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Knee Sports MCQs

Practice Set 45 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 881

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction of the knee, accurate anatomical placement of the fibular collateral ligament (FCL) femoral tunnel is critical. What is the correct relationship of the FCL femoral origin relative to the lateral epicondyle?

. Proximal and posterior
. Distal and anterior
. Directly over the lateral epicondyle
. Proximal and anterior
. Distal and posterior

Correct Answer & Explanation

. Proximal and posterior

Explanation

The femoral origin of the Fibular Collateral Ligament (FCL) is located slightly proximal (1.4 mm) and posterior (3.1 mm) to the lateral epicondyle. The origin of the popliteus tendon is located anterior and distal to the FCL origin. Recreating this anatomic footprint is vital for restoring normal knee kinematics during posterolateral corner reconstruction.

Question 882

Topic: Knee Sports

A 45-year-old male sustains a complete radial tear at the posterior horn root attachment of the medial meniscus. Biomechanical studies have demonstrated that this specific injury alters knee joint contact pressures in a manner most similar to which of the following?

. A partial medial meniscectomy
. A bucket-handle medial meniscus tear
. An anterior cruciate ligament rupture
. A total medial meniscectomy
. A normal, intact knee due to secondary restraints

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

The meniscal roots are essential for converting axial loads into hoop stresses within the meniscus. A complete tear of the posterior root of the medial meniscus completely disrupts this ability to generate hoop stresses, allowing the meniscus to extrude radially. Biomechanical studies have consistently shown that a medial meniscus posterior root tear results in a significant increase in peak contact pressures and a decrease in contact area, which are biomechanically equivalent to the derangements seen in a total medial meniscectomy.

Question 883

Topic: Knee Sports

A 28-year-old football player sustains a twisting injury to his knee. On physical examination, the dial test is performed. The examiner notes 15 degrees of increased external rotation of the tibia compared to the contralateral normal knee at 30 degrees of knee flexion. However, at 90 degrees of knee flexion, the external rotation is equal bilaterally. Which of the following structures is most likely injured?

. Anterior cruciate ligament and posterolateral corner
. Isolated posterior cruciate ligament
. Isolated posterolateral corner
. Posterior cruciate ligament and posterolateral corner
. Medial collateral ligament and posterior oblique ligament

Correct Answer & Explanation

. Isolated posterolateral corner

Explanation

The dial test evaluates for posterolateral instability. An increase of >10 degrees of external rotation at 30 degrees of flexion, but not at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. Increased external rotation at both 30 and 90 degrees suggests a combined PCL and PLC injury.

Question 884

Topic: Knee Sports

During a posterior cruciate ligament (PCL) reconstruction, understanding the biomechanics of the native bundles is essential to reproduce normal knee kinematics. Which of the following best describes the tensioning pattern of the anterolateral (AL) and posteromedial (PM) bundles of the native PCL?

. AL bundle is tight in extension; PM bundle is tight in flexion
. AL bundle is tight in flexion; PM bundle is tight in extension
. Both bundles are equally tight in deep flexion
. Both bundles are equally tight in full extension
. AL bundle is tight in internal rotation; PM bundle is tight in external rotation

Correct Answer & Explanation

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

Explanation

The PCL is composed of two main bundles: the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle is tight in flexion and lax in extension, while the PM bundle is tight in extension and lax in flexion. This reciprocal relationship is crucial when tensioning grafts during PCL reconstruction.

Question 885

Topic: Knee Sports

A 45-year-old female sustains a completely detached posterior root tear of the medial meniscus. From a biomechanical perspective, what is the direct consequence of this injury on the knee joint?

. It alters knee kinematics to a degree equivalent to a totally meniscectomized knee
. It predominantly causes isolated lateral compartment osteoarthritis over time
. It does not significantly alter peak tibiofemoral contact pressures
. It increases the mechanical efficiency of the intact anterior cruciate ligament
. It causes an immediate mechanical axis shift from varus to valgus

Correct Answer & Explanation

. It alters knee kinematics to a degree equivalent to a totally meniscectomized knee

Explanation

A complete tear of the medial meniscal root disrupts the transmission of circumferential hoop stresses. Biomechanical studies have shown that this results in a loss of meniscal function and an increase in peak contact pressures equivalent to that of a total meniscectomy, predisposing the knee to rapid medial compartment osteoarthritis.

Question 886

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, a surgeon places the femoral tunnel very high in the intercondylar notch, corresponding to the "12 o'clock" position in the coronal plane. What is the most likely biomechanical consequence of this vertically oriented graft placement?

. Over-constrained in extension and loose in flexion
. Effective at controlling rotational loads but poor at controlling anterior translation
. Highly isometric but fails to control rotational instability (pivot shift)
. Over-tensioned in flexion leading to capture of the knee
. Prone to early impingement on the posterior cruciate ligament (PCL)

Correct Answer & Explanation

. Highly isometric but fails to control rotational instability (pivot shift)

Explanation

A vertical femoral tunnel (e.g., 12 o'clock position) produces a highly isometric graft that effectively limits anterior-posterior translation (Lachman) but biomechanically fails to reproduce the native ACL's oblique orientation, resulting in an inability to control rotational instability (evidenced by a persistent positive pivot-shift test).

Question 887

Topic: Knee Sports
Following a knee dislocation (KD-III), a patient undergoes multiligament knee reconstruction including the posterolateral corner (PLC). Which of the following anatomical structures forms the primary static stabilizer to external tibial rotation at 30 degrees of knee flexion?
. Fibular collateral ligament (FCL)
. Popliteus tendon
. Popliteofibular ligament (PFL)
. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)

Correct Answer & Explanation

. Fibular collateral ligament (FCL)

Explanation

The Fibular Collateral Ligament (FCL) is the primary static stabilizer to varus stress and external tibial rotation at 30 degrees of flexion. The popliteus and PFL are secondary stabilizers for these forces.

Question 888

Topic: Knee Sports

During an isolated Posterior Cruciate Ligament (PCL) reconstruction using an anterolateral tibial tunnel technique, the 'killer turn' is associated with which of the following complications?

. Injury to the popliteal artery during reaming
. Attenuation, stretching, and early failure of the graft
. Iatrogenic chondral damage to the medial femoral condyle
. Post-operative arthrofibrosis
. Nonunion of the tibial tunnel

Correct Answer & Explanation

. Attenuation, stretching, and early failure of the graft

Explanation

The 'killer turn' in a transtibial PCL reconstruction refers to the acute angle the PCL graft must navigate as it exits the posterior tibial tunnel to pass anteriorly to the femur. This sharp angle causes repetitive abrasion, leading to attenuation, elongation, and potential early failure of the graft. The tibial inlay technique was developed to avoid this phenomenon.

Question 889

Topic: Knee Sports

A patient sustains a posterolateral corner (PLC) knee injury and develops a complete foot drop. Exploration of the common peroneal nerve is planned. The nerve is most vulnerable to tethering and injury at which anatomical site?

. Biceps femoris short head origin
. Fibular tunnel beneath the peroneus longus origin
. Popliteal fossa superior to the medial gastrocnemius
. Arcuate ligament complex
. Anterior intermuscular septum

Correct Answer & Explanation

. Fibular tunnel beneath the peroneus longus origin

Explanation

The common peroneal nerve is firmly tethered as it wraps around the fibular neck and passes beneath the fibrous edge of the peroneus longus muscle (the fibular tunnel). This rigid tethering point makes it highly vulnerable to severe stretch or traction injuries during varus and hyperextension trauma to the knee.

Question 890

Topic: Knee Sports

A 28-year-old rugby player sustains a knee injury. The dial test demonstrates 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the uninjured side, but symmetric external rotation at 90 degrees. Which of the following structures is most likely injured?

. Posterior cruciate ligament
. Posterolateral corner
. Medial collateral ligament
. Anterior cruciate ligament
. Posteromedial corner

Correct Answer & Explanation

. Posterolateral corner

Explanation

The dial test evaluates external rotation asymmetry. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion, but not at 90 degrees, indicates an isolated injury to the posterolateral corner (PLC). Increased external rotation at both 30 and 90 degrees indicates a combined injury to the PLC and the posterior cruciate ligament (PCL).

Question 891

Topic: Knee Sports

During reconstruction of the posterior cruciate ligament (PCL), the tibial inlay technique is theoretically designed to prevent which of the following mechanical complications associated with the traditional transtibial technique?

. Arthrofibrosis of the knee from over-constraining the joint
. Graft abrasion and attenuation at the posterior tibial aperture
. Popliteal artery injury during drilling of the tibial tunnel
. Posterior capsular contracture leading to extension deficit
. Hardware prominence and soft tissue irritation over the anterior tibia

Correct Answer & Explanation

. Graft abrasion and attenuation at the posterior tibial aperture

Explanation

The traditional transtibial PCL reconstruction technique requires the graft to bend sharply (often > 90 degrees) as it exits the posterior tibial tunnel to reach the femoral footprint. This acute angle is known as the 'killer turn' and is a site of significant mechanical stress, leading to graft abrasion, elongation, and potential failure. The tibial inlay technique secures the bone block directly to the posterior tibia, avoiding this turn.

Question 892

Topic: Knee Sports

Biomechanical studies of the knee demonstrate that a complete radial tear adjacent to the posterior root of the medial meniscus results in contact pressures that are most similar to which of the following conditions?

. An intact normal meniscus
. A total medial meniscectomy
. A bucket-handle meniscal tear
. A partial meniscectomy resecting 10% of the posterior horn
. An isolated anterior cruciate ligament deficiency

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A complete radial tear near the posterior root of the medial meniscus completely disrupts the circumferential continuity of the meniscus. Biomechanically, this results in a complete loss of 'hoop stresses', leading to meniscal extrusion under load. Studies have shown that this creates peak contact pressures and altered kinematics in the medial compartment equivalent to those of a total meniscectomy.

Question 893

Topic: Knee Sports

In a patient with an isolated complete rupture of the posterior cruciate ligament (PCL), the most significant increase in posterior tibial translation on examination occurs at what degree of knee flexion?

. 0 degrees
. 30 degrees
. 60 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 90 degrees

Explanation

The anterolateral (AL) bundle of the PCL is the primary restraint to posterior tibial translation at 90 degrees of knee flexion. Therefore, a complete PCL rupture yields the maximum abnormal posterior translation at 90 degrees of flexion, which is the basis for the posterior drawer test.

Question 894

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. Which of the following statements accurately describes the biomechanical function of the posterolateral (PL) bundle?

. It is the primary restraint to anterior tibial translation in 90 degrees of flexion
. It is tightest in full extension and is the primary restraint to rotatory loads
. It originates on the posteromedial aspect of the lateral femoral condyle and inserts on the anteromedial tibia
. It is larger and stronger than the anteromedial (AM) bundle
. It primarily resists valgus opening of the knee joint

Correct Answer & Explanation

. It is tightest in full extension and is the primary restraint to rotatory loads

Explanation

The ACL consists of the anteromedial (AM) and posterolateral (PL) bundles. The PL bundle is tightest in full extension and serves as the primary restraint to rotatory loads (e.g., resisting the pivot shift). The AM bundle is tightest in flexion (e.g., 90 degrees) and is the primary restraint to anterior tibial translation at that angle.

Question 895

Topic: Knee Sports

A 25-year-old athlete undergoes a physical examination after a knee injury. The dial test demonstrates 15 degrees of increased external rotation of the tibia compared to the contralateral 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 most likely diagnosis?

. Isolated ACL tear
. Isolated PCL tear
. Isolated posterolateral corner (PLC) tear
. Combined PCL and PLC tear
. Combined ACL and PLC tear

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) tear

Explanation

The dial test assesses tibial external rotation. Asymmetry of greater than 10 degrees at 30 degrees of flexion, which reduces to symmetry at 90 degrees of flexion, indicates an isolated posterolateral corner (PLC) injury. If the asymmetry persists or worsens at 90 degrees, it indicates a combined PLC and posterior cruciate ligament (PCL) injury.

Question 896

Topic: Knee Sports

The anterior cruciate ligament (ACL) consists of two distinct bundles. Which of the following statements accurately describes the biomechanical behavior of these bundles during knee range of motion?

. The anteromedial (AM) bundle is tight in extension and the posterolateral (PL) bundle is tight in flexion
. The anteromedial (AM) bundle is tight in flexion and the posterolateral (PL) bundle is tight in extension
. Both bundles are equally tight in deep flexion
. Both bundles are equally tight in terminal extension
. The PL bundle controls anteroposterior translation in deep flexion

Correct Answer & Explanation

. The anteromedial (AM) bundle is tight in flexion and the posterolateral (PL) bundle is tight in extension

Explanation

The ACL is composed of the anteromedial (AM) and posterolateral (PL) bundles. Biomechanically, the AM bundle is tightest in flexion and primarily resists anterior tibial translation in this position. The PL bundle is tightest in extension and plays a primary role in resisting rotatory loads near full extension.

Question 897

Topic: Knee Sports

The femoral footprint of the anterolateral (AL) bundle of the posterior cruciate ligament (PCL) is anatomically located in which area of the intercondylar notch?

. Shallow (anterior) on the lateral aspect of the medial femoral condyle
. Deep (posterior) on the lateral aspect of the medial femoral condyle
. Shallow (anterior) on the medial aspect of the lateral femoral condyle
. Deep (posterior) on the medial aspect of the lateral femoral condyle
. Directly at the apex (roof) of the intercondylar notch

Correct Answer & Explanation

. Shallow (anterior) on the lateral aspect of the medial femoral condyle

Explanation

The PCL originates on the lateral aspect of the medial femoral condyle. Its anterolateral (AL) bundle is located shallower (more anteriorly toward the articular cartilage edge) and higher (more proximally/superiorly), whereas the posteromedial (PM) bundle is located deeper (more posteriorly) and inferiorly.

Question 898

Topic: Knee Sports

A 24-year-old rugby player sustains a twisting knee injury. On physical examination, the 'dial test' reveals 15 degrees of increased external rotation of the tibia at 30 degrees of knee flexion compared to the uninjured side. However, at 90 degrees of knee flexion, the external rotation is symmetric bilaterally. What is the most likely diagnosis?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) tear

Explanation

The dial test assesses external rotation of the tibia on the femur. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion but not at 90 degrees indicates an isolated injury to the posterolateral corner (PLC). If increased external rotation is present at both 30 degrees and 90 degrees of flexion, it indicates a combined injury to both the PLC and the posterior cruciate ligament (PCL).

Question 899

Topic: Knee Sports

When comparing the independent anteromedial (AM) portal technique to the traditional transtibial technique for femoral tunnel drilling in anterior cruciate ligament (ACL) reconstruction, the AM portal technique typically results in a femoral tunnel that is:

. More vertical and higher in the femoral notch
. More horizontal and closer to the anatomic footprint
. Identical in position but with a shorter tunnel length
. Anterior to the resident's ridge
. Associated with a higher risk of PCL impingement

Correct Answer & Explanation

. More horizontal and closer to the anatomic footprint

Explanation

The independent anteromedial (AM) portal technique allows the surgeon to place the femoral tunnel independent of the tibial tunnel's trajectory. This typically results in a more horizontal femoral tunnel that is positioned lower in the notch, which better replicates the anatomic footprint of the native ACL. The transtibial technique often forces a more vertical, non-anatomic 'high noon' placement.

Question 900

Topic: Knee Sports

The medial patellofemoral ligament (MPFL) provides the primary soft tissue restraint against lateral patellar translation. At what degree of knee flexion does the MPFL contribute the greatest percentage of restraining force?

. 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 provides approximately 50-60% of the restraint to lateral patellar displacement in the first 0 to 30 degrees of knee flexion. Beyond 30 degrees of flexion, the patella typically engages the trochlear groove, and bony architecture (the lateral trochlear facet) becomes the primary stabilizer against lateral translation. Therefore, MPFL insufficiency is most clinically evident in early flexion/extension.

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