Menu

Knee Sports MCQs

Practice Set 68 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 1341

Topic: Knee Sports

A 45-year-old woman experiences a sudden 'pop' in the back of her knee while squatting. MRI demonstrates a medial meniscus posterior root tear and localized marrow edema in the medial femoral condyle. What is the primary biomechanical consequence of leaving this root tear untreated?

. Loss of the primary restraint to anterior tibial translation
. Failure to convert axial loads into hoop stresses, resulting in radial extrusion
. Decreased peak contact pressures in the medial compartment
. Increased forces transmitted to the posterior cruciate ligament
. Attenuation of the medial collateral ligament

Correct Answer & Explanation

. Failure to convert axial loads into hoop stresses, resulting in radial extrusion

Explanation

A meniscal root tear disrupts the circumferential continuity of the meniscus, causing a complete loss of its ability to convert axial loads into hoop stresses. This leads to radial extrusion of the meniscus, biomechanically equating to a total meniscectomy and rapidly resulting in increased peak contact pressures and accelerated osteoarthritis.

Question 1342

Topic: Knee Sports

A 14-year-old female gymnast presents with lateral elbow pain, clicking, and a 15-degree extension deficit. Radiographs demonstrate a lucency in the capitellum. MRI reveals an osteochondral defect with high T2 signal fluid surrounding the fragment, indicating instability. Her capitellar physis is open. What is the recommended treatment?

. Cessation of gymnastics and casting for 3 months
. Arthroscopic fragment excision and marrow stimulation (microfracture)
. Arthroscopic fragment fixation
. Osteochondral autograft transfer (OATS)
. Radial head excision

Correct Answer & Explanation

. Arthroscopic fragment fixation

Explanation

In a juvenile patient (open physis) with an unstable but intact osteochondritis dissecans (OCD) lesion of the capitellum (indicated by fluid behind the fragment on MRI), the standard of care is surgical fixation of the fragment to preserve the native articular cartilage. Marrow stimulation or OATS are typically reserved for unsalvageable fragments or failed primary fixation.

Question 1343

Topic: Knee Sports

A 22-year-old collegiate soccer player is evaluated for posterolateral knee pain and a feeling of instability after a twisting injury. On physical examination, the dial test demonstrates 15 degrees of increased external rotation compared to the contralateral normal knee at 30 degrees of knee flexion, but symmetric external rotation at 90 degrees of knee flexion. This finding is most indicative of an isolated injury to which of the following structures?

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

Correct Answer & Explanation

. Combined PCL and PLC

Explanation

The dial test is used to evaluate combined or isolated injuries of the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). An increase of >10 degrees of external rotation compared to the contralateral side at 30 degrees of flexion, with symmetric rotation at 90 degrees, is indicative of an isolated PLC injury. If external rotation is increased at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.

Question 1344

Topic: Knee Sports

A 30-year-old male sustains a severe knee hyperextension injury during American football, resulting in a knee dislocation. After closed reduction, his vascular exam is normal with biphasic pulses, but he exhibits a profound foot drop and absent sensation in the first web space. An MRI shown in Figure 5 demonstrates complete disruption of the ACL, PCL, and posterolateral corner (PLC). Which of the following anatomical structures is most closely associated with the pathway of the injured nerve and serves as a critical surgical landmark?

. Popliteofibular ligament
. Lateral collateral ligament
. Biceps femoris tendon
. Iliotibial band
. Popliteus tendon

Correct Answer & Explanation

. Biceps femoris tendon

Explanation

The clinical presentation describes a common peroneal nerve injury (foot drop, numbness in the first dorsal web space), a well-known complication of posterolateral corner (PLC) injuries and knee dislocations. The common peroneal nerve courses distally and laterally through the popliteal fossa, wrapping around the fibular neck just posterior and deep to the long and short heads of the biceps femoris tendon. The biceps femoris tendon is the key anatomical landmark for locating, protecting, and decompressing the common peroneal nerve during surgical approaches to the posterolateral knee.

Question 1345

Topic: Knee Sports

A 45-year-old active female felt a 'pop' in her knee while squatting. MRI reveals a full-thickness tear at the posterior meniscal root.

What biomechanical alteration is most likely present in her knee compared to a normal, uninjured state?

. Decreased contact pressures in the medial compartment
. Loss of hoop stresses leading to a biomechanical equivalent of a total meniscectomy
. Increased anterior tibial translation with intact cruciate ligaments
. Decreased varus laxity
. Increased patellofemoral contact pressure

Correct Answer & Explanation

. Loss of hoop stresses leading to a biomechanical equivalent of a total meniscectomy

Explanation

Meniscal root tears disrupt the circumferential continuity of the meniscus, leading to a complete loss of hoop stresses. This allows the meniscus to extrude radially under axial loads. Biomechanical studies have demonstrated that a posterior medial meniscus root tear increases peak contact pressures and decreases contact area in the medial compartment, making it biomechanically equivalent to a total meniscectomy.

Question 1346

Topic: Knee Sports

A 21-year-old football player sustains a direct blow to the anteromedial aspect of his knee. Physical examination shows 15 degrees of increased external rotation at 30 degrees of knee flexion, but symmetric external rotation at 90 degrees of knee flexion compared to the uninjured side.

Which structure is most likely injured?

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

Correct Answer & Explanation

. Isolated Posterolateral corner (PLC)

Explanation

The clinical exam describes the dial test. A positive dial test is defined as >10 degrees of increased external rotation compared to the contralateral knee. If the test is positive at 30 degrees of flexion but symmetric (negative) at 90 degrees, it indicates an isolated posterolateral corner (PLC) injury. If it is positive at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 1347

Topic: Knee Sports

During a double-bundle anterior cruciate ligament (ACL) reconstruction, precise knowledge of bundle anatomy and biomechanics is required. Which of the following statements regarding the anteromedial (AM) and posterolateral (PL) bundles of the ACL is correct?

. The AM bundle is tight in extension and primarily controls rotatory stability.
. The PL bundle is tight in flexion and primarily controls anterior translation.
. The AM bundle is tight in flexion and primarily controls anterior translation.
. The PL bundle is tight in flexion and primarily controls rotatory stability.
. Both bundles are equally tight throughout the entire range of motion.

Correct Answer & Explanation

. The AM bundle is tight in flexion and primarily controls anterior translation.

Explanation

The ACL is composed of the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle tightens in flexion and is the primary restraint to anterior tibial translation. The PL bundle tightens in extension and is the primary restraint to rotatory loads (e.g., positive pivot shift). During isolated single-bundle reconstruction, surgeons generally target the center of the footprint or slightly toward the AM bundle position to optimize AP stability.

Question 1348

Topic: Knee Sports

A 16-year-old dancer undergoes surgical reconstruction of the medial patellofemoral ligament (MPFL) for recurrent lateral patellar instability. To avoid non-anatomic graft placement, which can result in patellofemoral arthrosis or graft failure, where should the femoral footprint of the MPFL be anatomically positioned?

. Proximal to the adductor tubercle and anterior to the medial epicondyle
. Distal to the adductor tubercle and proximal and posterior to the medial epicondyle
. Anterior to the medial collateral ligament origin and distal to the medial epicondyle
. Proximal to the adductor tubercle and posterior to the medial epicondyle
. Distal to the medial epicondyle and anterior to the adductor tubercle

Correct Answer & Explanation

. Distal to the adductor tubercle and proximal and posterior to the medial epicondyle

Explanation

The anatomic femoral origin of the MPFL resides in a saddle-like depression located distal to the adductor tubercle, proximal and posterior to the medial epicondyle, and superficial to the superficial MCL origin. Radiographically, Schottle's point describes this optimal femoral attachment: 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the posterior point of Blumensaat's line.

Question 1349

Topic: Knee Sports

A 17-year-old female undergoes medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar instability. To ensure isometry of the graft, the femoral attachment must be placed precisely. In terms of anatomic landmarks on the medial femur, where is the origin of the MPFL located?

. Distal to the adductor tubercle and anterior to the medial epicondyle
. At the center of the posterior aspect of the medial femoral condyle
. Proximal to the adductor tubercle
. Between the medial epicondyle and the adductor tubercle
. At the direct center of the medial epicondyle

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle

Explanation

The anatomic origin of the MPFL is located in a saddle-shaped groove between the medial epicondyle and the adductor tubercle. On a true lateral radiograph, Schottle's point defines this radiographic location: 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior portion of Blumensaat's line.

Question 1350

Topic: Knee Sports

A 19-year-old collegiate soccer player undergoes anterior cruciate ligament (ACL) reconstruction using an anteromedial portal technique for femoral tunnel drilling. To avoid a critically short femoral tunnel and prevent posterior cortical blowout, at what approximate knee flexion angle should the femoral tunnel be drilled?

. 70 degrees
. 90 degrees
. 100 degrees
. 120 degrees
. 135 degrees

Correct Answer & Explanation

. 120 degrees

Explanation

When drilling the femoral tunnel through an anteromedial (AM) portal during ACL reconstruction, the knee must be hyperflexed (typically 120 degrees or more). This maneuver changes the trajectory of the drill in relation to the femur, ensuring a longer femoral tunnel and minimizing the risk of posterior cortical blowout. Drilling at 90 degrees or less via the AM portal typically results in a short tunnel and a high risk of violating the posterior femoral cortex.

Question 1351

Topic: Knee Sports

A 20-year-old female presents with recurrent lateral patellar instability and has failed conservative management. A medial patellofemoral ligament (MPFL) reconstruction is planned. Which of the following best describes the anatomical origin of the MPFL on the femur?

. Anterior to the medial epicondyle and distal to the adductor tubercle
. Posterior to the medial epicondyle and proximal to the adductor tubercle
. Proximal and posterior to the medial epicondyle, and distal to the adductor tubercle
. Distal and anterior to the adductor tubercle
. Directly on the medial epicondyle

Correct Answer & Explanation

. Proximal and posterior to the medial epicondyle, and distal to the adductor tubercle

Explanation

The femoral footprint of the MPFL is situated in a 'saddle' area that is proximal and posterior to the medial epicondyle, and distal to the adductor tubercle. Radiographically, this is described by Schöttle's point: 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior intersecting line of the femoral condyle, and proximal to Blumensaat's line.

Question 1352

Topic: Knee Sports

A 45-year-old woman experiences a 'pop' in the back of her knee while squatting. MRI reveals a complete radial tear of the posterior horn of the medial meniscus at its root attachment. If left untreated, the alteration in knee joint biomechanics most closely mimics which of the following conditions?

. Complete anterior cruciate ligament deficiency
. Total medial meniscectomy
. Grade III medial collateral ligament sprain
. Posterolateral corner deficiency
. Total lateral meniscectomy

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior horn medial meniscal root tear disrupts the circumferential hoop stresses of the meniscus. Biomechanical studies have shown that a root tear leads to meniscal extrusion and alters contact areas and peak contact pressures in the medial compartment to a degree that is functionally equivalent to a total medial meniscectomy. This leads to rapid progression of osteoarthritis if not repaired.

Question 1353

Topic: Knee Sports

A 24-year-old male is 3 months post-operative from an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. He complains of a painful clunk and inability to fully extend the knee. An MRI shows a nodular mass anterior to the ACL graft. What is the most likely diagnosis and appropriate next step in management?

. Septic arthritis; urgent joint aspiration and lavage.
. Graft impingement; revision ACL reconstruction with a more posterior femoral tunnel.
. Cyclops lesion; arthroscopic excision of the nodule.
. Arthrofibrosis; aggressive manipulation under anesthesia.
. Infrapatellar fat pad syndrome; corticosteroid injection.

Correct Answer & Explanation

. Cyclops lesion; arthroscopic excision of the nodule.

Explanation

A cyclops lesion is a localized form of anterior arthrofibrosis that occurs after ACL reconstruction. It typically presents with a loss of terminal extension and a painful clunk at terminal extension as the fibrotic nodule gets trapped between the femur and tibia. MRI classically demonstrates a soft-tissue nodule anterior to the tibial insertion of the ACL graft. The definitive treatment is arthroscopic excision, which generally restores full extension and resolves symptoms.

Question 1354

Topic: Knee Sports

A 28-year-old soccer player sustains a twisting knee injury. On physical examination, the Dial test reveals 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. However, at 90 degrees of knee flexion, the external rotation is symmetric bilaterally. Which of the following structures is most likely injured?

. Posterior cruciate ligament and lateral collateral ligament.
. Lateral collateral ligament, popliteus, and popliteofibular ligament.
. Posterior cruciate ligament alone.
. Posterior cruciate ligament, lateral collateral ligament, and popliteus.
. Anterior cruciate ligament and medial collateral ligament.

Correct Answer & Explanation

. Lateral collateral ligament, popliteus, and popliteofibular ligament.

Explanation

The Dial test evaluates external rotation of the tibia relative to the femur and is used to assess the integrity of the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). An increase of more than 10 degrees of external rotation compared to the normal side at 30 degrees of flexion, but not at 90 degrees, indicates an isolated injury to the PLC (which includes the lateral collateral ligament, popliteus tendon, and popliteofibular ligament). If the test is positive at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.

Question 1355

Topic: Knee Sports

A 17-year-old female is undergoing a medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar instability.

Intraoperative fluoroscopy is used to identify the anatomic femoral attachment of the MPFL (Schöttle's point). Which of the following radiographic descriptions best defines this exact location on a true lateral radiograph?

. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior articular border of the medial femoral condyle, and proximal to Blumensaat's line.
. 1 mm posterior to the posterior cortical line, 2.5 mm proximal to the posterior articular border, and distal to Blumensaat's line.
. 5 mm anterior to the posterior cortical line, located exactly on the midpoint of Blumensaat's line.
. Distal to Blumensaat's line and immediately anterior to the adductor tubercle.
. Proximal to the adductor tubercle and 5 mm posterior to the posterior cortical line.

Correct Answer & Explanation

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

Explanation

Schöttle's point is the radiographic landmark for the femoral origin of the MPFL on a true lateral radiograph. It is defined geometrically as: 1 mm anterior to a line extending the posterior cortex of the femoral shaft, 2.5 mm distal to a perpendicular line intersecting the posterior origin of the medial femoral condyle articular surface, and proximal to a perpendicular line intersecting the posterior extent of Blumensaat's line.

Question 1356

Topic: Knee Sports

A 24-year-old male presents with stiffness and loss of terminal knee flexion 6 months after an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Radiographs show the femoral tunnel positioned too anteriorly in the intercondylar notch. What is the primary clinical consequence of this specific tunnel malposition?

. Loss of terminal knee extension due to intercondylar roof impingement
. Loss of terminal knee flexion due to overtensioning of the graft
. Increased anterior tibial translation in full extension
. Patellar fracture due to increased extensor mechanism stress
. Postoperative arthrofibrosis isolated to the suprapatellar pouch

Correct Answer & Explanation

. Loss of terminal knee flexion due to overtensioning of the graft

Explanation

Non-anatomic graft placement is a leading cause of ACL reconstruction failure and stiffness. A femoral tunnel placed too anteriorly (high in the notch) results in the graft being overtensioned as the knee goes into flexion, functionally capturing the joint and causing a loss of terminal knee flexion. Conversely, a tibial tunnel placed too anteriorly leads to graft impingement against the intercondylar roof during extension, resulting in a loss of terminal knee extension.

Question 1357

Topic: Knee Sports

A 28-year-old soccer player sustains a twisting knee injury. Physical examination reveals a positive dial test at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees of knee flexion compared to the uninjured contralateral knee. Which of the following injury patterns is most consistent with these clinical findings?

. Isolated posterior cruciate ligament (PCL) injury
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injury
. Combined ACL and PLC injury
. Isolated medial collateral ligament (MCL) injury

Correct Answer & Explanation

. Combined PCL and PLC injury

Explanation

The dial test is used to evaluate injury to the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). An increase in external rotation of more than 10 degrees compared with the normal knee at 30 degrees of flexion, but not at 90 degrees, is indicative of an isolated PLC injury. If external rotation is increased at both 30 and 90 degrees of flexion, it indicates a combined injury to both the PLC and the PCL.

Question 1358

Topic: Knee Sports

When performing a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellofemoral instability, identifying the exact isometric femoral attachment point is critical to avoid overtensioning the graft during flexion. Radiographically, where is the anatomic femoral origin of the MPFL (Schöttle's point) located?

. Anterior to the adductor tubercle and proximal to the medial epicondyle
. In the saddle region between the adductor tubercle proximally and the medial epicondyle distally
. Posterior to the gastrocnemius tubercle
. Distal and anterior to the medial epicondyle
. Distal to the superficial medial collateral ligament insertion

Correct Answer & Explanation

. In the saddle region between the adductor tubercle proximally and the medial epicondyle distally

Explanation

The anatomic femoral insertion of the MPFL is located in a distinct saddle region that lies strictly between the adductor tubercle (proximal) and the medial epicondyle (distal). Schöttle et al. described this radiographically on a true lateral x-ray as 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 point of the Blumensaat line. Positioning the femoral tunnel non-anatomically, particularly too far proximally, will inappropriately overtension the graft during knee flexion.

Question 1359

Topic: Knee Sports

A 45-year-old recreational runner sustains a sudden pop in the posterior aspect of his knee while descending stairs. MRI confirms a complete radial tear immediately adjacent to the medial meniscus posterior root attachment. If managed conservatively, the knee biomechanics will be altered. The resulting tibiofemoral contact mechanics are most equivalent to which of the following conditions?

. A 20% partial medial meniscectomy
. An isolated anterior cruciate ligament tear
. A total medial meniscectomy
. An isolated medial collateral ligament tear
. A focal chondral defect of the medial femoral condyle

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

The posterior root anchors the medial meniscus, allowing it to convert axial loads into circumferential hoop stresses. A complete tear of the meniscal root disrupts this structural continuity, resulting in meniscal extrusion. Biomechanical studies have demonstrated that a medial meniscus posterior root tear leads to a complete loss of meniscal load-sharing ability, causing peak contact pressures in the medial compartment to increase to levels functionally equivalent to those seen after a total medial meniscectomy, accelerating the onset of osteoarthritis.

Question 1360

Topic: Knee Sports

A 13-year-old male gymnast complains of intermittent right knee swelling, pain, and mechanical catching.

Radiographs demonstrate a classic presentation of osteochondritis dissecans (OCD) in the knee. What is the most common anatomic location for this pathology?

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

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

Osteochondritis dissecans (OCD) of the knee predominantly affects the femoral condyles. By far the most common location, accounting for roughly 70-80% of all cases, is the lateral aspect of the medial femoral condyle (often remembered by the acronym LAME - Lateral Aspect Medial Epicondyle/Condyle). This is thought to be related to repetitive microtrauma from the tibial spine impinging upon the condyle during internal tibial rotation.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page