Menu

Knee Sports MCQs

Practice Set 7 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 121

Topic: Knee Sports

A 25-year-old rugby player sustains a direct blow to the anteromedial tibia with the knee flexed. Clinical exam reveals a positive Dial test at 30 degrees of flexion, but symmetric rotation at 90 degrees. What is the most likely injured structure?

. Isolated posterior cruciate ligament
. Isolated anterior cruciate ligament
. Isolated posterolateral corner structures
. Combined PCL and posterolateral corner
. Medial collateral ligament

Correct Answer & Explanation

. Isolated posterolateral corner structures

Explanation

A positive Dial test (increased external rotation of the tibia >10 degrees compared to the contralateral side) at 30 degrees only indicates an isolated posterolateral corner (PLC) injury. If the test is positive at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 122

Topic: Knee Sports

Which of the following zones of the meniscus is most amenable to successful surgical repair due to its robust vascular supply?

. White-white zone
. Red-white zone
. Red-red zone
. Inner avascular margin
. Central meniscal root

Correct Answer & Explanation

. Red-red zone

Explanation

The peripheral outer one-third (red-red zone) of the meniscus receives an excellent blood supply from the perimeniscal capillary plexus. Longitudinal tears in this zone have the highest healing rates following surgical repair.

Question 123

Topic: Knee Sports

What is the most common anatomic location for Osteochondritis Dissecans (OCD) lesions in the adolescent knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central articular surface of the patella
. Weight-bearing dome of the medial tibial plateau
. Trochlear groove

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most frequent location for an OCD lesion in the knee is the lateral aspect of the medial femoral condyle. The exact etiology is unknown but is highly associated with repetitive microtrauma and localized ischemia.

Question 124

Topic: Knee Sports

A 16-year-old gymnast experiences an acute lateral patellar dislocation upon landing a vault. Which ligament is the primary restraint to lateral patellar translation at 0 to 30 degrees of knee flexion, and is nearly universally torn in this scenario?

. Medial patellotibial ligament
. Lateral retinaculum
. Medial patellofemoral ligament (MPFL)
. Patellar tendon
. Medial collateral ligament

Correct Answer & Explanation

. Medial patellofemoral ligament (MPFL)

Explanation

The medial patellofemoral ligament (MPFL) provides 50-60% of the stabilizing restraining force against lateral patellar displacement during early flexion. It is anatomically torn in over 90% of acute lateral patellar dislocations.

Question 125

Topic: Knee Sports
A 16-year-old gymnast complains of chronic anterior knee pain. On examination, the patella is highly mobile laterally. You suspect patellofemoral instability. Reconstruction of the medial patellofemoral ligament (MPFL) is planned. Where is the normal anatomic femoral origin of the MPFL?
. Just proximal and posterior to the medial epicondyle
. Anterior to the medial epicondyle
. Distal to the adductor tubercle
. On the medial joint line
. At the superior pole of the patella

Correct Answer & Explanation

. Just proximal and posterior to the medial epicondyle

Explanation

The femoral footprint of the MPFL is located in a saddle-shaped depression between the medial epicondyle and the adductor tubercle, anatomically described as proximal and posterior to the medial epicondyle (Schöttle's point).

Question 126

Topic: Knee Sports

A 30-year-old runner presents with lateral knee pain that is worse when running downhill. Tenderness is maximal 2-3 cm proximal to the lateral joint line. Examination reveals a positive Noble compression test. What is the most likely diagnosis?

. Lateral meniscus tear
. Popliteus tendinitis
. Iliotibial band friction syndrome
. Biceps femoris tendinopathy
. LCL sprain

Correct Answer & Explanation

. Iliotibial band friction syndrome

Explanation

Iliotibial band friction syndrome commonly presents with lateral knee pain in runners, localized proximal to the lateral epicondyle. The Noble compression test is classically positive.

Question 127

Topic: Knee Sports

Which of the following physical examination findings is most specific for a complete posterior cruciate ligament (PCL) injury?

. Positive Lachman test
. Positive posterior sag sign
. Positive pivot shift test
. Positive Dial test at 30 degrees only
. Positive McMurray test

Correct Answer & Explanation

. Positive posterior sag sign

Explanation

The posterior sag sign (Godfrey's test) is highly specific and sensitive for PCL insufficiency. A posterior step-off of the tibia relative to the femoral condyles at 90 degrees of flexion confirms the diagnosis.

Question 128

Topic: Knee Sports

A 14-year-old gymnast presents with chronic anterior knee pain. Imaging reveals an osteochondritis dissecans (OCD) lesion. What is the most common anatomical location for this lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Lateral aspect of the lateral femoral condyle
. Inferior pole of the patella
. Trochlear groove

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for osteochondritis dissecans of the knee is the lateral aspect of the medial femoral condyle. It accounts for approximately 70-80% of all knee OCD lesions.

Question 129

Topic: Knee Sports

During medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, accurate anatomic placement of the femoral tunnel is critical for graft isometry. The normal femoral footprint of the MPFL is located:

. Anterior and proximal to the medial epicondyle
. Posterior and distal to the medial epicondyle
. In the saddle between the adductor tubercle and the medial epicondyle
. Directly on the adductor tubercle
. Anterior to the adductor tubercle

Correct Answer & Explanation

. In the saddle between the adductor tubercle and the medial epicondyle

Explanation

The anatomic femoral origin of the MPFL is located in the saddle-shaped depression between the medial epicondyle and the adductor tubercle. Non-anatomic placement can lead to abnormal graft tension and restricted range of motion.

Question 130

Topic: Knee Sports

The best clinical test for diagnosis of an anterior cruciate ligament (AC L) rupture is:

. Anterior drawer
. Pivot shift
. Losee
. Lachman
. Single leg hop

Correct Answer & Explanation

. Lachman

Explanation

The Lachman test provides the best predictive value of all clinical tests for diagnosis of an anterior cruciate ligament rupture. The diagnosis of a complete AC L rupture can be reliably made clinically without the added expense of a preoperative magnetic resonance image.

Question 131

Topic: Knee Sports

The reason a patient with an acute rupture of the anterior cruciate ligament will usually have a hemarthrosis is due to disruption of what main blood supply to the ligament:

. Lateral superior geniculate artery
. Medial superior geniculate artery
. Middle geniculate artery
. Medial inferior geniculate artery
. Lateral inferior geniculate artery

Correct Answer & Explanation

. Middle geniculate artery

Explanation

The major blood supply to the anterior cruciate ligament arises from the ligamentous branches of the middle genicular artery, with minor contribution from the terminal branches of the medial and lateral inferior genicular arteries. The AC L is covered in a synovial fold that is richly supplied by the middle geniculate artery.

Question 132

Topic: Knee Sports

A patient underwent bone-patellar-bone anterior cruciate ligament reconstruction. Postoperative radiographs show the femoral tunnel has been placed too far anteriorly. What is the most likely clinical result of anterior placement of the femoral tunnel:

. Limited extension
. Anterior instability
. Anterior knee pain
. Limited flexion
. Posterior instability

Correct Answer & Explanation

. Limited flexion

Explanation

A femoral tunnel that has been placed too anterior will limit extension. Numerous studies have shown the most common technical mistake intraoperatively is placement of either the tibial or the femoral tunnel, or both, too far anteriorly. Either of these aberrant placements may cause impingement of the graft and thus promote formation of a large lump of fibrous tissue, known as a Cyclops lesion. This lesion forms anterior to the graft, potentially blocking extension of the knee.

Question 133

Topic: Knee Sports

The anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) function synergistically. Which of the following best describes the primary biomechanical role of the posterolateral bundle?

. It is primarily tight in flexion and resists posterior tibial translation.
. It is the primary restraint to anterior tibial translation at 90 degrees of flexion.
. It is primarily tight in extension and highly controls rotatory loads.
. It is thicker and stronger than the AM bundle in the native knee.
. It attaches to the medial wall of the lateral femoral condyle near the roof of the notch.

Correct Answer & Explanation

. It is primarily tight in extension and highly controls rotatory loads.

Explanation

The PL bundle is tight in extension and provides the primary restraint against rotatory loads. Conversely, the AM bundle tightens in flexion and serves as the primary restraint to anterior tibial translation at 90 degrees of flexion.

Question 134

Topic: Knee Sports

A 24-year-old male sustains a knee injury during a soccer match. Physical exam reveals a positive Dial test with 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the uninjured side, but symmetric external rotation at 90 degrees. Which structure is most likely isolated in this injury?

. Posterior cruciate ligament
. Anterior cruciate ligament
. Posterolateral corner
. Medial collateral ligament
. Combined PCL and popliteofibular ligament

Correct Answer & Explanation

. Posterolateral corner

Explanation

Increased external rotation at 30 degrees of flexion but not at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If external rotation is increased at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.

Question 135

Topic: Knee Sports

Which of the following describes the functional anatomy of the anterior cruciate ligament (ACL) bundles during knee motion?

. The anteromedial bundle is tight in extension and lax in flexion
. The posterolateral bundle is tight in flexion and lax in extension
. The anteromedial bundle is tight in flexion and the posterolateral bundle is tight in extension
. Both bundles are equally tight throughout the entire range of motion
. The anteromedial bundle controls rotatory stability more than the posterolateral bundle

Correct Answer & Explanation

. The anteromedial bundle is tight in flexion and the posterolateral bundle is tight in extension

Explanation

The anteromedial (AM) bundle of the ACL is tightest in flexion and primarily controls anterior translation. The posterolateral (PL) bundle is tightest in extension and provides primary control against rotatory loads.

Question 136

Topic: Knee Sports

The anterior cruciate ligament (ACL) consists of two distinct functional bundles. Which of the following statements correctly describes the biomechanical role of the posterolateral bundle?

. It is the primary restraint to anterior tibial translation at 90 degrees of flexion
. It is tightest in full extension and provides primary rotational stability
. It originates on the high and anterior aspect of the femoral footprint
. It is the primary restraint to valgus laxity
. It is predominantly isometric throughout the range of motion

Correct Answer & Explanation

. It is tightest in full extension and provides primary rotational stability

Explanation

The posterolateral (PL) bundle of the ACL is tightest in extension and provides the primary restraint to internal rotation. The anteromedial (AM) bundle is tightest in flexion and resists anterior translation.

Question 137

Topic: Knee Sports

A 45-year-old patient suffers an acute posterior root tear of the medial meniscus. Biomechanically, this injury is most equivalent to which of the following conditions?

. Anterior cruciate ligament deficient knee
. Total medial meniscectomy
. Partial peripheral meniscectomy
. Posterior cruciate ligament deficient knee
. Isolated medial collateral ligament sprain

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus disrupts the hoop stresses, causing the meniscus to extrude under load. Biomechanically, this completely eliminates the load-sharing function, rendering the knee equivalent to one with a total medial meniscectomy.

Question 138

Topic: Knee Sports

The medial patellofemoral ligament (MPFL) provides the primary soft tissue restraint to lateral patellar translation at which of the following knee flexion angles?

. 0 to 30 degrees
. 45 to 60 degrees
. 60 to 90 degrees
. 90 to 120 degrees
. Beyond 120 degrees

Correct Answer & Explanation

. 0 to 30 degrees

Explanation

The MPFL is the primary restraint to lateral patellar displacement in early flexion (0 to 30 degrees). Beyond 30 degrees, the patella engages the trochlear groove, and bony stability becomes the primary restraint.

Question 139

Topic: Knee Sports

In the setting of chronic anterior cruciate ligament (AC L) deficiency, which of the following meniscal tear patterns is most common:

. Peripheral posterior horn tears of the medial meniscus
. Peripheral posterior horn tears of the lateral meniscus
. Peripheral anterior horn tears of the medial meniscus
. Peripheral anterior horn tears of the lateral meniscus
. C entral posterior horn tears of the medial meniscus

Correct Answer & Explanation

. Peripheral posterior horn tears of the medial meniscus

Explanation

Medial meniscal tears account for approximately 45% of acute tears and 70% of chronic tears in patients with AC L insufficiency. Peripheral posterior horn tears of the medial meniscus are the most common type of tear associated with chronic AC L deficiency.

Question 140

Topic: Knee Sports

Which of the following describes the most accurate femoral attachment site of the medial patellofemoral ligament (MPFL) in relation to the medial epicondyle and adductor tubercle?

. Anterior and distal to the medial epicondyle
. Posterior and proximal to the medial epicondyle (between the adductor tubercle and medial epicondyle)
. Directly on the adductor tubercle
. Distal to the adductor tubercle and posterior to the medial epicondyle
. Anterior to the adductor tubercle

Correct Answer & Explanation

. Posterior and proximal to the medial epicondyle (between the adductor tubercle and medial epicondyle)

Explanation

The femoral footprint of the MPFL is located in a saddle-like sulcus posterior and proximal to the medial epicondyle, and distal and anterior to the adductor tubercle.

Test Yourself

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

On this Page