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Knee Sports MCQs

Practice Set 5 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 81

Topic: Knee Sports

What is the primary anatomical and biomechanical rationale for utilizing a tibial inlay technique over a standard transtibial technique during posterior cruciate ligament (PCL) reconstruction?

. It prevents posterior capsular scarring and stiffness.
. It avoids the "killer turn" of the graft at the posterior tibial aperture.
. It allows for a significantly shorter overall graft length.
. It decreases the risk of intraoperative popliteal artery injury.
. It eliminates the need for femoral tunnel preparation.

Correct Answer & Explanation

. It avoids the "killer turn" of the graft at the posterior tibial aperture.

Explanation

The tibial inlay technique bypasses the acute angle (killer turn) at the posterior tibial tunnel opening, which can lead to graft attenuation and failure seen in transtibial PCL reconstructions.

Question 82

Topic: Knee Sports

Which of the following physical examination tests is most specific for evaluating posterolateral corner (PLC) rotatory instability?

. Anterior drawer in internal rotation
. Pivot shift test
. Reverse pivot shift test
. Posterior sag sign
. Valgus stress test at 0 degrees

Correct Answer & Explanation

. Reverse pivot shift test

Explanation

The reverse pivot shift test specifically evaluates for PLC injury. A positive test occurs when a posteriorly subluxated lateral tibial plateau reduces as the knee is flexed past 20 to 30 degrees.

Question 83

Topic: Knee Sports

A 35-year-old patient presents with a chronic posterolateral corner (PLC) deficiency and a noticeable varus thrust during gait. Radiographs show medial compartment narrowing and significant mechanical varus alignment. What is the most appropriate initial surgical management?

. Isolated PLC anatomical reconstruction
. Valgus-producing high tibial osteotomy (HTO)
. Unicompartmental knee arthroplasty
. Combined ACL and PLC reconstruction
. Fibular head advancement

Correct Answer & Explanation

. Valgus-producing high tibial osteotomy (HTO)

Explanation

In chronic PLC deficiency associated with varus malalignment, a proximal tibial valgus-producing osteotomy must be performed (either staged before or concurrently) to prevent the failure of the soft-tissue PLC reconstruction.

Question 84

Topic: Knee Sports

A 28-year-old football player presents with acute knee pain and lateral swelling after a direct blow to the anteromedial tibia. A radiograph is obtained.

Based on the classical significance of the "arcuate sign" shown, what associated structural injury is almost certainly present?

. Anterior cruciate ligament tear
. Medial collateral ligament avulsion
. Posterolateral corner injury
. Isolated popliteus tendon rupture
. Quadriceps tendon rupture

Correct Answer & Explanation

. Posterolateral corner injury

Explanation

The arcuate sign is an avulsion fracture of the fibular styloid. It is highly pathognomonic for an injury to the posterolateral corner (PLC) structures.

Question 85

Topic: Knee Sports

During a single-bundle posterior cruciate ligament (PCL) reconstruction, which specific bundle is typically reconstructed, and at what angle of knee flexion should the graft be tensioned?

. Posteromedial bundle, tensioned at 90 degrees
. Posteromedial bundle, tensioned at full extension
. Anterolateral bundle, tensioned at 90 degrees
. Anterolateral bundle, tensioned at full extension
. Anterolateral bundle, tensioned at 30 degrees

Correct Answer & Explanation

. Anterolateral bundle, tensioned at 90 degrees

Explanation

The anterolateral bundle is the larger and stronger component of the PCL. It is tightest in flexion and is standardly reconstructed and tensioned at 90 degrees of knee flexion.

Question 86

Topic: Knee Sports
A patient is diagnosed with a grade III MCL tear combined with an ACL rupture. MRI reveals the distal MCL has avulsed from its tibial insertion and retracted superficial to the pes anserinus (Stener-like lesion of the knee). What is the recommended management strategy?
. Nonoperative management in a hinged knee brace for 6 weeks, followed by ACL reconstruction.
. Immediate ACL reconstruction with nonoperative management of the MCL.
. Acute surgical repair of the MCL with concurrent or staged ACL reconstruction.
. Delayed combined reconstruction of both ligaments at 3 months.
. Isolated nonoperative management of both ligaments.

Correct Answer & Explanation

. Acute surgical repair of the MCL with concurrent or staged ACL reconstruction.

Explanation

While most combined ACL/MCL injuries are treated with bracing for the MCL and delayed ACL reconstruction, a distal MCL avulsion trapped superficial to the pes anserinus cannot heal nonoperatively and requires acute surgical repair.

Question 87

Topic: Knee Sports

Which neurological structure is at highest risk during an acute posterolateral corner injury, and what specific clinical finding dictates the poorest prognosis for conservative recovery?

. Tibial nerve; loss of plantar flexion
. Common peroneal nerve; complete palsy present immediately at the time of injury
. Saphenous nerve; medial knee numbness
. Deep peroneal nerve; isolated first web space numbness
. Sural nerve; lateral foot numbness

Correct Answer & Explanation

. Common peroneal nerve; complete palsy present immediately at the time of injury

Explanation

The common peroneal nerve is injured in up to 30% of severe PLC injuries. A complete palsy documented immediately at the time of injury has a much lower rate of spontaneous recovery compared to partial or delayed-onset lesions.

Question 88

Topic: Knee Sports

A 22-year-old female skier presents after a twisting knee injury. Radiographs reveal the finding shown.

This classical fracture (Segond fracture) represents an avulsion of which structure and strongly correlates with which associated injury?

. Biceps femoris tendon; PCL tear
. Fibular collateral ligament; PLC injury
. Anterolateral ligament; ACL tear
. Iliotibial band; Meniscal tear
. Popliteus tendon; ACL tear

Correct Answer & Explanation

. Anterolateral ligament; ACL tear

Explanation

The Segond fracture is a cortical avulsion off the lateral tibial plateau involving the anterolateral capsule and anterolateral ligament (ALL). It is highly pathognomonic for an anterior cruciate ligament (ACL) tear.

Question 89

Topic: Knee Sports

When performing an anatomical posterolateral corner (PLC) reconstruction, at what knee position should the fibular collateral ligament (FCL) graft be properly tensioned?

. 90 degrees of flexion with a varus stress
. 60 degrees of flexion in neutral rotation
. 20 degrees of flexion with a valgus stress
. Full extension with external rotation
. 90 degrees of flexion with internal rotation

Correct Answer & Explanation

. 20 degrees of flexion with a valgus stress

Explanation

During PLC reconstruction, the FCL graft is typically tensioned at 20 degrees of knee flexion while a valgus force is applied. In contrast, the popliteus graft is tensioned at 60 degrees of flexion in neutral rotation.

Question 90

Topic: Knee Sports

A 40-year-old male presents with a suspected posterior cruciate ligament (PCL) injury. On examination, a positive posterior sag sign is noted. Which radiographic view is most accurate for quantifying the exact degree of posterior tibial translation?

. AP weight-bearing view in full extension
. Merchant patellofemoral view
. Bilateral kneeling lateral radiographs
. Rosenberg view
. Lateral view at 30 degrees of flexion

Correct Answer & Explanation

. Bilateral kneeling lateral radiographs

Explanation

Bilateral kneeling lateral radiographs provide a consistent, gravity and body-weight directed posterior force to the proximal tibia. This allows for highly accurate quantification of posterior tibial translation compared to the uninjured side.

Question 91

Topic: Knee Sports

A 50-year-old patient presents with acute posteromedial knee pain after deep flexion. MRI demonstrates the lesion shown.

If left untreated, a complete posterior horn medial meniscal root tear is biomechanically equivalent to which of the following?

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

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A meniscal root tear disrupts the crucial circumferential hoop stresses of the meniscus, rendering it functionally incompetent. Biomechanically, it is completely equivalent to a total meniscectomy and leads to rapid articular cartilage degeneration.

Question 92

Topic: Knee Sports

During an anatomical posterolateral corner (PLC) reconstruction, tunnels must be placed accurately in the lateral femoral condyle. What is the spatial relationship of the normal fibular collateral ligament (FCL) femoral attachment relative to the popliteus tendon attachment?

. FCL is anterior and distal to the popliteus.
. FCL is proximal and posterior to the popliteus.
. FCL is distal and posterior to the popliteus.
. FCL is anterior and proximal to the popliteus.
. They share a conjoined origin at the lateral epicondyle.

Correct Answer & Explanation

. FCL is proximal and posterior to the popliteus.

Explanation

On the lateral femoral condyle, the popliteus tendon insertion is located at the anterior end of the popliteal sulcus. The origin of the FCL is located 18.5 mm proximal and posterior to the popliteus insertion.

Question 93

Topic: Knee Sports

Use of functional knee bracing after anterior cruciate ligament (AC L) reconstruction will most likely result in which of the following scenarios:

. Better range of motion at the 2-year follow-up
. Better knee stability at the 2-year follow-up
. Better knee function at the 2-year follow-up
. More knee pain at the 3-month follow-up
. More quadriceps atrophy at the 3-month follow-up

Correct Answer & Explanation

. More quadriceps atrophy at the 3-month follow-up

Explanation

Two-year follow-up has failed to show any differences in range of motion, stability, function, strength, pain, or atrophy in patients who were braced after AC L reconstruction vs. patients who were treated without a brace. The only difference between the two groups is that the braced group has better knee function in the early postoperative period, despite having more quadriceps atrophy.

Question 94

Topic: Knee Sports

The microfracture technique for articular cartilage lesions is most successful for which chondral lesions:

. 2 cm diameter
. Smaller than a 2 cm diameter
. Kissing lesions
. Loss of subchondral bone integrity
. Partial thickness chondral lesions

Correct Answer & Explanation

. Smaller than a 2 cm diameter

Explanation

The inventors of the microfracture technique described a 70% to 80% success rate after microfracture of lesions smaller than 2 cm in diameter. The technique involves maintenance of some subchondral bone integrity and is indicated for full thickness chondral lesions. Lesions involving both the tibia and femur have resulted in less satisfactory outcomes.

Question 95

Topic: Knee Sports

The following structures are found in the superficial layer of the posterolateral corner:

. The biceps tendon and fabellofibular ligament
. The patellofemoral ligaments and quadriceps retinaculum
. The iliotibial tract and biceps tendon
. The joint capsule and fabellofibular ligament
. The popliteofibular ligament and biceps tendon

Correct Answer & Explanation

. The iliotibial tract and biceps tendon

Explanation

An anatomic study described three distinct layers that compose the posterolateral corner of the knee. Layer one includes the biceps tendon, the iliotibial tract, the prepatellar bursa, and peroneal nerve. Layer two includes the quadriceps retinaculum and patellofemoral ligaments. Layer three, the deepest layer, includes the lateral part of the joint capsule, the popliteus tendon passing through the hiatus, the fibular collateral ligament, the fabellofibular ligament, arcuate complex, and popliteofibular ligament.

Question 96

Topic: Knee Sports

The following structures are found in the second, or middle layer, of the posterolateral corner:

. The biceps tendon and fabellofibular ligament
. The patellofemoral ligaments and quadriceps retinaculum
. The iliotibial tract and biceps tendon
. The joint capsule and fabellofibular ligament
. The popliteofibular ligament and biceps tendon

Correct Answer & Explanation

. The patellofemoral ligaments and quadriceps retinaculum

Explanation

An anatomic study described three distinct layers that compose the posterolateral corner of the knee. Layer one includes the biceps tendon, the iliotibial tract, the prepatellar bursa, and peroneal nerve. Layer two includes the quadriceps retinaculum and patellofemoral ligaments. Layer three, the deepest layer, includes the lateral part of the joint capsule, the popliteus tendon passing through the hiatus, the fibular collateral ligament, the fabellofibular ligament, arcuate complex, and popliteofibular ligament.

Question 97

Topic: Knee Sports

The following structures are found in the deep layer of the posterolateral corner:

. The biceps tendon and fabellofibular ligament
. The patellofemoral ligaments and quadriceps retinaculum
. The iliotibial tract and biceps tendon
. The joint capsule and fabellofibular ligament
. The popliteofibular ligament and biceps tendon

Correct Answer & Explanation

. The joint capsule and fabellofibular ligament

Explanation

An anatomic study described three distinct layers that compose the posterolateral corner of the knee. Layer one includes the biceps tendon, the iliotibial tract, the prepatellar bursa, and peroneal nerve. Layer two includes the quadriceps retinaculum and patellofemoral ligaments. Layer three, the deepest layer, includes the lateral part of the joint capsule, the popliteus tendon passing through the hiatus, the fibular collateral ligament, the fabellofibular ligament, arcuate complex, and popliteofibular ligament.

Question 98

Topic: Knee Sports

The reverse pivot shift is most useful for diagnosing which of the following knee injuries:

. Anterior cruciate ligament injuries
. Posterior cruciate ligament injuries
. Medial collateral ligament injuries
. Posterolateral corner injuries
. Meniscal injuries

Correct Answer & Explanation

. Posterolateral corner injuries

Explanation

The reverse pivot shift is positive if there is a palpable shift or jerk as the lateral tibial plateau reduces while bringing the knee from 90° of flexion to full extension with the foot in external rotation. This is indicative of posterolateral corner knee injury but has been reported to be positive in 11% to 35% of normal asymptomatic patients.

Question 99

Topic: Knee Sports

When using the tibial external rotation test on a patient, increased external rotation at 30° but not at 90° of knee flexion is indicative of:

. Anterior cruciate ligament injury
. Posterior cruciate ligament injury
. Isolated posterolateral corner injury
. Posterior cruciate and posterolateral corner injury
. Anterior cruciate and posterior cruciate ligament injury

Correct Answer & Explanation

. Isolated posterolateral corner injury

Explanation

The tibial external rotation test is performed at 30° and 90° of knee flexion. The degree of foot external rotation with regard to the femur is evaluated. Increased external rotation at 30 ° is consistent with an isolated posterolateral corner injury. Increased external rotation at 30° and 90° is consistent with a combined posterolateral and posterior cruciate ligament injury.

Question 100

Topic: Knee Sports

During reconstruction of the medial patellofemoral ligament (MPFL) for recurrent patellar instability, the femoral tunnel must be placed at the anatomic origin. Where is this located radiographically (Schottle's point)?

. Anterior to the posterior cortical line and proximal to Blumensaat's line
. Anterior to the posterior cortical line and distal to Blumensaat's line
. Posterior to the posterior cortical line and proximal to Blumensaat's line
. Posterior to the posterior cortical line and distal to Blumensaat's line
. Directly on Blumensaat's line at the anterior cortex

Correct Answer & Explanation

. Anterior to the posterior cortical line and proximal to Blumensaat's line

Explanation

Schottle's point is located approximately 1 mm anterior to the posterior cortical line and proximal to the posterior extension of Blumensaat's line. Precise placement is critical to avoid non-isometric graft tensioning.

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