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Knee Sports MCQs

Practice Set 69 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 1361

Topic: Knee Sports

During an anatomic single-bundle anterior cruciate ligament (ACL) reconstruction, identifying the native footprint is critical. With the knee in 90 degrees of flexion, the native ACL femoral footprint is located immediately posterior to which of the following arthroscopic bony landmarks?

. Lateral bifurcate ridge
. Lateral intercondylar ridge (Resident's ridge)
. Medial intercondylar ridge
. Posterior cruciate ligament facet
. Gerdy's tubercle

Correct Answer & Explanation

. Lateral intercondylar ridge (Resident's ridge)

Explanation

The lateral intercondylar ridge, also known as resident's ridge, is the most consistent and reliable anatomic landmark for identifying the anterior border of the ACL on the lateral femoral condyle. The entire ACL femoral footprint is located posterior to this ridge. The lateral bifurcate ridge separates the anteromedial (AM) and posterolateral (PL) bundles of the ACL, but it is less consistently identified than the lateral intercondylar ridge.

Question 1362

Topic: Knee Sports

A 50-year-old female presents with acute medial knee pain and a popping sensation after squatting. MRI reveals a posterior medial meniscus root tear. Biomechanical studies have shown that a complete medial meniscus posterior root tear alters knee joint kinematics most similarly to which of the following?

. Complete ACL tear
. Total medial meniscectomy
. Partial medial meniscectomy
. Complete MCL tear
. Total lateral meniscectomy

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A complete tear of the posterior root of the medial meniscus leads to the complete loss of circumferential hoop stresses within the meniscus, resulting in meniscal extrusion under load. Biomechanical cadaveric studies have demonstrated that this increases peak contact pressures and decreases contact area in the medial compartment to levels equivalent to those seen after a total medial meniscectomy. This accelerates the progression of osteoarthritis if left untreated.

Question 1363

Topic: Knee Sports

A 17-year-old female experiences recurrent lateral patellar instability, and a medial patellofemoral ligament (MPFL) reconstruction is planned.

To maintain proper graft isometry, the femoral tunnel must be placed accurately at the anatomic footprint. Radiographically, Schöttle's point is best described on a true lateral view as being located:

. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line
. 1 mm anterior to the posterior cortex extension line, 2.5 mm proximal to the posterior articular border, and proximal to Blumensaat's line
. 1 mm posterior to the posterior cortex extension line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line
. Anterior to Blumensaat's line and distal to the adductor tubercle
. Directly at the apex of the medial epicondyle

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line

Explanation

Schöttle's point is a radiographic landmark for the anatomic femoral origin of the MPFL. On a strict true lateral radiograph, it is identified as 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior border of the medial femoral condyle articular surface, and proximal to the posterior extent of Blumensaat's line. Placing the graft at this isometric point prevents over-constraining the patellofemoral joint during flexion.

Question 1364

Topic: Knee Sports

A 14-year-old male gymnast complains of chronic lateral elbow pain and mechanical catching for the past 6 months. Radiographs demonstrate a radiolucent defect in the capitellum. MRI reveals a fragmented, unstable 1.2 cm osteochondral lesion with fluid tracking behind the fragment. What is the most appropriate definitive management?

. Rest and complete cessation of gymnastics for 6 months
. Corticosteroid injection into the radiocapitellar joint
. Arthroscopic fragment excision and marrow stimulation (microfracture)
. Ulnar collateral ligament reconstruction
. Open reduction and internal fixation with compression screws

Correct Answer & Explanation

. Arthroscopic fragment excision and marrow stimulation (microfracture)

Explanation

The patient has osteochondritis dissecans (OCD) of the capitellum. While nonoperative management (rest, cessation of throwing/weight-bearing) is indicated for stable lesions in patients with open physes, this patient has mechanical symptoms and an MRI showing fluid behind a fragmented lesion, indicating instability. For unstable, non-reconstructable fragments smaller than 1.5 cm, arthroscopic excision, loose body removal, and marrow stimulation (microfracture) of the base is the standard of care to stimulate fibrocartilage repair.

Question 1365

Topic: Knee Sports

The posterior cruciate ligament (PCL) consists of two functional bundles: the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. Which of the following statements accurately describes their respective biomechanical tensioning patterns during knee range of motion?

. The AL bundle is tightest in extension and the PM bundle is tightest in flexion
. The AL bundle is tightest in flexion and the PM bundle is tightest in extension
. Both bundles are maximally taut in full extension
. Both bundles are maximally taut in deep flexion
. The AL bundle primarily restrains valgus stress while the PM bundle restrains varus stress

Correct Answer & Explanation

. The AL bundle is tightest in flexion and the PM bundle is tightest in extension

Explanation

The PCL is the primary restraint to posterior tibial translation. The anterolateral (AL) bundle is the larger and stiffer of the two; it is relatively lax in extension and becomes tight in flexion (maximally taut around 80-90 degrees). The smaller posteromedial (PM) bundle exhibits the opposite pattern: it is tight in full extension and becomes lax as the knee flexes. This reciprocal tensioning allows the PCL to function effectively throughout the entire arc of motion.

Question 1366

Topic: Knee Sports

A 16-year-old female soccer player undergoes primary ACL reconstruction with a bone-patellar tendon-bone autograft. Which of the following radiographic anatomical factors is most highly associated with an increased risk of primary ACL tear and subsequent graft failure?

. Increased posterior tibial slope
. Decreased Q angle
. Increased intercondylar notch width
. Decreased lateral tibial slope
. Patella baja

Correct Answer & Explanation

. Increased posterior tibial slope

Explanation

Increased posterior tibial slope is a well-documented independent risk factor for both primary anterior cruciate ligament (ACL) tears and subsequent ACL reconstruction graft failure. A steeper slope increases the anterior translational force on the tibia during axial loading, placing higher strain on the native ACL or the graft. Decreased intercondylar notch width (stenosis), not increased width, is also a recognized risk factor.

Question 1367

Topic: Knee Sports

A 45-year-old male recreational tennis player presents with acute posterior knee pain after a deep lunge. MRI reveals a complete radial tear of the posterior horn of the medial meniscus at its root attachment.

Biomechanically, this injury is equivalent to which of the following?

. A structurally intact meniscus
. A 50% partial meniscectomy
. A total meniscectomy
. An isolated ACL tear
. An isolated PCL tear

Correct Answer & Explanation

. A total meniscectomy

Explanation

A complete radial tear at the meniscal root completely disrupts the circumferential hoop stresses of the meniscus. Biomechanically, it leads to extrusion of the meniscus and an increase in peak tibiofemoral contact pressures that is equivalent to a total meniscectomy. This severely predisposes the knee to rapid articular cartilage degeneration and early-onset osteoarthritis if left untreated.

Question 1368

Topic: Knee Sports

A 17-year-old female suffers an acute lateral patellar dislocation. MRI shows a tear of the medial patellofemoral ligament (MPFL). During an MPFL reconstruction, identifying the isometric point on the femur is critical. According to Schöttle's radiographic landmarks, where is the anatomic femoral attachment of the MPFL on a true lateral radiograph?

. Anterior to the posterior cortical line of the femur and proximal to Blumensaat's line
. Anterior to the posterior cortical line of the femur and distal to Blumensaat's line
. Posterior to the posterior cortical line of the femur and proximal to Blumensaat's line
. Anterior to the posterior cortical line of the femur and strictly on Blumensaat's line
. Distal to the medial epicondyle

Correct Answer & Explanation

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

Explanation

Schöttle's point reliably identifies the femoral footprint of the MPFL on a true lateral radiograph. It is located 1.3 mm anterior to the posterior cortical line of the femur, 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. Misplacement of the femoral tunnel, particularly too proximal or anterior, leads to abnormal graft tensioning and high failure rates.

Question 1369

Topic: Knee Sports

A 26-year-old male sustains an isolated grade III posterior cruciate ligament (PCL) injury during a motorcycle collision. Biomechanically, the anterolateral (AL) bundle of the PCL is tightest in which position, and what is its primary role?

. Tightest in extension, primary restraint to posterior translation in extension
. Tightest in flexion, primary restraint to posterior translation in flexion
. Tightest in extension, primary restraint to internal rotation
. Tightest in flexion, primary restraint to external rotation
. Tightest in mid-flexion, primary restraint to varus stress

Correct Answer & Explanation

. Tightest in flexion, primary restraint to posterior translation in flexion

Explanation

The PCL consists of two main functional bundles: the anterolateral (AL) bundle and the posteromedial (PM) bundle. The AL bundle is larger and stronger, and it is tightest in knee flexion (typically between 80 to 90 degrees). Its primary role is to act as the primary restraint to posterior tibial translation when the knee is flexed. The PM bundle is tightest in knee extension.

Question 1370

Topic: Knee Sports

A 24-year-old professional rugby player undergoes a multiligament knee reconstruction, including an anatomic posterolateral corner (PLC) reconstruction using a fibular-based technique. During the creation of the fibular tunnel, the drill is passed from anterolateral to posteromedial.

Which of the following structures is at greatest risk of iatrogenic injury during this specific step, and what is its primary clinical manifestation if injured?

. Common peroneal nerve; weakness in ankle plantar flexion
. Common peroneal nerve; decreased sensation over the dorsum of the foot and weakness in ankle dorsiflexion
. Tibial nerve; decreased sensation over the plantar aspect of the foot
. Saphenous nerve; decreased sensation over the medial aspect of the leg
. Deep peroneal nerve; isolated weakness in great toe extension

Correct Answer & Explanation

. Common peroneal nerve; decreased sensation over the dorsum of the foot and weakness in ankle dorsiflexion

Explanation

The common peroneal nerve is intimately associated with the fibular head and neck. During anatomic posterolateral corner (PLC) reconstruction, creating the fibular tunnel (especially when dissecting distally on the fibular head or drilling from anterolateral to posteromedial) places the common peroneal nerve at significant risk. Injury to the common peroneal nerve leads to weakness in ankle dorsiflexion and eversion (foot drop) and decreased sensation over the anterolateral leg and the dorsum of the foot. The deep peroneal nerve branches further distally and isolated injury here during a fibular tunnel drill is less likely than a main trunk injury.

Question 1371

Topic: Knee Sports

When performing an anatomic reconstruction of the posterolateral corner (PLC) of the knee, identifying the exact femoral attachments is critical to restore native biomechanics. Which of the following describes the correct anatomic location of the fibular collateral ligament (FCL) origin relative to the popliteus tendon origin on the lateral femoral condyle?

. 10.6 mm distal and anterior
. 10.6 mm proximal and posterior
. 18.5 mm proximal and posterior
. 18.5 mm distal and anterior
. 5.0 mm proximal and anterior

Correct Answer & Explanation

. 18.5 mm proximal and posterior

Explanation

Based on quantitative anatomic studies by LaPrade et al., the femoral attachment of the fibular collateral ligament (FCL) is consistently located 18.5 mm proximal and 4.3 mm posterior to the popliteus tendon attachment on the lateral femoral condyle. Recognizing this relationship is crucial during anatomic PLC reconstructions to avoid graft anisometry and subsequent failure.

Question 1372

Topic: Knee Sports

During reconstruction of the medial patellofemoral ligament (MPFL) for recurrent patellar instability, identifying the anatomic femoral attachment is critical to avoid graft anisometry. Radiographically, Schöttle's point is best described on a true lateral radiograph of the knee as:

. 1 mm posterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior notch
. 1 mm anterior to the posterior cortex extension line, 2.5 mm proximal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior notch
. 1 mm posterior to the posterior cortex extension line, 2.5 mm proximal to the posterior origin of the medial femoral condyle, and distal to the level of the posterior notch
. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior notch
. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and distal to the level of the posterior notch

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior notch

Explanation

Schöttle's point is the established radiographic landmark for the anatomic femoral origin of the MPFL. On a strict lateral radiograph, it is defined as: 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior origin (articular border) of the medial femoral condyle, and proximal to the posterior point of Blumensaat's line (the posterior notch).

Question 1373

Topic: Knee Sports

A 45-year-old marathon runner feels a sharp 'pop' in the posterior aspect of his knee while performing a deep squat. MRI reveals a posterior root tear of the medial meniscus. Radiographs show no significant osteoarthritis (Kellgren-Lawrence grade 1). Which of the following best describes the biomechanical consequence of leaving this tear untreated?

. It decreases peak tibiofemoral contact pressures by 25%.
. It alters knee kinematics similar to an anterior cruciate ligament tear.
. It is biomechanically equivalent to a total medial meniscectomy.
. It leads to isolated patellofemoral compartment overload.
. It restricts internal rotation of the tibia during terminal knee extension.

Correct Answer & Explanation

. It is biomechanically equivalent to a total medial meniscectomy.

Explanation

A posterior root tear of the medial meniscus disrupts the circumferential hoop stresses that normally distribute axial loads across the joint. Biomechanical studies have demonstrated that a medial meniscus posterior root tear is functionally and biomechanically equivalent to a total medial meniscectomy. This results in significantly decreased contact area and increased peak contact pressures, leading to rapid chondral wear and extrusion of the meniscus if left unmanaged. Surgical repair is indicated in active patients without advanced osteoarthritis.

Question 1374

Topic: Knee Sports

A 17-year-old female dancer suffers her third lateral patellar dislocation. Evaluation reveals normal lower extremity alignment and a tibial tubercle-trochlear groove (TT-TG) distance of 14 mm. An isolated medial patellofemoral ligament (MPFL) reconstruction is planned.

Which of the following statements is true regarding the biomechanics of the MPFL?

. It is the primary restraint to lateral patellar translation at 90 degrees of knee flexion.
. Its femoral origin is located anterior to the medial epicondyle and distal to the adductor tubercle.
. Its isolated rupture is rarely associated with acute lateral patellar dislocations.
. It provides the greatest restraint to lateral patellar translation from 0 to 30 degrees of knee flexion.
. Over-tensioning the graft will cause a medial patellar subluxation exclusively in deep flexion.

Correct Answer & Explanation

. It provides the greatest restraint to lateral patellar translation from 0 to 30 degrees of knee flexion.

Explanation

The medial patellofemoral ligament (MPFL) is the primary passive soft-tissue restraint against lateral patellar translation, providing 50% to 60% of the total restraining force from 0 to 30 degrees of knee flexion. Beyond 30 degrees of flexion, the patella engages the trochlear groove, and bony architecture becomes the primary stabilizer. The anatomic femoral origin of the MPFL (Schottle's point) is located between the medial epicondyle and the adductor tubercle. Over-tensioning an MPFL graft typically restricts flexion and increases medial compartment contact pressures.

Question 1375

Topic: Knee Sports

A 28-year-old downhill skier sustains a high-energy multi-ligamentous knee dislocation (KD-III L) involving the anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner. In the emergency department, the patient exhibits a complete foot drop and cannot actively extend the toes. Given the expected nerve injury, which of the following sensory deficits is most likely to accompany this motor finding?

. Numbness over the medial aspect of the lower leg and medial malleolus
. Numbness over the dorsum of the foot and the lateral aspect of the lower leg
. Numbness isolated to the plantar aspect of the foot and heel
. Numbness over the posterior calf and lateral aspect of the fifth toe
. Numbness extending into the anterior thigh

Correct Answer & Explanation

. Numbness over the dorsum of the foot and the lateral aspect of the lower leg

Explanation

Knee dislocations involving the posterolateral corner have a high association (up to 40%) with common peroneal nerve injury due to traction or direct trauma as the nerve winds around the fibular neck. The common peroneal nerve bifurcates into the deep and superficial peroneal nerves. Injury results in loss of ankle dorsiflexion and toe extension (foot drop) and a sensory deficit over the lateral aspect of the lower leg (superficial peroneal nerve) and the dorsum of the foot, specifically including the first web space (deep peroneal nerve). Medial numbness indicates saphenous nerve involvement, while plantar numbness suggests tibial nerve injury.

Question 1376

Topic: Knee Sports

A 25-year-old male sustains a severe twisting injury to his right knee while playing soccer. On physical examination, the dial test reveals 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of knee flexion, the dial test shows 20 degrees of increased external rotation compared to the normal knee. Based on these examination findings, which of the following injury patterns is most likely present?

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

Correct Answer & Explanation

. Combined injury to the posterolateral corner and posterior cruciate ligament

Explanation

The dial test is utilized to evaluate for posterolateral instability. Increased external rotation (>10 degrees compared to the contralateral side) isolated at 30 degrees of flexion indicates an isolated posterolateral corner (PLC) injury. However, if there is increased external rotation at both 30 degrees and 90 degrees of flexion, it signifies a combined injury to both the PLC and the posterior cruciate ligament (PCL). Isolated PCL injuries may show slight asymmetry at 90 degrees but are not the primary driver of the marked external rotation seen in combined injuries.

Question 1377

Topic: Knee Sports

A 50-year-old active female experiences a 'pop' in the back of her knee while descending stairs. An MRI demonstrates a complete radial tear at the posterior root of the medial meniscus with no significant osteoarthritis (Outerbridge grade II). If left untreated, what is the primary biomechanical consequence of this specific injury pattern?

. Increased anterior tibial translation during the pivot shift test
. Altered patellofemoral tracking leading to lateral facet overload
. Complete loss of meniscal hoop stresses, resulting in tibiofemoral contact pressures equivalent to a total meniscectomy
. Increased varus alignment due to failure of the lateral collateral ligament
. Decreased internal rotation of the tibia on the femur during the gait cycle

Correct Answer & Explanation

. Complete loss of meniscal hoop stresses, resulting in tibiofemoral contact pressures equivalent to a total meniscectomy

Explanation

A complete meniscal root tear disrupts the circumferential collagen fibers of the meniscus. Biomechanically, this results in meniscal extrusion under axial load and a complete loss of meniscal hoop stresses. The resulting peak tibiofemoral contact pressures in the affected compartment are equivalent to those seen after a total meniscectomy, leading to rapid progression of articular cartilage degeneration.

Question 1378

Topic: Knee Sports

A 17-year-old female presents with recurrent lateral patellar instability.

Radiographs demonstrate a Caton-Deschamps ratio of 1.1 and normal trochlear depth. A CT scan measures the tibial tubercle-trochlear groove (TT-TG) distance at 14 mm. MRI reveals an incompetent medial patellofemoral ligament (MPFL) with no loose bodies. What is the most appropriate surgical management for this patient?

. Isolated MPFL reconstruction
. Tibial tubercle medialization osteotomy
. Tibial tubercle distalization osteotomy
. Sulcus-deepening trochleoplasty
. Lateral retinacular release alone

Correct Answer & Explanation

. Isolated MPFL reconstruction

Explanation

This patient has recurrent patellar instability with an incompetent MPFL, which is the primary restraint to lateral patellar translation at early flexion. Her anatomic risk factors are within normal limits: a normal TT-TG distance (<20 mm indicates no need for medialization), normal patellar height (Caton-Deschamps ratio 0.8-1.2, no need for distalization), and no significant trochlear dysplasia. Therefore, isolated MPFL reconstruction is the most appropriate and biomechanically sound surgical treatment.

Question 1379

Topic: Knee Sports

A 12-year-old skeletally immature male presents with vague anterior knee pain. Radiographs demonstrate an osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. MRI confirms an intact cartilage cap with no T2 fluid signal behind the bony fragment.

What is the most appropriate initial management?

. Arthroscopic transarticular drilling of the lesion
. Arthroscopic fixation with bioabsorbable screws
. Activity modification and non-weight bearing for 3 to 6 months
. Osteochondral autograft transfer (OATS)
. Arthroscopic microfracture

Correct Answer & Explanation

. Activity modification and non-weight bearing for 3 to 6 months

Explanation

In skeletally immature patients, a stable OCD lesion (intact cartilage cap, absence of fluid behind the fragment on MRI) has a high propensity for spontaneous healing. The standard initial management is a 3- to 6-month trial of nonoperative treatment consisting of activity restriction, immobilization, and/or weight-bearing modifications before considering surgical intervention.

Question 1380

Topic: Knee Sports

A 19-year-old female gymnast undergoes an acute lateral patellar dislocation which is reduced in the emergency department. This is her first dislocation. MRI reveals a tear of the medial patellofemoral ligament (MPFL) at its femoral origin, with no osteochondral fractures. There is no evidence of severe trochlear dysplasia. What is the primary patellar restraint provided by the MPFL, and what is the recommended initial management?

. Primary restraint to medial translation at 0-30 degrees of flexion; manage with immediate MPFL reconstruction
. Primary restraint to lateral translation at 0-30 degrees of flexion; manage with physical therapy and bracing
. Primary restraint to lateral translation at 60-90 degrees of flexion; manage with immediate MPFL reconstruction
. Primary restraint to medial translation at 60-90 degrees of flexion; manage with physical therapy and bracing
. Primary restraint to superior translation at full extension; manage with immediate MPFL reconstruction

Correct Answer & Explanation

. Primary restraint to lateral translation at 0-30 degrees of flexion; manage with physical therapy and bracing

Explanation

The MPFL is the primary soft-tissue restraint against lateral patellar translation, providing over 50% of the restraining force, and it functions maximally in early flexion (0 to 30 degrees) before the patella fully engages the trochlear groove. For a first-time dislocator without osteochondral loose bodies or severe anatomic variants, nonoperative treatment with brief immobilization, physical therapy, and bracing is the recommended initial standard of care.

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