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Knee Sports MCQs

Practice Set 4 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 61

Topic: Knee Sports

When reconstructing the anterior cruciate ligament (ACL), the surgeon must identify the lateral intercondylar ridge (resident's ridge). What is the anatomical relationship of the native ACL footprint to this ridge?

. The ACL footprint is completely posterior to the ridge
. The ACL footprint is completely anterior to the ridge
. The ridge bisects the anteromedial and posterolateral bundles
. The ACL footprint is completely superior to the ridge
. The ACL footprint is completely inferior to the ridge

Correct Answer & Explanation

. The ACL footprint is completely posterior to the ridge

Explanation

The lateral intercondylar ridge (resident's ridge) marks the anterior boundary of the ACL femoral footprint when the knee is in 90 degrees of flexion. No native ACL fibers attach anterior to this ridge, making it a critical landmark for femoral tunnel placement.

Question 62

Topic: Knee Sports

What is the primary restraint to posterior tibial translation at 90 degrees of knee flexion?

. Anterolateral bundle of the PCL
. Posteromedial bundle of the PCL
. Posterior oblique ligament
. Anterior cruciate ligament
. Popliteofibular ligament

Correct Answer & Explanation

. Anterolateral bundle of the PCL

Explanation

The anterolateral (AL) bundle of the Posterior Cruciate Ligament (PCL) is the primary restraint to posterior tibial translation at 90 degrees of flexion. It is the larger and stronger bundle and becomes tight in flexion.

Question 63

Topic: Knee Sports
A patient presents with a chronic grade III isolated PCL injury treated non-operatively 15 years ago. Which compartments of the knee are at the highest risk for developing secondary osteoarthritis?
. Lateral and patellofemoral compartments
. Medial and patellofemoral compartments
. Medial and lateral compartments
. Isolated lateral compartment
. Isolated medial compartment

Correct Answer & Explanation

. Medial and patellofemoral compartments

Explanation

Chronic PCL deficiency leads to altered knee kinematics, specifically increasing contact pressures in the medial compartment and the patellofemoral joint. This predictably leads to early degenerative changes in these specific areas over time.

Question 64

Topic: Knee Sports

During a physical examination for a suspected knee ligament injury, the examiner actively flexes the patient's quadriceps while the knee is held at 90 degrees of flexion. The tibia is observed to translate anteriorly. This finding is pathognomonic for an injury to which structure?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Medial collateral ligament
. Popliteus tendon
. Fibular collateral ligament

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

The quadriceps active test is highly specific for a complete posterior cruciate ligament (PCL) tear. In a PCL-deficient knee resting at 90 degrees of flexion, the tibia sags posteriorly; active quadriceps contraction pulls the tibia anteriorly into its normal reduced position.

Question 65

Topic: Knee Sports

The meniscofemoral ligaments of the knee are intimately associated with the posterior cruciate ligament (PCL). Which of the following correctly describes their anatomical relationship?

. The ligament of Wrisberg passes anterior to the PCL
. The ligament of Humphrey passes posterior to the PCL
. The ligament of Humphrey passes anterior to the PCL and Wrisberg passes posterior
. Both pass anterior to the PCL
. Both pass posterior to the PCL

Correct Answer & Explanation

. The ligament of Humphrey passes anterior to the PCL and Wrisberg passes posterior

Explanation

The ligament of Humphrey runs anterior to the PCL, whereas the ligament of Wrisberg runs posterior to the PCL. They attach the posterior horn of the lateral meniscus to the medial femoral condyle.

Question 66

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction using an anatomical technique (e.g., LaPrade), three main structures are reconstructed. Which of the following is NOT one of the three primarily reconstructed structures?

. Fibular collateral ligament
. Popliteus tendon
. Popliteofibular ligament
. Iliotibial band
. None of the above

Correct Answer & Explanation

. Iliotibial band

Explanation

Anatomic PLC reconstruction aims to recreate the three major static restraints: the fibular collateral ligament (LCL), the popliteus tendon, and the popliteofibular ligament. The iliotibial band is a dynamic stabilizer and is not routinely reconstructed in this procedure.

Question 67

Topic: Knee Sports

An isolated posterolateral corner injury is diagnosed. Which physical exam finding would most accurately differentiate an isolated PLC injury from a combined PLC and PCL injury?

. Positive posterior drawer test at 90 degrees of flexion
. Positive dial test at 30 degrees of flexion
. Positive reverse pivot shift test
. Positive varus stress test at 30 degrees
. Positive external rotation recurvatum test

Correct Answer & Explanation

. Positive posterior drawer test at 90 degrees of flexion

Explanation

The posterior drawer test at 90 degrees evaluates the integrity of the PCL. An isolated PLC injury will have a normal posterior drawer at 90 degrees, whereas a combined PLC/PCL injury will demonstrate increased posterior translation.

Question 68

Topic: Knee Sports

A patient sustains an avulsion fracture of the anterolateral proximal tibia.

This finding is considered pathognomonic for a tear of which major knee ligament?

. Medial collateral ligament
. Posterior cruciate ligament
. Anterior cruciate ligament
. Fibular collateral ligament
. Anterolateral ligament

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion of the anterolateral capsular complex from the proximal tibia. It is highly associated (pathognomonic) with an underlying Anterior Cruciate Ligament (ACL) tear.

Question 69

Topic: Knee Sports
A patient is evaluated for a knee dislocation. Which specific knee dislocation classification implies a tear of the anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament, while the posterolateral corner remains intact?
. KD-I
. KD-II
. KD-III M
. KD-III L
. KD-IV

Correct Answer & Explanation

. KD-III M

Explanation

In the Schenck classification, KD-III refers to injuries involving both cruciates and one collateral ligament. KD-III M indicates the medial collateral ligament is torn, while KD-III L indicates the lateral (PLC) structures are torn.

Question 70

Topic: Knee Sports

A 30-year-old male undergoes a single-bundle anterior cruciate ligament (ACL) reconstruction. To optimally control both anterior translation and rotational instability, where is the most appropriate location for the femoral tunnel within the native footprint?

. High and anterior (at the 12 o'clock position)
. Central within the native footprint
. In the center of the posteromedial bundle footprint
. Anterior to the lateral intercondylar ridge
. At the center of the medial femoral condyle

Correct Answer & Explanation

. Central within the native footprint

Explanation

Modern ACL reconstruction emphasizes anatomical placement central within the native footprint. Vertical placement (12 o'clock) fails to control rotational instability, and placement anterior to the resident's ridge leads to graft impingement against the PCL or notch.

Question 71

Topic: Knee Sports

Which of the following structures form the primary static stabilizing complex of the posterolateral corner (PLC) of the knee?

. Iliotibial band, popliteus tendon, and lateral collateral ligament
. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament
. Biceps femoris tendon, lateral collateral ligament, and arcuate ligament
. Popliteofibular ligament, arcuate ligament, and fabellofibular ligament
. Lateral collateral ligament, anterolateral ligament, and popliteus tendon

Correct Answer & Explanation

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

The primary static stabilizers of the PLC are the lateral collateral ligament (fibular collateral ligament), the popliteus tendon, and the popliteofibular ligament. These structures work together synergistically to resist varus, external rotation, and posterior translation of the tibia.

Question 72

Topic: Knee Sports

During physical examination of a patient with a suspected multiligamentous knee injury, the dial test reveals 15 degrees of increased external tibial rotation compared to the contralateral side at 30 degrees of knee flexion. At 90 degrees of flexion, the side-to-side difference in external rotation is 2 degrees. What is the most likely injury pattern?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

An isolated PLC injury characteristically results in increased external rotation at 30 degrees of flexion with a normal (symmetric) dial test at 90 degrees. A combined PCL and PLC injury will demonstrate increased external rotation at both 30 and 90 degrees of knee flexion.

Question 73

Topic: Knee Sports

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

. It is the smaller bundle and is tightest in knee extension.
. It is the smaller bundle and is tightest in knee flexion.
. It is the larger bundle and is tightest in knee extension.
. It is the larger bundle and is tightest in knee flexion.
. It acts primarily to resist varus angulation in full extension.

Correct Answer & Explanation

. It is the larger bundle and is tightest in knee flexion.

Explanation

The PCL is composed of the larger, stronger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle is tight in knee flexion and lax in extension, whereas the PM bundle is tight in extension and lax in flexion.

Question 74

Topic: Knee Sports

Review the radiograph demonstrating a small cortical avulsion fracture from the medial aspect of the proximal tibia (Reverse Segond fracture).

This radiographic finding is virtually pathognomonic for which of the following combined injuries?

. Anterior cruciate ligament and medial meniscus tear
. Anterior cruciate ligament and lateral meniscus tear
. Posterior cruciate ligament and medial meniscus tear
. Medial collateral ligament and patellar tendon rupture
. Posterolateral corner and anterior cruciate ligament tear

Correct Answer & Explanation

. Posterior cruciate ligament and medial meniscus tear

Explanation

A reverse Segond fracture is an avulsion of the deep capsular component of the medial collateral ligament. It is highly associated with posterior cruciate ligament (PCL) tears and peripheral tears of the medial meniscus.

Question 75

Topic: Knee Sports

During surgical reconstruction of the posterolateral corner (PLC) using a fibular-based technique, a surgeon must be extremely careful to protect the common peroneal nerve. Where is this nerve most vulnerable during the approach?

. Deep to the lateral head of the gastrocnemius
. Posterior to the biceps femoris tendon at the fibular head
. Between the iliotibial band and the lateral collateral ligament
. Anterior to the anterior tibial artery at the interosseous membrane
. Superficial to the lateral collateral ligament near its femoral origin

Correct Answer & Explanation

. Posterior to the biceps femoris tendon at the fibular head

Explanation

The common peroneal nerve runs posterior to the biceps femoris tendon and wraps around the fibular neck. It must be identified and protected during a lateral approach or fibular-based PLC reconstruction to avoid iatrogenic foot drop.

Question 76

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

Correct Answer & Explanation

. KD III-L

Explanation

The Schenck classification describes multiligamentous knee injuries based on the involved structures. KD III-L involves the ACL, PCL, and the lateral structures (PLC/LCL), whereas KD III-M involves the ACL, PCL, and medial structures.

Question 77

Topic: Knee Sports

A 28-year-old male presents with recurrent instability 2 years after an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Clinical examination reveals an intact ACL graft on Lachman testing but significant varus thrust during gait and a positive reverse pivot shift. Failure to address which of the following at the index procedure most likely caused this outcome?

. Medial collateral ligament tear
. Posterolateral corner deficiency
. Posteromedial corner deficiency
. Ramp lesion of the medial meniscus
. Anterolateral ligament tear

Correct Answer & Explanation

. Posterolateral corner deficiency

Explanation

Unrecognized or untreated posterolateral corner (PLC) deficiency results in pathologically increased varus and external rotation forces. This abnormally increased stress on an ACL graft frequently leads to chronic graft elongation and ultimate failure.

Question 78

Topic: Knee Sports
A 22-year-old collegiate football player sustains an acute combined grade III anterior cruciate ligament (ACL) tear and grade III medial collateral ligament (MCL) tear. Assuming non-operative treatment of the MCL is chosen, what is the most widely accepted management strategy?
. Immediate single-stage reconstruction of the ACL and repair of the MCL
. Hinged knee bracing for 4 to 6 weeks followed by delayed ACL reconstruction
. Immediate ACL reconstruction with rigid immobilization in full extension for 6 weeks
. Simultaneous repair of the ACL and MCL within 3 days of injury
. Conservative treatment for both ligaments with a return to play at 3 months

Correct Answer & Explanation

. Hinged knee bracing for 4 to 6 weeks followed by delayed ACL reconstruction

Explanation

The standard management for combined ACL and MCL injuries often involves bracing the knee to allow the MCL to heal, followed by delayed ACL reconstruction once full range of motion is restored. This staged approach significantly minimizes the high risk of postoperative arthrofibrosis.

Question 79

Topic: Knee Sports
Which type of knee dislocation is most strongly associated with a stretch or complete rupture injury to the common peroneal nerve?
. Anterior dislocation
. Posterior dislocation
. Medial dislocation
. Posterolateral dislocation
. Anteromedial dislocation

Correct Answer & Explanation

. Posterolateral dislocation

Explanation

Posterolateral knee dislocations, and multiligament injuries involving the posterolateral corner (KD III-L), have the highest rate of common peroneal nerve injury. This is due to severe traction across the nerve as it wraps around the fibular neck.

Question 80

Topic: Knee Sports

An isolated rupture of the posterolateral corner (PLC) is suspected in a 25-year-old athlete. During the Dial test, what are the expected physical examination findings that differentiate an isolated PLC injury from a combined PLC and posterior cruciate ligament (PCL) injury?

. Asymmetric external rotation greater than 10 degrees at 30 degrees of flexion, with symmetric rotation at 90 degrees of flexion.
. Asymmetric external rotation greater than 10 degrees at 90 degrees of flexion, with symmetric rotation at 30 degrees of flexion.
. Asymmetric external rotation greater than 10 degrees at both 30 degrees and 90 degrees of flexion.
. Asymmetric internal rotation greater than 10 degrees at 30 degrees of flexion only.
. Symmetric external rotation at 30 degrees of flexion, but excessive posterior tibial translation at 90 degrees.

Correct Answer & Explanation

. Asymmetric external rotation greater than 10 degrees at 30 degrees of flexion, with symmetric rotation at 90 degrees of flexion.

Explanation

An isolated PLC injury exhibits excessive external rotation at 30 degrees of knee flexion but reduces to normal at 90 degrees due to an intact PCL. If external rotation is increased at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

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