. Total meniscectomy

Explanation

A complete tear of the medial meniscus posterior root disrupts the hoop stresses of the meniscus. Biomechanical studies have demonstrated that this leads to extrusion of the meniscus under load, rendering the knee biomechanically equivalent to a total meniscectomy. This results in significantly increased peak contact pressures in the medial compartment, rapidly predisposing the patient to osteoarthritis if left untreated.

Question 693

Topic: Knee Sports
An 18-year-old female with recurrent patellar dislocations is scheduled for medial patellofemoral ligament (MPFL) reconstruction. Correct placement of the femoral tunnel is critical to ensure anisometry is minimized. Fluoroscopically, the correct femoral attachment (Schöttle point) is best identified by which of the following landmarks on a true lateral radiograph?
. Anterior to the posterior femoral cortex line and distal to Blumensaat line
. 1 mm anterior to the posterior femoral cortex line and just proximal to the posterior extension of Blumensaat line
. 5 mm anterior to the posterior femoral cortex line and distal to Blumensaat line
. Posterior to the posterior femoral cortex line and proximal to Blumensaat line
. Anterior to the anterior femoral cortex

Correct Answer & Explanation

. 1 mm anterior to the posterior femoral cortex line and just proximal to the posterior extension of Blumensaat line

Explanation

The Schöttle point is a highly reliable radiographic landmark for the femoral origin of the MPFL. On a 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 just proximal to the posterior point of Blumensaat line. Proper placement prevents the graft from becoming inappropriately tight or loose during knee range of motion.

Question 694

Topic: Knee Sports

A 30-year-old male sustains an isolated posterior cruciate ligament (PCL) injury during a motor vehicle collision. On physical examination, the posterior drawer test is utilized to assess posterior tibial translation. At what degree of knee flexion is the PCL subjected to the highest in situ forces, making it the most reliable position for this test?

. 0 degrees
. 30 degrees
. 60 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 90 degrees

Explanation

The primary restraint to posterior tibial translation is the posterior cruciate ligament (PCL). Biomechanical studies have shown that the PCL experiences the highest in situ forces at 90 degrees of knee flexion. Consequently, the posterior drawer test is performed at 90 degrees of flexion to most accurately assess the integrity of the PCL. The anterolateral bundle is the larger, tighter bundle in flexion.

Question 695

Topic: Knee Sports

A 22-year-old female undergoes an anterior cruciate ligament (ACL) reconstruction. Post-operatively, she complains of a persistent lack of full knee extension. Imaging reveals that the graft is impinging against the intercondylar roof. What is the most likely technical error leading to this complication?

. Femoral tunnel placed too anterior
. Tibial tunnel placed too anterior
. Tibial tunnel placed too posterior
. Femoral tunnel placed too posterior
. Graft tensioned in full flexion

Correct Answer & Explanation

. Tibial tunnel placed too anterior

Explanation

A tibial tunnel that is placed too far anteriorly will result in the graft impinging on the intercondylar roof (Blumensaat line) during knee extension, leading to a loss of full extension and potential graft abrasion/failure. Conversely, a femoral tunnel placed too anteriorly results in a graft that becomes unphysiologically tight in flexion, limiting knee flexion.

Question 696

Topic: Knee Sports

A 14-year-old male presents with knee pain and catching. Radiographs reveal a classic osteochondritis dissecans (OCD) lesion.

What is the most common anatomic location for an OCD lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central weight-bearing portion of the medial femoral condyle
. Trochlear groove
. Inferior pole of the patella

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for osteochondritis dissecans (OCD) of the knee is the lateral aspect of the medial femoral condyle, accounting for roughly 70-80% of cases. A helpful mnemonic is 'LAME' (Lateral Aspect of Medial Epicondyle/condyle). The underlying etiology is thought to be repetitive microtrauma to a susceptible area of subchondral bone.

Question 697

Topic: Knee Sports

A 25-year-old male suffers a varus blow to his anteromedial knee while his foot is planted. Examination demonstrates increased external rotation of the tibia at 30 degrees of knee flexion compared to the uninjured side, but symmetrical tibial rotation at 90 degrees of flexion. Which structure is predominantly injured?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Isolated Posterolateral corner (PLC)
. Combined PCL and PLC tear
. Medial collateral ligament

Correct Answer & Explanation

. Isolated Posterolateral corner (PLC)

Explanation

The physical exam described is the Dial test. Increased external rotation (>10 degrees compared to the contralateral side) at 30 degrees of flexion, but not at 90 degrees, indicates an isolated injury to the posterolateral corner (PLC). If the test were positive at both 30 and 90 degrees, it would suggest a combined PLC and posterior cruciate ligament (PCL) injury, as the PCL becomes the primary restraint to external rotation at 90 degrees.

Question 698

Topic: Knee Sports

A 28-year-old male presents with right knee pain following a dashboard mechanism injury. On examination, the posterior drawer test is negative. The dial test demonstrates 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the uninjured side. At 90 degrees of knee flexion, external rotation is symmetric bilaterally. Which of the following structures is most likely injured?

. Posterior cruciate ligament (PCL) only
. Posterior cruciate ligament (PCL) and Posterolateral corner (PLC)
. Posterolateral corner (PLC) only
. Anterior cruciate ligament (ACL) and Medial collateral ligament (MCL)
. Lateral collateral ligament (LCL) only

Correct Answer & Explanation

. Posterolateral corner (PLC) only

Explanation

The dial test is used to evaluate the integrity of the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). Increased external rotation (>10-15 degrees difference from the contralateral side) at 30 degrees of flexion with symmetric rotation at 90 degrees indicates an isolated PLC injury. If the dial test is positive at both 30 degrees and 90 degrees of flexion, it suggests a combined injury to both the PLC and the PCL. The negative posterior drawer test further confirms the PCL is intact.

Question 699

Topic: Knee Sports

A 14-year-old male presents with vague knee pain and occasional catching. Radiographs reveal a 1.5 cm osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. MRI confirms the lesion is completely intact with no high T2 fluid signal behind the fragment. His distal femoral physes remain wide open. What is the initial treatment of choice?

. Arthroscopic transarticular drilling of the lesion
. Non-weight bearing and activity modification for 3 to 6 months
. Arthroscopic fixation with bioabsorbable screws
. Osteochondral autograft transfer (OATS)
. Autologous chondrocyte implantation (ACI)

Correct Answer & Explanation

. Arthroscopic transarticular drilling of the lesion

Explanation

This is a case of juvenile osteochondritis dissecans (JOCD) characterized by open physes and a stable lesion on MRI (no fluid behind the fragment, intact overlying cartilage). Stable JOCD lesions have a very high rate of spontaneous healing (up to 70-80%) with conservative management. The initial treatment is strict activity modification and weight-bearing restriction. Surgical intervention (drilling, fixation, or cartilage restoration) is indicated only if the lesion is unstable (fluid behind fragment), if the fragment is detached, or if there is failure of 6 months of nonoperative management.

Question 700

Topic: Knee Sports

Regarding the native anterior cruciate ligament (ACL), which of the following statements correctly describes the biomechanical function of its two distinct bundles?

. The anteromedial (AM) bundle is tight in extension and primarily controls rotational stability.
. The posterolateral (PL) bundle is tight in flexion and primarily controls anterior translation.
. The AM bundle is tight in flexion and primarily resists anterior tibial translation.
. The PL bundle is tight in flexion and primarily resists rotational instability.
. Both bundles maintain equal tension throughout the entire range of motion.

Correct Answer & Explanation

. The anteromedial (AM) bundle is tight in extension and primarily controls rotational stability.

Explanation

The native ACL has two main bundles: the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle is tight in flexion and is the primary restraint to anterior tibial translation. The PL bundle is tight in extension and is the primary restraint to rotational instability.

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