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Knee Sports MCQs

Practice Set 43 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 841

Topic: Knee Sports
A 28-year-old male sustains an isolated, grade III posterior cruciate ligament (PCL) injury during a rugby match. He opts for non-operative management. Long-term follow-up studies of isolated, non-operatively treated PCL tears indicate that altered knee kinematics most commonly lead to the premature development of osteoarthritis in which compartments?
. Medial and patellofemoral compartments
. Lateral and patellofemoral compartments
. Medial and lateral compartments
. Lateral compartment only
. Patellofemoral compartment only

Correct Answer & Explanation

. Medial and patellofemoral compartments

Explanation

A deficient PCL leads to posterior tibial sag. This altered biomechanics increases contact pressures significantly in both the medial compartment and the patellofemoral joint. Long-term natural history studies of non-operatively treated PCL tears consistently show a high incidence of degenerative changes in the medial and patellofemoral compartments.

Question 842

Topic: Knee Sports

During reconstruction of the posterolateral corner (PLC) of the knee, identifying the insertion of the popliteofibular ligament (PFL) is crucial. Where does the PFL anatomically insert?

. Anterior aspect of the fibular head
. Posteromedial aspect of the fibular styloid
. Anterolateral aspect of the fibular head
. Posterolateral aspect of the lateral tibial plateau
. Gerdy's tubercle

Correct Answer & Explanation

. Posteromedial aspect of the fibular styloid

Explanation

The posterolateral corner (PLC) includes the lateral collateral ligament (LCL), popliteus tendon, and popliteofibular ligament (PFL). The PFL originates from the popliteus musculotendinous junction and inserts on the posteromedial aspect of the fibular styloid (tip of the fibular head). This ligament is a primary restraint to external rotation of the tibia.

Question 843

Topic: Knee Sports

A 50-year-old female presents with sudden onset medial knee pain without mechanical locking. MRI demonstrates a medial meniscus posterior root tear with 4 mm of meniscal extrusion. Biomechanically, untreated meniscal root tears have been shown to be equivalent to which of the following?

. Total meniscectomy
. Partial meniscectomy
. Anterior cruciate ligament deficiency
. Medial collateral ligament sprain
. Posterior cruciate ligament deficiency

Correct Answer & Explanation

. Total meniscectomy

Explanation

Meniscal root tears completely disrupt the circumferential hoop stresses of the meniscus. Without these intact roots anchoring the meniscus to the tibial plateau, axial loading simply pushes the meniscus out of the joint (extrusion). Biomechanical studies have demonstrated that an untreated meniscal root tear leads to peak contact pressures identical to a total meniscectomy, resulting in rapid joint degeneration.

Question 844

Topic: Knee Sports

A posterior medial meniscal root tear severely compromises normal knee biomechanics. Which of the following statements regarding the biomechanical consequence of a complete posterior medial root tear is most accurate?

. It results in increased tension on the anterior cruciate ligament but does not alter contact pressures.
. Peak contact pressures in the medial compartment are equivalent to those seen after a total medial meniscectomy.
. The tear increases hoop stresses but maintains normal tibiofemoral kinematics.
. It primarily increases lateral compartment contact pressures due to a varus shift.
. Biomechanical forces remain unchanged if the meniscofemoral ligament of Wrisberg is intact.

Correct Answer & Explanation

. Peak contact pressures in the medial compartment are equivalent to those seen after a total medial meniscectomy.

Explanation

A complete tear of the posterior medial meniscal root disrupts the meniscal ring, abolishing its ability to convert axial loads into hoop stresses. Biomechanical studies have shown that this effectively renders the meniscus non-functional, resulting in peak contact pressures in the medial compartment that are equivalent to those measured after a total medial meniscectomy.

Question 845

Topic: Knee Sports

A 22-year-old collegiate football player sustains a twisting injury to his knee during a tackle. Radiographs reveal an avulsion fracture of the lateral aspect of the proximal tibia, just distal to the articular surface (a Segond fracture). Which ligamentous injury is most strongly associated with this pathognomonic finding?

. Posterior cruciate ligament (PCL) tear
. Medial collateral ligament (MCL) tear
. Lateral collateral ligament (LCL) tear
. Anterior cruciate ligament (ACL) tear
. Medial patellofemoral ligament (MPFL) tear

Correct Answer & Explanation

. Anterior cruciate ligament (ACL) tear

Explanation

A Segond fracture is an avulsion fracture of the anterolateral capsule and the anterolateral ligament (ALL) complex from the lateral tibial plateau. It is considered pathognomonic for an anterior cruciate ligament (ACL) tear. It typically occurs via an internal rotation and varus stress mechanism.

Question 846

Topic: Knee Sports

Biomechanically, a complete radial tear of the posterior horn of the medial meniscus root alters knee kinematics most similarly to which of the following conditions?

. Total meniscectomy
. 50% partial meniscectomy
. ACL deficiency
. PCL deficiency
. Isolated MCL tear

Correct Answer & Explanation

. Total meniscectomy

Explanation

Complete meniscal root tears or complete radial tears disrupt the circumferential hoop stresses of the meniscus. This results in functional meniscal extrusion under axial load, biomechanically mimicking a total meniscectomy and dramatically increasing peak tibiofemoral contact pressures.

Question 847

Topic: Knee Sports

A 26-year-old recreational skier sustains a twisting knee injury. On physical examination, the physician notes a positive dial test (increased external rotation of the tibia relative to the femur) at 30 degrees of knee flexion, but the test normalizes and is symmetric to the contralateral uninjured side at 90 degrees of flexion. Which of the following structures is most likely injured?

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

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

A positive dial test (increased external rotation of the tibia >10 degrees compared to the normal side) at 30 degrees of flexion that normalizes at 90 degrees of flexion indicates an isolated injury to the posterolateral corner (PLC). If the dial test is positive at both 30 degrees and 90 degrees of flexion, it indicates a combined injury involving both the PLC and the PCL.

Question 848

Topic: Knee Sports



A 22-year-old elite soccer player undergoes an anterior cruciate ligament (ACL) reconstruction. Preoperatively, she demonstrated a high-grade pivot shift test. The surgeon decides to perform an anterolateral ligament (ALL) reconstruction concurrently to improve rotational stability. Which of the following is true regarding the anatomy and biomechanics of the ALL?

. Its femoral origin is proximal and anterior to the fibular collateral ligament (FCL) attachment.
. It acts as a primary restraint to varus opening at 30 degrees of flexion.
. Its femoral origin is posterior and proximal to the lateral epicondyle.
. It inserts directly onto the fibular head.
. It is primarily responsible for preventing posterior tibial translation.

Correct Answer & Explanation

. Its femoral origin is posterior and proximal to the lateral epicondyle.

Explanation

The anterolateral ligament (ALL) originates posterior and proximal to the lateral femoral epicondyle and inserts on the proximal tibia midway between Gerdy's tubercle and the fibular head. It acts as a secondary restraint to internal tibial rotation and the pivot shift phenomenon.

Question 849

Topic: Knee Sports

Which of the following best describes the functional anatomy and biomechanics of the posterior cruciate ligament (PCL)?

. The anterolateral bundle is tight in flexion and lax in extension
. The anterolateral bundle is tight in extension and lax in flexion
. The posteromedial bundle is tight in flexion and lax in extension
. The meniscofemoral ligaments are present in less than 20% of knees
. It is the primary restraint to anterior tibial translation

Correct Answer & Explanation

. The posteromedial bundle is tight in flexion and lax in extension

Explanation

The PCL consists of two main bundles: the anterolateral (AL) bundle and the posteromedial (PM) bundle. The AL bundle is the larger of the two and is tight in flexion and lax in extension. Conversely, the smaller PM bundle is tight in extension and lax in flexion.

Question 850

Topic: Knee Sports

During a double-bundle posterior cruciate ligament (PCL) reconstruction, the surgeon aims to accurately recreate the native anatomy. Which of the following accurately describes the tensioning protocol for the two distinct bundles?

. The anterolateral bundle is tensioned in full extension, while the posteromedial bundle is tensioned in 90 degrees of flexion.
. The anterolateral bundle is tensioned in 90 degrees of flexion, while the posteromedial bundle is tensioned in full extension.
. Both bundles are tensioned simultaneously in 90 degrees of flexion.
. Both bundles are tensioned simultaneously in full extension.
. The anterolateral bundle is tensioned in 45 degrees of flexion, while the posteromedial bundle is tensioned in 90 degrees of flexion.

Correct Answer & Explanation

. The anterolateral bundle is tensioned in 90 degrees of flexion, while the posteromedial bundle is tensioned in full extension.

Explanation

The native PCL consists of two main bundles: the anterolateral (AL) bundle and the posteromedial (PM) bundle. The AL bundle is larger and provides primary restraint to posterior tibial translation in flexion; thus, it is tensioned and fixed at 90 degrees of flexion. The PM bundle is smaller and is tight in extension; therefore, it is tensioned and fixed at 0 to 30 degrees of flexion (near full extension).

Question 851

Topic: Knee Sports

The posterior cruciate ligament (PCL) is composed of two primary bundles. Which of the following accurately describes the biomechanical behavior of the anterolateral (AL) and posteromedial (PM) bundles during knee range of motion?

. AL bundle is tight in flexion; PM bundle is tight in extension
. AL bundle is tight in extension; PM bundle is tight in flexion
. Both bundles are maximally tight in flexion
. Both bundles are maximally tight in extension
. AL bundle limits external rotation; PM bundle limits internal rotation

Correct Answer & Explanation

. AL bundle is tight in flexion; PM bundle is tight in extension

Explanation

The PCL consists of the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. Biomechanically, the AL bundle is tightest in knee flexion and lax in extension. Conversely, the PM bundle is tightest in knee extension and lax in flexion. This reciprocal relationship is vital to understanding PCL reconstruction biomechanics.

Question 852

Topic: Knee Sports

A 22-year-old male undergoes arthroscopic evaluation of the knee for a medial meniscus tear. The surgeon must decide between meniscal repair and partial meniscectomy. The potential for meniscal healing is primarily dictated by its vascular supply. Which area of the meniscus possesses the greatest intrinsic potential for healing following surgical repair?

. The inner third (white-white zone)
. The middle third (red-white zone)
. The peripheral third (red-red zone)
. The anterior horn exclusively
. The posterior root exclusively

Correct Answer & Explanation

. The peripheral third (red-red zone)

Explanation

The vascular supply to the meniscus originates from the perimeniscal capillary plexus, which supplies only the peripheral 10% to 30% of the meniscus. Tears in this peripheral third (the 'red-red' zone) have robust blood supply and the highest potential for healing following surgical repair.

Question 853

Topic: Knee Sports

Following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, a patient exhibits a lack of full knee flexion but achieves full extension. The physical examination reveals a tight graft in flexion. Which of the following technical errors during graft placement most likely accounts for this finding?

. Femoral tunnel placed too anteriorly
. Femoral tunnel placed too posteriorly
. Tibial tunnel placed too anteriorly
. Tibial tunnel placed too posteriorly
. Graft tensioned in full flexion

Correct Answer & Explanation

. Femoral tunnel placed too anteriorly

Explanation

Placement of the femoral tunnel in ACL reconstruction is critical for graft isometry. If the femoral tunnel is placed too anteriorly, the distance between the femoral and tibial origins increases as the knee flexes. This results in a graft that is tight in flexion (causing loss of flexion) and lax in extension.

Question 854

Topic: Knee Sports

When performing an anatomic single-bundle anterior cruciate ligament (ACL) reconstruction, improper tunnel placement can lead to graft failure.

Positioning the femoral tunnel too anterior (shallow in the notch) will result in a graft that is:

. Tight in flexion and loose in extension
. Loose in flexion and tight in extension
. Tight in both flexion and extension
. Loose in both flexion and extension
. Associated with increased risk of posterior cruciate ligament impingement

Correct Answer & Explanation

. Tight in flexion and loose in extension

Explanation

In ACL reconstruction, if the femoral tunnel is placed too anteriorly (high in the notch with the knee flexed), the distance between the femoral and tibial attachments will increase as the knee goes into flexion. This causes the graft to be inappropriately tight in flexion and excessively loose in extension.

Question 855

Topic: Knee Sports

A 24-year-old male presents to the emergency department after a high-velocity knee dislocation. Following closed reduction, you document an absent pedal pulse, and the vascular surgeon performs an emergent popliteal artery repair.

Postoperatively, the patient demonstrates an inability to extend his great toe and reports numbness isolated to the dorsal first web space of the foot. Which of the following knee structures is most likely concomitantly injured?

. Posteromedial corner
. Anterolateral ligament
. Posterolateral corner
. Superficial peroneal nerve
. Medial collateral ligament

Correct Answer & Explanation

. Posterolateral corner

Explanation

The inability to extend the great toe (EHL weakness) and numbness in the first dorsal web space indicate a deep peroneal nerve palsy. In the setting of a multi-ligament knee injury or dislocation, peroneal nerve injury is highly associated with damage to the Posterolateral Corner (PLC) of the knee, as the common peroneal nerve wraps around the fibular neck in close proximity to the biceps femoris and LCL.

Question 856

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, the surgeon places the femoral tunnel excessively anterior to the anatomic footprint. What is the most likely biomechanical consequence of this malpositioning?

. The graft will be excessively tight in flexion and loose in extension
. The graft will be excessively tight in extension and loose in flexion
. The graft will be excessively tight in both flexion and extension
. The graft will be loose in both flexion and extension
. The graft will only exhibit laxity in internal rotation

Correct Answer & Explanation

. The graft will be excessively tight in flexion and loose in extension

Explanation

Femoral tunnel position is critical in ACL reconstruction. If the femoral tunnel is placed too far anteriorly (shallow), the distance between the femoral and tibial tunnels increases as the knee flexes. This results in the graft being tight in flexion (potentially limiting knee flexion or causing graft failure/stretching) and loose in extension. Conversely, a tunnel placed too posterior will be tight in extension and loose in flexion.

Question 857

Topic: Knee Sports

A 24-year-old football player sustains a twisting injury to the knee. On examination, there is a normal posterior sag sign. The dial test demonstrates 15 degrees of increased external rotation compared to the contralateral side at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees of flexion. What is the most likely diagnosis?

. 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 Posteromedial corner injury

Correct Answer & Explanation

. Isolated Posterolateral Corner (PLC) injury

Explanation

The dial test evaluates the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion, but symmetric rotation at 90 degrees, indicates an isolated PLC injury. Increased external rotation at both 30 and 90 degrees indicates a combined PCL and PLC injury.

Question 858

Topic: Knee Sports

A 25-year-old male undergoes an isolated posterior cruciate ligament (PCL) reconstruction using an anterolateral bundle (ALB) single-bundle technique. At what degree of knee flexion should the ALB graft be tensioned and fixed to best replicate native biomechanics?

. 0 degrees (full extension)
. 30 degrees
. 45 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 90 degrees

Explanation

The native PCL consists of the anterolateral bundle (ALB) and posteromedial bundle (PMB). The ALB is tightest in flexion, and the PMB is tightest in extension. During a single-bundle PCL reconstruction targeting the ALB, the graft is typically tensioned and fixed at 90 degrees of flexion while an anterior drawer force is applied to restore the normal tibial step-off.

Question 859

Topic: Knee Sports
A 19-year-old female undergoes MPFL reconstruction for recurrent patellar instability. To ensure proper isometry, the femoral attachment (Schöttle's point) must be accurately identified on a true lateral radiograph. Where is this point located?
. Anterior to the posterior femoral cortical line and distal to Blumensaat's 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's line
. 1 mm posterior to the posterior femoral cortical line, 2.5 mm proximal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line
. 2.5 mm anterior to the posterior femoral cortical line and exactly on Blumensaat's line
. Posterior to the posterior femoral cortical line and distal to Blumensaat's 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's line

Explanation

Schöttle's point is a radiographic landmark for the femoral origin of the medial patellofemoral ligament (MPFL). On a strict lateral radiograph, it is defined as 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior articular border of the medial femoral condyle, and proximal to the level of the posterior point of Blumensaat's line. Placing the graft at this point helps achieve near-isometric behavior.

Question 860

Topic: Knee Sports

During an anatomic double-bundle Anterior Cruciate Ligament (ACL) reconstruction, the surgeon aims to replicate native knee kinematics. Which of the following accurately describes the tensioning pattern of the native ACL bundles during knee range of motion?

. The AM bundle is tightest in extension and the PL bundle in flexion
. The AM bundle is tightest in flexion and the PL bundle is tightest in extension
. Both bundles are tightest in deep flexion
. Both bundles are tightest in full extension
. The PL bundle controls purely valgus stability

Correct Answer & Explanation

. The AM bundle is tightest in flexion and the PL bundle is tightest in extension

Explanation

The native ACL consists of two primary bundles: the anteromedial (AM) bundle and the posterolateral (PL) bundle. Biomechanically, the AM bundle is tightest in flexion (providing primary anterior stability at 90 degrees), while the PL bundle is tightest in extension (providing primary rotatory stability near full extension).

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