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Knee Sports MCQs

Practice Set 52 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 1021

Topic: Knee Sports

A 24-year-old football player sustains a blow to the anteromedial knee. He demonstrates a positive dial test at 30 degrees of flexion, which normalizes at 90 degrees of flexion. Which of the following structures is most likely injured?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Medial collateral ligament
. Posterolateral corner structures
. Medial patellofemoral ligament

Correct Answer & Explanation

. Posterolateral corner structures

Explanation

A positive dial test (increased external rotation of the tibia) at 30 degrees that normalizes at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If the dial test is positive at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.

Question 1022

Topic: Knee Sports

The posterior cruciate ligament (PCL) consists of two main bundles. Which of the following statements correctly describes the biomechanics of the anterolateral (AL) bundle?

. It is tight in extension and lax in flexion
. It is tight in flexion and lax in extension
. It provides primary restraint to valgus stress
. It provides primary restraint to external rotation at 30 degrees
. It is primarily vascularized by the inferior geniculate artery

Correct Answer & Explanation

. It is tight in flexion and lax in extension

Explanation

The PCL is composed of the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle is tight in flexion and lax in extension, whereas the PM bundle is tight in extension and lax in flexion.

Question 1023

Topic: Knee Sports

What is the primary blood supply to the anterior cruciate ligament (ACL)?

. Superior medial genicular artery
. Inferior medial genicular artery
. Middle genicular artery
. Descending genicular artery
. Recurrent anterior tibial artery

Correct Answer & Explanation

. Middle genicular artery

Explanation

The middle genicular artery, a branch of the popliteal artery, provides the primary blood supply to the ACL. It pierces the posterior capsule to supply both cruciate ligaments and the surrounding synovial tissue.

Question 1024

Topic: Knee Sports
A 25-year-old male sustains a contact injury to his knee resulting in a combined ACL and medial collateral ligament (MCL) grade III tear. What is the most appropriate initial management for the MCL injury in the setting of ACL reconstruction?
. Nonoperative management of the MCL followed by delayed ACL reconstruction
. Primary repair of the MCL and delayed ACL reconstruction
. Acute reconstruction of the MCL and ACL
. Nonoperative management of the MCL and acute ACL reconstruction
. Immobilization for 6 weeks followed by staged ACL and MCL reconstructions

Correct Answer & Explanation

. Nonoperative management of the MCL followed by delayed ACL reconstruction

Explanation

Grade III MCL tears combined with ACL injuries are typically managed nonoperatively for the MCL to allow healing, followed by delayed ACL reconstruction once range of motion is restored. This prevents postoperative arthrofibrosis.

Question 1025

Topic: Knee Sports

During an anatomic double-bundle PCL reconstruction, the anterolateral and posteromedial bundles are reconstructed. Which of the following statements regarding the biomechanics of these bundles is true?

. The anterolateral bundle is tight in flexion and the posteromedial bundle is tight in extension.
. The anterolateral bundle is tight in extension and the posteromedial bundle is tight in flexion.
. Both bundles are tightest in full extension.
. Both bundles are tightest at 90 degrees of flexion.
. The anterolateral bundle controls internal rotation, while the posteromedial bundle controls external rotation.

Correct Answer & Explanation

. The anterolateral bundle is tight in flexion and the posteromedial bundle is tight in extension.

Explanation

The anterolateral bundle of the PCL is the larger of the two and becomes tight in knee flexion. The smaller posteromedial bundle is tight in knee extension.

Question 1026

Topic: Knee Sports

A positive Dial test at 30 degrees of flexion but symmetric at 90 degrees indicates an isolated injury to which of the following?

. Posterolateral corner
. Posterior cruciate ligament
. Combined posterolateral corner and posterior cruciate ligament
. Anterior cruciate ligament
. Medial collateral ligament

Correct Answer & Explanation

. Posterolateral corner

Explanation

Increased external rotation (a positive Dial test) at 30 degrees of flexion that reduces at 90 degrees indicates an isolated posterolateral corner injury. If the asymmetry persists or increases at 90 degrees, it suggests a combined posterolateral corner and posterior cruciate ligament injury.

Question 1027

Topic: Knee Sports

In the setting of a multiple ligament knee injury, an avulsion of the fibular collateral ligament and biceps femoris tendon from the fibular head is encountered. During surgical repair, which nerve is at greatest risk of iatrogenic injury?

. Tibial nerve
. Common peroneal nerve
. Deep peroneal nerve
. Saphenous nerve
. Sural nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve courses posterior to the biceps femoris tendon and wraps around the fibular neck. It is at high risk of injury during trauma to the posterolateral corner and during surgical approaches in this region.

Question 1028

Topic: Knee Sports

A patient undergoes PCL reconstruction utilizing an inlay technique for tibial fixation. This approach specifically minimizes the risk of which of the following complications compared to a transtibial tunnel technique?

. Popliteal artery injury during drilling
. Anterior knee pain
. Killer turn graft abrasion
. Saphenous nerve neuritis
. Loss of full extension

Correct Answer & Explanation

. Killer turn graft abrasion

Explanation

The tibial inlay technique secures the bone block directly to the posterior tibia, avoiding the acute angle (the killer turn) that the graft must negotiate when passed through a transtibial tunnel. This reduces the risk of graft abrasion and attenuation.

Question 1029

Topic: Knee Sports

A 24-year-old male sustains a knee injury resulting in a dimple sign on the medial joint line with valgus stress. MRI reveals an MCL tear with the distal end of the superficial MCL displaced superficial to the pes anserinus. What is this lesion called, and what is its clinical significance?

. Segond fracture; indicates an ACL tear
. Stener-like lesion; requires surgical repair due to lack of healing potential
. Pellegrini-Stieda lesion; typically resolves with conservative care
. ODonoghues triad; requires simultaneous ACL and MCL reconstruction
. Reverse Segond fracture; indicates a PCL tear

Correct Answer & Explanation

. Stener-like lesion; requires surgical repair due to lack of healing potential

Explanation

A Stener-like lesion of the knee occurs when the distal end of the superficial MCL flips superficial to the pes anserinus. This displacement prevents anatomic reduction and healing, necessitating operative repair or reconstruction.

Question 1030

Topic: Knee Sports

During a posterior cruciate ligament (PCL) reconstruction, the surgeon evaluates the native anatomy to properly place the graft bundles. Which of the following statements regarding the normal biomechanics of the PCL is correct?

. The anterolateral bundle is tight in flexion.
. The posteromedial bundle is tight in flexion.
. Both the anterolateral and posteromedial bundles are tight in extension.
. The anteromedial bundle is the primary restraint to posterior translation in extension.
. The posterolateral bundle is the largest and most critical component.

Correct Answer & Explanation

. The posteromedial bundle is tight in flexion.

Explanation

The PCL consists of two main bundles: the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle tightens in flexion, while the PM bundle tightens in extension.

Question 1031

Topic: Knee Sports

A 30-year-old male sustains a traumatic knee injury. On examination, a Dial test is performed. There is 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side, but symmetric external rotation at 90 degrees of flexion. This finding is most indicative of:

. Isolated PCL injury
. Isolated ACL injury
. Isolated Posterolateral Corner (PLC) injury
. Combined PCL and PLC injury
. Combined ACL and PLC injury

Correct Answer & Explanation

. Isolated Posterolateral Corner (PLC) injury

Explanation

The Dial test is utilized to differentiate isolated PLC injuries from combined PCL/PLC injuries. Asymmetry of >10 degrees of external rotation at 30 degrees of flexion, but not at 90 degrees, indicates an isolated PLC injury.

Question 1032

Topic: Knee Sports

A 19-year-old collegiate football player sustains an isolated Grade II PCL tear based on physical examination and MRI. What is the best initial management strategy?

. Immediate single-bundle PCL reconstruction
. Immediate double-bundle PCL reconstruction
. Hinged brace locked in extension followed by physical therapy emphasizing quadriceps strengthening
. Physical therapy emphasizing hamstring strengthening
. Cylinder cast immobilization for 6 weeks

Correct Answer & Explanation

. Hinged brace locked in extension followed by physical therapy emphasizing quadriceps strengthening

Explanation

Isolated Grade I and II PCL tears are generally treated non-operatively with excellent functional results. Initial management includes bracing in extension to prevent posterior tibial sag, followed by therapy emphasizing quadriceps strengthening to dynamically stabilize the tibia.

Question 1033

Topic: Knee Sports
A 35-year-old male is evaluated in the trauma bay following a high-velocity knee dislocation (KD-III). He has absent active foot eversion and dorsiflexion, as well as decreased sensation over the dorsum of the foot. Injury to which of the following ligamentous structures is most highly associated with this neurologic deficit?
. Anterior cruciate ligament
. Posterior cruciate ligament
. Medial collateral ligament
. Posterolateral corner
. Patellar tendon

Correct Answer & Explanation

. Posterolateral corner

Explanation

Common peroneal nerve injuries occur in up to 15-30% of knee dislocations and are most closely associated with posterolateral corner (PLC) disruptions. The nerve's anatomic course around the fibular neck makes it vulnerable to traction during severe varus or hyperextension injuries.

Question 1034

Topic: Knee Sports

A patient is evaluated 1 year after an ACL reconstruction. The Lachman test is negative, but a pivot shift test is prominently positive. Radiographs demonstrate that the femoral tunnel is positioned at the 12 o'clock position in the coronal plane. This tunnel placement primarily fails to control which biomechanical force?

. Anterior translation
. Posterior translation
. Varus opening
. Rotational stability
. Valgus opening

Correct Answer & Explanation

. Rotational stability

Explanation

A vertical femoral tunnel (e.g., 12 o'clock position) in ACL reconstruction successfully limits sagittal plane translation, resulting in a negative Lachman test. However, it fails to restore rotational stability, yielding a persistent pivot shift.

Question 1035

Topic: Knee Sports

During an anatomic reconstruction of the posterolateral corner (PLC) of the knee, accurate placement of the fibular collateral ligament (FCL) femoral tunnel is crucial. Relative to the lateral epicondyle, where is the native femoral footprint of the FCL located?

. 1.4 mm proximal and 3.1 mm posterior
. 3.1 mm distal and 1.4 mm anterior
. Directly over the lateral epicondyle apex
. 5.0 mm distal to the popliteus sulcus
. Anterior to the popliteus insertion

Correct Answer & Explanation

. 1.4 mm proximal and 3.1 mm posterior

Explanation

The anatomic femoral footprint of the fibular collateral ligament (FCL) is situated approximately 1.4 mm proximal and 3.1 mm posterior to the lateral epicondyle. Accurate placement ensures proper isometric tensioning of the graft during PLC reconstruction.

Question 1036

Topic: Knee Sports

A 22-year-old collegiate soccer player sustains a twisting injury to his knee. On examination, he has a normal Lachman test and normal posterior drawer test. The dial test shows 15 degrees of increased external rotation of the tibia at 30 degrees of knee flexion compared to the contralateral side, but symmetric external rotation at 90 degrees of flexion. Which structure is most likely injured?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Posterolateral corner
. Medial collateral ligament
. Popliteomeniscal fascicles

Correct Answer & Explanation

. Posterolateral corner

Explanation

An isolated posterolateral corner (PLC) injury presents with increased external rotation at 30 degrees of flexion but symmetric rotation at 90 degrees. If the posterior cruciate ligament (PCL) were also injured, the dial test would be positive at both 30 and 90 degrees.

Question 1037

Topic: Knee Sports
During reconstruction of the medial patellofemoral ligament (MPFL), where is the anatomic femoral attachment (Schöttle's point) located?
. Anterior to the medial epicondyle and distal to the adductor tubercle
. Posterior to the medial epicondyle and proximal to the adductor tubercle
. Just proximal to the medial epicondyle and distal to the adductor tubercle
. Directly on the adductor tubercle
. Posterior to the adductor tubercle

Correct Answer & Explanation

. Posterior to the medial epicondyle and proximal to the adductor tubercle

Explanation

The anatomic femoral origin of the MPFL (Schöttle's point) is located just proximal and posterior to the medial epicondyle, and just distal to the adductor tubercle.

Question 1038

Topic: Knee Sports

What is the most common location for an osteochondritis dissecans (OCD) lesion in the knee?

. Medial aspect of the medial femoral condyle
. Lateral aspect of the medial femoral condyle
. Lateral aspect of the lateral femoral condyle
. Medial aspect of the lateral femoral condyle
. Patellar articular surface

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for a knee OCD lesion is the lateral aspect of the medial femoral condyle (LAME: Lateral Aspect Medial Epicondyle/Condyle).

Question 1039

Topic: Knee Sports
A 30-year-old male sustains a knee dislocation resulting in an acute Grade III MCL tear and a complete ACL rupture. What is the generally recommended initial management for the MCL injury?
. Immediate primary repair of the MCL with simultaneous ACL reconstruction
. Hinged knee brace for 6 weeks, followed by delayed ACL reconstruction
. Immediate ACL reconstruction with non-operative MCL management
. Simultaneous allograft reconstruction of both the ACL and MCL acutely
. Primary repair of the ACL and MCL

Correct Answer & Explanation

. Hinged knee brace for 6 weeks, followed by delayed ACL reconstruction

Explanation

For combined ACL and Grade III MCL tears, current evidence supports non-operative management of the MCL with a hinged brace first. This allows the MCL to heal, followed by delayed ACL reconstruction to minimize the risk of arthrofibrosis.

Question 1040

Topic: Knee Sports

A 24-year-old passenger sustains a dashboard injury in a motor vehicle collision.

Examination reveals a positive posterior drawer test. At what angle of knee flexion is the posterior cruciate ligament (PCL) the primary restraint to posterior tibial translation?

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

Correct Answer & Explanation

. 90 degrees

Explanation

The PCL provides its maximum restraint to posterior tibial translation at 90 degrees of knee flexion. The posterior drawer test is therefore most accurate when performed at this angle.

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