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Knee Sports MCQs

Practice Set 6 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 101

Topic: Knee Sports

A patient presents with knee pain and instability after a hyperextension injury. The Dial test demonstrates increased external rotation at 30 degrees of knee flexion but normal rotation at 90 degrees compared to the contralateral side. This finding indicates injury to which of the following structures?

. Posterior cruciate ligament (PCL) only
. Posterolateral corner (PLC) only
. Both PCL and PLC
. Anterior cruciate ligament (ACL)
. Medial collateral ligament (MCL)

Correct Answer & Explanation

. Posterolateral corner (PLC) only

Explanation

Increased external rotation at 30 degrees of flexion with normal rotation at 90 degrees indicates an isolated posterolateral corner injury. If external rotation is increased at both 30 and 90 degrees, it suggests a combined PLC and PCL injury.

Question 102

Topic: Knee Sports

A 50-year-old woman complains of posterior medial knee pain after a deep squat. MRI reveals a medial meniscus posterior root tear. Biomechanically, this injury is most equivalent to which of the following?

. Normal knee kinematics
. Anterior cruciate ligament tear
. Total medial meniscectomy
. Partial medial meniscectomy
. Posterior cruciate ligament tear

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior meniscal root tear disrupts the circumferential hoop stresses of the meniscus, causing it to extrude. Biomechanically, it leads to increased contact pressures comparable to a total meniscectomy.

Question 103

Topic: Knee Sports

In posterior cruciate ligament (PCL) reconstruction, the tibial inlay technique was developed primarily to avoid which of the following complications associated with the transtibial technique?

. Neurovascular injury
. Graft attenuation at the killer turn
. Posterior knee stiffness
. Deep joint infection
. Saphenous nerve neuritis

Correct Answer & Explanation

. Graft attenuation at the killer turn

Explanation

The tibial inlay technique avoids the sharp angle, known as the 'killer turn', at the posterior tibial aperture seen in transtibial PCL reconstruction. This sharp turn can lead to graft abrasion, attenuation, and eventual failure.

Question 104

Topic: Knee Sports

A 12-year-old boy presents with vaguely localized knee pain and intermittent catching. Radiographs reveal an osteochondritis dissecans (OCD) lesion. What is the most common anatomic location for an OCD lesion in the knee?

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

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for osteochondritis dissecans in the knee is the lateral aspect of the medial femoral condyle. It accounts for approximately 70-80% of all knee OCD lesions.

Question 105

Topic: Knee Sports

When performing a posterior cruciate ligament (PCL) reconstruction, the tibial inlay technique is theoretically chosen over the transtibial endoscopic technique to minimize which of the following graft-related complications?

. Popliteal artery injury
. Posterior capsular contracture
. The 'killer turn' graft abrasion
. Saphenous nerve injury
. Graft-tunnel length mismatch

Correct Answer & Explanation

. The 'killer turn' graft abrasion

Explanation

The tibial inlay technique places the bone block directly into the posterior tibia, avoiding the sharp angulation ('killer turn') seen in transtibial techniques. This theoretically reduces graft abrasion and subsequent attenuation.

Question 106

Topic: Knee Sports

A 30-year-old male sustains a traumatic knee dislocation. Clinical examination reveals an asymmetric foot drop and an inability to extend the great toe. Which of the following injury patterns is most likely present?

. Isolated ACL rupture
. Isolated PCL rupture
. Posteromedial corner injury
. Posterolateral corner injury
. Medial meniscus root tear

Correct Answer & Explanation

. Posterolateral corner injury

Explanation

Foot drop indicates common peroneal nerve palsy. This nerve travels around the fibular neck and is highly susceptible to traction injuries during a posterolateral corner (PLC) injury or knee dislocation.

Question 107

Topic: Knee Sports
When reconstructing the medial patellofemoral ligament (MPFL) for recurrent patellar instability, the anatomical femoral attachment site (Schöttle's point) is best described as being located:
. Anterior to the medial epicondyle and proximal to the adductor tubercle
. Posterior to the medial epicondyle and distal to the adductor tubercle
. Distal to the adductor tubercle and posterior to the medial epicondyle
. Between the adductor tubercle and the medial epicondyle
. Directly on the medial epicondyle

Correct Answer & Explanation

. Between the adductor tubercle and the medial epicondyle

Explanation

The anatomic femoral origin of the MPFL lies in a saddle-shaped depression between the adductor tubercle proximally and the medial epicondyle distally. Precise placement is critical to avoid non-isometric graft tensioning.

Question 108

Topic: Knee Sports

A patient presents with knee instability after a hyperextension injury. The dial test shows 15 degrees of increased external rotation compared to the contralateral side at 30 degrees of knee flexion, but symmetric rotation at 90 degrees. This finding indicates an isolated injury to the:

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

Correct Answer & Explanation

. Posterolateral corner

Explanation

Increased external rotation at 30 degrees of flexion that normalizes at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If rotation is increased at both 30 and 90 degrees, a combined PLC and PCL injury is present.

Question 109

Topic: Knee Sports

Which of the following surgical or patient factors provides the best prognosis for healing following a meniscal repair?

. Patient age over 40 years
. Tear location in the avascular white-white zone
. Concomitant anterior cruciate ligament (ACL) reconstruction
. Complex multi-planar tear pattern
. Surgical delay greater than 6 months from injury

Correct Answer & Explanation

. Concomitant anterior cruciate ligament (ACL) reconstruction

Explanation

Concomitant ACL reconstruction enhances meniscal healing. The intra-articular bleeding and release of bone marrow elements from drilling the ACL tunnels create a biologically favorable environment for the meniscus to heal.

Question 110

Topic: Knee Sports

A 24-year-old football player sustains a knee injury. The dial test shows 15 degrees of increased external rotation compared to the contralateral knee at 30 degrees of flexion, but equal external rotation at 90 degrees. What is the most likely diagnosis?

. Isolated anterior cruciate ligament tear
. Isolated posterior cruciate ligament tear
. Isolated posterolateral corner injury
. Combined PCL and posterolateral corner injury
. Medial collateral ligament tear

Correct Answer & Explanation

. Isolated posterolateral corner injury

Explanation

Asymmetrical external rotation at 30 degrees but symmetrical at 90 degrees indicates an isolated posterolateral corner (PLC) injury. A combined PCL and PLC injury would show increased external rotation at both 30 and 90 degrees.

Question 111

Topic: Knee Sports

Which of the following is the most consistent anatomic landmark for femoral tunnel placement during a Medial Patellofemoral Ligament (MPFL) reconstruction (Schottle's point)?

. Anterior to the posterior femoral cortical line, proximal to Blumensaat's line
. Posterior to the posterior femoral cortical line, distal to Blumensaat's line
. At the medial epicondyle
. At the adductor tubercle
. Distal to the medial joint line

Correct Answer & Explanation

. Anterior to the posterior femoral cortical line, proximal to Blumensaat's line

Explanation

Schottle's point is the radiographic landmark for the femoral origin of the MPFL. It is located 1 mm anterior to the posterior femoral cortical line and proximal to Blumensaat's line.

Question 112

Topic: Knee Sports

Which of the following physical examination findings is most indicative of a combined posterior cruciate ligament (PCL) and posterolateral corner (PLC) injury?

. Positive Dial test at 30 degrees but negative at 90 degrees
. Positive Dial test at both 30 and 90 degrees
. Increased anterior translation of the tibia in internal rotation
. A positive pivot shift test
. A positive Lachman test with a soft endpoint

Correct Answer & Explanation

. Positive Dial test at both 30 and 90 degrees

Explanation

A positive Dial test (increased external rotation >10 degrees compared to the contralateral side) at 30 degrees indicates an isolated PLC injury. Positivity at both 30 and 90 degrees indicates combined PLC and PCL injuries.

Question 113

Topic: Knee Sports

During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, non-anatomic femoral tunnel placement that is too proximal will most likely result in which of the following?

. Graft laxity in full extension
. Graft tensioning predominantly in early flexion only
. Increased graft tension and restriction in deep knee flexion
. Development of patella baja
. Lateral patellar tilt in extension

Correct Answer & Explanation

. Increased graft tension and restriction in deep knee flexion

Explanation

Placing the femoral tunnel too proximal during MPFL reconstruction causes the graft to tighten excessively as the knee moves into deep flexion, leading to restricted motion and elevated medial patellofemoral cartilage pressures.

Question 114

Topic: Knee Sports

What is the most classic and frequent anatomical location for osteochondritis dissecans (OCD) lesions in the knee?

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

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

Approximately 70-80% of knee osteochondritis dissecans (OCD) lesions occur on the lateral aspect of the medial femoral condyle.

Question 115

Topic: Knee Sports

An 18-year-old football player sustains a high-energy valgus and twisting knee injury. MRI confirms rupture of the ACL, MCL, and a medial meniscus tear. What is the classic eponym for this injury pattern?

. Terrible triad of the knee
. Segond's triad
. O'Donoghue's unhappy triad
. Dial's pattern
. Stener's triad

Correct Answer & Explanation

. O'Donoghue's unhappy triad

Explanation

O'Donoghue's unhappy triad traditionally consists of injury to the ACL, MCL, and the medial meniscus. Note that modern literature shows lateral meniscus tears are actually more common in acute ACL injuries.

Question 116

Topic: Knee Sports
When comparing anterior cruciate ligament (ACL) reconstruction using autogenous hamstrings and ACL reconstruction using autogenous patellar tendon, the most consistent difference is:
. The patellar tendon group has more patellofemoral pain.
. The hamstring group has more loss of motion.
. The patellar tendon group is more likely to return to activity.
. The hamstring group has a higher incidence of graft failures.
. The hamstring group has better results with arthrometer testing.

Correct Answer & Explanation

. The patellar tendon group has more patellofemoral pain.

Explanation

Shaieb and associates recently reported a prospective randomized study comparing autogenous hamstring ACL reconstruction to autogenous patellar tendon ACL reconstruction. The only significant differences that were elicited between the groups at a minimum of 2-years' follow-up were the incidences of patellofemoral pain and loss of motion, both in favor of the hamstring group.

Question 117

Topic: Knee Sports

During reconstruction of the posterior cruciate ligament (PCL), understanding the bundle anatomy is critical for restoring normal knee kinematics. Which of the following statements regarding the anterolateral (AL) and posteromedial (PM) bundles is correct?

. The AL bundle is tight in extension and the PM bundle is tight in flexion
. The AL bundle is tight in flexion and the PM bundle is tight in extension
. Both bundles are maximally tight in deep flexion
. Both bundles are maximally tight in full extension

Correct Answer & Explanation

. The AL bundle is tight in flexion and the PM bundle is tight in extension

Explanation

The PCL consists of the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. Biomechanically, the AL bundle is tight in flexion, while the PM bundle is tight in extension.

Question 118

Topic: Knee Sports

A 24-year-old football player sustains a direct blow to the anteromedial tibia with the knee in extension. Physical examination reveals a positive dial test with 15 degrees of asymmetric external rotation at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees compared to the contralateral knee. What is the most likely injured structure?

. Isolated posterior cruciate ligament
. Isolated posterolateral corner
. Combined PCL and posterolateral corner
. Isolated anterior cruciate ligament

Correct Answer & Explanation

. Isolated posterolateral corner

Explanation

An asymmetric increase in external rotation of greater than 10 degrees at 30 degrees of flexion, but not at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. If asymmetry is present at both 30 and 90 degrees, it suggests a combined PLC and PCL injury.

Question 119

Topic: Knee Sports
In a patient with recurrent lateral patellar dislocations undergoing medial patellofemoral ligament (MPFL) reconstruction, the femoral tunnel must be placed anatomically to prevent abnormal patellofemoral contact pressures. Where is the anatomical femoral attachment of the MPFL located?
. Anterior to the adductor tubercle and proximal to the medial epicondyle
. Posterior to the adductor tubercle and distal to the medial epicondyle
. Between the adductor tubercle proximally and the medial epicondyle distally
. Directly on the medial epicondyle

Correct Answer & Explanation

. Between the adductor tubercle proximally and the medial epicondyle distally

Explanation

The anatomic femoral origin of the MPFL, clinically referred to as Schöttle's point, is located in the saddle region between the adductor tubercle proximally and the medial epicondyle distally.

Question 120

Topic: Knee Sports

A 45-year-old patient experiences a sudden 'pop' in the posterior knee while squatting. MRI reveals a posterior medial meniscus root tear. Biomechanically, this injury is equivalent to which of the following?

. A partial meniscectomy
. A total meniscectomy
. An anterior horn tear
. A radial tear of the lateral meniscus

Correct Answer & Explanation

. A total meniscectomy

Explanation

A meniscal root tear completely disrupts the hoop stresses of the meniscus, rendering it biomechanically nonfunctional. Contact pressures and joint kinematics become equivalent to a total meniscectomy, leading to rapid cartilage degeneration.

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