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Knee Sports MCQs

Practice Set 65 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 1281

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles that function synergistically throughout the knee's range of motion. In which position of the knee is the anteromedial (AM) bundle most taut?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 degrees of flexion
. 120 degrees of flexion

Correct Answer & Explanation

. Full extension

Explanation

The ACL has two distinct bundles: the anteromedial (AM) and posterolateral (PL). The AM bundle tightens in flexion and is the primary restraint to anterior tibial translation at 90 degrees of flexion, whereas the PL bundle is tightest in extension.

Question 1282

Topic: Knee Sports

During an open reconstruction of the posterolateral corner (PLC) of the knee, the surgeon develops an interval between the biceps femoris and the iliotibial band. Which of the following neurovascular structures is at greatest risk during this approach, and what is its correct anatomical relationship?

. Tibial nerve; passes posterior to the fibular head
. Common peroneal nerve; wraps anteriorly around the fibular neck deep to the peroneus longus
. Common peroneal nerve; passes posterior to the fibular neck superficial to the lateral gastrocnemius
. Deep peroneal nerve; courses anteriorly over the fibular head in the subcutaneous tissue
. Sural nerve; crosses the lateral aspect of the fibular head deep to the soleus

Correct Answer & Explanation

. Tibial nerve; passes posterior to the fibular head

Explanation

The common peroneal nerve is highly vulnerable during surgical approaches to the posterolateral corner. It courses distally on the posterior aspect of the biceps femoris, then wraps anteriorly around the fibular neck deep to the fascia of the peroneus longus muscle.

Question 1283

Topic: Knee Sports

Which of the following structures is considered a primary static stabilizer of the posterolateral corner (PLC) of the knee?

. Anterior cruciate ligament
. Medial collateral ligament
. Popliteofibular ligament
. Posterior oblique ligament
. Biceps femoris tendon

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

The primary static stabilizers of the posterolateral corner (PLC) are the lateral collateral ligament (LCL), the popliteus tendon, and the popliteofibular ligament. The biceps femoris is a dynamic stabilizer.

Question 1284

Topic: Knee Sports

When performing an anterior drawer test at 90 degrees of knee flexion, which bundle of the anterior cruciate ligament (ACL) is the primary restraint to anterior tibial translation?

. Posterolateral bundle
. Anteromedial bundle
. Posteromedial bundle
. Anterolateral bundle
. Transverse bundle

Correct Answer & Explanation

. Posterolateral bundle

Explanation

The ACL has two main bundles: the anteromedial (AM) and posterolateral (PL). The AM bundle is tightest in flexion and is the primary restraint to anterior translation at 90 degrees, while the PL bundle is tightest in extension.

Question 1285

Topic: Knee Sports

The medial patellofemoral ligament (MPFL) is a primary restraint to lateral patellar displacement. Where is its femoral attachment located?

. Anterior to the medial epicondyle and proximal to the adductor tubercle
. Posterior to the medial epicondyle and distal to the adductor tubercle
. Between the medial epicondyle and the adductor tubercle
. Directly on the medial epicondyle
. On the medial supracondylar ridge

Correct Answer & Explanation

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

Explanation

The femoral footprint of the MPFL (Schöttle's point) is located between the medial epicondyle and the adductor tubercle. It provides the primary restraint to lateral patellar subluxation at 0 to 30 degrees of flexion.

Question 1286

Topic: Knee Sports

The posterior cruciate ligament (PCL) consists of two functional bundles. Which bundle is most taut in full knee extension?

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

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The PCL is composed of the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The PM bundle is taut in full extension, while the AL bundle is taut in flexion.

Question 1287

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction of the knee, anatomic femoral tunnel placement is critical. Which of the following describes the correct anatomic relationship of the popliteus tendon attachment on the lateral femur relative to the lateral collateral ligament (LCL) attachment?

. Popliteus attaches anterior and inferior to the LCL
. Popliteus attaches posterior and superior to the LCL
. Popliteus attaches directly to the fibular head
. LCL attaches anterior and inferior to the popliteus
. LCL attaches posterior and inferior to the popliteus

Correct Answer & Explanation

. Popliteus attaches anterior and inferior to the LCL

Explanation

On the lateral femoral epicondyle, the popliteus tendon inserts in a sulcus that is positioned anterior and inferior to the origin of the lateral collateral ligament (LCL).

Question 1288

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles that function synergistically during knee range of motion. Which of the following statements most accurately describes the biomechanics of these bundles?

. The anteromedial bundle provides primary rotational stability in extension
. The posterolateral bundle is the primary restraint to anterior translation in 90 degrees of flexion
. The anteromedial bundle tightens in flexion, while the posterolateral bundle tightens in extension
. The posterolateral bundle tightens in flexion, while the anteromedial bundle tightens in extension
. Both bundles remain perfectly isometric throughout the entire arc of motion

Correct Answer & Explanation

. The anteromedial bundle provides primary rotational stability in extension

Explanation

The anteromedial (AM) bundle of the ACL tightens in flexion to control anterior translation, while the posterolateral (PL) bundle tightens in extension to provide primary rotational stability.

Question 1289

Topic: Knee Sports

Failure to recognize and repair a posterior medial meniscus root tear leads to biomechanical consequences equivalent to a total meniscectomy. Where is the exact anatomical insertion of the posterior horn of the medial meniscus root?

. Anterior to the ACL tibial footprint
. Posterior to the PCL tibial footprint
. Directly anterior to the PCL tibial footprint
. Medial to the medial collateral ligament insertion
. Directly on the lateral meniscus posterior root

Correct Answer & Explanation

. Anterior to the ACL tibial footprint

Explanation

The posterior root of the medial meniscus attaches to the posterior intercondylar fossa of the tibia, located directly anterior to the tibial attachment of the posterior cruciate ligament (PCL).

Question 1290

Topic: Knee Sports

A 16-year-old female undergoes medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. Anatomic femoral graft placement is critical to avoid altering joint contact pressures. What is the native anatomic origin of the MPFL on the femur?

. Directly on the adductor tubercle
. Directly on the medial epicondyle
. In the saddle region between the adductor tubercle and medial epicondyle
. On the medial joint line
. On the proximal tibia

Correct Answer & Explanation

. Directly on the adductor tubercle

Explanation

The MPFL originates on the medial femur in a distinct saddle-like depression located between the adductor tubercle superiorly and the medial femoral epicondyle inferiorly.

Question 1291

Topic: Knee Sports

When performing a posterior cruciate ligament (PCL) reconstruction, the surgeon must accurately identify the native anatomic footprint. Which of the following correctly describes the femoral attachment of the PCL?

. Anterolateral aspect of the medial femoral condyle
. Posteromedial aspect of the lateral femoral condyle
. Posterolateral aspect of the medial femoral condyle
. Anteromedial aspect of the lateral femoral condyle
. Directly within the intercondylar notch roof

Correct Answer & Explanation

. Anterolateral aspect of the medial femoral condyle

Explanation

The PCL attaches to the anterolateral aspect of the medial femoral condyle. In contrast, the ACL attaches to the posteromedial aspect of the lateral femoral condyle.

Question 1292

Topic: Knee Sports

When reconstructing the posterolateral corner (PLC) of the knee, understanding the anatomic relationship of the femoral attachments is critical. Which of the following correctly describes the origin of the lateral collateral ligament (LCL) relative to the popliteus tendon on the lateral femoral epicondyle?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly medial

Correct Answer & Explanation

. Proximal and posterior

Explanation

On the lateral femoral epicondyle, the LCL origin is located proximal and posterior to the popliteus tendon insertion. This relationship is critical for anatomic PLC reconstruction.

Question 1293

Topic: Knee Sports

During an anatomic reconstruction of the posterolateral corner (PLC) of the knee, identifying the fibular collateral ligament (FCL) footprint is critical. What is the anatomical relationship of the FCL femoral footprint to the popliteus tendon insertion?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly anterior

Correct Answer & Explanation

. Proximal and posterior

Explanation

The femoral attachment of the FCL is located slightly proximal and posterior to the popliteus tendon attachment on the lateral femoral epicondyle. Recognizing this spatial relationship is essential for anatomic tunnel placement.

Question 1294

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two functional bundles. During a physical examination, when the knee is in full extension, how are these bundles oriented relative to each other in terms of tension?

. Both bundles are equally lax
. The anteromedial bundle is lax and the posterolateral bundle is tight
. The anteromedial bundle is tight and the posterolateral bundle is lax
. Both bundles are parallel and maximally tight
. The bundles uncross and rely on secondary stabilizers

Correct Answer & Explanation

. Both bundles are equally lax

Explanation

In full knee extension, the posterolateral (PL) bundle is tight and provides the primary restraint to anterior tibial translation. The anteromedial (AM) bundle becomes tightest in deeper knee flexion.

Question 1295

Topic: Knee Sports

A 30-year-old male sustains a twisting injury to his knee. Examination reveals increased external tibial rotation at 30 degrees of knee flexion, but symmetrical rotation at 90 degrees of flexion compared to the contralateral side. Which of the following structures is most likely injured?

. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Medial collateral ligament (MCL)
. Popliteofibular ligament
. Posterior oblique ligament

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

Increased external rotation at 30 degrees of flexion with normal rotation at 90 degrees indicates an isolated posterolateral corner (PLC) injury, which involves the popliteofibular ligament, LCL, and popliteus tendon. Combined PLC and PCL injuries typically show increased rotation at both 30 and 90 degrees.

Question 1296

Topic: Knee Sports

A 22-year-old female undergoes ACL reconstruction. The surgeon drills the femoral tunnel independently to accurately recreate the anatomic footprint of the ACL. Which of the following accurately describes the biomechanical function of the anteromedial (AM) bundle of the native ACL?

. It is primarily tight in extension and resists anterior translation.
. It is primarily tight in flexion and resists anterior translation.
. It is tight in both flexion and extension and resists varus stress.
. It provides the primary restraint to rotatory loads in extension.
. It originates on the medial femoral condyle.

Correct Answer & Explanation

. It is primarily tight in extension and resists anterior translation.

Explanation

The ACL consists of two main bundles. The anteromedial (AM) bundle is primarily tight in flexion and provides anterior-posterior stability, while the posterolateral (PL) bundle is tight in extension and provides rotational stability.

Question 1297

Topic: Knee Sports

A 16-year-old female with recurrent patellar dislocations is scheduled for medial patellofemoral ligament (MPFL) reconstruction. The femoral origin of the MPFL (Schöttle's point) is best described anatomically 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
. Between the medial epicondyle and the adductor tubercle
. On the anterior medial femoral condyle articular margin
. At the insertion of the semitendinosus tendon

Correct Answer & Explanation

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

Explanation

The femoral footprint of the MPFL is located in a saddle-shaped depression between the adductor tubercle (superiorly) and the medial epicondyle (inferiorly). Proper anatomic placement is critical to restore patellar tracking without over-constraining the joint.

Question 1298

Topic: Knee Sports

A 30-year-old male presents with persistent medial ankle pain 6 months after an inversion injury. An MRI shows an osteochondral lesion of the medial talar dome measuring 1.1 cm in diameter, without subchondral cysts. What is the most appropriate primary surgical intervention?

. Osteochondral autograft transfer (OATS)
. Arthroscopic bone marrow stimulation (microfracture)
. Matrix-induced autologous chondrocyte implantation (MACI)
. Ankle arthrodesis
. Total ankle arthroplasty

Correct Answer & Explanation

. Osteochondral autograft transfer (OATS)

Explanation

For symptomatic osteochondral lesions of the talus (OLTs) smaller than 1.5 cm^2 that fail conservative treatment, arthroscopic bone marrow stimulation (microfracture or drilling) is the standard initial surgical treatment.

Question 1299

Topic: Knee Sports

A 28-year-old female presents with deep ankle pain and catching 1 year after a severe ankle sprain. MRI demonstrates a 1.2 cm osteochondral lesion on the posteromedial talar dome with intact overlying cartilage. What is the most appropriate initial surgical approach?

. Open osteochondral autograft transfer (OATS)
. Ankle arthrodesis
. Arthroscopic bone marrow stimulation (microfracture)
. Matrix-induced autologous chondrocyte implantation (MACI)
. Arthroscopic retrograde drilling

Correct Answer & Explanation

. Open osteochondral autograft transfer (OATS)

Explanation

For an intact osteochondral lesion of the talus (especially with underlying subchondral cysts), retrograde drilling promotes revascularization and healing. This technique avoids breaching the intact overlying articular cartilage.

Question 1300

Topic: Knee Sports

A 25-year-old woman presents with deep, chronic anterior ankle pain 1 year after a severe inversion sprain. MRI shows a 1.2 cm^2 (10 mm diameter) primary osteochondral lesion of the medial talar dome. Nonoperative management has failed. What is the most appropriate next step?

. Arthroscopic bone marrow stimulation (microfracture)
. Osteochondral autograft transfer (OATS)
. Matrix-induced autologous chondrocyte implantation (MACI)
. Ankle arthrodesis
. Distal tibial osteotomy

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

For symptomatic primary osteochondral lesions of the talus that are less than 1.5 cm^2 (or <15 mm in diameter), arthroscopic debridement and bone marrow stimulation (microfracture) is the first-line surgical treatment.

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