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Knee Sports MCQs

Practice Set 46 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 901

Topic: Knee Sports
A 55-year-old female experiences sudden posteromedial knee pain while deeply squatting. MRI confirms a posterior root tear of the medial meniscus. From a biomechanical perspective, the loss of hoop stress transmission in this condition most closely replicates the tibiofemoral contact mechanics of which of the following?
. Anterior cruciate ligament rupture
. Complete radial tear of the anterior horn
. Total medial meniscectomy
. Isolated grade III medial collateral ligament tear
. Focal grade III chondral defect

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

The meniscal roots are essential for anchoring the meniscus and converting axial tibiofemoral compressive loads into circumferential 'hoop stresses.' A complete tear or avulsion of the posterior meniscal root completely disrupts this mechanism, allowing the meniscus to extrude radially. Biomechanical studies have demonstrated that a medial meniscal root tear alters joint contact areas and peak pressures to a degree equivalent to a total medial meniscectomy, leading to rapid compartmental osteoarthritis if left untreated.

Question 902

Topic: Knee Sports

When performing an anterior cruciate ligament (ACL) reconstruction, placing the femoral tunnel too far anteriorly (shallow) in the intercondylar notch will result in which of the following biomechanical consequences?

. The graft will be tight in extension and loose in flexion
. The graft will be tight in flexion and loose in extension
. The graft will be tight in both flexion and extension
. The graft will impinge on the PCL
. The graft will fail to control varus-valgus laxity

Correct Answer & Explanation

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

Explanation

Placing the femoral tunnel too anteriorly (shallow) is a common technical error in ACL reconstruction. This results in the graft being loose in extension and becoming excessively tight as the knee moves into flexion, often leading to limited knee flexion or graft rupture. Conversely, placing the tunnel too vertically fails to control rotational stability.

Question 903

Topic: Knee Sports

Which of the following biological or surgical factors provides the best prognosis for the successful healing of an isolated meniscal repair?

. Patient age over 40 years
. Complex, multi-planar tear pattern
. Tear location strictly within the avascular white-white zone
. Concomitant anterior cruciate ligament (ACL) reconstruction
. Delayed repair performed more than 6 months post-injury

Correct Answer & Explanation

. Concomitant anterior cruciate ligament (ACL) reconstruction

Explanation

Meniscal repair performed concurrently with ACL reconstruction has a higher healing rate than isolated meniscal repair. This is attributed to the intra-articular bleeding and marrow elements (containing stem cells and growth factors) released during the creation of the femoral and tibial tunnels, which biologically augment the meniscal healing environment.

Question 904

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction, the femoral tunnel must be placed accurately to ensure isometry. The Schöttle point is a radiographic landmark for this attachment. Which of the following accurately describes its location on a true lateral radiograph?
. Anterior to the posterior cortex line, distal to the Blumensaat line
. Anterior to the posterior cortex line, proximal to the Blumensaat line
. Anterior to the posterior cortex line, at the intersection of Blumensaat line
. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle
. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior border of Blumensaat line

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior border of Blumensaat line

Explanation

The Schöttle point is a reliable radiographic landmark for the femoral origin of the MPFL. It is located 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior border of Blumensaat line, and proximal to the posterior origin of the medial femoral condyle.

Question 905

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. In full knee extension, what is the relative tension and orientation of the anteromedial (AM) and posterolateral (PL) bundles?

. Both bundles are lax
. AM bundle is tight, PL bundle is lax
. PL bundle is tight, AM bundle is moderately lax
. Both bundles cross each other tightly
. AM bundle is tight, PL bundle is tight

Correct Answer & Explanation

. PL bundle is tight, AM bundle is moderately lax

Explanation

The ACL consists of the AM and PL bundles. In full extension, the posterolateral (PL) bundle is tight and provides essential rotational stability, while the anteromedial (AM) bundle is relatively lax. In flexion, the AM bundle tightens to control anterior translation, and the PL bundle becomes lax.

Question 906

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, the femoral tunnel is inadvertently placed too anteriorly (shallow) in the intercondylar notch. What is the expected biomechanical consequence on the graft during knee range of motion?

. The graft will be tight in extension and lax in flexion
. The graft will be tight in flexion and lax in extension
. The graft will experience excessive rotational instability only
. The graft will impinge against the PCL
. The graft will undergo immediate failure due to stretching in extension

Correct Answer & Explanation

. The graft will be tight in flexion and lax in extension

Explanation

A femoral tunnel placed too anteriorly (shallow, non-isometric) results in the distance between the tibial and femoral tunnels increasing as the knee flexes. Consequently, the graft becomes inappropriately tight in flexion (causing loss of flexion/capture) and lax in extension (resulting in an extension lag or instability).

Question 907

Topic: Knee Sports
During a reconstruction of the medial patellofemoral ligament (MPFL), the surgeon identifies Schöttle's point using intraoperative fluoroscopy to determine the anatomic femoral footprint. Anatomically, this femoral attachment is located in a saddle-shaped sulcus situated between which two bony landmarks?
. Between the adductor tubercle and the medial epicondyle
. Proximal to the adductor tubercle
. Distal to the medial epicondyle
. Anterior to the medial collateral ligament origin
. Directly on the medial joint line

Correct Answer & Explanation

. Between the adductor tubercle and the medial epicondyle

Explanation

The femoral footprint of the MPFL lies in a sulcus located between the adductor tubercle (proximal) and the medial epicondyle (distal). Schöttle's point on a lateral radiograph is 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 level of the posterior point of Blumensaat's line.

Question 908

Topic: Knee Sports

The posterior cruciate ligament (PCL) provides primary restraint to posterior tibial translation. During a physical examination or biomechanical testing, at which degree of knee flexion is the anterolateral (AL) bundle of the PCL most taut?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 to 120 degrees of flexion
. 10 degrees of hyperextension

Correct Answer & Explanation

. 90 to 120 degrees of flexion

Explanation

The PCL has two main bundles: the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle is most taut in deep flexion (90 to 120 degrees), whereas the PM bundle is tightest in extension and deep flexion.

Question 909

Topic: Knee Sports

A 12-year-old active boy complains of vague knee pain and occasional catching. Radiographs reveal an osteochondritis dissecans (OCD) lesion. What is the single most common anatomic location for an OCD lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central portion of the patellar articular surface
. Lateral aspect of the lateral femoral condyle
. Weight-bearing surface of the medial tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for OCD in the knee is the lateral aspect of the medial femoral condyle, often remembered by the mnemonic LAME (Lateral Aspect Medial Epiphysis/Condyle). This accounts for approximately 70-80% of knee OCD lesions.

Question 910

Topic: Knee Sports

A patient demonstrates increased external rotation of the tibia at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees of knee flexion. Which structure is most likely injured?

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

Correct Answer & Explanation

. Posterolateral corner (PLC) only

Explanation

The Dial test evaluates PLC and PCL injuries. Asymmetry (increased external rotation >10 degrees compared to the normal side) at 30 degrees only indicates an isolated posterolateral corner (PLC) injury. Asymmetry at both 30 and 90 degrees indicates combined PLC and PCL injury.

Question 911

Topic: Knee Sports

In anterior cruciate ligament (ACL) reconstruction, the addition of an anterolateral ligament (ALL) reconstruction or lateral extra-articular tenodesis (LET) is primarily indicated to control which biomechanical parameter?

. Anterior tibial translation at 90 degrees of flexion
. Posterior tibial translation at 30 degrees of flexion
. Internal rotation and the pivot-shift phenomenon
. Valgus gapping in full extension
. External rotation recurvatum

Correct Answer & Explanation

. Internal rotation and the pivot-shift phenomenon

Explanation

The anterolateral ligament (ALL) and lateral extra-articular structures act as secondary stabilizers to anterior tibial translation but are primary stabilizers against internal tibial rotation. Reconstructing these structures is indicated in high-risk patients to help control the pivot-shift phenomenon.

Question 912

Topic: Knee Sports

A 45-year-old patient undergoes an MRI which reveals a complete radial tear at the posterior root insertion of the medial meniscus. If left untreated, what is the primary biomechanical consequence of this specific injury on knee joint dynamics?

. Loss of hoop stresses equivalent to a total meniscectomy
. Increased anterior tibial translation comparable to a complete ACL tear
. Paradoxical motion of the patella during deep flexion
. Decreased peak contact pressures in the medial compartment
. Increased tension on the lateral collateral ligament leading to varus thrust

Correct Answer & Explanation

. Loss of hoop stresses equivalent to a total meniscectomy

Explanation

The meniscal roots anchor the meniscus to the tibial plateau, allowing the meniscus to convert axial compressive loads into circumferential tension, known as "hoop stresses." A complete radial tear at the meniscal root functionally un-anchors the meniscus, resulting in extrusion under load. Biomechanically, a meniscal root tear leads to a complete loss of hoop stresses, drastically increasing peak articular contact pressures in a manner equivalent to a total meniscectomy. This predisposes the patient to rapid progression of osteoarthritis.

Question 913

Topic: Knee Sports

The posterior cruciate ligament (PCL) is the primary restraint to posterior tibial translation and consists of an anterolateral (AL) bundle and a posteromedial (PM) bundle. Which of the following best describes the physiological tensioning pattern of these bundles during knee range of motion?

. The AL bundle is tightest in flexion, and the PM bundle is tightest in extension.
. Both bundles are tightest in deep flexion.
. The AL bundle is tightest in extension, and the PM bundle is tightest in flexion.
. The PM bundle is the primary restraint to posterior translation at 90 degrees of flexion.
. Both bundles exhibit isometric behavior throughout the full range of motion.

Correct Answer & Explanation

. The AL bundle is tightest in extension, and the PM bundle is tightest in flexion.

Explanation

The PCL is composed of two functional bundles named for their tibial attachments: the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. Biomechanically, the AL bundle becomes increasingly tense during knee flexion and acts as the primary restraint to posterior translation at 90 degrees of flexion. The PM bundle is tight in extension and relatively lax in flexion. Double-bundle PCL reconstructions attempt to recreate this reciprocal tensioning relationship.

Question 914

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, identifying the exact femoral attachment site is critical to ensuring an isometric graft. Which radiographic landmarks accurately define Schöttle's point on a true lateral radiograph of the knee?
. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the Blumensaat line
. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and distal to the Blumensaat line
. 1 mm anterior to the posterior cortex line, 2.5 mm proximal to the posterior origin of the medial femoral condyle, and proximal to the Blumensaat line
. 1 mm posterior to the posterior cortex line, 2.5 mm proximal to the posterior origin of the medial femoral condyle, and proximal to the Blumensaat line
. 1 mm anterior to the posterior cortex line, 2.5 mm proximal to the posterior origin of the medial femoral condyle, and distal to the Blumensaat line

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the Blumensaat line

Explanation

Schöttle's point defines the anatomic and isometric femoral footprint of the MPFL on a true lateral radiograph. It is located 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 the level of the posterior point of Blumensaat's line.

Question 915

Topic: Knee Sports

During a transtibial posterior cruciate ligament (PCL) reconstruction, the graft is subjected to severe mechanical stress as it exits the posterior tibial tunnel, a phenomenon termed the 'killer turn.' Which surgical technique was specifically developed to completely avoid this acute angulation?

. Double-bundle transtibial technique
. Remnant-preserving technique
. Tibial inlay technique
. Anterolateral ligament (ALL) reconstruction
. Fibular collateral ligament reconstruction

Correct Answer & Explanation

. Tibial inlay technique

Explanation

In a standard transtibial PCL reconstruction, the graft must navigate a sharp, nearly 90-degree turn ('killer turn') as it exits the posterior tibial tunnel to reach its femoral origin. This acute angle causes graft abrasion and attenuation, leading to premature laxity or failure. The tibial inlay technique avoids this entirely by using a posterior approach to secure a bone block directly into a trough at the anatomic posterior tibial footprint, eliminating the tibial tunnel.

Question 916

Topic: Knee Sports
A 28-year-old male is brought to the emergency department after sustaining a traumatic knee dislocation (KD-III). Following closed reduction, neurologic examination reveals foot drop and absent sensation over the dorsum of the foot, including the first web space. Which structure was most likely injured?
. Superficial peroneal nerve
. Saphenous nerve
. Common peroneal nerve
. Tibial nerve
. Sural nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve is uniquely tethered at the fibular head and is frequently injured in multiligamentous knee injuries, particularly those involving posterolateral corner disruption. The clinical presentation of complete foot drop (weakness of both anterior and lateral compartments) and sensory deficit over the dorsum (superficial peroneal) and first web space (deep peroneal) confirms a lesion of the common peroneal nerve proximal to its bifurcation.

Question 917

Topic: Knee Sports

During an anatomic anterior cruciate ligament (ACL) reconstruction, the surgeon aims to accurately position the femoral tunnel. Relative to the lateral intercondylar ridge (resident's ridge) and the lateral bifurcate ridge, where is the native footprint of the anteromedial (AM) bundle of the ACL located?

. Anterior to the lateral intercondylar ridge
. Posterior to the lateral intercondylar ridge and superior to the lateral bifurcate ridge
. Posterior to the lateral intercondylar ridge and inferior to the lateral bifurcate ridge
. Directly on the lateral intercondylar ridge
. Distal to the lateral bifurcate ridge

Correct Answer & Explanation

. Posterior to the lateral intercondylar ridge and superior to the lateral bifurcate ridge

Explanation

The entire native ACL footprint on the femur is located posterior (deep) to the lateral intercondylar ridge (resident's ridge). The footprint is further divided into AM and PL bundles by the lateral bifurcate ridge. When the knee is viewed in 90 degrees of flexion, the AM bundle footprint is located posterior to the lateral intercondylar ridge and superior (proximal) to the lateral bifurcate ridge, whereas the PL bundle is posterior to the intercondylar ridge and inferior (distal) to the bifurcate ridge.

Question 918

Topic: Knee Sports

A patient is evaluated for a knee injury using the dial test in the prone position. At 30 degrees of knee flexion, the injured leg shows 15 degrees of increased external rotation compared to the normal leg. At 90 degrees of knee flexion, the external rotation is symmetric between both legs. What is the most likely diagnosis?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

The dial test assesses the integrity of the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). An increase in external rotation of >10 degrees compared to the contralateral side is considered positive. If the test is positive at 30 degrees of flexion but normal at 90 degrees, it indicates an isolated PLC injury (the intact PCL limits external rotation at 90 degrees). If the test is positive at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 919

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles, the anteromedial (AM) and posterolateral (PL) bundles. During physiologic knee range of motion, how do the tension patterns of these distinct bundles behave?

. The AM bundle becomes tight in flexion, while the PL bundle is tight in extension
. Both bundles become equally tight in flexion
. The PL bundle becomes tight in flexion, while the AM bundle is tight in extension
. Both bundles are lax in flexion and tight in extension
. The tension of both bundles remains constant throughout the range of motion

Correct Answer & Explanation

. The AM bundle becomes tight in flexion, while the PL bundle is tight in extension

Explanation

The anteromedial (AM) bundle of the ACL is primarily tight in flexion and is the main restraint to anterior tibial translation at 90 degrees of flexion. The posterolateral (PL) bundle is tightest in extension and is the primary restraint against rotatory instability.

Question 920

Topic: Knee Sports
A 28-year-old football player is evaluated for acute knee instability. The tibial dial test is performed in the supine position. The examiner notes >10 degrees of increased external rotation on the injured side compared to the normal side when the knee is flexed at 30 degrees. However, when the knee is flexed to 90 degrees, the external rotation is symmetric bilaterally. This specific pattern confirms injury to which structure(s)?
. Isolated Posterolateral Corner (PLC)
. Combined Posterolateral Corner (PLC) and Posterior Cruciate Ligament (PCL)
. Isolated Posterior Cruciate Ligament (PCL)
. Anterolateral Ligament (ALL) and Anterior Cruciate Ligament (ACL)
. Medial Collateral Ligament (MCL) and Posterior Oblique Ligament (POL)

Correct Answer & Explanation

. Isolated Posterolateral Corner (PLC)

Explanation

The dial test assesses external rotation of the tibia. Increased external rotation (>10 degrees compared to the contralateral side) at 30 degrees of flexion indicates an injury to the Posterolateral Corner (PLC). If the external rotation reduces and becomes symmetric at 90 degrees, the PCL is intact (isolated PLC injury). If external rotation is increased at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

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