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Knee Sports MCQs

Practice Set 54 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 1061

Topic: Knee Sports
A 22-year-old football player sustains a multiligamentous knee injury. Physical examination demonstrates >10 degrees of increased external tibial rotation compared to the contralateral knee at both 30 degrees and 90 degrees of knee flexion. This finding indicates injury to the:
. Posterolateral corner (PLC) only
. Posterior cruciate ligament (PCL) only
. Posterolateral corner (PLC) and Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL) and PLC
. Medial collateral ligament (MCL) and PCL

Correct Answer & Explanation

. Posterolateral corner (PLC) and Posterior cruciate ligament (PCL)

Explanation

The dial test evaluates external tibial rotation. Asymmetry of >10 degrees at 30 degrees only indicates an isolated PLC injury, while asymmetry at both 30 and 90 degrees indicates a combined PLC and PCL injury.

Question 1062

Topic: Knee Sports

A 28-year-old male is diagnosed with an isolated Grade II posterior cruciate ligament (PCL) tear following a dashboard injury. He is prescribed a physical therapy program. To optimize dynamic stabilization of the knee, the rehabilitation protocol should heavily emphasize strengthening of which muscle group?

. Quadriceps
. Hamstrings
. Gastrocnemius
. Popliteus
. Iliotibial band

Correct Answer & Explanation

. Quadriceps

Explanation

The quadriceps act as dynamic antagonists to the PCL by providing an anterior translational force on the tibia. Strengthening the quadriceps is the cornerstone of nonoperative rehabilitation for PCL injuries to prevent posterior tibial sag.

Question 1063

Topic: Knee Sports
A 15-year-old female requires medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. Anatomic femoral graft placement is critical to avoid anisometry. Radiographically, the anatomic femoral origin of the MPFL (Schöttle's point) is located:
. Proximal to the adductor tubercle and posterior to the posterior femoral cortical line
. Anterior to the posterior femoral cortical line and distal to the medial epicondyle
. Between the medial epicondyle and the adductor tubercle, anterior to the posterior femoral cortical line
. Distal to the medial epicondyle and posterior to the Blumensaat line
. Proximal to the medial epicondyle and anterior to the Blumensaat line

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle, anterior to the posterior femoral cortical line

Explanation

Schöttle's point, the radiographic anatomic origin of the MPFL, is located 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 medial epicondyle (between the medial epicondyle and adductor tubercle).

Question 1064

Topic: Knee Sports

During an ACL reconstruction, the surgeon evaluates the two functional bundles of the anterior cruciate ligament. Which of the following accurately describes the anatomy and biomechanics of the ACL bundles?

. The anteromedial bundle is tight in extension and controls anterior translation.
. The posterolateral bundle controls rotatory stability and is tight in extension.
. The anteromedial bundle is the primary restraint to pivot shift in full extension.
. The posterolateral bundle is tight in flexion and loose in extension.
. The anteromedial and posterolateral bundles are named for their tibial insertions but cross in the intercondylar notch in extension.

Correct Answer & Explanation

. The posterolateral bundle controls rotatory stability and is tight in extension.

Explanation

The ACL has two main bundles named for their tibial footprint: anteromedial (AM) and posterolateral (PL). The PL bundle is tight in extension, loose in flexion, and is the primary restraint to rotatory loads (tested via the pivot shift).

Question 1065

Topic: Knee Sports

A 12-year-old boy presents with vague, activity-related anterior knee pain. Radiographs reveal a juvenile osteochondritis dissecans (JOCD) lesion. What is the most common anatomic location for this lesion?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central weight-bearing dome of the medial femoral condyle
. Inferior pole of the patella
. Lateral aspect of the lateral tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for osteochondritis dissecans of the knee is the lateral aspect of the medial femoral condyle, accounting for approximately 70-80% of lesions. In a patient with open physes, initial treatment is usually nonoperative.

Question 1066

Topic: Knee Sports

A 50-year-old patient sustains a medial meniscus posterior root tear. Biomechanical studies have demonstrated that this injury alters knee contact pressures most similarly to which of the following conditions?

. Total meniscectomy
. Partial meniscectomy
. Anterior cruciate ligament tear
. Medial collateral ligament tear
. Chondromalacia patellae

Correct Answer & Explanation

. Total meniscectomy

Explanation

A posterior root tear of the medial meniscus disrupts hoop stresses, leading to radial extrusion of the meniscus. Biomechanically, this results in peak contact pressures and contact areas equivalent to a total meniscectomy.

Question 1067

Topic: Knee Sports

A 16-year-old female sustains an acute lateral patellar dislocation. She is scheduled for medial patellofemoral ligament (MPFL) reconstruction. The normal anatomic femoral origin of the MPFL is located:

. Anterior to the medial epicondyle
. Between the medial epicondyle and adductor tubercle
. Proximal to the adductor tubercle
. Distal to the superficial medial collateral ligament attachment
. On the posterior aspect of the medial femoral condyle

Correct Answer & Explanation

. Between the medial epicondyle and adductor tubercle

Explanation

The femoral attachment of the MPFL is located in a saddle-like depression between the adductor tubercle (superiorly) and the medial epicondyle (inferiorly). Properly placing the femoral tunnel here is critical for restoring normal patellofemoral kinematics.

Question 1068

Topic: Knee Sports

A 30-year-old male sustains a dashboard injury to his knee. Examination reveals a posterior sag sign and a posterior drawer test showing 8 mm of posterior tibial translation with a firm endpoint. There is no other ligamentous laxity.

What is the recommended initial management?

. Immediate surgical reconstruction of the PCL
. Protected weight-bearing and focused quadriceps rehabilitation
. Hamstring strengthening program
. Primary repair of the PCL
. Application of a cylinder cast in 30 degrees of flexion for 6 weeks

Correct Answer & Explanation

. Protected weight-bearing and focused quadriceps rehabilitation

Explanation

An isolated Grade II PCL tear (5-10 mm of posterior translation) is typically treated non-operatively. Rehabilitation focuses on resolving swelling, regaining motion, and strengthening the quadriceps to counteract posterior tibial translation.

Question 1069

Topic: Knee Sports

A 26-year-old soccer player undergoes an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Six months postoperatively, she reports persistent stiffness and restricted knee flexion. What is the most common cause of technical failure leading to loss of flexion in ACL reconstruction?

. Inadequate graft tensioning
. Femoral tunnel placed too anteriorly
. Tibial tunnel placed too posteriorly
. Failure of fixation hardware
. Premature return to sport

Correct Answer & Explanation

. Femoral tunnel placed too anteriorly

Explanation

The most common cause of technical failure in ACL reconstruction is non-anatomic tunnel placement. A femoral tunnel placed too anteriorly results in increased graft tension during flexion, leading to restricted knee motion or eventual graft stretching and rupture.

Question 1070

Topic: Knee Sports

A 50-year-old male presents with acute onset of medial joint line pain in his knee after a deep squat. MRI reveals a medial meniscus posterior root tear with 4 mm of meniscal extrusion. Biomechanically, this injury is most similar to which of the following conditions?

. A stable longitudinal tear of the medial meniscus
. A radial tear of the anterior horn of the medial meniscus
. Total medial meniscectomy
. Partial anterior meniscectomy
. Isolated anterior cruciate ligament deficiency

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus completely disrupts circumferential hoop stresses, causing meniscal extrusion under axial load. Biomechanical studies demonstrate that this loss of hoop tension results in joint contact pressures and kinematics equivalent to a total medial meniscectomy.

Question 1071

Topic: Knee Sports

The anterior cruciate ligament (ACL) receives its primary blood supply from which of the following vascular structures?

. Lateral inferior genicular artery
. Medial inferior genicular artery
. Middle genicular artery
. Descending genicular artery
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Middle genicular artery

Explanation

The middle genicular artery, a branch of the popliteal artery, pierces the posterior capsule to provide the primary blood supply to the cruciate ligaments via the synovial fold.

Question 1072

Topic: Knee Sports

The primary vascular supply to the anterior cruciate ligament (ACL) is derived from which of the following arteries?

. Lateral inferior genicular artery
. Medial inferior genicular artery
. Middle genicular artery
. Descending genicular artery
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Middle genicular artery

Explanation

The middle genicular artery originates from the popliteal artery, pierces the posterior capsule, and provides the primary vascular supply to the central pivot structures of the knee, including the ACL and PCL.

Question 1073

Topic: Knee Sports

A 45-year-old construction worker falls 15 feet, sustaining a T12 burst fracture. He remains neurologically intact. Which of the following radiographic findings is the most reliable indicator of a concurrent posterior ligamentous complex (PLC) injury?

. Splaying of the spinous processes on the AP radiograph
. Anterior wedge compression of 30%
. Retropulsion of bone into the spinal canal
. Loss of vertebral body height
. Bilateral pedicle fractures

Correct Answer & Explanation

. Splaying of the spinous processes on the AP radiograph

Explanation

Splaying or widening of the interspinous distance on an AP or lateral radiograph indicates disruption of the posterior ligamentous complex (PLC). This finding upgrades the injury classification, often making it highly unstable and an indication for surgical stabilization.

Question 1074

Topic: Knee Sports

Following a marrow-stimulating procedure (e.g., microfracture) for a full-thickness chondral defect, the resulting repair tissue is predominantly composed of:

. Type I collagen
. Type II collagen
. Type IX collagen
. Type X collagen
. Type XI collagen

Correct Answer & Explanation

. Type I collagen

Explanation

Microfracture stimulates a marrow-based healing response that typically fills the defect with fibrocartilage rather than native hyaline cartilage. Fibrocartilage is structurally inferior and is predominantly composed of Type I collagen.

Question 1075

Topic: Knee Sports

Following a microfracture procedure for a focal full-thickness articular cartilage defect in the knee, what type of tissue predominantly fills the defect?

. Hyaline cartilage rich in Type II collagen
. Fibrocartilage rich in Type I collagen
. Elastic cartilage rich in elastin
. Calcified cartilage rich in Type X collagen
. Lamellar bone

Correct Answer & Explanation

. Hyaline cartilage rich in Type II collagen

Explanation

Microfracture penetrates the subchondral bone, releasing marrow elements and mesenchymal stem cells. These cells differentiate to form a repair tissue predominantly composed of fibrocartilage (rich in Type I collagen) rather than native hyaline cartilage.

Question 1076

Topic: Knee Sports

During harvest of the semitendinosus and gracilis tendons for ACL reconstruction, the saphenous nerve is at risk. The saphenous nerve exits the adductor (Hunter's) canal by penetrating the vastoadductor membrane. Which artery accompanies it as it exits?

. Superficial femoral artery
. Deep femoral artery
. Descending genicular artery
. Medial superior genicular artery
. Popliteal artery

Correct Answer & Explanation

. Superficial femoral artery

Explanation

The saphenous nerve travels in the adductor canal with the superficial femoral artery. However, before the artery passes through the adductor hiatus to become the popliteal artery, the saphenous nerve exits the canal anteriorly, accompanied by the descending genicular artery.

Question 1077

Topic: Knee Sports

During a posterolateral corner reconstruction of the knee, the surgeon isolates the popliteus tendon. Where is the femoral attachment of the popliteus tendon located relative to the fibular collateral ligament (FCL)?

. Proximal and posterior
. Distal and posterior
. Proximal and anterior
. Distal and anterior
. Directly deep to the FCL origin

Correct Answer & Explanation

. Proximal and posterior

Explanation

The popliteus tendon inserts on the lateral femoral condyle distal and anterior to the origin of the fibular collateral ligament (LCL).

Question 1078

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two main bundles. Which of the following best describes the function of the anteromedial (AM) bundle?

. Tight in extension, controls rotational stability
. Tight in flexion, controls anterior translation
. Tight in extension, controls anterior translation
. Tight in flexion, controls rotational stability
. Slack in flexion, tight in extension

Correct Answer & Explanation

. Tight in extension, controls rotational stability

Explanation

The anteromedial (AM) bundle of the ACL is primarily tight in flexion and controls anterior tibial translation, whereas the posterolateral (PL) bundle is tight in extension and controls rotatory stability.

Question 1079

Topic: Knee Sports

An MRI of the knee demonstrates an avulsion of the popliteus tendon from its femoral insertion. Where is the normal anatomic footprint of the popliteus tendon on the femur relative to the lateral collateral ligament (LCL) origin?

. Anterior and inferior
. Posterior and inferior
. Anterior and superior
. Posterior and superior
. Directly medial

Correct Answer & Explanation

. Anterior and inferior

Explanation

The popliteus tendon inserts on the lateral femoral condyle anterior and inferior to the origin of the lateral collateral ligament (LCL). This spatial relationship is critical during posterolateral corner reconstructions.

Question 1080

Topic: Knee Sports

An orthopedic surgeon is performing an anatomical ACL reconstruction. The anteromedial (AM) bundle of the ACL is tightest in which knee position, and where does it insert on the tibia relative to the posterolateral (PL) bundle?

. Flexion; inserts anteromedial to the PL bundle
. Extension; inserts anteromedial to the PL bundle
. Flexion; inserts posterolateral to the PL bundle
. Extension; inserts posterolateral to the PL bundle
. Extension; inserts directly posterior to the PL bundle

Correct Answer & Explanation

. Flexion; inserts anteromedial to the PL bundle

Explanation

The anteromedial (AM) bundle of the ACL is tightest in flexion and controls anterior translation. It inserts anteromedial to the posterolateral (PL) bundle on the tibial footprint.

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