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Knee Sports MCQs

Practice Set 58 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 1141

Topic: Knee Sports

When assessing a patient with a suspected multiligamentous knee injury, the 'dial test' is performed. Increased external rotation of the tibia of 15 degrees compared to the contralateral side at 30 degrees of flexion, but equal rotation at 90 degrees of flexion, indicates an isolated injury to which of the following structures?

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

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

The dial test assesses for posterolateral instability by measuring external rotation of the tibia. Increased rotation at 30 degrees of flexion only indicates an isolated posterolateral corner (PLC) injury. Increased rotation at both 30 and 90 degrees indicates combined injury to the PLC and the posterior cruciate ligament (PCL).

Question 1142

Topic: Knee Sports

During posterior cruciate ligament (PCL) reconstruction, the surgeon targets the primary function of the larger, stronger bundle of the PCL. Which bundle is this, and at what knee position is it most taut?

. Posteromedial bundle, taut in flexion
. Posteromedial bundle, taut in extension
. Anterolateral bundle, taut in flexion
. Anterolateral bundle, taut in extension
. Anteromedial bundle, taut in flexion

Correct Answer & Explanation

. Posteromedial bundle, taut in flexion

Explanation

The PCL consists of the larger anterolateral bundle (ALB) and the smaller posteromedial bundle (PMB). The ALB is most taut in flexion, whereas the PMB is taut in extension. Single-bundle PCL reconstructions primarily aim to restore the ALB.

Question 1143

Topic: Knee Sports

During an arthroscopic anterior cruciate ligament (ACL) reconstruction using an anteromedial portal technique for femoral tunnel drilling, what is the most significant surgical risk associated with this method compared to a traditional transtibial approach?

. Mismatch between the tunnel and the graft diameter
. Posterior wall blowout of the lateral femoral condyle
. Excessively vertical placement of the femoral tunnel
. Injury to the common peroneal nerve
. Increased incidence of cyclops lesion formation

Correct Answer & Explanation

. Mismatch between the tunnel and the graft diameter

Explanation

Drilling the femoral tunnel through the anteromedial portal allows for more anatomical placement of the ACL graft compared to the transtibial technique. However, it increases the risk of posterior wall blowout, creating a critically short femoral tunnel, and potentially damaging the medial femoral condyle articular cartilage during drilling.

Question 1144

Topic: Knee Sports

A 24-year-old athlete undergoes evaluation for a revision anterior cruciate ligament (ACL) reconstruction. Preoperative computed tomography (CT) reveals significant widening of the previous tibial and femoral tunnels, both measuring 17 mm in diameter. What is the most appropriate surgical strategy?

. Single-stage revision using a doubled bone-patellar tendon-bone graft
. Two-stage revision, starting with bone grafting of the enlarged tunnels
. Extra-articular anterolateral ligament reconstruction alone
. Single-stage revision utilizing only oversized interference screws
. Nonoperative management emphasizing hamstring strengthening

Correct Answer & Explanation

. Single-stage revision using a doubled bone-patellar tendon-bone graft

Explanation

In revision ACL reconstruction, severe tunnel widening (typically greater than 14-15 mm) or malpositioned tunnels that intersect with the planned anatomic tunnels mandate a two-stage approach. The first stage involves bone grafting the enlarged tunnels, followed by a second-stage ACL reconstruction 4 to 6 months later.

Question 1145

Topic: Knee Sports

A 55-year-old avid runner sustains an acute posterior root tear of the medial meniscus. If left untreated, this injury is biomechanically equivalent to which of the following?

. A total medial meniscectomy
. An isolated anterior cruciate ligament tear
. A medial collateral ligament avulsion
. Normal knee biomechanics

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A complete tear of the medial meniscus posterior root leads to a complete loss of meniscal hoop stresses. Biomechanically, this results in increased contact pressures and cartilage overload equivalent to a total medial meniscectomy, predisposing to rapid osteoarthritis.

Question 1146

Topic: Knee Sports

A 25-year-old rugby player receives a direct blow to the anteromedial aspect of the tibia. On examination, the dial test shows 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the uninjured side, but symmetric rotation at 90 degrees of flexion. Which structure is injured?

. Isolated posterior cruciate ligament
. Isolated posterolateral corner
. Combined posterior cruciate ligament and posterolateral corner
. Anterior cruciate ligament

Correct Answer & Explanation

. Isolated posterior cruciate ligament

Explanation

A positive dial test (increased external rotation of >10 degrees) at 30 degrees of flexion with a negative test at 90 degrees of flexion 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 1147

Topic: Knee Sports

Which of the following anatomical variants is considered an independent risk factor for sustaining a non-contact anterior cruciate ligament (ACL) tear?

. Increased intercondylar notch width
. Increased posterior tibial slope
. Decreased posterior tibial slope
. Increased patellar height (Patella alta)

Correct Answer & Explanation

. Increased intercondylar notch width

Explanation

An increased posterior tibial slope is a well-established bony risk factor for ACL tears. A steeper slope increases the anterior translational force on the tibia during axial loading, thereby placing greater strain on the ACL.

Question 1148

Topic: Knee Sports

A 14-year-old boy presents with insidious onset of anterior knee pain and catching. Radiographs demonstrate an osteochondritis dissecans (OCD) lesion. What is the most common anatomic location for this lesion?

. Medial aspect of the lateral femoral condyle
. Lateral aspect of the medial femoral condyle
. Central trochlear groove
. Inferior pole of the patella

Correct Answer & Explanation

. Medial aspect of the lateral femoral condyle

Explanation

Osteochondritis dissecans (OCD) of the knee most commonly affects the lateral aspect of the medial femoral condyle. This location accounts for approximately 70-80% of all knee OCD lesions.

Question 1149

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, placing the femoral tunnel too anteriorly (high in the notch) will result in which of the following biomechanical consequences?

. The graft will be tight in flexion and loose in extension
. The graft will be loose in flexion and tight in extension
. The graft will be tight in both flexion and extension
. The graft will be loose in both flexion and extension
. Impingement of the posterior cruciate ligament (PCL)

Correct Answer & Explanation

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

Explanation

A femoral tunnel placed anterior to the isometric point increases the distance between the tibial and femoral attachment sites as the knee flexes. This results in a graft that is excessively tight in flexion and loose in extension, limiting terminal knee flexion.

Question 1150

Topic: Knee Sports

A 25-year-old soccer player sustains an isolated Grade II posterior cruciate ligament (PCL) sprain. What is the most appropriate initial management?

. Early arthroscopic PCL reconstruction
. Protected weight-bearing with a dynamic brace and quadriceps strengthening
. Immobilization in 90 degrees of flexion
. Aggressive hamstring strengthening program
. High tibial osteotomy

Correct Answer & Explanation

. Early arthroscopic PCL reconstruction

Explanation

Isolated Grade I and II PCL injuries are treated nonoperatively with a brief period of immobilization in extension or use of a dynamic PCL brace to prevent posterior tibial sag. Rehabilitation focuses heavily on quadriceps strengthening to counteract posterior tibial translation.

Question 1151

Topic: Knee Sports

A 45-year-old recreational runner feels a 'pop' in the back of his knee while squatting. MRI shows a medial meniscus posterior root tear with meniscal extrusion. Biomechanically, this injury is most equivalent to which of the following?

. Total meniscectomy
. Anterior cruciate ligament rupture
. Posterior cruciate ligament rupture
. Peripheral longitudinal meniscal tear
. Partial meniscectomy

Correct Answer & Explanation

. Total meniscectomy

Explanation

A posterior root tear disrupts the hoop stresses of the meniscus, causing it to extrude under load. Biomechanically, this failure to convert axial loads into hoop stresses renders the knee functionally equivalent to one that has undergone a total meniscectomy.

Question 1152

Topic: Knee Sports

During reconstruction of the medial patellofemoral ligament (MPFL) for recurrent patellar instability, the anatomical femoral attachment site (Schöttle's point) is best identified radiographically in relation to which landmarks?

. 1 mm anterior to the posterior cortex extension and 2.5 mm distal to the posterior origin of the medial femoral condyle
. Anterior to Blumensaat's line and proximal to the posterior cortex line
. 1 mm anterior to the posterior cortex extension line and 2.5 mm proximal to the posterior border of Blumensaat's line
. Distal to the medial epicondyle and anterior to the collateral ligament origin
. Proximal to the adductor tubercle on the anterior femoral flare

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex extension and 2.5 mm distal to the posterior origin of the medial femoral condyle

Explanation

Schöttle's point marks the isometric femoral origin of the MPFL. On a strict lateral radiograph, it is located 1 mm anterior to the posterior cortical extension line, 2.5 mm proximal to the posterior border of Blumensaat's line, and proximal to the posterior origin of the medial femoral condyle.

Question 1153

Topic: Knee Sports

The most devastating neurovascular complication during tibial tunnel drilling for a posterior cruciate ligament (PCL) reconstruction is injury to which of the following structures?

. Popliteal artery
. Common peroneal nerve
. Tibial nerve
. Saphenous nerve
. Anterior tibial artery

Correct Answer & Explanation

. Popliteal artery

Explanation

The popliteal artery lies directly posterior to the PCL tibial attachment site on the posterior capsule. Over-penetration of the guide pin or drill during tibial tunnel creation is a well-known risk for catastrophic popliteal artery injury.

Question 1154

Topic: Knee Sports

A 14-year-old gymnast presents with vague anterior knee pain. Radiographs

reveal an osteochondritis dissecans (OCD) lesion. In the knee, what is the most common anatomic location for an OCD lesion?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central trochlea
. Inferior pole of the patella
. Lateral aspect of the lateral femoral condyle

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most frequent location for an osteochondritis dissecans (OCD) lesion in the knee is the lateral aspect of the medial femoral condyle. It accounts for roughly 70-80% of all knee OCD lesions.

Question 1155

Topic: Knee Sports

A 22-year-old female presents with recurrent instability 18 months after an anterior cruciate ligament (ACL) reconstruction. Physical examination reveals a positive Lachman and pivot-shift test. Radiographs and MRI suggest graft failure. What is the most common technical error leading to ACL graft failure?

. Tibial tunnel placed too posteriorly
. Tibial tunnel placed too anteriorly
. Femoral tunnel placed too anteriorly (vertically)
. Femoral tunnel placed too posteriorly (low on the wall)
. Inadequate notchplasty

Correct Answer & Explanation

. Tibial tunnel placed too posteriorly

Explanation

The most common technical error leading to recurrent instability and ACL graft failure is placing the femoral tunnel too anteriorly or vertically. This results in poor control of rotational instability and increased stress on the graft during knee flexion.

Question 1156

Topic: Knee Sports

A 55-year-old man feels a sudden 'pop' in the posterior aspect of his knee while squatting. MRI reveals a complete radial tear at the posterior root of the medial meniscus. If left untreated, this injury most closely mimics the biomechanical consequences of which of the following?

. Partial meniscectomy
. Total meniscectomy
. Anterior cruciate ligament deficiency
. Posterior cruciate ligament deficiency
. Medial collateral ligament insufficiency

Correct Answer & Explanation

. Partial meniscectomy

Explanation

A complete tear of the meniscal root eliminates the meniscus's ability to convert axial loads into hoop stresses. Biomechanically, this functions identically to a total meniscectomy, leading to rapid compartmental cartilage degradation.

Question 1157

Topic: Knee Sports

A 28-year-old skier presents with acute knee pain after a twisting injury. On physical examination, the dial test shows 15 degrees of increased external rotation on the injured side at 30 degrees of knee flexion, but symmetric external rotation at 90 degrees of flexion. This examination finding is most consistent with an isolated injury to which of the following structures?

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

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A positive dial test (increased external rotation of >10 degrees compared to the contralateral side) at 30 degrees of flexion, but not at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. If it is positive at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 1158

Topic: Knee Sports

A 16-year-old female presents with recurrent lateral patellar dislocations. Imaging demonstrates a normal TT-TG distance (12 mm) but an elevated Caton-Deschamps index of 1.5. Which of the following surgical procedures is most appropriate to address her specific pathoanatomy in addition to medial patellofemoral ligament (MPFL) reconstruction?

. Medialization of the tibial tubercle
. Lateral retinacular release
. Trochleoplasty
. Distalization of the tibial tubercle
. Anteriorization of the tibial tubercle (Maquet procedure)

Correct Answer & Explanation

. Medialization of the tibial tubercle

Explanation

A Caton-Deschamps index > 1.2 indicates patella alta, a major risk factor for patellar instability. When performing an MPFL reconstruction in a patient with significant patella alta, distalization of the tibial tubercle should be performed to engage the patella into the trochlea earlier in flexion.

Question 1159

Topic: Knee Sports

An 11-year-old male presents with vague anterior knee pain and catching. Radiographs reveal an osteochondritis dissecans (OCD) lesion. In the knee, what is the most common anatomic location for an OCD lesion?

. Lateral aspect of the lateral femoral condyle
. Medial aspect of the lateral femoral condyle
. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Central trochlear groove

Correct Answer & Explanation

. Lateral aspect of the lateral femoral condyle

Explanation

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

Question 1160

Topic: Knee Sports
A 30-year-old male sustains a grade III posterior cruciate ligament (PCL) tear in a dashboard injury. When planning an isolated single-bundle PCL reconstruction, which native bundle is typically reconstructed to restore maximal restraint to posterior tibial translation at 90 degrees of flexion?
. Anterolateral bundle
. Posteromedial bundle
. Anteromedial bundle
. Posterolateral bundle
. Ligament of Wrisberg

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The anterolateral bundle of the PCL is the larger, stronger bundle and is tightest in deeper knee flexion (90 degrees). Single-bundle PCL reconstructions primarily target the anterolateral bundle to restore the primary restraint against posterior tibial translation.

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