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Knee Sports MCQs

Practice Set 40 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 781

Topic: Knee Sports

In a skeletally immature patient with an osteochondritis dissecans (OCD) lesion of the knee, which location is most common, and which MRI finding best indicates instability of the lesion that may require surgical fixation?

. Lateral aspect of the medial femoral condyle; high T2 signal behind the lesion
. Medial aspect of the lateral femoral condyle; bone marrow edema
. Central trochlea; low T1 signal rim
. Lateral aspect of the medial femoral condyle; extensive bone marrow edema
. Patella; subchondral cysts

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle; high T2 signal behind the lesion

Explanation

The classic and most common location for an OCD lesion of the knee is the lateral aspect of the medial femoral condyle (LAME acronym). In MRI evaluation, a high T2 signal rim (fluid) completely interposing behind the lesion and separating it from the underlying bone is the most reliable sign of instability, often necessitating surgical intervention.

Question 782

Topic: Knee Sports

A 25-year-old male sustains a twisting knee injury. Examination reveals increased external tibial rotation at 30 degrees of knee flexion compared to the contralateral side. However, external rotation is symmetric at 90 degrees of knee flexion. Which structure is most likely injured?

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

Correct Answer & Explanation

. Posterolateral corner (PLC) alone

Explanation

The dial test measures external tibial rotation. Increased rotation at 30 degrees but not at 90 degrees indicates an isolated injury to the posterolateral corner. If rotation is increased at both 30 and 90 degrees, a combined PLC and PCL injury is present.

Question 783

Topic: Knee Sports

A 30-year-old undergoes a microfracture procedure for a 1.5 cm2 full-thickness chondral defect on the medial femoral condyle. What is the primary histological composition of the repair tissue generated by this marrow stimulation technique?

. Predominantly Type I collagen
. Predominantly Type II collagen
. Equal mix of Type I and Type II collagen
. Predominantly Type IX collagen
. Predominantly Type X collagen

Correct Answer & Explanation

. Predominantly Type I collagen

Explanation

Marrow stimulation techniques, such as microfracture, result in a fibrocartilage repair response. Fibrocartilage is primarily composed of Type I collagen, which has inferior mechanical durability compared to the Type II collagen found in normal hyaline cartilage.

Question 784

Topic: Knee Sports

A 14-year-old male presents with vague, activity-related knee pain. Radiographs demonstrate 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 medial femoral condyle
. Central weight-bearing portion of the lateral femoral condyle
. Inferior pole of the patella
. Trochlear groove

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The lateral aspect of the medial femoral condyle is the classic and most frequent location for osteochondritis dissecans of the knee, accounting for approximately 70-80% of all cases.

Question 785

Topic: Knee Sports

The native anterior cruciate ligament (ACL) consists of two distinct functional bundles. Which of the following best describes the primary biomechanical function of the posterolateral (PL) bundle?

. Resists anterior tibial translation in deep flexion
. Provides primary resistance to rotatory loads near extension
. Functions as the primary secondary stabilizer to valgus stress
. Remains uniformly tight throughout the entire arc of motion
. Provides primary resistance to posterior tibial translation

Correct Answer & Explanation

. Provides primary resistance to rotatory loads near extension

Explanation

The posterolateral (PL) bundle of the ACL is tightest in extension and provides primary resistance to rotatory loads, directly resisting the pivot shift phenomenon. The anteromedial (AM) bundle is tightest in flexion and primarily resists anterior tibial translation.

Question 786

Topic: Knee Sports

In reconstructing the posterolateral corner (PLC) of the knee, understanding native anatomy is critical to restoring stability. The popliteofibular ligament originates from the popliteus musculotendinous junction and inserts onto which specific anatomic landmark?

. Anteromedial aspect of the fibular head
. Posteromedial down-slope of the fibular styloid
. Gerdy's tubercle
. Lateral femoral epicondyle
. Posterior aspect of the lateral tibial plateau

Correct Answer & Explanation

. Posteromedial down-slope of the fibular styloid

Explanation

The popliteofibular ligament is a crucial static stabilizer of the PLC, originating from the popliteus complex and inserting on the posteromedial down-slope of the fibular styloid. It acts as a primary restraint against excessive external tibial rotation.

Question 787

Topic: Knee Sports

The medial patellofemoral ligament (MPFL) is a critical stabilizer of the extensor mechanism. At which degree of knee flexion does the MPFL provide the greatest percentage of restraint to lateral patellar translation?

. 0 to 30 degrees
. 30 to 60 degrees
. 60 to 90 degrees
. 90 to 120 degrees
. Greater than 120 degrees

Correct Answer & Explanation

. 0 to 30 degrees

Explanation

The MPFL acts as the primary soft-tissue restraint (providing up to 60% of restraining force) to lateral patellar translation in early flexion (0 to 30 degrees). Beyond 30 degrees of flexion, the patella typically engages the bony trochlear groove, which then becomes the primary stabilizer.

Question 788

Topic: Knee Sports

A 25-year-old male sustains a high-velocity knee injury. Clinical examination demonstrates a deep transverse furrow ('dimple sign') over the medial joint line, and the knee is irreducible by closed means. Which structural interposition is most likely preventing reduction?

. Anterior cruciate ligament stump folded into the notch
. Posterior cruciate ligament entrapment
. Bucket-handle tear of the medial meniscus
. Medial femoral condyle buttonholing through the medial capsule and retinaculum
. Lateral collateral ligament interposition

Correct Answer & Explanation

. Medial femoral condyle buttonholing through the medial capsule and retinaculum

Explanation

The 'dimple sign' or transverse furrow across the medial joint line in a posterolateral knee dislocation is pathognomonic for an irreducible dislocation. It occurs when the medial femoral condyle buttonholes through the medial capsule and extensor retinaculum. Closed reduction is contraindicated as it can cause further soft tissue and skin necrosis; open reduction is strictly mandated.

Question 789

Topic: Knee Sports

When harvesting the central third of the quadriceps tendon for an anterior cruciate ligament (ACL) reconstruction, violating the deepest layer of the extensor mechanism risks entry into the suprapatellar pouch. The quadriceps tendon is composed of multiple layers. Which muscle's aponeurosis contributes exclusively to the deepest layer of the quadriceps tendon?

. Rectus femoris
. Vastus medialis
. Vastus lateralis
. Vastus intermedius
. Articularis genus

Correct Answer & Explanation

. Vastus intermedius

Explanation

The quadriceps tendon has three distinct anatomical layers. The superficial layer is formed by the rectus femoris. The middle layer is formed by the conjoined aponeuroses of the vastus medialis and vastus lateralis. The deep layer is formed entirely by the vastus intermedius. During graft harvest, careful dissection avoids violating the vastus intermedius and the underlying synovial joint capsule (suprapatellar pouch).

Question 790

Topic: Knee Sports
During reconstruction of the medial patellofemoral ligament (MPFL), identifying the anatomic femoral footprint is critical. According to Schöttle's radiographic criteria on a true lateral knee radiograph, where is the anatomic femoral origin of the MPFL located?
. Just anterior to the posterior cortical line, distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line
. Posterior to the anterior cortical line, proximal to the joint line, and distal to Blumensaat's line
. Anterior to the posterior cortical line, distal to the posterior origin of the medial femoral condyle, and distal to Blumensaat's line
. Directly on the adductor tubercle, intersecting the midpoint of Blumensaat's line
. Posterior to the posterior cortical line and proximal to Blumensaat's line

Correct Answer & Explanation

. Just anterior to the posterior cortical line, distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line

Explanation

Schöttle's point for the femoral attachment of the MPFL is defined radiographically on a strict lateral view. It is precisely located approximately 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior articular origin of the medial femoral condyle, and just proximal to the posterior projection of Blumensaat's line. Non-anatomic placement alters graft tension across the flexion arc.

Question 791

Topic: Knee Sports

During the physical examination of a patient with a multiple-ligament knee injury, the 'Dial test' is performed. The patient exhibits 15 degrees of increased external rotation of the tibia compared to the contralateral side at 30 degrees of knee flexion, and 15 degrees of increased external rotation at 90 degrees of flexion. Which structural injury pattern does this indicate?

. Isolated Posterolateral Corner (PLC) tear
. Isolated Posterior Cruciate Ligament (PCL) tear
. Combined PLC and PCL tear
. Combined Anterior Cruciate Ligament (ACL) and Medial Collateral Ligament (MCL) tear
. Combined ACL and PLC tear

Correct Answer & Explanation

. Combined PLC and PCL tear

Explanation

The Dial test evaluates external rotation asymmetry of the tibia. An increase of >10 degrees compared to the uninjured side is considered clinically significant. Increased external rotation at 30 degrees of flexion only indicates an isolated posterolateral corner (PLC) injury. Increased external rotation at both 30 degrees and 90 degrees of flexion strongly indicates a combined injury to both the PLC and the posterior cruciate ligament (PCL).

Question 792

Topic: Knee Sports
A 22-year-old female undergoes medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. Postoperatively, she demonstrates severely restricted knee flexion but normal full extension. Patellofemoral contact pressures are noted to be abnormally high in deep flexion. What is the most likely error regarding the placement of the femoral tunnel?
. Positioned too proximal and anterior
. Positioned too distal and posterior
. Positioned too medial and distal
. Positioned perfectly at the Schöttle point
. Positioned directly on the posterior articular margin

Correct Answer & Explanation

. Positioned too proximal and anterior

Explanation

Correct placement of the MPFL femoral tunnel is critical for graft isometry. If the femoral tunnel is placed too proximal and anterior to the anatomic footprint (Schöttle point), the graft will be loose in extension but become excessively tight in flexion, leading to restricted knee flexion and increased patellofemoral contact pressures.

Question 793

Topic: Knee Sports

A 28-year-old football player sustains a twisting injury to his knee. On physical examination, the dial test reveals +10 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. What is the most likely injury pattern?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) tear

Explanation

The dial test assesses external rotation of the tibia. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion, but symmetric at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. If the asymmetry persists or increases at 90 degrees of flexion, it indicates a combined PLC and PCL injury.

Question 794

Topic: Knee Sports

During posterior cruciate ligament (PCL) reconstruction, graft attenuation and ultimate failure can occur due to the sharp angle the graft must navigate as it exits the proximal posterior tibia and heads toward the medial femoral condyle. This phenomenon is termed the 'killer turn'. Which surgical technique is most strongly associated with this biomechanical disadvantage?

. Transtibial tunnel technique
. Tibial inlay technique
. Double-bundle femoral technique
. Single-bundle anterolateral technique
. Over-the-top femoral routing

Correct Answer & Explanation

. Tibial inlay technique

Explanation

The 'killer turn' refers to the acute angle (approximately 90 degrees) the PCL graft makes as it exits the posterior aperture of a standard transtibial tunnel and courses anteriorly to the femur. This sharp turn creates high friction and stress on the graft, leading to attenuation. The tibial inlay technique was developed specifically to avoid this 'killer turn' by securing a bone block directly to the posterior tibial plateau.

Question 795

Topic: Knee Sports

A 45-year-old female undergoes anatomic repair of a complete posterior medial meniscal root tear. By restoring the anatomical insertion of the root, which of the following biomechanical consequences of the tear is most directly mitigated?

. Anterior tibial translation during the Lachman test
. Complete loss of circumferential hoop stresses leading to radial meniscal extrusion
. Varus gapping of the knee joint at 0 degrees of extension
. Valgus gapping of the knee joint at 30 degrees of flexion
. Increased external rotation of the tibia at 90 degrees of flexion

Correct Answer & Explanation

. Complete loss of circumferential hoop stresses leading to radial meniscal extrusion

Explanation

The meniscal roots anchor the meniscus to the tibial plateau, converting axial loads into circumferential hoop stresses. A complete root tear disrupts this mechanism, making the meniscus biomechanically behave as if a total meniscectomy was performed, leading to radial extrusion of the meniscus and rapid onset of osteoarthritis. Root repair restores these hoop stresses.

Question 796

Topic: Knee Sports
A 28-year-old male suffers a high-energy knee dislocation. Vascular examination is normal with an Ankle-Brachial Index (ABI) of 1.1. Post-reduction MRI reveals complete rupture of the ACL, PCL, and posterolateral corner (PLC) structures. Which nerve is most commonly injured in this specific injury pattern, and what is its primary motor deficit?
. Tibial nerve; ankle plantarflexion
. Deep peroneal nerve; ankle plantarflexion
. Common peroneal nerve; ankle dorsiflexion and eversion
. Saphenous nerve; knee extension
. Femoral nerve; knee extension

Correct Answer & Explanation

. Common peroneal nerve; ankle dorsiflexion and eversion

Explanation

This injury pattern is a KD-IIIL (dislocation with ACL, PCL, and lateral-sided/PLC disruption). Due to the traction force on the lateral aspect of the knee, the common peroneal nerve is highly susceptible to stretch injury, resulting in a foot drop (loss of ankle dorsiflexion and eversion).

Question 797

Topic: Knee Sports

During a single-bundle anterior cruciate ligament (ACL) reconstruction, if the surgeon inadvertently places the femoral tunnel too anteriorly (high in the notch at the 12 o'clock position) rather than in the anatomic footprint, what biomechanical consequence will the graft exhibit?

. Tight in flexion and loose in extension
. Loose in flexion and tight in extension
. Excessively tight in both flexion and extension
. Excessively loose in both flexion and extension
. Isotonic tension throughout the full range of motion

Correct Answer & Explanation

. Tight in flexion and loose in extension

Explanation

A non-anatomic femoral tunnel placed too anteriorly (high in the intercondylar notch) results in an ACL graft that becomes excessively tight in flexion, significantly limiting knee flexion, and becomes excessively loose in extension, failing to control anterior translation near extension.

Question 798

Topic: Knee Sports

During an isolated posterior cruciate ligament (PCL) reconstruction using an anterolateral (AL) bundle single-bundle technique, at what knee flexion angle should the graft classically be tensioned to optimally restore its primary biomechanical function?

. 90 degrees of flexion
. Full extension (0 degrees)
. 30 degrees of flexion
. 120 degrees of flexion
. 45 degrees of flexion

Correct Answer & Explanation

. 90 degrees of flexion

Explanation

The native PCL consists of a larger anterolateral (AL) bundle and a smaller posteromedial (PM) bundle. The AL bundle is tightest in flexion and is the primary restraint to posterior tibial translation at 90 degrees. Therefore, single-bundle AL reconstructions are traditionally tensioned and fixed at 90 degrees of knee flexion.

Question 799

Topic: Knee Sports

In anatomic reconstruction of the posterolateral corner (PLC) of the knee, precisely understanding the attachments to the fibular head is critical. Which of the following accurately describes the insertions of the fibular collateral ligament (FCL) and the popliteofibular ligament (PFL)?

. FCL inserts on the anterolateral aspect; PFL inserts on the posteromedial aspect of the fibular styloid
. FCL inserts on the posteromedial aspect; PFL inserts on the anterolateral aspect
. Both insert conjointly on the anterior aspect of the fibular head
. FCL inserts on the tip of the fibular styloid; PFL inserts on the lateral neck
. FCL inserts on the fibular neck; PFL inserts on the anterior crest

Correct Answer & Explanation

. FCL inserts on the anterolateral aspect; PFL inserts on the posteromedial aspect of the fibular styloid

Explanation

For anatomic PLC reconstruction (e.g., the LaPrade technique), the exact footprint locations are essential. The FCL (LCL) attaches to a depression on the anterolateral aspect of the proximal fibular head. The popliteofibular ligament (PFL) attaches at the posteromedial aspect of the fibular styloid tip.

Question 800

Topic: Knee Sports

During an anatomic reconstruction of the posterolateral corner (PLC) of the knee, the surgeon is preparing the femoral tunnels for the popliteus tendon and the fibular collateral ligament (FCL). What is the anatomic relationship of the popliteus insertion relative to the FCL insertion on the lateral femoral epicondyle?

. Popliteus is proximal and posterior to the FCL
. Popliteus is distal and anterior to the FCL
. Popliteus is proximal and anterior to the FCL
. Popliteus is distal and posterior to the FCL
. Popliteus and FCL share a common footprint

Correct Answer & Explanation

. Popliteus is distal and anterior to the FCL

Explanation

On the lateral femoral epicondyle, the popliteus tendon inserts in the anterior fifth of the popliteal sulcus, which is located 18.5 mm distal and anterior to the insertion of the fibular collateral ligament (FCL).

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