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Knee Sports MCQs

Practice Set 47 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 921

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, accurate femoral tunnel placement is critical to avoid graft mal-tensioning. Radiographically, 'Schöttle's point' is used to identify the anatomic femoral footprint. Anatomically, where is this point located?
. 1 cm distal to the medial epicondyle
. In the saddle region between the adductor tubercle and the medial epicondyle
. Directly on the prominence of the adductor tubercle
. 2 cm anterior to the medial epicondyle
. At the insertion of the superficial medial collateral ligament

Correct Answer & Explanation

. In the saddle region between the adductor tubercle and the medial epicondyle

Explanation

The anatomic femoral origin of the MPFL is located in the saddle-shaped depression between the adductor tubercle (proximal) and the medial epicondyle (distal). Radiographically, Schöttle's point is 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line.

Question 922

Topic: Knee Sports

When performing an anterior cruciate ligament (ACL) reconstruction, drilling the femoral tunnel via an anteromedial (AM) portal instead of a transtibial technique is advantageous primarily because it allows for:

. A more vertical femoral tunnel, reducing rotational instability
. Independent placement of the femoral tunnel closer to the native ACL footprint
. Decreased risk of posterior wall blowout
. Longer femoral tunnel length for better graft incorporation
. Avoidance of the need to hyperflex the knee during drilling

Correct Answer & Explanation

. Independent placement of the femoral tunnel closer to the native ACL footprint

Explanation

The primary advantage of the anteromedial (AM) portal technique over the traditional transtibial technique is that it uncouples the femoral tunnel from the tibial tunnel trajectory. This allows for independent, anatomic placement of the femoral tunnel at the native ACL footprint, which creates a more oblique graft that better restores rotational stability.

Question 923

Topic: Knee Sports
A 28-year-old male sustains a high-energy multiligamentous knee injury with complete ruptures of the ACL, PCL, and MCL (Schenck KD-III M). Upon closed reduction in the emergency department, his pedal pulses are palpable, but his ankle-brachial index (ABI) is 0.85. What is the most appropriate next step in management?
. Observation and repeat the ABI in 4 hours
. Perform a CT angiogram of the lower extremity
. Immediate surgical exploration of the popliteal artery
. Apply a hinged knee brace and perform duplex ultrasound
. Initiate intravenous heparin infusion

Correct Answer & Explanation

. Perform a CT angiogram of the lower extremity

Explanation

An ABI < 0.9 in the setting of a multiligament knee injury (knee dislocation) is highly suspicious for a popliteal artery injury, even if pedal pulses are palpable. A CT angiogram is the gold standard next step to evaluate the arterial tree before proceeding with possible vascular repair.

Question 924

Topic: Knee Sports

Compared to a traditional transtibial drilling technique, utilizing an independent anteromedial (AM) portal drilling technique for the femoral tunnel in an anterior cruciate ligament (ACL) reconstruction increases the risk of which of the following intraoperative complications?

. Vertical graft placement in the coronal plane
. Posterior cruciate ligament impingement
. Posterior wall blowout of the lateral femoral condyle
. Anterior placement of the femoral tunnel
. Inability to adequately tension the graft

Correct Answer & Explanation

. Posterior wall blowout of the lateral femoral condyle

Explanation

The anteromedial (AM) portal technique allows for more anatomic placement of the femoral tunnel footprint compared to the transtibial technique, which often results in a more vertical and non-anatomic graft. However, drilling through the AM portal is associated with specific risks, particularly a shorter femoral tunnel length and a higher risk of posterior wall blowout of the lateral femoral condyle due to the acute angle of the drill trajectory relative to the intercondylar notch.

Question 925

Topic: Knee Sports

During an anatomical reconstruction of the posterolateral corner (PLC) of the knee, the surgeon aims to recreate the three primary static stabilizing structures. Which of the following correctly identifies these three structures?

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament
. Biceps femoris tendon, popliteus tendon, and lateral collateral ligament
. Iliotibial band, popliteofibular ligament, and fabellofibular ligament
. Arcuate ligament, popliteus tendon, and fibular collateral ligament
. Fibular collateral ligament, lateral meniscus, and popliteofibular ligament

Correct Answer & Explanation

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

The three major static stabilizers of the posterolateral corner (PLC) of the knee are the fibular collateral ligament (also known as the lateral collateral ligament), the popliteus tendon, and the popliteofibular ligament. Anatomical PLC reconstructions (such as the LaPrade technique) specifically reconstruct these three distinct structures.

Question 926

Topic: Knee Sports

During a physical examination of a patient with a suspected multiligamentous knee injury, the Dial test is performed. The patient exhibits 15 degrees of increased external rotation compared to the contralateral knee at 30 degrees of flexion, but symmetric external rotation at 90 degrees of flexion. What is the most likely diagnosis?

. Isolated Posterior Cruciate Ligament (PCL) injury
. 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

The Dial test evaluates external rotation of the tibia. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of knee flexion, but NOT at 90 degrees, indicates an isolated Posterolateral Corner (PLC) injury. If increased external rotation is present at both 30 and 90 degrees, it suggests a combined injury to both the PLC and the Posterior Cruciate Ligament (PCL).

Question 927

Topic: Knee Sports

During reconstruction of the posterior cruciate ligament (PCL), recreating the anterolateral (AL) bundle is crucial. At what degree of knee flexion is the AL bundle of the native PCL most taut?

. 0 degrees (Full extension)
. 30 degrees
. 60 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 90 degrees

Explanation

The PCL consists of two main bundles: the anterolateral (AL) and posteromedial (PM) bundles. The AL bundle is larger and is most taut in flexion (typically reaching maximum tension around 90 degrees), whereas the PM bundle is most taut in extension.

Question 928

Topic: Knee Sports

During an anatomic anterior cruciate ligament (ACL) reconstruction, the surgeon aims to accurately restore the native footprints of the anteromedial (AM) and posterolateral (PL) bundles on the femur. With the knee in full extension, which of the following accurately describes their relative positions on the medial wall of the lateral femoral condyle?

. The AM bundle is proximal and posterior; the PL bundle is distal and anterior.
. The AM bundle is distal and anterior; the PL bundle is proximal and posterior.
. The AM bundle is superior and anterior; the PL bundle is inferior and posterior.
. The AM bundle is distal and posterior; the PL bundle is proximal and anterior.
. Both bundles share an identical origin footprint with no distinct spatial separation.

Correct Answer & Explanation

. The AM bundle is proximal and posterior; the PL bundle is distal and anterior.

Explanation

On the medial wall of the lateral femoral condyle, with the knee in extension, the anteromedial (AM) bundle originates proximal and posterior to the posterolateral (PL) bundle. The PL bundle originates distal and anterior. During knee flexion, their relative orientation changes as the bundles cross one another.

Question 929

Topic: Knee Sports

During the physical examination of a patient with a suspected multiligament knee injury, the 'dial test' is performed. Which of the following findings is diagnostic of an isolated posterolateral corner (PLC) injury?

. Increased external rotation of >10 degrees at 30 degrees of flexion, but normal at 90 degrees
. Increased external rotation of >10 degrees at 90 degrees of flexion, but normal at 30 degrees
. Increased external rotation of >10 degrees at both 30 and 90 degrees of flexion
. Increased internal rotation at 30 degrees of flexion
. Increased internal rotation at both 30 and 90 degrees of flexion

Correct Answer & Explanation

. Increased external rotation of >10 degrees at 30 degrees of flexion, but normal at 90 degrees

Explanation

The dial test evaluates external rotation of the tibia relative to the femur. An isolated injury to the posterolateral corner (PLC) is indicated by increased external rotation (>10 degrees compared to the uninjured contralateral side) at 30 degrees of knee flexion, but not at 90 degrees. If external rotation is increased at both 30 and 90 degrees, it indicates a combined injury of both the PLC and the posterior cruciate ligament (PCL).

Question 930

Topic: Knee Sports

During physical examination of a knee with a suspected anterior cruciate ligament (ACL) injury, the pivot-shift test is performed. This test primarily isolates and evaluates which specific structural component of the ACL?

. Anteromedial bundle
. Posterolateral bundle
. Intermediate bundle
. Posteromedial bundle
. Anterolateral bundle

Correct Answer & Explanation

. Anteromedial bundle

Explanation

The ACL has two main bundles: the anteromedial (AM) and the posterolateral (PL). The AM bundle tightens in flexion and provides the primary restraint to anterior tibial translation (tested by the Lachman and anterior drawer tests). The PL bundle tightens in extension and provides the primary restraint to rotatory instability, which is clinically evaluated using the pivot-shift test.

Question 931

Topic: Knee Sports

During the physical examination of a knee with a suspected multi-ligamentous injury, the Dial test is performed. The patient demonstrates 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of flexion, the external rotation is symmetric bilaterally. This finding indicates an isolated injury to the:

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

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

A positive Dial test (asymmetry of >10 degrees of external rotation) at 30 degrees of flexion, but negative at 90 degrees, is indicative of an isolated posterolateral corner (PLC) injury. If the test is positive at both 30 and 90 degrees, it suggests a combined injury of the PLC and PCL.

Question 932

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, a surgical error results in the femoral tunnel being placed too anteriorly (shallow) in the intercondylar notch. What specific kinematic abnormality will this graft exhibit during knee range of motion?

. The graft will be tight in flexion and loose in extension
. The graft will be tight in extension and loose in flexion
. The graft will be symmetrically tight throughout the entire range of motion
. The graft will impinge on the posterior cruciate ligament (PCL)
. The graft will cause obligatory excessive external rotation of the tibia

Correct Answer & Explanation

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

Explanation

An anteriorly placed (shallow) femoral tunnel causes the distance between the femoral and tibial insertion sites to increase as the knee moves into flexion. Consequently, the graft captures the joint, becoming overly tight in flexion (limiting ROM) and remaining loose in extension.

Question 933

Topic: Knee Sports

A Segond fracture observed on an AP radiograph of the knee is widely recognized as pathognomonic for an anterior cruciate ligament (ACL) tear. This bony avulsion occurs at the tibial insertion of the anterolateral ligament (ALL). Where does the ALL anatomically originate?

. Medial femoral epicondyle, distal to the adductor tubercle
. Gerdy's tubercle, merging with the iliotibial band
. Posterolateral corner of the fibular head
. Lateral femoral epicondyle, anterior and distal to the fibular collateral ligament origin
. Posterior aspect of the lateral femoral condyle, superior to the popliteus insertion

Correct Answer & Explanation

. Lateral femoral epicondyle, anterior and distal to the fibular collateral ligament origin

Explanation

The Segond fracture is a cortical avulsion fracture off the proximal anterolateral tibia, associated with ACL injuries. Anatomical studies identify this as the tibial insertion of the anterolateral ligament (ALL) or the lateral capsular ligament. The ALL originates on the lateral femoral epicondyle, slightly anterior and distal to the origin of the fibular collateral ligament (FCL), and inserts on the anterolateral tibia midway between Gerdy's tubercle and the fibular head.

Question 934

Topic: Knee Sports

An 11-year-old male with widely open physes sustains a mid-substance anterior cruciate ligament (ACL) tear. To avoid physeal injury, an all-epiphyseal ACL reconstruction is planned. During preparation of the femoral tunnel, the starting point should be correctly established in which of the following locations?

. Proximal to the lateral epicondyle and directed distally
. Distal to the lateral femoral physis and directed medially within the epiphysis
. Transphyseal, crossing through the center of the intercondylar notch
. Proximal to the medial epicondyle and directed laterally
. Through the center of the distal femoral physis to minimize peripheral growth arrest

Correct Answer & Explanation

. Distal to the lateral femoral physis and directed medially within the epiphysis

Explanation

An all-epiphyseal ACL reconstruction is designed to completely avoid crossing the distal femoral and proximal tibial physes. On the femoral side, the tunnel is drilled strictly within the epiphysis, distal to the lateral femoral physis. The trajectory goes from the lateral aspect of the lateral femoral condyle, aiming medially toward the native ACL footprint on the inner wall of the lateral condyle, remaining entirely within the epiphyseal bone.

Question 935

Topic: Knee Sports

A 50-year-old female presents with the sudden onset of medial knee pain and a popping sensation while performing a deep squat. MRI reveals a complete radial tear of the posterior horn of the medial meniscus exactly at its root attachment. Biomechanically, this injury is equivalent to which of the following conditions?

. An intact, functional meniscus
. A partial medial meniscectomy
. A total medial meniscectomy
. An isolated anterior cruciate ligament tear
. An isolated posterior cruciate ligament tear

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A complete tear of the meniscal root disrupts the circumferential hoop stresses that allow the meniscus to convert axial loads into tensile stresses. Biomechanically, a complete posterior root tear renders the meniscus completely nonfunctional, leading to contact pressures and joint kinematics that are equivalent to a total meniscectomy. This results in accelerated articular cartilage wear and rapid progression of osteoarthritis.

Question 936

Topic: Knee Sports
A patient with a multi-ligamentous knee injury undergoes a dial test. There is >10 degrees of increased external rotation on the injured side compared to the normal side at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees of knee flexion. Which structure is isolated as injured?
. Posterolateral corner (PLC) only
. Posterior cruciate ligament (PCL) only
. Both PLC and PCL
. Anterior cruciate ligament (ACL) and PLC
. Medial collateral ligament (MCL) and posterior oblique ligament (POL)

Correct Answer & Explanation

. Both PLC and PCL

Explanation

In the dial test, increased external rotation at 30 degrees only indicates an isolated posterolateral corner (PLC) injury. If increased external rotation is present at both 30 degrees and 90 degrees, it indicates a combined PLC and posterior cruciate ligament (PCL) injury.

Question 937

Topic: Knee Sports

A 24-year-old football player sustains a high-energy knee injury. Clinical examination reveals a grade 3 positive dial test at 30 degrees of flexion, which reduces to a grade 1 at 90 degrees. He also exhibits an abnormal varus thrust during gait. Which structure is most likely disrupted?

. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Medial collateral ligament (MCL)
. Posterolateral corner (PLC)
. Posteromedial corner (PMC)

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

An isolated posterolateral corner (PLC) injury is characterized by increased external rotation (positive dial test) at 30 degrees of flexion, but not at 90 degrees. If the dial test is positive at both 30 and 90 degrees, it suggests a combined PCL and PLC injury. A varus thrust during gait is a classic dynamic clinical finding for PLC deficiency.

Question 938

Topic: Knee Sports

Which of the following statements correctly describes the tensioning patterns of the two functional bundles of the anterior cruciate ligament (ACL) during knee range of motion?

. The anteromedial (AM) bundle is tightest in flexion, and the posterolateral (PL) bundle is tightest in extension
. The anteromedial (AM) bundle is tightest in extension, and the posterolateral (PL) bundle is tightest in flexion
. Both the AM and PL bundles reach maximum tension in full flexion
. Both the AM and PL bundles reach maximum tension in full extension
. The AM bundle primarily controls external rotation, while the PL bundle primarily controls internal rotation

Correct Answer & Explanation

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

Explanation

The ACL is composed of two main bundles: the anteromedial (AM) bundle and the posterolateral (PL) bundle. The AM bundle is primarily tight in flexion and provides the main restraint to anterior tibial translation at 90 degrees of flexion. The PL bundle is tight in extension and is the primary restraint to rotatory loads.

Question 939

Topic: Knee Sports

During an anatomical reconstruction of the posterolateral corner (PLC) of the knee, a fibular-based technique is utilized. Which three primary static stabilizing structures are being reconstructed?

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament
. Fibular collateral ligament, iliotibial band, and biceps femoris tendon
. Popliteus tendon, lateral meniscus posterior horn, and arcuate ligament
. Fibular collateral ligament, arcuate ligament, and fabellofibular ligament
. Popliteofibular ligament, lateral gastrocnemius tendon, and popliteus tendon

Correct Answer & Explanation

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

Anatomical reconstructions of the posterolateral corner of the knee focus on restoring the three primary static stabilizers: the fibular collateral ligament (FCL, also known as the LCL), the popliteus tendon (PLT), and the popliteofibular ligament (PFL). These structures primarily resist varus opening and external rotation.

Question 940

Topic: Knee Sports

A 25-year-old soccer player sustains a twisting injury to his knee. On physical examination, the dial test reveals 15 degrees of increased external rotation on the injured side 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 anatomic structure(s) is/are injured?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

The dial test is used to differentiate isolated posterolateral corner (PLC) injuries from combined PLC and PCL injuries. An increase in external rotation of >10 degrees at 30 degrees of flexion, but not at 90 degrees, indicates an isolated PLC injury. If the asymmetry is present at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.

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