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Knee Sports MCQs

Practice Set 67 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 1321

Topic: Knee Sports

A surgeon is repairing a posterolateral corner (PLC) injury of the knee. The fibular collateral ligament (FCL), popliteus tendon (PT), and popliteofibular ligament (PFL) are the primary static stabilizers of the PLC. What is the typical femoral footprint insertion site of the FCL relative to the lateral epicondyle?

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

Correct Answer & Explanation

. Proximal and posterior

Explanation

Detailed anatomical studies (such as those by LaPrade et al.) have mapped the footprints of the PLC. The fibular collateral ligament (FCL) arises from the lateral femoral condyle approximately 1.4 mm proximal and 3.1 mm posterior to the lateral epicondyle. The popliteus tendon inserts on the femur 18.5 mm anterior and distal to the FCL origin. Accurate knowledge of these footprints is necessary for successful anatomic reconstruction of the PLC.

Question 1322

Topic: Knee Sports

During reconstruction of the posterolateral corner of the knee, the surgeon identifies the popliteofibular ligament. Which of the following accurately describes the origin and insertion of this structure?

. Originates from the popliteus musculotendinous junction and inserts on the posteromedial aspect of the fibular styloid
. Originates from the lateral epicondyle and inserts on the fibular head
. Originates from the lateral meniscus and inserts on the proximal tibia
. Originates from the popliteus tendon and inserts on the anterolateral tibia
. Originates from the Gerdy tubercle and inserts on the fibular head

Correct Answer & Explanation

. Originates from the popliteus musculotendinous junction and inserts on the posteromedial aspect of the fibular styloid

Explanation

The popliteofibular ligament is a critical static stabilizer of the posterolateral corner. It originates from the popliteus musculotendinous junction and inserts distally onto the posteromedial fibular styloid.

Question 1323

Topic: Knee Sports

The femoral attachment (footprint) of the anterior cruciate ligament (ACL) is anatomically located on the:

. Posterolateral aspect of the medial femoral condyle
. Anteromedial aspect of the lateral femoral condyle
. Anterolateral aspect of the medial femoral condyle
. Roof of the intercondylar notch
. Posteromedial aspect of the lateral femoral condyle

Correct Answer & Explanation

. Posterolateral aspect of the medial femoral condyle

Explanation

The ACL originates from the posteromedial aspect of the lateral femoral condyle. It then courses distally, medially, and anteriorly to insert on the anterior intercondylar area of the tibia.

Question 1324

Topic: Knee Sports

During a posterolateral corner reconstruction of the knee, identifying the femoral footprints of the stabilizing structures is crucial. What is the anatomic relationship of the popliteus tendon (PT) insertion relative to the fibular collateral ligament (FCL) origin on the lateral femoral condyle?

. PT is proximal and posterior to FCL
. PT is distal and anterior to FCL
. PT is distal and posterior to FCL
. PT is proximal and anterior to FCL
. PT is directly anterior to FCL

Correct Answer & Explanation

. PT is proximal and posterior to FCL

Explanation

On the lateral femoral condyle, the popliteus tendon inserts an average of 18.5 mm distal and anterior to the origin of the fibular collateral ligament. This anatomical relationship is critical to recreate during posterolateral corner reconstructions.

Question 1325

Topic: Knee Sports

During arthroscopic anterior cruciate ligament (ACL) reconstruction, the surgeon drills the tibial tunnel. To maximally protect the popliteal artery from injury, how should the knee be positioned?

. Extension, to pull the artery anteriorly
. Flexion, to allow the artery to fall posteriorly
. Flexion, to tighten the posterior capsule
. Extension, to relax the hamstrings
. 90 degrees of flexion, to maximize patellar tendon length

Correct Answer & Explanation

. Flexion, to allow the artery to fall posteriorly

Explanation

Flexing the knee allows the popliteal artery to fall further posteriorly away from the posterior capsule. This safely increases the distance between the artery and the exiting guide pin or drill.

Question 1326

Topic: Knee Sports

During an anatomic reconstruction of the posterolateral corner (PLC) of the knee, identifying the normal anatomic footprint of the popliteus tendon on the femur is critical. Where is it located relative to the lateral collateral ligament (LCL) origin?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly deep to the LCL origin

Correct Answer & Explanation

. Distal and anterior

Explanation

On the lateral femoral epicondyle, the footprint of the popliteus tendon is located distal and anterior to the origin of the lateral collateral ligament (LCL). Respecting this anatomy ensures appropriate graft isometry.

Question 1327

Topic: Knee Sports

In reconstructing the posterolateral corner (PLC) of the knee, the surgeon must anatomically restore the insertion of the popliteus tendon on the femur. What is its correct anatomic relationship to the fibular collateral ligament (FCL) attachment on the lateral femoral condyle?

. Anterior and inferior
. Anterior and superior
. Posterior and inferior
. Posterior and superior
. Directly medial

Correct Answer & Explanation

. Anterior and inferior

Explanation

On the lateral femoral condyle, the popliteus tendon consistently inserts anterior and inferior to the origin of the fibular collateral ligament (FCL). Re-establishing this exact footprint is critical for restoring normal PLC kinematics.

Question 1328

Topic: Knee Sports

During medial patellofemoral ligament (MPFL) reconstruction, accurate femoral tunnel positioning is crucial to avoid non-physiologic graft tension and altered patellofemoral kinematics. According to Schöttle's method, what is the correct radiographic location of the MPFL femoral insertion on a strict lateral radiograph?

. 1 mm posterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle
. 1 mm anterior to the posterior cortex line, 2.5 mm proximal to the posterior origin of the medial femoral condyle
. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, proximal to Blumensaat's line
. 1 mm posterior to the posterior cortex line, 2.5 mm proximal to the posterior origin of the medial femoral condyle, distal to Blumensaat's line
. Directly on the posterior cortex line, exactly at the intersection with Blumensaat's line

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, proximal to Blumensaat's line

Explanation

Schöttle et al. described highly reliable radiographic landmarks for the femoral insertion of the MPFL on a true lateral radiograph: 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior aspect of Blumensaat's line.

Question 1329

Topic: Knee Sports

Following a posterolateral corner (PLC) and ACL injury, a patient is undergoing surgical reconstruction. When drilling the fibular collateral ligament (FCL) femoral tunnel, understanding the anatomy is essential. What is the anatomic relationship of the FCL femoral footprint to the popliteus sulcus/attachment?

. Proximal and posterior to the popliteus attachment
. Proximal and anterior to the popliteus attachment
. Distal and posterior to the popliteus attachment
. Distal and anterior to the popliteus attachment
. Directly medial to the popliteus attachment

Correct Answer & Explanation

. Proximal and posterior to the popliteus attachment

Explanation

On the lateral femoral epicondyle, the fibular collateral ligament (FCL) originates an average of 1.4 mm proximal and 3.1 mm posterior to the lateral epicondyle, effectively positioning it proximal and posterior to the popliteus femoral attachment.

Question 1330

Topic: Knee Sports

During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, identifying the correct femoral footprint is critical for proper graft isometry. Radiographically, Schöttle's point representing the femoral origin of the MPFL is located:

. Anterior to the posterior femoral cortical line and proximal to Blumensaat's line
. Posterior to the posterior femoral cortical line and distal to Blumensaat's line
. Anterior to the posterior femoral cortical line and distal to Blumensaat's line
. Posterior to the posterior femoral cortical line and proximal to Blumensaat's line
. Bisecting the posterior femoral cortical line and Blumensaat's line

Correct Answer & Explanation

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

Explanation

Schöttle's point is a radiographic landmark used to identify the anatomic femoral origin of the MPFL on a perfect lateral radiograph. It is located 1 mm anterior to the posterior femoral cortical extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line.

Question 1331

Topic: Knee Sports

A 19-year-old female soccer player sustains a twisting injury to her knee. Radiographs reveal an avulsion fracture of the lateral tibial plateau.

Which of the following intra-articular structures is most likely to be injured concurrently?

. Posterior cruciate ligament
. Medial collateral ligament
. Anterior cruciate ligament
. Posterolateral corner
. Popliteus tendon

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion fracture of the anterolateral proximal tibia at the attachment of the anterolateral ligament (ALL) and the anterolateral capsule. It is considered a pathognomonic radiographic sign for an anterior cruciate ligament (ACL) tear.

Question 1332

Topic: Knee Sports

A 50-year-old female experiences a sudden pop in her posterior knee while squatting. MRI demonstrates a radial tear at the posterior root of the medial meniscus.

Biomechanically, leaving this medial meniscus posterior root tear untreated is most comparable to which of the following?

. Total medial meniscectomy
. Partial medial meniscectomy
. Isolated anterior cruciate ligament tear
. Isolated posterior oblique ligament tear
. Chondral defect of the medial femoral condyle

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus completely disrupts the circumferential hoop stresses of the meniscus, allowing the meniscus to extrude radially under axial load. Biomechanical studies demonstrate that an untreated posterior root tear alters knee kinematics, decreases contact area, and increases peak contact pressures to levels equivalent to those seen after a total medial meniscectomy, accelerating osteoarthritis.

Question 1333

Topic: Knee Sports

A 25-year-old professional rugby player sustains a contact injury to his right knee. Physical examination reveals a positive dial test with 20 degrees of increased external rotation compared to the contralateral side at both 30 degrees and 90 degrees of knee flexion. Varus stress testing demonstrates grade III laxity at both 0 degrees and 30 degrees of flexion. Which combination of ligamentous structures is most likely injured?

. Lateral collateral ligament (LCL) and Popliteofibular ligament only
. LCL, Popliteus tendon, Popliteofibular ligament, and ACL
. LCL, Posterolateral corner (PLC), and PCL
. PCL and ACL only
. Medial collateral ligament (MCL) and Posterior oblique ligament (POL)

Correct Answer & Explanation

. LCL, Posterolateral corner (PLC), and PCL

Explanation

A positive dial test showing >10 degrees of asymmetric external rotation at 30 degrees of knee flexion indicates a posterolateral corner (PLC) injury. When this asymmetry persists or increases at 90 degrees of flexion, it indicates a combined PLC and posterior cruciate ligament (PCL) injury. Grade III varus laxity at 30 degrees confirms LCL injury (a component of the PLC), and grade III varus laxity at 0 degrees confirms the involvement of a cruciate ligament, classically the PCL in this combined injury pattern.

Question 1334

Topic: Knee Sports

A 16-year-old female experiences a first-time lateral patellar dislocation while playing soccer. The patella spontaneously reduces. Initial radiographs reveal no acute fractures. Which of the following is an absolute indication for surgical intervention following this primary dislocation event?

. Positive apprehension sign on physical examination
. Patella alta with an Insall-Salvati ratio > 1.2
. Presence of a displaced osteochondral loose body in the joint
. MRI confirmation of medial patellofemoral ligament (MPFL) rupture at the femoral origin
. Type C trochlear dysplasia on axial imaging

Correct Answer & Explanation

. Presence of a displaced osteochondral loose body in the joint

Explanation

The standard of care for a primary, uncomplicated patellar dislocation is non-operative management with a short period of immobilization followed by physical therapy focusing on vastus medialis obliquus (VMO) strengthening. However, absolute indications for early surgical intervention include a displaced osteochondral fracture/loose body, an avulsion fracture of the medial patellar border, or a massive medial soft tissue avulsion with lateral patellar subluxation that fails to spontaneously reduce. MPFL tears are expected in acute dislocations and do not mandate early surgery without other complications.

Question 1335

Topic: Knee Sports

A 28-year-old soccer player sustains a direct blow to the anteromedial aspect of the proximal tibia while the knee is flexed. On physical examination, the dial test reveals 25 degrees of external rotation of the tibia compared to 10 degrees on the contralateral side at 30 degrees of knee flexion. However, at 90 degrees of knee flexion, the external rotation is symmetric bilaterally. Which of the following structures is most likely injured?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Isolated posterolateral corner
. Combined posterior cruciate ligament and posterolateral corner
. Medial collateral ligament

Correct Answer & Explanation

. Combined posterior cruciate ligament and posterolateral corner

Explanation

The dial test is utilized to evaluate for posterolateral instability. An increase in external rotation of greater than 10 degrees compared to the normal, contralateral knee is considered positive. Increased external rotation at 30 degrees of knee flexion, which then reduces to symmetric rotation at 90 degrees, is pathognomonic for an isolated posterolateral corner (PLC) injury. If the external rotation remains asymmetrical and increased at both 30 and 90 degrees of flexion, it indicates a combined injury to both the PLC and the posterior cruciate ligament (PCL).

Question 1336

Topic: Knee Sports

A 50-year-old active female feels a sharp 'pop' in her posterior knee while rising from a deep squat. MRI reveals a complete radial tear immediately adjacent to the posterior horn medial meniscus attachment, with 4 mm of meniscal extrusion seen on coronal sequences. Biomechanically, in terms of tibiofemoral contact pressures, this injury is most equivalent to which of the following?

. An anterior horn medial meniscus tear
. A total medial meniscectomy
. A partial meniscectomy of the pars intermedia
. An isolated grade III medial collateral ligament sprain
. A grade II focal cartilage delamination

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A complete medial meniscus posterior root tear disrupts the crucial circumferential hoop stresses of the meniscus. Without intact osseous attachments, the meniscus is extruded radially under axial load. Extensive biomechanical studies have demonstrated that a posterior root tear effectively abolishes the load-sharing function of the meniscus, dramatically increasing peak contact pressures in the medial compartment to levels essentially equivalent to those observed after a total medial meniscectomy, thereby predisposing the patient to rapid articular cartilage wear and osteoarthritis.

Question 1337

Topic: Knee Sports

During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon utilizes intraoperative fluoroscopy to identify the anatomic femoral attachment site (Schöttle's point). Which of the following accurately describes the correct radiographic landmarks for this location on a strict lateral radiograph?

. Anterior to the posterior femoral cortical line and distal to Blumensaat's line.
. 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line.
. 5 mm anterior to the posterior femoral cortical line and 5 mm distal to Blumensaat's line.
. Posterior to the posterior femoral cortical line and proximal to Blumensaat's line.
. 1 mm posterior to the posterior femoral cortical line, 2.5 mm proximal to the posterior border of the condyle, and distal to Blumensaat's line.

Correct Answer & Explanation

. 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line.

Explanation

Schöttle's point represents the radiographic femoral footprint of the MPFL on a true lateral radiograph. It is accurately located 1 mm anterior to the posterior cortex line extension, 2.5 mm distal to the posterior articular border of the medial femoral condyle, and proximal to the level of the posterior point of Blumensaat's line. Precise placement is crucial; a femoral tunnel placed too proximal or anterior leads to a graft that is non-isometric and excessively tight in flexion, causing increased patellofemoral contact pressures and potential graft failure.

Question 1338

Topic: Knee Sports

A 24-year-old professional soccer player presents with recurrent knee instability 2 years after an arthroscopic anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. He reports a 'giving way' episode without a new traumatic event. A sagittal MRI from his recent evaluation is shown in Figure 1.

What is the most common etiology for early clinical failure of this reconstructed ligament?

. Missed concomitant posterolateral corner injury
. Inadequate rehabilitation protocol
. Non-anatomic tunnel placement
. Failure of graft incorporation
. Untreated medial meniscus ramp lesion

Correct Answer & Explanation

. Non-anatomic tunnel placement

Explanation

The most common cause of recurrent instability and failure following primary ACL reconstruction is non-anatomic tunnel placement. Specifically, a femoral tunnel placed too anteriorly or vertically results in a graft that is non-isometric, leading to over-tensioning in flexion and stretching or rupture over time. While missed concomitant injuries (like posterolateral corner injuries or ramp lesions) are important secondary causes of failure, surgical technique errors regarding tunnel positioning remain the leading overall cause.

Question 1339

Topic: Knee Sports

A 26-year-old rugby player sustained a direct blow to the anteromedial aspect of his knee while it was fully extended. On physical examination, he demonstrates 15 degrees of increased external tibial rotation at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of flexion, the external rotation side-to-side difference is only 3 degrees. Which of the following structures is most likely injured?

. Isolated Anterior Cruciate Ligament (ACL)
. Isolated Posterior Cruciate Ligament (PCL)
. Popliteus complex and lateral collateral ligament (LCL)
. Combined PCL and posterolateral corner (PLC)
. Medial patellofemoral ligament (MPFL)

Correct Answer & Explanation

. Popliteus complex and lateral collateral ligament (LCL)

Explanation

The patient's physical examination describes a positive Dial test at 30 degrees of knee flexion but a negative Dial test at 90 degrees. This finding is indicative of an isolated posterolateral corner (PLC) injury. The PLC (which includes the LCL, popliteus tendon, and popliteofibular ligament) is the primary restraint to external tibial rotation at 30 degrees. If the Dial test is positive at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.

Question 1340

Topic: Knee Sports

A 40-year-old marathon runner feels a sudden pop in the posterior aspect of his knee while decelerating. MRI demonstrates a complete radial tear at the posterior root of the medial meniscus. If left untreated, this specific injury pattern most closely mimics the biomechanical effects of which of the following?

. Total medial meniscectomy
. Anterior cruciate ligament (ACL) rupture
. Medial collateral ligament (MCL) rupture
. Partial medial meniscectomy of the anterior horn
. Isolated cartilage delamination of the medial femoral condyle

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A medial meniscus posterior root tear effectively completely disrupts the continuity of the meniscal ring. This leads to an inability to convert axial joint loads into hoop stresses. Biomechanically, this results in medial compartment peak contact pressures and contact areas that are functionally equivalent to those seen after a total medial meniscectomy, rapidly accelerating the progression of osteoarthritis. Thus, root repairs are strongly advocated in active, appropriately selected patients.

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