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Knee Sports MCQs

Practice Set 64 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 1261

Topic: Knee Sports

A 26-year-old skier presents with a significantly swollen knee after a twisting fall. An anteroposterior radiograph reveals a small elliptical bone avulsion fragment from the proximal lateral tibia, known as a Segond fracture. What is the most commonly associated intra-articular injury?

. Posterior cruciate ligament tear
. Anterior cruciate ligament tear
. Medial collateral ligament avulsion
. Lateral collateral ligament midsubstance tear
. Popliteofibular ligament disruption

Correct Answer & Explanation

. Posterior cruciate ligament tear

Explanation

A Segond fracture is a cortical avulsion of the anterolateral ligament (ALL) and lateral capsule from the proximal lateral tibia. It is considered highly pathognomonic for an underlying anterior cruciate ligament (ACL) tear, occurring in up to 75 to 100 percent of these cases.

Question 1262

Topic: Knee Sports

A 26-year-old male presents with a posterior sag sign after a dashboard injury. Which of the following physical examination findings most suggests a combined Posterior Cruciate Ligament (PCL) and Posterolateral Corner (PLC) injury?

. Increased external rotation of the tibia at both 30 and 90 degrees of knee flexion
. Increased external rotation of the tibia at 30 degrees but symmetric at 90 degrees
. Positive pivot shift test
. Medial joint line tenderness
. Positive anterior drawer test

Correct Answer & Explanation

. Increased external rotation of the tibia at both 30 and 90 degrees of knee flexion

Explanation

An isolated PLC injury typically presents with increased external rotation only at 30 degrees of knee flexion. If external tibial rotation is increased at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 1263

Topic: Knee Sports

A 16-year-old girl dislocates her patella laterally. The primary soft-tissue restraint to lateral patellar translation is ruptured. Where is the femoral footprint of this structure located?

. Anterior and distal to the medial epicondyle
. Between the adductor tubercle and the medial epicondyle
. At the medial condylar notch
. Just proximal to the medial joint line
. Directly on the adductor magnus tendon insertion

Correct Answer & Explanation

. Anterior and distal to the medial epicondyle

Explanation

The medial patellofemoral ligament (MPFL) is the primary restraint to lateral patellar dislocation. Its femoral attachment (Schöttle's point) is located in the saddle between the medial epicondyle and the adductor tubercle.

Question 1264

Topic: Knee Sports

A 14-year-old boy presents with mechanical catching in his knee. Radiographs confirm Osteochondritis Dissecans (OCD). What is the most common anatomic location for an OCD lesion in the knee?

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

Correct Answer & Explanation

. Lateral aspect of the medial 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 (often remembered by the mnemonic LAME).

Question 1265

Topic: Knee Sports

During ACL reconstruction in a patient with a high-grade pivot shift, an anterolateral ligament (ALL) reconstruction is considered. The ALL primarily acts to control which specific knee motion?

. Internal tibial rotation
. External tibial rotation
. Varus angulation
. Valgus angulation
. Posterior tibial translation

Correct Answer & Explanation

. Internal tibial rotation

Explanation

The anterolateral ligament (ALL) functions as an important secondary stabilizer to the ACL. It specifically resists internal tibial rotation and helps eliminate the pivot shift phenomenon.

Question 1266

Topic: Knee Sports

A 32-year-old male sustains a dashboard injury to his knee. On examination, the tibia rests posteriorly relative to the femoral condyles. A posterior drawer test reveals significantly increased posterior translation of the tibia at 90 degrees of flexion. Which of the following bundles of the affected ligament is the primary restraint to posterior tibial translation at 90 degrees of knee flexion?

. Anterolateral bundle of the PCL
. Posteromedial bundle of the PCL
. Anteromedial bundle of the ACL
. Posterolateral bundle of the ACL
. Popliteofibular ligament

Correct Answer & Explanation

. Anterolateral bundle of the PCL

Explanation

The posterior cruciate ligament (PCL) consists of two main bundles. The anterolateral bundle is the primary restraint to posterior tibial translation at 90 degrees of knee flexion, whereas the posteromedial bundle is tightest in full extension.

Question 1267

Topic: Knee Sports

A patient presents with a hyperextension-varus injury to the knee, resulting in a small anteromedial tibial plateau fracture and an avulsion fracture of the fibular head. Which concomitant ligamentous injury must be highly suspected?

. Isolated anterior cruciate ligament (ACL) rupture
. Posterolateral corner (PLC) injury
. Isolated medial collateral ligament (MCL) rupture
. Patellar tendon rupture
. Medial patellofemoral ligament (MPFL) rupture

Correct Answer & Explanation

. Isolated anterior cruciate ligament (ACL) rupture

Explanation

A hyperextension-varus force characteristically results in a posterolateral corner (PLC) injury, often manifesting radiographically as a fibular head avulsion (arcuate sign). The anteromedial tibial plateau fracture occurs from impaction during the varus stress.

Question 1268

Topic: Knee Sports

A 30-year-old man is brought to the trauma bay after a high-velocity knee injury. Examination reveals a severe posterolateral dislocation with a prominent transverse groove or 'dimple sign' at the medial joint line. Attempted closed reduction is unsuccessful. What is the most likely anatomic reason for the irreducibility?

. Interposition of the medial collateral ligament
. Incarceration of the medial meniscus
. Avulsion and interposition of the anterior cruciate ligament
. The medial femoral condyle buttonholing through the medial capsule
. Interposition of the patellar tendon

Correct Answer & Explanation

. Interposition of the medial collateral ligament

Explanation

A 'dimple sign' on the medial aspect of the knee indicates a posterolateral knee dislocation where the medial femoral condyle has buttonholed through the medial capsule and medial collateral ligament. This is an irreducible injury that requires emergent open reduction.

Question 1269

Topic: Knee Sports

A 45-year-old man sustains a Schatzker II tibial plateau fracture.

Which associated intra-articular injury is most commonly encountered during surgical fixation?

. ACL tear
. PCL tear
. Lateral meniscus tear
. Medial meniscus tear
. MCL tear

Correct Answer & Explanation

. ACL tear

Explanation

The lateral meniscus is torn in approximately 50% of split-depressed (Schatzker II) lateral tibial plateau fractures. It must be addressed during articular elevation to ensure joint congruity.

Question 1270

Topic: Knee Sports

In the evaluation of a thoracolumbar fracture, identifying posterior ligamentous complex (PLC) injury is critical for surgical decision making. Which of the following MRI sequences and findings is most sensitive for indicating a disrupted PLC?

. T1-weighted sagittal showing loss of disc height
. T2-weighted or STIR sagittal showing hyperintensity in the interspinous region
. T1-weighted axial showing an epidural hematoma
. T2-weighted axial showing hypointensity in the facet joints
. Gradient-echo imaging showing hemosiderin deposition

Correct Answer & Explanation

. T1-weighted sagittal showing loss of disc height

Explanation

Fat-suppressed T2-weighted or STIR MRI sequences are highly sensitive for detecting edema. Hyperintensity in the interspinous region strongly correlates with disruption of the posterior ligamentous complex (PLC).

Question 1271

Topic: Knee Sports

During surgical reconstruction of the posterolateral corner of the knee, the fibular collateral ligament (FCL) and popliteus tendon (PT) are identified. What is the anatomic relationship of their femoral attachments?

. The FCL attaches proximal and posterior to the PT
. The FCL attaches distal and anterior to the PT
. The FCL attaches proximal and anterior to the PT
. The FCL attaches distal and posterior to the PT
. They share a conjoined attachment on the lateral epicondyle

Correct Answer & Explanation

. The FCL attaches proximal and posterior to the PT

Explanation

On the lateral femoral condyle, the attachment of the fibular collateral ligament (FCL) is consistently located proximal and posterior to the attachment of the popliteus tendon.

Question 1272

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. Which of the following best describes the biomechanical function of the posterolateral (PL) bundle?

. It is tightest in full extension and provides primary restraint to internal rotation.
. It is tightest in 90 degrees of flexion and provides primary restraint to anterior translation.
. It is tightest in full extension and provides primary restraint to posterior translation.
. It is tightest in 90 degrees of flexion and provides primary restraint to valgus stress.
. It is tightest in full extension and provides primary restraint to external rotation.

Correct Answer & Explanation

. It is tightest in full extension and provides primary restraint to internal rotation.

Explanation

The posterolateral (PL) bundle of the ACL is tightest in extension and primarily controls rotatory stability (internal rotation). The anteromedial (AM) bundle is tightest in flexion and primarily restricts anterior tibial translation.

Question 1273

Topic: Knee Sports

The primary restraint to valgus stress at the knee when tested at 30 degrees of flexion is the:

. Deep medial collateral ligament
. Superficial medial collateral ligament
. Posterior oblique ligament
. Anterior cruciate ligament
. Medial meniscus

Correct Answer & Explanation

. Deep medial collateral ligament

Explanation

The superficial medial collateral ligament (sMCL) provides the vast majority of restraint to valgus forces at the knee. This is best isolated clinically at 30 degrees of flexion.

Question 1274

Topic: Knee Sports

In an anterior cruciate ligament (ACL)-deficient knee, which of the following structures acts as the primary secondary restraint to anterior tibial translation?

. Posterior horn of the medial meniscus
. Iliotibial band
. Posterior horn of the lateral meniscus
. Medial collateral ligament
. Popliteus tendon

Correct Answer & Explanation

. Posterior horn of the medial meniscus

Explanation

The posterior horn of the medial meniscus acts as the primary secondary wedge against anterior tibial translation in an ACL-deficient knee. This accounts for the high rate of medial meniscus tears seen in chronic ACL deficiency.

Question 1275

Topic: Knee Sports

During a lateral patellar dislocation, the medial patellofemoral ligament (MPFL) is typically ruptured. Biomechanically, the MPFL provides its greatest contribution to restraining lateral patellar translation at which knee flexion angle?

. 0 to 30 degrees
. 45 to 60 degrees
. 60 to 90 degrees
. 90 to 120 degrees
. Greater than 120 degrees

Correct Answer & Explanation

. 0 to 30 degrees

Explanation

The MPFL is the primary soft-tissue restraint to lateral patellar translation in early knee flexion (0 to 30 degrees). Beyond 30 degrees, the patella fully engages in the trochlear groove, and bony geometry dictates stability.

Question 1276

Topic: Knee Sports

A 26-year-old football player sustains a direct blow to the proximal tibia with the knee flexed, resulting in a posterior cruciate ligament (PCL) tear. The PCL consists of two functional bundles. Which of the following best describes their tension patterns during knee range of motion?

. The anterolateral bundle is taut in flexion, and the posteromedial bundle is taut in extension
. The anterolateral bundle is taut in extension, and the posteromedial bundle is taut in flexion
. Both bundles are taut in extension and lax in flexion
. Both bundles are taut in flexion and lax in extension
. Tension remains isometric in both bundles throughout the full arc of motion

Correct Answer & Explanation

. The anterolateral bundle is taut in flexion, and the posteromedial bundle is taut in extension

Explanation

The PCL's larger anterolateral (AL) bundle is primarily taut in flexion, preventing posterior translation of the tibia. The smaller posteromedial (PM) bundle becomes taut in extension.

Question 1277

Topic: Knee Sports

During an arthroscopic anterior cruciate ligament (ACL) reconstruction, careful attention is paid to the vascular supply of the notch. Which artery provides the primary blood supply to the native ACL?

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

Correct Answer & Explanation

. Medial inferior genicular artery

Explanation

The middle genicular artery pierces the posterior capsule to provide the primary blood supply to the cruciate ligaments. It arborizes within the synovial fold enveloping the ACL and PCL.

Question 1278

Topic: Knee Sports

During a pivot shift test for an ACL deficient knee, the tibia subluxates anteriorly in extension and reduces in flexion. Which specific anatomic bundle of the ACL is primarily responsible for resisting rotatory loads and anterior translation near full knee extension?

. Anteromedial bundle
. Posteromedial bundle
. Anterolateral bundle
. Posterolateral bundle
. Meniscofemoral ligament of Wrisberg

Correct Answer & Explanation

. Anteromedial bundle

Explanation

The anterior cruciate ligament has two distinct bundles. The posterolateral (PL) bundle is tight in extension and primarily controls rotatory stability, whereas the anteromedial (AM) bundle is tight in flexion and controls anterior translation.

Question 1279

Topic: Knee Sports

During clinical examination of knee kinematics, you observe the "screw-home" mechanism as the patient's knee reaches terminal extension. Which of the following best describes the osteokinematics and primary anatomical driver of this phenomenon?

. Internal rotation of the tibia on the femur driven by the popliteus
. External rotation of the tibia on the femur driven by the asymmetry of the femoral condyles
. Internal rotation of the femur on the tibia driven by the posterior cruciate ligament
. External rotation of the femur on the tibia driven by the anterior cruciate ligament
. Valgus alignment of the tibia driven by the medial collateral ligament

Correct Answer & Explanation

. Internal rotation of the tibia on the femur driven by the popliteus

Explanation

The screw-home mechanism involves obligatory external rotation of the tibia relative to the femur during terminal knee extension. This is primarily driven by the asymmetry of the femoral condyles, as the medial condyle has a larger articular surface than the lateral condyle.

Question 1280

Topic: Knee Sports

A 32-year-old male dashboard injury victim undergoes a posterior cruciate ligament (PCL) reconstruction. The surgeon opts for a double-bundle technique to anatomically restore native kinematics. Which of the following accurately describes the behavior of the native PCL bundles?

. The anterolateral bundle is tightest in full extension.
. The posteromedial bundle is tightest in deep flexion.
. The anterolateral bundle is the primary restraint to posterior translation in 90 degrees of flexion.
. The posteromedial bundle is larger and stiffer than the anterolateral bundle.
. Both bundles maintain constant, equal tension throughout the entire range of motion.

Correct Answer & Explanation

. The anterolateral bundle is tightest in full extension.

Explanation

The native PCL consists of the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle is tight in knee flexion (maximal at 90 degrees) and restrains posterior translation, whereas the PM bundle is tight in extension.

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