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Knee Sports MCQs

Practice Set 38 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 741

Topic: Knee Sports

Physical examination of a knee injury reveals increased external tibial rotation at 30 degrees of flexion compared to the contralateral side, but symmetric external rotation at 90 degrees. This finding indicates an isolated injury to the:

. Anterior cruciate ligament
. Posterior cruciate ligament
. Posterolateral corner
. Superficial medial collateral ligament
. Posterior oblique ligament

Correct Answer & Explanation

. Posterolateral corner

Explanation

A positive dial test at 30 degrees but normal at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If external rotation is increased at both 30 and 90 degrees, it suggests a combined PLC and posterior cruciate ligament (PCL) injury.

Question 742

Topic: Knee Sports

Osteochondritis dissecans (OCD) lesions of the knee most frequently occur in which of the following anatomical locations?

. 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 classic and most common location for osteochondritis dissecans in the knee is the lateral aspect of the medial femoral condyle (LAME - Lateral Aspect Medial Epicondyle/Condyle), accounting for roughly 70% of cases.

Question 743

Topic: Knee Sports

A 25-year-old football player presents with a knee injury. On physical examination, the dial test shows 15 degrees of increased external rotation at 30 degrees of flexion compared to the contralateral knee, but equal external rotation at 90 degrees of flexion. Which structure is most likely injured?

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

Correct Answer & Explanation

. Posterolateral corner (PLC) only

Explanation

Increased external rotation on the dial test at 30 degrees of flexion, but not at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. If asymmetry persists at both 30 and 90 degrees, a combined PLC and PCL injury is present.

Question 744

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, femoral tunnel placement proximal to Schöttle's point will result in which of the following graft kinematics?
. The graft will be tightest in full extension and lax in deep flexion.
. The graft will be tightest in deep flexion and lax in extension.
. The graft will maintain perfect isometric tension throughout the entire range of motion.
. The graft will cause increased lateral patellar tracking.
. The graft will primarily limit internal rotation of the tibia.

Correct Answer & Explanation

. The graft will be tightest in deep flexion and lax in extension.

Explanation

Placing the MPFL femoral attachment too proximal results in the graft being overly tight in flexion and loose in extension, risking loss of knee flexion and medial patellar overload. Correct placement is slightly anterior to the posterior femoral cortex extension line.

Question 745

Topic: Knee Sports

What is the most common anatomic location for an osteochondritis dissecans (OCD) lesion in the knee?

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

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The lateral aspect of the medial femoral condyle is the classic and most common location for osteochondritis dissecans (OCD) lesions of the knee. This is often remembered by the mnemonic 'LAME' (Lateral Aspect Medial Epicondyle/condyle).

Question 746

Topic: Knee Sports

When performing a single-bundle posterior cruciate ligament (PCL) reconstruction, recreating the anterolateral (AL) bundle is prioritized. During which phase of knee range of motion is the native AL bundle most taut?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 degrees of flexion
. 120 degrees of flexion

Correct Answer & Explanation

. 90 degrees of flexion

Explanation

The anterolateral (AL) bundle of the PCL is the larger, stiffer bundle and is most taut at 90 degrees of knee flexion. The posteromedial (PM) bundle is tight in extension and deep flexion.

Question 747

Topic: Knee Sports
A 10-year-old boy sustained an injury to the left knee. The radiographic findings shown in Figure 19 are most commonly associated with injury to which of the following structures?
. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Patellar tendon
. Lateral capsule
. Pes anserinus

Correct Answer & Explanation

. Anterior cruciate ligament (ACL)

Explanation

The radiograph shows a bony avulsion of the ACL attachment site on the tibial spine in this skeletally immature patient. In this age group, injury often results in failure of the bony attachment site rather than the substance of the ligament.

Question 748

Topic: Knee Sports

During a primary posterior cruciate ligament (PCL)-retaining total knee arthroplasty, the surgeon notes that the trial components result in a knee that is well-balanced in extension but exhibits a significantly tight flexion gap with restricted femoral rollback. Which of the following is the most likely cause of this kinematic abnormality?

. The polyethylene insert is too thick
. The femoral component is undersized
. The tibial component was cut in excessive varus
. The posterior cruciate ligament (PCL) is too tight
. Excessive distal femoral bone was resected

Correct Answer & Explanation

. The posterior cruciate ligament (PCL) is too tight

Explanation

In a PCL-retaining TKA, a tight flexion gap with restricted rollback and anterior lift-off of the tibial tray indicates a tight PCL. Management includes sequential release of the PCL or increasing the posterior slope of the tibial cut to open the flexion gap.

Question 749

Topic: Knee Sports

A 50-year-old female suffers an acute tear of the posterior root of the medial meniscus. If left untreated, what is the primary biomechanical consequence of this specific injury on the knee joint?

. Loss of circumferential hoop stresses leading to contact pressures equivalent to a total meniscectomy
. Increased anterior tibial translation during the Lachman test
. Decreased contact pressures in the medial compartment
. Immediate patellofemoral cartilage degradation due to altered tracking
. Lateral compartment overload leading to valgus deformity

Correct Answer & Explanation

. Loss of circumferential hoop stresses leading to contact pressures equivalent to a total meniscectomy

Explanation

A medial meniscal root tear completely unanchors the meniscus, leading to radial extrusion and a complete loss of circumferential hoop stresses. Biomechanically, this failure of load distribution results in articular contact pressures that are essentially equivalent to those seen after a complete total meniscectomy, rapidly accelerating medial compartment osteoarthritis.

Question 750

Topic: Knee Sports

A patient sustains a knee dislocation. Physical exam reveals a positive dial test at 30 degrees of flexion that normalizes to symmetry at 90 degrees of flexion. Which structures are most likely injured?

. Posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL)
. Isolated posterolateral corner (PLC)
. Combined PLC and PCL
. Medial collateral ligament (MCL) and ACL
. Isolated posteromedial corner (PMC)

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

The dial test assesses external rotation of the tibia relative to the femur. A positive test is defined as >10 degrees of external rotation compared to the contralateral side. Increased external rotation at 30 degrees that normalizes at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If it is increased at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 751

Topic: Knee Sports
A 32-year-old male sustains an isolated Grade III posterior cruciate ligament (PCL) injury. Non-operative management is chosen. Which of the following rehabilitation protocols is most appropriate during the first 2-4 weeks to optimize ligament healing?
. Immobilization in full extension
. Immobilization in 90 degrees of flexion
. Immediate active knee flexion exercises
. Weight-bearing as tolerated in a hinged brace locked at 45 degrees
. Immediate open kinetic chain hamstring strengthening

Correct Answer & Explanation

. Immobilization in full extension

Explanation

For acute isolated PCL injuries, conservative management emphasizes immobilization in full extension (or slight hyperextension) for 2 to 4 weeks. This position minimizes posterior tibial sag, keeping the PCL in a shortened, reduced position to promote healing. Active hamstring exercises pull the tibia posteriorly and must be avoided in the early phases.

Question 752

Topic: Knee Sports
A 17-year-old female requires medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar instability. According to Schöttle's point, where is the optimal anatomic femoral origin of the MPFL located radiographically on a true lateral view?
. Anterior to a line extending the posterior femoral cortex and distal to Blumensaat's line
. Anterior to a line extending the posterior femoral cortex and proximal to Blumensaat's line
. Posterior to a line extending the posterior femoral cortex and proximal to Blumensaat's line
. Posterior to a line extending the posterior femoral cortex and distal to Blumensaat's line
. Centered on the adductor tubercle

Correct Answer & Explanation

. Anterior to a line extending the posterior femoral cortex and proximal to Blumensaat's line

Explanation

Schöttle's point is the radiographic landmark for the femoral origin of the MPFL. On a true lateral radiograph, it 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 Blumensaat's line. Placing the graft here ensures proper isometry, avoiding over-tensioning in flexion.

Question 753

Topic: Knee Sports

A 25-year-old football player sustains a lateral blow to his knee. On examination, he has a positive dial test at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees compared to the uninjured side. Which structure is most likely injured?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

The dial test assesses for posterolateral knee instability. Asymmetry at 30 degrees of flexion with symmetry at 90 degrees indicates an isolated posterolateral corner (PLC) injury, whereas asymmetry at both 30 and 90 degrees suggests combined PLC and PCL injury.

Question 754

Topic: Knee Sports
An 18-year-old female is undergoing medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. To ensure proper graft isometry, the femoral tunnel is placed at Schöttle's point. Where is this point located anatomically and radiographically on a true lateral view?
. Anterior to the posterior cortical line and distal to Blumensaat's line
. Anterior to the posterior cortical line and proximal to Blumensaat's line
. Posterior to the posterior cortical line and proximal to Blumensaat's line
. Anterior to the posterior cortical line and directly crossing Blumensaat's line
. Directly on the medial epicondyle prominence

Correct Answer & Explanation

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

Explanation

Schöttle's point is the radiographic anatomical origin of the MPFL. 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 extension of Blumensaat's line.

Question 755

Topic: Knee Sports

A 55-year-old female presents with sudden medial knee pain. MRI shows a medial meniscus posterior root tear with 4 mm of meniscal extrusion. What is the primary biomechanical consequence of this specific injury pattern?

. Increased anterior tibial translation during terminal extension
. Complete loss of hoop stresses leading to increased peak contact pressures
. Decreased peak contact pressures across the medial compartment
. Increased internal rotation of the tibia at 90 degrees of flexion
. Loss of secondary valgus restraint

Correct Answer & Explanation

. Complete loss of hoop stresses leading to increased peak contact pressures

Explanation

A meniscal root tear results in complete loss of circumferential hoop stresses, making it biomechanically equivalent to a total meniscectomy. This leads to increased peak contact pressures and rapid progression of osteoarthritis.

Question 756

Topic: Knee Sports

A 50-year-old female experiences a sudden pop in the back of her knee while squatting. MRI reveals a medial meniscus posterior root tear with meniscal extrusion. Biomechanically, what is the primary consequence if this injury is left untreated?

. Increased hoop stresses on the remaining meniscus
. Conversion of hoop stresses to destructive shear stresses
. Decreased contact pressures in the medial compartment
. Prevention of further meniscal extrusion
. Reversal of the screw-home mechanism

Correct Answer & Explanation

. Conversion of hoop stresses to destructive shear stresses

Explanation

A meniscal root tear disrupts the circumferential continuity of the meniscus, preventing the proper generation of hoop stresses. This converts normal compressive loads into shear stresses, functioning biomechanically like a total meniscectomy and leading to rapid cartilage wear.

Question 757

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the femoral tunnel must be placed anatomically to avoid non-isometric graft tension. Which anatomical landmarks define Schöttle's point for the femoral origin?
. Anterior to the posterior cortical line extension and distal to Blumensaat's line
. Between the adductor tubercle and the medial epicondyle
. At the center of the medial femoral condyle articular surface
. Posterior to the adductor magnus insertion
. On the lateral femoral condyle distal to the popliteus insertion

Correct Answer & Explanation

. Between the adductor tubercle and the medial epicondyle

Explanation

The anatomic femoral origin of the MPFL (Schöttle's point) is located in the saddle-shaped depression between the adductor tubercle and the medial epicondyle. Accurate placement prevents graft overtensioning during knee flexion.

Question 758

Topic: Knee Sports

To minimize the risk of popliteal artery injury during tibial tunnel reaming in an arthroscopic posterior cruciate ligament (PCL) reconstruction, in what position should the knee be placed and why?

. Extension, as it moves the artery anteriorly
. Flexion past 90 degrees, as it increases the distance between the posterior capsule and the artery
. Flexion past 90 degrees, as it moves the artery laterally
. Extension, to tighten the posterior capsule
. 45 degrees of flexion, to maximize capsular volume

Correct Answer & Explanation

. Flexion past 90 degrees, as it increases the distance between the posterior capsule and the artery

Explanation

Flexing the knee beyond 90 degrees allows the popliteal artery to fall posteriorly away from the joint capsule. This maximizes the safe distance between the reamer and the neurovascular bundle during PCL tibial tunnel creation.

Question 759

Topic: Knee Sports

A 22-year-old football player sustains a complex knee injury. Physical examination reveals a positive Dial test with increased external rotation at 30 degrees of knee flexion, but symmetric external rotation at 90 degrees of flexion. Which structures are most likely injured?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

An increase in external rotation at 30 degrees of flexion that normalizes at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If external rotation is increased at both 30 and 90 degrees, a combined PLC and PCL injury is suspected.

Question 760

Topic: Knee Sports

A 19-year-old female undergoes an anterior cruciate ligament (ACL) reconstruction. If the femoral tunnel is placed too vertically (at the 12 o'clock position) in the intercondylar notch, what is the most likely clinical outcome?

. Loss of full knee extension
. Intact rotational stability but persistent anterior-posterior laxity
. Intact anterior-posterior stability but persistent rotational laxity (positive pivot shift)
. Increased risk of graft impingement against the PCL
. Early patellofemoral arthritis

Correct Answer & Explanation

. Intact anterior-posterior stability but persistent rotational laxity (positive pivot shift)

Explanation

A vertically placed ACL graft will adequately resist anterior tibial translation but fails to control rotational kinematics. This commonly presents postoperatively as a persistent pivot shift despite a negative Lachman test.

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