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Knee Sports MCQs

Practice Set 37 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 721

Topic: Knee Sports

When performing an anterior cruciate ligament (ACL) reconstruction, placing the femoral tunnel using a traditional transtibial technique rather than an independent anteromedial portal technique most commonly results in a tunnel that is:

. Too anterior and too vertical
. Too posterior and too horizontal
. Too anterior and too horizontal
. Too posterior and too vertical
. Anatomically positioned in the footprint

Correct Answer & Explanation

. Too anterior and too vertical

Explanation

The traditional transtibial technique constrains the femoral tunnel trajectory based on the tibial tunnel, frequently resulting in a femoral tunnel that is placed too vertical and too anterior in the intercondylar notch, failing to control rotational instability.

Question 722

Topic: Knee Sports

The posterior cruciate ligament (PCL) consists of two main bundles. Which of the following best describes the biomechanical behavior of the anterolateral (AL) bundle?

. It is tight in extension and loose in flexion
. It is tight in flexion and loose in extension
. It is the primary restraint to valgus stress at 30 degrees
. It provides primary restraint to external rotation at 90 degrees
. It originates on the medial tibia and inserts on the lateral femur

Correct Answer & Explanation

. It is tight in flexion and loose in extension

Explanation

The PCL has a larger anterolateral (AL) bundle that is tight in flexion and loose in extension, and a smaller posteromedial (PM) bundle that is tight in extension and loose in flexion.

Question 723

Topic: Knee Sports

A 28-year-old male presents with chronic knee instability following a football injury 9 months ago. Physical examination reveals a positive Lachman test, a positive pivot shift, and significant laxity to varus stress at 30 degrees of flexion. His dial test is asymmetric at 30 and 90 degrees. Standing full-length radiographs demonstrate a mechanical axis passing through the medial compartment (varus morphotype). What is the most appropriate initial surgical management?

. Simultaneous arthroscopic ACL reconstruction and open posterolateral corner (PLC) reconstruction
. High tibial osteotomy (HTO), with delayed ligamentous reconstruction if symptomatic instability persists
. Isolated ACL reconstruction, followed by a derotational brace for 12 weeks
. Isolated PLC reconstruction to restore varus stability, followed by physical therapy
. Simultaneous HTO, ACL reconstruction, and PLC reconstruction

Correct Answer & Explanation

. Simultaneous arthroscopic ACL reconstruction and open posterolateral corner (PLC) reconstruction

Explanation

In the setting of chronic combined ACL and posterolateral corner (PLC) deficiency coupled with varus mechanical alignment, performing ligamentous reconstruction alone without addressing the bony malalignment results in exceptionally high failure rates due to excessive tensile forces on the grafts. The standard of care is a staged approach: an initial High Tibial Osteotomy (HTO) to correct the varus alignment (shifting the mechanical axis laterally), followed by delayed ACL/PLC reconstruction. Often, the bony correction provides sufficient stability that the patient may not require the second-stage ligament reconstruction.

Question 724

Topic: Knee Sports

A 19-year-old female dancer presents with recurrent lateral patellar instability. An MRI of her knee reveals a Tibial Tubercle to Trochlear Groove (TT-TG) distance of 23 mm, a Caton-Deschamps index of 1.0, and a Dejour Type A trochlear dysplasia. She has failed conservative management. Which of the following surgical procedures is most appropriate to minimize her risk of recurrence?

. Isolated Medial Patellofemoral Ligament (MPFL) reconstruction
. MPFL reconstruction combined with a medializing tibial tubercle osteotomy (TTO)
. MPFL reconstruction combined with a distalizing tibial tubercle osteotomy (TTO)
. Lateral retinacular release and medial plication
. Isolated trochleoplasty

Correct Answer & Explanation

. Isolated Medial Patellofemoral Ligament (MPFL) reconstruction

Explanation

The patient has recurrent patellar instability with an abnormally high TT-TG distance. A normal TT-TG distance is generally < 15 mm. A distance of > 20 mm is considered pathologic and is an absolute indication for a medializing tibial tubercle osteotomy (TTO) to centralize the extensor mechanism. Performing an isolated MPFL reconstruction in the setting of a TT-TG > 20 mm subjects the graft to excessive lateralizing forces, resulting in an unacceptably high rate of graft failure. Because her Caton-Deschamps index is 1.0 (normal patellar height), a distalizing TTO is not indicated.

Question 725

Topic: Knee Sports
A 55-year-old female feels a sudden 'pop' in the posterior aspect of her knee while descending stairs. She complains of intense posteromedial knee pain. An MRI reveals >3 mm of medial meniscal extrusion on the coronal sequence and a 'ghost sign' on the sagittal sequence. This specific meniscal injury pattern is most strongly associated with the subsequent development of which of the following conditions if left untreated?
. Anterior cruciate ligament insufficiency
. Subchondral insufficiency fracture of the knee (SIFK) / spontaneous osteonecrosis (SONK)
. Pigmented villonodular synovitis (PVNS)
. Patellofemoral osteoarthritis
. Popliteal artery entrapment

Correct Answer & Explanation

. Subchondral insufficiency fracture of the knee (SIFK) / spontaneous osteonecrosis (SONK)

Explanation

The clinical presentation and MRI findings (extrusion > 3 mm, 'ghost sign') are pathognomonic for a medial meniscus posterior root tear. The posterior root anchor is essential for converting axial loads into hoop stresses. Disruption of the root biomechanically mimics a total meniscectomy, leading to drastically increased focal contact pressures in the medial compartment. If left untreated, this rapid loss of load distribution is highly associated with the development of a subchondral insufficiency fracture of the knee (SIFK), classically referred to as spontaneous osteonecrosis of the knee (SONK), and rapid progression of osteoarthritis.

Question 726

Topic: Knee Sports

A 30-year-old male is evaluated for knee instability following a wrestling injury. A Dial test is performed in the prone position. There is 20 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 bilaterally. Which structure(s) are primarily injured?

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

Correct Answer & Explanation

. Isolated posterior cruciate ligament (PCL)

Explanation

The Dial test evaluates posterolateral rotatory instability. Increased external rotation (>10 degrees compared to the normal knee) at 30 degrees of flexion, but normal at 90 degrees, indicates an isolated injury to the posterolateral corner (PLC). If increased external rotation is present at both 30 and 90 degrees, it indicates a combined injury to the PLC and the posterior cruciate ligament (PCL).

Question 727

Topic: Knee Sports

A 28-year-old male requires open reduction and internal fixation of a large, displaced tibial-sided avulsion fracture of the posterior cruciate ligament (PCL). A traditional posteromedial approach to the knee is planned. The deep surgical dissection passes between the medial head of the gastrocnemius and which other muscle to expose the posterior capsule?

. Popliteus
. Soleus
. Semimembranosus
. Biceps femoris
. Gracilis

Correct Answer & Explanation

. Popliteus

Explanation

The posteromedial approach to the knee (often attributed to Burks and Schaffer) relies on the internervous/intermuscular plane between the medial head of the gastrocnemius (tibial nerve) and the semimembranosus (sciatic nerve). Retracting the gastrocnemius laterally protects the midline neurovascular structures.

Question 728

Topic: Knee Sports

A 24-year-old athlete sustains a twisting injury to his knee. On physical examination, he demonstrates 15 degrees of increased external tibial rotation compared to the contralateral side at 30 degrees of flexion, but symmetric external rotation at 90 degrees of flexion. What is the most likely injured structure?

. Posterior cruciate ligament (PCL) isolated tear
. Posterolateral corner (PLC) isolated injury
. Combined PCL and PLC injury
. Anterior cruciate ligament (ACL) isolated tear
. Medial collateral ligament (MCL) isolated tear

Correct Answer & Explanation

. Posterolateral corner (PLC) isolated injury

Explanation

The Dial test assesses external tibial rotation. Increased rotation at 30 degrees but not at 90 degrees indicates an isolated posterolateral corner (PLC) injury. Combined PCL and PLC injuries show increased rotation at both 30 and 90 degrees.

Question 729

Topic: Knee Sports
A 24-year-old male sustains a high-energy posterior knee dislocation (KD III). Following successful closed reduction, his foot is warm and pink, and ABIs are >0.9 bilaterally. He undergoes multi-ligament knee reconstruction 3 weeks later. During surgery on the posterolateral corner, the common peroneal nerve is visualized and protected. However, postoperatively he has a new-onset foot drop. What is the most likely cause of this isolated nerve palsy?
. Direct transection of the nerve during the posterolateral approach
. Traction injury to the nerve due to a tight fascial band at the fibular neck during surgical positioning/manipulation
. Intraoperative tourniquet ischemia
. Compartment syndrome of the anterior leg
. Entrapment of the nerve within the fibular collateral ligament reconstruction

Correct Answer & Explanation

. Traction injury to the nerve due to a tight fascial band at the fibular neck during surgical positioning/manipulation

Explanation

The common peroneal nerve is tightly tethered at the fibular neck. Indirect traction injuries during posterolateral corner reconstruction or positioning are the most common cause of iatrogenic palsy in this setting, even when the nerve is directly visualized and protected.

Question 730

Topic: Knee Sports

During the physical examination of a patient with a traumatic knee injury, the dial test reveals a 15-degree increase in external rotation on the injured side compared to the normal side when tested at 30 degrees of knee flexion. However, at 90 degrees of knee flexion, the external rotation is symmetric bilaterally. What is the correct diagnosis?

. Isolated posterior cruciate ligament (PCL) injury
. Isolated lateral collateral ligament (LCL) injury
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injury
. Combined ACL and PLC injury

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

A positive dial test (asymmetry of >10 degrees of external rotation) exclusively at 30 degrees of flexion indicates an isolated posterolateral corner (PLC) injury. If the test is positive at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.

Question 731

Topic: Knee Sports

A 16-year-old female suffers an acute, traumatic lateral patellar dislocation. Which of the following soft-tissue structures is the primary restraint to lateral patellar translation at 0 to 20 degrees of knee flexion, and is nearly universally ruptured in this injury?

. Vastus medialis obliquus (VMO)
. Medial patellotibial ligament
. Medial patellofemoral ligament (MPFL)
. Lateral retinaculum
. Medial meniscopatellar ligament

Correct Answer & Explanation

. Medial patellofemoral ligament (MPFL)

Explanation

The medial patellofemoral ligament (MPFL) provides approximately 50-60% of the restraint against lateral patellar displacement in early knee flexion (0 to 20 degrees). MPFL rupture is the essential pathologic lesion in an acute lateral patellar dislocation.

Question 732

Topic: Knee Sports

Following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, a patient complains of a significant loss of knee flexion, though full extension is maintained. Which of the following technical errors is the most likely cause of this specific complication?

. Anterior placement of the femoral tunnel
. Posterior placement of the femoral tunnel
. Anterior placement of the tibial tunnel
. Posterior placement of the tibial tunnel
. Harvesting a graft that is too wide

Correct Answer & Explanation

. Anterior placement of the femoral tunnel

Explanation

An anteriorly placed femoral tunnel during ACL reconstruction results in a graft that becomes overly tight in flexion, causing a significant loss of knee flexion. Conversely, an anterior tibial tunnel typically restricts extension.

Question 733

Topic: Knee Sports

Which of the following describes the tensioning pattern of the native posterior cruciate ligament (PCL) bundles during knee range of motion?

. The anterolateral bundle is tight in extension and lax in flexion
. The posteromedial bundle is tight in flexion and lax in extension
. The anterolateral bundle is tight in flexion and the posteromedial bundle is tight in extension
. Both bundles exhibit isometric behavior throughout the full arc of motion
. The anterolateral bundle primarily restrains varus rotation in full extension

Correct Answer & Explanation

. The anterolateral bundle is tight in flexion and the posteromedial bundle is tight in extension

Explanation

The PCL consists of two main bundles: the anterolateral (AL) and posteromedial (PM). The larger AL bundle tightens during knee flexion, while the smaller PM bundle tightens in extension.

Question 734

Topic: Knee Sports

A 55-year-old female presents with acute posterior knee pain after descending stairs. MRI reveals a posterior root tear of the medial meniscus. Biomechanically, this injury is most equivalent to which of the following?

. An intact meniscus with an anterior horn tear
. A total medial meniscectomy
. A partial meniscectomy with intact hoop stresses
. A complete anterior cruciate ligament tear
. An isolated medial collateral ligament rupture

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A complete posterior root tear of the medial meniscus disrupts the circumferential hoop stresses of the meniscus. Biomechanically, this results in altered peak contact pressures and kinematics equivalent to a total meniscectomy.

Question 735

Topic: Knee Sports

In medial patellofemoral ligament (MPFL) reconstruction, identifying the correct femoral attachment (Schottle point) is critical. Where is this point located on a true lateral radiograph of the knee?

. Anterior to the posterior femoral cortical line and distal to the Blumensaat line
. Anterior to the posterior femoral cortical line and proximal to the Blumensaat line
. Posterior to the posterior femoral cortical line and distal to the Blumensaat line
. 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 line
. 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and distal to Blumensaat line

Correct Answer & Explanation

. 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 line

Explanation

Schottle point is located radiographically 1 mm anterior to the extension of the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the Blumensaat line.

Question 736

Topic: Knee Sports

Which of the following factors is most strongly associated with a poor prognosis for nonoperative healing in a patient with an osteochondritis dissecans (OCD) lesion of the medial femoral condyle?

. Patient age of 10 years
. Lesion size of 1 cm
. Open distal femoral physis
. Presence of cystic changes deep to the lesion on MRI
. Lesion location on the classic lateral aspect of the medial femoral condyle

Correct Answer & Explanation

. Presence of cystic changes deep to the lesion on MRI

Explanation

Signs of instability on MRI, such as high T2 signal behind the fragment or cystic changes deep to the lesion, indicate a poor prognosis for conservative management. Closed physes are also a strong predictor of non-healing.

Question 737

Topic: Knee Sports

Regarding the anatomy and biomechanics of the anterior cruciate ligament (ACL), which of the following statements best describes the anteromedial (AM) bundle?

. It is tightest in full extension.
. It primarily controls rotatory stability of the knee.
. It is tightest in deep flexion.
. It originates posterior to the PL bundle on the lateral femoral condyle.
. It inserts posterior to the PL bundle on the tibial footprint.

Correct Answer & Explanation

. It primarily controls rotatory stability of the knee.

Explanation

The anteromedial (AM) bundle of the ACL is tightest in knee flexion and primarily restrains anterior tibial translation. Conversely, the posterolateral (PL) bundle is tightest in extension and primarily controls rotatory stability.

Question 738

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction, accurate identification of the femoral attachment (Schöttle's point) is critical to prevent graft anisometry. Radiographically, this anatomic point is located:
. Anterior to the posterior femoral cortical extension line.
. Distal to the posterior extent of Blumensaat's line.
. Proximal to the adductor tubercle.
. Between the adductor tubercle and the medial epicondyle.
. Anterior to Blumensaat's line.

Correct Answer & Explanation

. Anterior to Blumensaat's line.

Explanation

The anatomical femoral origin of the MPFL sits in a saddle between the medial epicondyle and the adductor tubercle. On a true lateral radiograph, Schöttle's point is 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior border of the medial femoral condyle, and proximal to Blumensaat's line.

Question 739

Topic: Knee Sports

Which structure serves as the primary restraint to varus stress of the knee at 30 degrees of flexion?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Fibular collateral ligament (LCL)
. Popliteofibular ligament
. Iliotibial band

Correct Answer & Explanation

. Fibular collateral ligament (LCL)

Explanation

The fibular collateral ligament (LCL) is the primary restraint to varus stress at both 0 and 30 degrees of knee flexion. The popliteus and popliteofibular ligament primarily restrain external rotation.

Question 740

Topic: Knee Sports

Which MRI finding is most classically associated with a posterior medial meniscus root tear, functionally representing a loss of meniscal hoop stresses?

. Medial meniscus extrusion greater than 3 mm on coronal MRI
. Parameniscal cyst formation in the anterior horn
. Double PCL sign on sagittal MRI
. Subchondral edema isolated to the lateral femoral condyle
. Focal articular cartilage defect in the trochlea

Correct Answer & Explanation

. Medial meniscus extrusion greater than 3 mm on coronal MRI

Explanation

A posterior root tear disrupts the circumferential hoop stresses of the meniscus, causing it to functionally behave like a total meniscectomy. This loss of tension leads to meniscal extrusion of > 3 mm beyond the tibial margin on a coronal MRI.

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