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Knee Sports MCQs

Practice Set 49 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 961

Topic: Knee Sports

A 25-year-old athlete undergoes a physical examination after a knee injury. The 'dial test' reveals 15 degrees of increased external rotation of the tibia compared to the contralateral side when the knee is flexed to 30 degrees. However, when the knee is flexed to 90 degrees, the external rotation is symmetric bilaterally. This examination pattern indicates an isolated injury to which of the following structures?

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

Correct Answer & Explanation

. Posterolateral corner

Explanation

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

Question 962

Topic: Knee Sports
A 24-year-old football player sustains a knee dislocation (Schenck KD-III) after a high-velocity tackle. On examination, the foot is cool with diminished dorsalis pedis and posterior tibial pulses. His Ankle-Brachial Index (ABI) is 0.7. What is the most appropriate next step in management after emergent closed reduction of the knee?
. Immediate MRI of the knee to evaluate ligamentous injury
. Observation with serial neurovascular checks for 24 hours
. Emergent CT angiography (CTA) of the lower extremity or surgical exploration
. Application of a hinged knee brace and delayed ACL/PCL reconstruction
. Immediate application of an external fixator and discharge

Correct Answer & Explanation

. Emergent CT angiography (CTA) of the lower extremity or surgical exploration

Explanation

An ABI < 0.9 or asymmetric pulses following a knee dislocation is a hard indication for advanced vascular imaging, most commonly CT angiography (CTA), or immediate surgical exploration to rule out a popliteal artery injury. A normal ABI (>0.9) can be observed with serial checks, but an abnormal ABI requires immediate further investigation or intervention.

Question 963

Topic: Knee Sports

During the physical examination of a patient with a knee injury, the dial test reveals a 15-degree increase in 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 injury pattern does this indicate?

. Isolated Posterior Cruciate Ligament (PCL) injury
. Isolated Posterolateral Corner (PLC) injury
. Combined PCL and PLC injury
. Combined ACL and MCL injury
. Isolated Lateral Collateral Ligament (LCL) injury

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). Increased external rotation (>10 degrees compared to the normal side) solely at 30 degrees indicates an isolated PLC injury. If increased external rotation is present at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 964

Topic: Knee Sports

Biomechanical studies have demonstrated that an un-repaired complete radial tear of the medial meniscus posterior root alters the contact mechanics and joint kinematics of the knee most similarly to which of the following conditions?

. Anterior cruciate ligament tear
. Total medial meniscectomy
. Isolated medial collateral ligament tear
. Partial medial meniscectomy
. Normal intact knee

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus completely disrupts the hoop stresses that allow the meniscus to convert axial loads into circumferential tension. Biomechanically, this failure of hoop stress makes the knee function almost identically to a knee that has undergone a total medial meniscectomy, leading to rapid articular cartilage wear and osteoarthritis.

Question 965

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon seeks the anatomic femoral attachment site (Schöttle's point) using fluoroscopy. Anatomically, where does the MPFL originate on the medial femur?
. Anterior to the medial epicondyle and proximal to the adductor tubercle
. Posterior to the medial epicondyle and distal to the adductor tubercle
. Between the medial epicondyle and adductor tubercle
. Anterior to the adductor tubercle and distal to the medial epicondyle
. Directly on the peak of the adductor tubercle

Correct Answer & Explanation

. Between the medial epicondyle and adductor tubercle

Explanation

The anatomic femoral origin of the MPFL is located in a saddle-shaped depression between the adductor tubercle (proximally) and the medial epicondyle (distally and anteriorly). On a perfect lateral radiograph, Schöttle's point is located 1 mm anterior to the posterior cortex extension 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 966

Topic: Knee Sports
A 10-year-old boy (Tanner stage I) sustains an anterior cruciate ligament (ACL) tear. His parents opt for surgical reconstruction due to recurrent instability. To minimize the risk of physeal arrest and subsequent growth disturbance, which of the following techniques is most appropriate?
. Transphyseal reconstruction using an autologous bone-patellar tendon-bone graft
. Over-the-top extra-articular tenodesis combined with a transphyseal tibial tunnel
. Epiphyseal-sparing (all-epiphyseal) ACL reconstruction
. Transphyseal reconstruction with an 11-mm soft tissue graft
. Primary ACL repair using a synthetic augmentation device

Correct Answer & Explanation

. Epiphyseal-sparing (all-epiphyseal) ACL reconstruction

Explanation

In a skeletally immature patient with significant remaining growth (e.g., Tanner stage I or II, open physes), ACL reconstruction techniques must minimize the risk of iatrogenic physeal injury. An all-epiphyseal (epiphyseal-sparing) ACL reconstruction or an entirely physeal-sparing technique is indicated to avoid drilling across the femoral and tibial physes. Transphyseal techniques may be considered in older adolescents (Tanner III/IV) but should use soft tissue grafts (not bone plugs). Bone-patellar tendon-bone grafts are contraindicated due to the risk of bone blocks bridging the physis, leading to premature arrest.

Question 967

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, positioning the femoral tunnel too anteriorly (shallow) will result in which of the following graft behaviors 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 tight in both flexion and extension
. The graft will be loose in both flexion and extension
. The graft tension will remain isometric throughout the range of motion

Correct Answer & Explanation

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

Explanation

In ACL reconstruction, an anteriorly (shallow) placed femoral tunnel creates a length mismatch where the graft becomes tight in flexion and loose in extension. Conversely, a posteriorly (deep) placed femoral tunnel results in a graft that is tight in extension and loose in flexion. Optimal isometric placement or anatomic placement avoids these extremes, allowing normal range of motion without over-constraining the joint or leaving it unstable.

Question 968

Topic: Knee Sports

An 18-year-old football halfback reports that he had immediate right knee pain after being tackled 1 week ago. Examination now reveals moderate tenderness over the proximal medial tibia and lateral joint and normal cruciate stability. In evaluating the integrity of the posterolateral knee structures, what is the most reliable examination finding?

. Excessive varus laxity at 30 degrees of flexion
. Reverse pivot shift
. Posterolateral drawer laxity at 90 degrees of flexion
. Asymmetric tibial external rotation at 30 degrees of flexion
. Positive external rotation/recurvatum test

Correct Answer & Explanation

. Asymmetric tibial external rotation at 30 degrees of flexion

Explanation

The most reliable test for a relatively isolated posterolateral complex (PLC) injury is the asymmetric tibial external rotation or "dial test." It can be performed with the patient prone or supine. When greater than 10 degrees of external rotation at 30 degrees of flexion is present when compared with the opposite knee, it indicates significant damage to the posterolateral structures. Asymmetric external rotation, which is also present at 90 degrees of flexion, indicates injury to the posterior cruciate ligament (PCL) as well. Varus laxity may indicate significant damage to both the PLC and PCL. Approximately 35% of the normal population may have a reverse pivot shift when examined under anesthesia; therefore, it is considered a less specific test. The external rotation/recurvatum and posterolateral drawer tests are adjunctive in assessing isolated posterolateral laxity but are not thought to be as reliable. Veltri DM, Warren RF: Isolated and combined posterior cruciate injuries. J Am Acad Orthop Surg 1993;1:67-75.

Question 969

Topic: Knee Sports

A 15-year-old boy reports feeling a pop and notes sudden giving way of the left knee while playing basketball. He has immediate pain and swelling in the knee. An AP radiograph is shown in Figure 32. A small avulsion fragment from the lateral tibial margin is the only finding. What is the most likely diagnosis?

Orthopedic Surgery Board Review 2026 | High-Yield MCQs - Set 5 - Figure 107

. Avulsion of the lateral collateral ligament
. Avulsion of the pes anserinus
. Avulsion of the iliotibial band
. Tear of the anterior cruciate ligament
. Tear of the posterior cruciate ligament

Correct Answer & Explanation

. Avulsion of the lateral collateral ligament

Explanation

An avulsion fracture from the lateral tibial margin carries the eponym Segond fracture and is pathognomonic for an anterior cruciate ligament (ACL) tear. The fragment is located posterior to Gerdy's tubercle and is superior and anterior to the fibular head. It represents an avulsion of the lateral capsular ligament of the knee and is caused by the same mechanism that causes the ACL tear. The pes anserinus is the insertion point of the medial hamstrings and would not be affected in a lateral avulsion injury. The posterior cruciate ligament may be seen on a lateral view if associated with an avulsion fragment, but a tear of the PCL generally cannot be diagnosed on an AP view. The insertion of the iliotibial band is broad and is unlikely to produce an avulsion injury such as that seen in the radiograph. This view is not consistent with the appearance of a lateral collateral ligament injury. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 533-557.

Question 970

Topic: Knee Sports
A 30-year-old woman injures her knee while skiing. Based on the MRI scan shown in Figure 5, treatment should consist of:
. anterior cruciate ligament reconstruction.
. medial collateral ligament (MCL) reconstruction.
. MCL repair.
. functional rehabilitation and early motion.
. medial meniscal repair.

Correct Answer & Explanation

. functional rehabilitation and early motion.

Explanation

The MRI scan demonstrates a grade III MCL tear. Basic science and clinical studies have shown that nonsurgical management is preferred for MCL tears. Functional rehabilitation and early motion have led to consistently better results than has surgical repair.

Question 971

Topic: Knee Sports

According to the Thoracolumbar Injury Classification and Severity (TLICS) score, which of the following factors is given the highest point value when determining the need for surgical stabilization?

. Compression fracture morphology
. Intact posterior ligamentous complex (PLC)
. Suspected PLC injury
. Complete spinal cord injury
. Definite posterior ligamentous complex (PLC) disruption

Correct Answer & Explanation

. Definite posterior ligamentous complex (PLC) disruption

Explanation

In the TLICS system, an unequivocally disrupted posterior ligamentous complex (PLC) is assigned 3 points. Incomplete spinal cord injury is also assigned 3 points. Surgical management is generally indicated for a total score of 5 or more.

Question 972

Topic: Knee Sports

A 13-year-old male gymnast presents with lateral elbow pain and clicking. MRI demonstrates osteochondritis dissecans (OCD) of the capitellum with an unstable, detached osteochondral fragment resting in situ. What is the most appropriate management?

. Rest and strict cessation of gymnastics for 6 months
. Arthroscopic fragment excision and marrow stimulation (microfracture)
. In situ retrograde drilling of the capitellum
. Corticosteroid injection into the radiocapitellar joint
. Capitellar closing wedge osteotomy

Correct Answer & Explanation

. Arthroscopic fragment excision and marrow stimulation (microfracture)

Explanation

In an adolescent with capitellar OCD demonstrating an unstable or detached fragment on MRI, surgical intervention is indicated. Arthroscopic fragment excision with microfracture of the base, or fragment fixation if amenable, is the standard of care.

Question 973

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two main functional bundles. During deep knee flexion, which bundle is under the most tension, and what is its primary biomechanical role?

. Posterolateral bundle; resists anterior translation
. Posterolateral bundle; resists internal rotation
. Anteromedial bundle; resists anterior translation
. Anteromedial bundle; resists valgus stress
. Intermediate bundle; resists hyperextension

Correct Answer & Explanation

. Anteromedial bundle; resists anterior translation

Explanation

The anteromedial bundle of the ACL tightens in flexion and is the primary restraint to anterior tibial translation. The posterolateral bundle tightens in extension and acts primarily to resist rotational loads.

Question 974

Topic: Knee Sports
Following a complete rupture of the anterior cruciate ligament (ACL), the initial phase of biological healing features a hematoma. Which type of collagen is predominantly synthesized by fibroblasts during the early proliferative phase of ligament healing?
. Type I
. Type II
. Type III
. Type IX
. Type X

Correct Answer & Explanation

. Type III

Explanation

During the early proliferative phase of ligament and tendon healing, fibroblasts predominantly synthesize disorganized Type III collagen. Over the subsequent remodeling and maturation phases, this is gradually replaced by stronger, longitudinally aligned Type I collagen.

Question 975

Topic: Knee Sports

The posteromedial approach to the knee is often utilized for repairing tibial avulsions of the posterior cruciate ligament (PCL) or accessing the posterior horn of the medial meniscus. This approach develops an interval between which of the following muscle bellies?

. Semitendinosus and Gracilis
. Semimembranosus and Medial head of gastrocnemius
. Sartorius and Vastus medialis
. Medial head of gastrocnemius and Soleus
. Biceps femoris and Lateral head of gastrocnemius

Correct Answer & Explanation

. Semimembranosus and Medial head of gastrocnemius

Explanation

The posteromedial approach to the knee utilizes the interval between the semimembranosus and the medial head of the gastrocnemius. Protecting the medial sural cutaneous nerve and the saphenous nerve and vein is important during the superficial dissection.

Question 976

Topic: Knee Sports

A patient is undergoing reconstruction of the posterolateral corner (PLC) of the knee. Which of the following structures constitutes the primary static stabilizer to external tibial rotation at 30 degrees of knee flexion?

. Popliteus tendon
. Lateral collateral ligament (LCL)
. Popliteofibular ligament (PFL)
. Iliotibial band
. Biceps femoris tendon

Correct Answer & Explanation

. Popliteofibular ligament (PFL)

Explanation

The popliteofibular ligament (PFL) is a critical component of the PLC and acts as the primary static stabilizer against external rotation of the tibia. The LCL is the primary restraint to varus stress.

Question 977

Topic: Knee Sports

A patient undergoes surgical reconstruction of the posterolateral corner (PLC) of the knee. The surgeon reconstructs the popliteofibular ligament, which originates from the popliteus musculotendinous junction and inserts onto the fibular styloid. What is its primary biomechanical role?

. Resists posterior tibial translation at 90 degrees of flexion
. Resists anterior tibial translation at 30 degrees of flexion
. Resists primary external rotation of the tibia
. Resists primary internal rotation of the tibia
. Resists valgus gapping at 0 and 30 degrees of flexion

Correct Answer & Explanation

. Resists primary external rotation of the tibia

Explanation

The popliteofibular ligament is a key static stabilizer of the posterolateral corner of the knee. Its primary biomechanical function, along with the lateral collateral ligament and popliteus tendon, is resisting external rotation of the tibia.

Question 978

Topic: Knee Sports

A surgeon is reconstructing the posterolateral corner of the knee. The fibular collateral ligament (FCL) and the popliteus tendon (PT) both insert on the lateral femoral epicondyle. What is the spatial relationship of the FCL footprint relative to the PT footprint on the femur?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly medial

Correct Answer & Explanation

. Proximal and posterior

Explanation

On the lateral femoral condyle, the origin of the fibular collateral ligament (FCL) is located proximal and posterior to the origin of the popliteus tendon.

Question 979

Topic: Knee Sports

A surgeon is reconstructing the medial patellofemoral ligament (MPFL) for recurrent patellar instability. Anatomically, the femoral origin of the native MPFL is located in a saddle-like depression between which two osseous landmarks?

. Adductor tubercle and medial epicondyle
. Gastrocnemius tubercle and adductor tubercle
. Medial epicondyle and medial tibial plateau
. Medial epicondyle and Blumensaat's line
. Adductor tubercle and the medial collateral ligament insertion

Correct Answer & Explanation

. Adductor tubercle and medial epicondyle

Explanation

The femoral origin of the MPFL lies in a saddle-shaped depression located between the medial epicondyle (distally) and the adductor tubercle (proximally). Finding this isometric point is critical for avoiding abnormal graft tension during knee flexion.

Question 980

Topic: Knee Sports

The posterolateral corner (PLC) of the knee provides primary restraint to varus stress and posterolateral rotation. Which of the following structures is considered one of the three major static stabilizers of the PLC?

. Biceps femoris tendon
. Lateral gastrocnemius tendon
. Popliteofibular ligament
. Iliotibial band
. Arcuate ligament

Correct Answer & Explanation

. Popliteofibular ligament

Explanation

The three primary static stabilizers of the posterolateral corner of the knee are the fibular collateral ligament (FCL), the popliteus tendon, and the popliteofibular ligament. The biceps femoris and iliotibial band provide dynamic, rather than static, stability.

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