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Knee Sports MCQs

Practice Set 66 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 1301

Topic: Knee Sports

A 28-year-old male runner presents with chronic, deep anterolateral ankle pain following a severe inversion injury 18 months ago. Non-operative management, including immobilization and physical therapy, has failed. MRI reveals a 1.8 square centimeter osteochondral lesion on the lateral talar dome with underlying subchondral cysts measuring 5 mm in depth. Which of the following is the most appropriate surgical treatment?

. Arthroscopic bone marrow stimulation (microfracture)
. Osteochondral autograft transfer (OATS)
. Arthroscopic debridement alone
. Retrograde drilling
. Matrix-induced autologous chondrocyte implantation (MACI) without bone grafting

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

The management of osteochondral lesions of the talus (OLT) depends on the size of the lesion and the presence of subchondral cysts. While arthroscopic bone marrow stimulation (microfracture) is the first-line surgical treatment for lesions smaller than 1.5 square centimeters without significant cystic changes, larger lesions (> 1.5 square centimeters) and those with deep subchondral cysts are better treated with structural bone grafting to restore the subchondral architecture. Osteochondral autograft transfer (OATS) provides a viable hyaline cartilage surface and addresses the subchondral bony defect simultaneously.

Question 1302

Topic: Knee Sports

A 14-year-old male baseball pitcher presents with chronic lateral elbow pain, clicking, and occasional locking. Radiographs show a lesion on the capitellum with an intact overlying articular cartilage. MRI confirms an osteochondritis dissecans (OCD) lesion of the capitellum, demonstrating a stable fragment. He has failed conservative management. What is the MOST appropriate surgical intervention?

. Loose body removal
. Debridement and microfracture
. Open reduction and internal fixation of the fragment
. Drilling of the lesion
. Total elbow arthroplasty

Correct Answer & Explanation

. Loose body removal

Explanation

For a stable osteochondritis dissecans (OCD) lesion of the capitellum in an adolescent athlete that has failed conservative management, surgical drilling (arthroscopic or open) is often the initial intervention. Drilling aims to stimulate revascularization and healing of the subchondral bone, facilitating integration of the fragment. Debridement and microfracture are typically for unstable or fragmented lesions where the cartilage is damaged or detached. Loose body removal is indicated if the fragment has completely detached and is causing locking. ORIF is reserved for large, unstable, but salvageable fragments. Total elbow arthroplasty is not indicated in a young patient with an OCD lesion.

Question 1303

Topic: Knee Sports

A surgeon is performing an arthroscopic repair of a lateral meniscal tear. To ensure proper fixation and stability, the surgeon must understand the meniscal attachments. Which ligament attaches the posterior horn of the lateral meniscus to the medial femoral condyle, potentially hindering its mobility?

. Meniscofemoral ligament of Wrisberg
. Meniscofemoral ligament of Humphry
. Transverse meniscal ligament
. Posterior meniscotibial ligament
. Coronary ligament

Correct Answer & Explanation

. Meniscofemoral ligament of Wrisberg

Explanation

There are two meniscofemoral ligaments associated with the posterior horn of the lateral meniscus: the ligament of Humphry (anterior meniscofemoral ligament) and the ligament of Wrisberg (posterior meniscofemoral ligament). The ligament of Humphry passes anterior to the posterior cruciate ligament (PCL) to attach to the medial femoral condyle. The ligament of Wrisberg passes posterior to the PCL to attach to the medial femoral condyle. Both can potentially tether the lateral meniscus, reducing its mobility. The question specifically asks for the one attachingtothe medial femoral condylehindering mobility, which is the function of these ligaments. Both Humphry and Wrisberg fit the description of attaching to the medial femoral condyle. However, Wrisberg is more consistently present and often described as the stronger tether. Given the options, Wrisberg is the most appropriate answer describing an attachmentfromthe lateral meniscustothe medial femoral condyle. The transverse meniscal ligament connects the anterior horns. Posterior meniscotibial ligaments are part of the posterior capsule. Coronary ligaments connect the meniscus to the tibial plateau periphery.

Question 1304

Topic: Knee Sports

A surgeon is performing an anterior cruciate ligament (ACL) reconstruction. When preparing the tibial tunnel, it is critical to avoid impingement of the graft. Which anatomical structure marks the anteromedial border of the intercondylar notch on the tibia and serves as a key landmark for tibial tunnel placement?

. Medial tibial spine
. Lateral tibial spine
. Posterior cruciate ligament (PCL) footprint
. Anteromedial bundle footprint of the ACL
. PCL fascicle to the lateral meniscus

Correct Answer & Explanation

. Medial tibial spine

Explanation

The lateral tibial spine (also known as the lateral intercondylar tubercle or tubercle of Gerty) is a crucial anatomical landmark for ACL reconstruction. It marks the anteromedial border of the intercondylar notch on the tibia. Proper placement of the tibial tunnel, posterior and lateral to the lateral tibial spine, helps avoid roof impingement of the ACL graft. The medial tibial spine is on the medial side. The PCL footprint is posterior. The anteromedial bundle footprint is the desired target but the lateral tibial spine helps define its anterior limit. There is no specific PCL fascicle to the lateral meniscus in a general sense that serves as this landmark.

Question 1305

Topic: Knee Sports

A surgeon is performing an anatomical anterior cruciate ligament (ACL) reconstruction. Accurate placement of the femoral tunnel is crucial. Which specific anatomical landmark on the lateral femoral condyle represents the most isometric and stable attachment point for the native ACL?

. Blumensaat's line
. Lateral intercondylar notch roof
. Resident's ridge (lateral bifurcate ridge)
. Medial condylar wall
. Posterior cortex of the lateral condyle

Correct Answer & Explanation

. Blumensaat's line

Explanation

Resident's ridge, also known as the lateral bifurcate ridge, is a critical anatomical landmark on the lateral wall of the intercondylar notch. It consistently separates the anteromedial (AM) and posterolateral (PL) bundles of the native ACL. Placing the femoral tunnel posterior to and above this ridge provides the most isometric and anatomically appropriate attachment for an ACL graft, minimizing impingement and maximizing stability. Blumensaat's line is a radiographic landmark representing the intercondylar roof. The other options are either incorrect landmarks or less precise. Accurate femoral tunnel placement relative to Resident's ridge is key to anatomical ACL reconstruction.

Question 1306

Topic: Knee Sports

Regarding the anatomy of the knee, which structure forms the most posterior boundary of the intercondylar notch of the femur?

. Anterior cruciate ligament (ACL) insertion
. Posterior cruciate ligament (PCL) insertion
. Medial femoral condyle
. Lateral femoral condyle
. Blumensaat's line

Correct Answer & Explanation

. Anterior cruciate ligament (ACL) insertion

Explanation

The intercondylar notch of the femur is bounded anteriorly by the intercondylar line (Blumensaat's line radiographically), laterally by the medial surface of the lateral femoral condyle, medially by the lateral surface of the medial femoral condyle, and posteriorly by the posterior cruciate ligament (PCL) insertion footprint. The PCL originates from the anterior part of the lateral surface of the medial femoral condyle, but its main bulk is posterior. The ACL inserts into the posteromedial aspect of the lateral femoral condyle, which is more anterior within the notch than the PCL insertion. Therefore, the PCL insertion forms the most posterior boundary.

Question 1307

Topic: Knee Sports

Which anatomical structure of the knee provides the primary static restraint to posterior translation of the tibia relative to the femur?

. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Medial collateral ligament (MCL)
. Lateral collateral ligament (LCL)
. Menisci

Correct Answer & Explanation

. Anterior cruciate ligament (ACL)

Explanation

The posterior cruciate ligament (PCL) is the primary static restraint to posterior translation of the tibia relative to the femur. It is a strong ligament that originates from the lateral surface of the medial femoral condyle and inserts into the posterior intercondylar area of the tibia. The anterior cruciate ligament (ACL) primarily resists anterior translation. The MCL and LCL are collateral ligaments, providing valgus and varus stability, respectively. The menisci provide load distribution and secondary stability but are not the primary static restraint to AP translation.

Question 1308

Topic: Knee Sports

During reconstruction of the posterolateral corner (PLC) of the knee, achieving anatomic femoral tunnel placement is critical for restoring biomechanics. Relative to the lateral epicondyle, where does the popliteus tendon insert on the femur?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly over the lateral epicondyle

Correct Answer & Explanation

. Proximal and posterior

Explanation

The popliteus tendon inserts into the popliteal sulcus on the lateral femoral condyle. Anatomically, this insertion site is located approximately 18.5 mm anterior and distal to the fibular collateral ligament (FCL) origin, which lies slightly proximal and posterior to the lateral epicondyle.

Question 1309

Topic: Knee Sports

A 28-year-old female undergoes arthroscopic reconstruction of a torn posterior cruciate ligament (PCL). While preparing the tibial footprint, the surgeon must exercise extreme caution to avoid catastrophic vascular injury. At the level of the PCL tibial insertion, the popliteal artery is anatomically separated from the posterior joint capsule by which of the following?

. Popliteus muscle belly
. Oblique popliteal ligament
. A thin layer of fat only
. Medial head of the gastrocnemius
. Plantaris muscle tendon

Correct Answer & Explanation

. Popliteus muscle belly

Explanation

At the level of the PCL insertion on the posterior aspect of the proximal tibia (the PCL facet), the popliteal artery lies directly posterior to the joint capsule, separated only by a very thin layer of fat. This intimate relationship makes the popliteal artery highly vulnerable to injury during PCL reconstruction and posterior meniscal repair.

Question 1310

Topic: Knee Sports

A 22-year-old collegiate football player sustains a multi-ligament knee injury. An MRI demonstrates a complete rupture of the posterolateral corner (PLC) structures. During surgical reconstruction, the surgeon isolates the fibular head to accurately recreate the insertions of the lateral collateral ligament (LCL) and the popliteofibular ligament (PFL). What is the normal anatomical relationship of the LCL footprint relative to the PFL footprint on the fibula?

. LCL inserts anterolateral to the PFL.
. LCL inserts posteromedial to the PFL.
. LCL inserts directly inferior to the PFL.
. LCL inserts anteromedial to the PFL.
. The LCL and PFL share an identical, conjoined footprint.

Correct Answer & Explanation

. LCL inserts anterolateral to the PFL.

Explanation

On the fibular head, the lateral collateral ligament (LCL) inserts on the anterolateral aspect. The popliteofibular ligament (PFL) inserts on the posteromedial aspect of the fibular styloid. Accurate recognition of these distinct footprints is essential for anatomical reconstruction of the posterolateral corner (PLC) of the knee.

Question 1311

Topic: Knee Sports

A 24-year-old professional soccer player sustains a multi-ligamentous knee injury, including a complete tear of the posterolateral corner (PLC). During surgical reconstruction, the surgeon must anatomically restore the femoral attachment of the fibular collateral ligament (FCL). What is the anatomical location of the FCL femoral footprint relative to the popliteus tendon footprint?

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

Correct Answer & Explanation

. Proximal and posterior

Explanation

On the lateral femoral condyle, the popliteus tendon inserts anteriorly and distally within the popliteal sulcus. The femoral footprint of the Fibular Collateral Ligament (FCL) is situated proximal and posterior to the popliteus tendon attachment (averaging 18.5 mm away). Proper identification of this relationship is critical for anatomical PLC reconstruction to restore proper biomechanics and avoid graft isometry mismatch.

Question 1312

Topic: Knee Sports

In the reconstruction of the posterolateral corner (PLC) of the knee, understanding precise anatomical insertions is crucial. The popliteofibular ligament, a primary static stabilizer against external rotation, originates from the popliteus musculotendinous junction and inserts onto which of the following areas?

. Anterior aspect of the lateral tibial condyle
. Anterolateral aspect of the fibular head
. Posteromedial aspect of the fibular styloid
. Lateral epicondyle of the femur
. Gerdy's tubercle

Correct Answer & Explanation

. Anterior aspect of the lateral tibial condyle

Explanation

The posterolateral corner (PLC) of the knee primarily consists of the lateral collateral ligament (LCL), popliteus tendon, and the popliteofibular ligament. The popliteofibular ligament is a critical stabilizer against posterior translation, varus angulation, and external rotation of the tibia. It originates from the popliteus complex and inserts anatomically on the posteromedial aspect of the fibular styloid (tip of the fibular head).

Question 1313

Topic: Knee Sports

During a reconstruction of the posterolateral corner (PLC) of the knee, the surgeon must identify the anatomic footprints of the structures involved. Where is the normal femoral attachment of the popliteus tendon located relative to the lateral collateral ligament (LCL) origin?

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

Correct Answer & Explanation

. Proximal and posterior

Explanation

The femoral attachment of the popliteus tendon is located distal and anterior to the femoral attachment of the lateral collateral ligament (LCL) on the lateral femoral condyle. The popliteus attaches in the popliteal sulcus, whereas the LCL attaches slightly proximal and posterior to the lateral epicondyle.

Question 1314

Topic: Knee Sports

A 24-year-old football player sustains a multi-ligamentous knee injury including the posterolateral corner (PLC). Surgical reconstruction is planned. During dissection, the surgeon identifies the popliteofibular ligament. Which of the following best describes the anatomical origin and insertion of this critical structure?

. Originates from the lateral femoral epicondyle and inserts on the fibular styloid
. Originates from the popliteus musculotendinous junction and inserts on the posteromedial aspect of the fibular head
. Originates from the lateral meniscus and inserts on the fibular head
. Originates from the posterior tibia and inserts on the anterior fibular head
. Originates from the iliotibial band and inserts on the posterolateral tibia (Gerdy's tubercle)

Correct Answer & Explanation

. Originates from the lateral femoral epicondyle and inserts on the fibular styloid

Explanation

The popliteofibular ligament (PFL) is a key static stabilizer of the posterolateral corner of the knee, resisting posterior translation, varus angulation, and external rotation. It originates from the popliteus musculotendinous junction and courses distally and laterally to insert on the posteromedial aspect of the fibular head (fibular styloid). The lateral collateral ligament (LCL) originates from the lateral femoral epicondyle and inserts on the fibular head. Gerdy's tubercle is the insertion site for the iliotibial band.

Question 1315

Topic: Knee Sports

A 22-year-old athlete is undergoing surgical reconstruction of the posterolateral corner (PLC) of the knee. The surgeon is isolating the structures attaching to the fibula. What is the precise anatomical insertion of the popliteofibular ligament?

. Anterior aspect of the fibular head
. Posteromedial aspect of the fibular styloid process
. Anteromedial aspect of the fibular styloid process
. Lateral epicondyle of the femur
. Posterior horn of the lateral meniscus

Correct Answer & Explanation

. Anterior aspect of the fibular head

Explanation

The popliteofibular ligament (PFL) is a crucial static stabilizer of the posterolateral corner of the knee, resisting external rotation and posterior translation. It originates from the musculotendinous junction of the popliteus and inserts onto the posteromedial aspect of the fibular styloid process. The fibular collateral ligament (LCL) inserts slightly more anterior and lateral on the fibular head.

Question 1316

Topic: Knee Sports

A 24-year-old professional soccer player sustains a posterolateral corner (PLC) injury of the knee. Surgical reconstruction is planned. During anatomical reconstruction of the PLC, precise tunnel placement on the lateral femoral condyle is critical. What is the correct anatomical relationship of the fibular collateral ligament (FCL) and the popliteus tendon (PT) femoral attachments?

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

Correct Answer & Explanation

. The PT attaches proximal and posterior to the FCL attachment.

Explanation

The femoral attachment of the popliteus tendon is located an average of 18.5 mm anterior and distal (inferior) to the fibular collateral ligament (FCL/LCL) attachment on the lateral femoral condyle. Recognizing this spatial relationship is essential for anatomic PLC reconstruction to restore proper knee kinematics and stability.

Question 1317

Topic: Knee Sports

A 24-year-old football player sustains a multi-ligament knee injury. MRI demonstrates complete disruption of the posterolateral corner structures. For anatomical reconstruction, the surgeon identifies the femoral footprints of the lateral collateral ligament (LCL) and the popliteus tendon. What is the anatomic location of the LCL origin relative to the popliteus tendon insertion on the lateral femoral epicondyle?

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

Correct Answer & Explanation

. Proximal and posterior

Explanation

On the lateral femoral epicondyle, the origin of the fibular collateral ligament (LCL) is located proximal and posterior to the popliteus tendon insertion. This is a highly tested anatomical relationship crucial for anatomic reconstruction of the posterolateral corner of the knee.

Question 1318

Topic: Knee Sports

A 22-year-old collegiate football player sustains a complex multi-ligament knee injury. Physical examination using the dial test reveals 15 degrees of increased external rotation of the tibia compared to the uninjured side at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees of flexion. This isolated physical examination finding is most indicative of an injury to which of the following structures?

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

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

The dial test assesses the integrity of the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). Increased external rotation (>10 degrees compared to the contralateral normal knee) exclusively at 30 degrees of knee flexion implies an isolated PLC injury. If external rotation is increased at both 30 and 90 degrees, it indicates a combined injury involving both the PLC and the PCL.

Question 1319

Topic: Knee Sports

A 24-year-old professional soccer player undergoes surgical reconstruction of the posterolateral corner (PLC) of the knee following a multiligamentous injury. During the exposure, the femoral footprints of both the fibular collateral ligament (FCL) and the popliteus tendon are identified. What is the location of the popliteus tendon femoral footprint relative to the FCL footprint?

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

Correct Answer & Explanation

. Proximal and posterior

Explanation

Anatomical reconstruction of the posterolateral corner requires precise knowledge of femoral footprints. The popliteus tendon footprint is located an average of 18.5 mm distal and anterior to the footprint of the fibular collateral ligament (FCL, also known as the lateral collateral ligament) on the lateral femoral condyle.

Question 1320

Topic: Knee Sports

A 25-year-old athlete sustains a multi-ligament knee injury. Physical examination reveals an asymmetric, increased external tibial rotation at both 30 degrees and 90 degrees of knee flexion compared to the contralateral side. The primary static stabilizing structures of the posterolateral corner (PLC) are ruptured. Which of the following correctly lists the three major static stabilizers of the PLC?

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament
. Lateral collateral ligament, biceps femoris tendon, and iliotibial band
. Popliteus tendon, posterior cruciate ligament, and oblique popliteal ligament
. Arcuate ligament, fabellofibular ligament, and anterolateral ligament
. Popliteofibular ligament, lateral meniscus, and coronary ligament

Correct Answer & Explanation

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

The primary static stabilizers of the posterolateral corner (PLC) of the knee are the lateral collateral ligament (LCL), the popliteus tendon, and the popliteofibular ligament. An injury to these structures results in posterolateral rotatory instability. An isolated PLC injury typically demonstrates increased external rotation on the Dial test at 30 degrees, which decreases at 90 degrees. If external rotation is increased at both 30 and 90 degrees, it suggests a combined injury of the PLC and the posterior cruciate ligament (PCL).

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