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Knee Sports MCQs

Practice Set 71 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 1401

Topic: Knee Sports

A 45-year-old recreational runner feels a "pop" in the posterior aspect of her knee while performing a deep squat. An MRI confirms a complete radial tear of the posterior horn of the medial meniscus at its root attachment. If left untreated, which of the following biomechanical alterations is most likely to occur in the affected knee compartment?

. Decreased peak contact pressure and increased tibiofemoral contact area
. Increased peak contact pressure and decreased tibiofemoral contact area
. Decreased anterior tibial translation and increased varus stability
. Increased hoop stresses leading to subchondral sclerosis
. No significant change in tibiofemoral contact mechanics compared to the intact state

Correct Answer & Explanation

. Increased peak contact pressure and decreased tibiofemoral contact area

Explanation

A meniscal root tear structurally defunctions the meniscus, preventing it from converting axial loads into hoop stresses. Biomechanically, an unrepaired medial meniscus posterior root tear is equivalent to a total medial meniscectomy. This results in a significantly decreased tibiofemoral contact area and a consequent profound increase in peak contact pressure, predisposing the patient to rapid articular cartilage degeneration and subchondral insufficiency fractures.

Question 1402

Topic: Knee Sports

A 16-year-old female presents with recurrent lateral patellar instability. MRI demonstrates a torn medial patellofemoral ligament (MPFL). She has failed nonoperative management and is scheduled for an MPFL reconstruction.

To achieve isometric graft function, the femoral origin of the MPFL graft should be placed anatomically. Relative to the osseous landmarks on the medial distal femur, the anatomic origin of the MPFL is located:

. Directly on the medial epicondyle
. In the saddle region between the medial epicondyle and the adductor tubercle
. Distal and anterior to the medial epicondyle
. Proximal to the adductor tubercle
. At the origin of the medial collateral ligament

Correct Answer & Explanation

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

Explanation

The anatomic femoral origin of the medial patellofemoral ligament (MPFL) is located in the saddle-shaped depression between the medial epicondyle and the adductor tubercle. Placement in this exact location (often approximated fluoroscopically by Schöttle's point) is crucial; non-anatomic placement can lead to graft laxity in flexion or excessive tightness causing medial patellofemoral cartilage overload.

Question 1403

Topic: Knee Sports

A 26-year-old male presents with lateral knee pain and instability after being tackled directly on the anteromedial aspect of his tibia. Physical examination reveals increased external rotation of the tibia compared to the contralateral side at 30 degrees of knee flexion, but this asymmetry resolves at 90 degrees of knee flexion. Which of the following structures constitute the primary static stabilizers of the anatomically defined "posterolateral corner" (PLC) that is injured in this scenario?

. Iliotibial band, lateral collateral ligament, and popliteus tendon
. Lateral collateral ligament, biceps femoris tendon, and arcuate ligament
. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament
. Popliteus tendon, popliteofibular ligament, and posterior cruciate ligament
. Lateral collateral ligament, popliteus tendon, and posterolateral capsule

Correct Answer & Explanation

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

A positive dial test at 30 degrees that does not persist at 90 degrees indicates an isolated posterolateral corner (PLC) injury. (If positive at both 30 and 90, it suggests combined PLC and PCL injuries). The three primary static stabilizers of the PLC are the lateral (fibular) collateral ligament, the popliteus tendon, and the popliteofibular ligament. Anatomic reconstruction of the PLC aims to recreate these three specific structures.

Question 1404

Topic: Knee Sports

A 28-year-old male is evaluated for knee pain and instability after a motorcycle accident. Examination reveals a normal posterior drawer test but increased varus laxity at 30 degrees of flexion. The dial test shows 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side, but symmetric external rotation at 90 degrees. Which of the following structures is most likely injured?

. Isolated Posterior Cruciate Ligament (PCL)
. Isolated Posterolateral Corner (PLC)
. Combined PCL and PLC
. Combined ACL and PLC
. Medial Collateral Ligament (MCL)

Correct Answer & Explanation

. Isolated Posterolateral Corner (PLC)

Explanation

The dial test is used to evaluate the posterolateral corner (PLC) and posterior cruciate ligament (PCL). Increased external rotation (>10 degrees compared to the normal knee) strictly at 30 degrees of flexion with symmetric rotation at 90 degrees indicates an isolated PLC injury. If the dial test is positive at both 30 and 90 degrees, it strongly suggests a combined PCL and PLC injury.

Question 1405

Topic: Knee Sports

A 16-year-old female dancer experiences her third lateral patellar dislocation. Conservative management and physical therapy have failed. Radiographs show a Caton-Deschamps index of 1.1 and a sulcus angle of 135 degrees. A CT scan reveals a tibial tubercle-trochlear groove (TT-TG) distance of 22 mm. Which of the following surgical interventions is most appropriate to restore stability?

. Isolated medial patellofemoral ligament (MPFL) reconstruction
. Isolated lateral retinacular release
. MPFL reconstruction combined with medializing tibial tubercle osteotomy
. Distal femoral derotational osteotomy
. Trochleoplasty

Correct Answer & Explanation

. MPFL reconstruction combined with medializing tibial tubercle osteotomy

Explanation

The patient has recurrent patellar instability with a significantly elevated TT-TG distance (normal is <15 mm; >20 mm is widely considered a biomechanical indication for a medializing tibial tubercle osteotomy). MPFL reconstruction performed in isolation in the presence of an elevated TT-TG distance places excessive tension on the graft, leading to a high risk of graft failure and recurrent instability. Combined MPFL reconstruction and medializing TTO is the most appropriate management.

Question 1406

Topic: Knee Sports

A 10-year-old boy complains of a clunking sensation and pain in his lateral right knee. He has no history of trauma. MRI confirms the diagnosis of a symptomatic complete discoid lateral meniscus. There is no meniscal tear. What is the most appropriate surgical treatment?

. Total meniscectomy
. Nonoperative management with physical therapy
. Arthroscopic saucerization with preservation of a peripheral rim
. Arthroscopic meniscal repair
. Anterior cruciate ligament reconstruction

Correct Answer & Explanation

. Arthroscopic saucerization with preservation of a peripheral rim

Explanation

The standard surgical treatment for a symptomatic complete discoid lateral meniscus without an unstable tear or peripheral detachment is arthroscopic saucerization. The goal is to reshape the meniscus to a more normal, crescentic configuration while preserving a stable peripheral rim (about 6-8 mm) to maintain its shock-absorbing function. Total meniscectomy is avoided due to the high risk of early osteoarthritis.

Question 1407

Topic: Knee Sports
A 12-year-old boy presents with a painful, swollen knee after falling from a bicycle. Radiographs reveal a completely displaced (Meyers-McKeever Type III) tibial eminence fracture. Attempts at closed reduction in full extension fail to anatomically reduce the fragment. Which structure is most commonly entrapped beneath the fragment, blocking reduction?
. Anterior horn of the medial meniscus
. Posterior horn of the medial meniscus
. Anterior cruciate ligament fibers
. Posterior cruciate ligament
. Medial collateral ligament

Correct Answer & Explanation

. Anterior horn of the medial meniscus

Explanation

Tibial eminence (spine) fractures represent an avulsion of the anterior cruciate ligament insertion in children. When a Type III (completely displaced) fracture cannot be reduced closed, the most common anatomic block to reduction is the entrapment of the anterior horn of the medial meniscus (or the transverse intermeniscal ligament) under the bony fragment. Operative intervention (arthroscopic or open) is required to free the entrapped tissue and fix the fragment.

Question 1408

Topic: Knee Sports

A 12-year-old boy presents with vague, poorly localized knee pain and occasional catching. Radiographs demonstrate an osteochondritis dissecans (OCD) lesion.

In which of the following anatomic locations is an OCD lesion of the knee most classically found?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central portion of the medial femoral condyle
. Patellar articular surface
. Tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

Osteochondritis dissecans (OCD) of the knee is most commonly found on the lateral aspect of the medial femoral condyle. This classic location accounts for approximately 70-80% of all knee OCD lesions. A helpful mnemonic is 'LAME': Lateral Aspect of the Medial Epicondyle/condyle. The lateral femoral condyle is the second most common site, usually on the inferocentral aspect.

Question 1409

Topic: Knee Sports

A 22-year-old woman presents with recurrent lateral patellar dislocations after failing 6 months of targeted physical therapy.

Advanced imaging demonstrates a tibial tubercle-trochlear groove (TT-TG) distance of 23 mm and a Caton-Deschamps index of 1.35. Which of the following is the most appropriate surgical treatment?

. Medial patellofemoral ligament (MPFL) reconstruction alone
. MPFL reconstruction combined with distalization and medialization of the tibial tubercle
. MPFL reconstruction combined with anteriorization of the tibial tubercle
. Lateral retinacular release alone
. Sulcus-deepening trochleoplasty alone

Correct Answer & Explanation

. MPFL reconstruction combined with distalization and medialization of the tibial tubercle

Explanation

This patient has significant patella alta (Caton-Deschamps index > 1.2) and an abnormally elevated TT-TG distance (> 20 mm) contributing to instability. Management requires MPFL reconstruction to restore the primary medial restraint, combined with a tibial tubercle osteotomy (distalization and medialization) to correct the anatomic risk factors.

Question 1410

Topic: Knee Sports

A 28-year-old male sustains a direct blow to the anteromedial aspect of his proximal tibia while his knee is flexed. Physical examination reveals increased external rotation of the tibia compared to the contralateral side when tested at 30 degrees of knee flexion, but symmetric external rotation when tested at 90 degrees of knee flexion. Which of the following structures is most likely injured?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Posterolateral corner
. Posteromedial corner
. Superficial medial collateral ligament

Correct Answer & Explanation

. Posterolateral corner

Explanation

The dial test is used to evaluate the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). Increased external rotation of more than 10 degrees compared to the uninjured knee at 30 degrees of flexion, but symmetric external rotation at 90 degrees of flexion, is indicative of an isolated PLC injury. If the external rotation was increased at both 30 and 90 degrees, it would suggest a combined PLC and PCL injury.

Question 1411

Topic: Knee Sports

In a posterior-stabilized (PS) total knee arthroplasty, the cam-post mechanism is designed to mechanically substitute for the resected posterior cruciate ligament (PCL). What is the primary kinematic function of this mechanism during deep knee flexion?

. To induce femoral rollback and prevent anterior translation of the femur on the tibia
. To limit excessive internal rotation of the tibia
. To provide varus-valgus stability in deep flexion
. To prevent posterior subluxation of the tibia in extension
. To force paradoxical anterior sliding of the femur on the tibia

Correct Answer & Explanation

. To induce femoral rollback and prevent anterior translation of the femur on the tibia

Explanation

In a native knee, the PCL causes the femur to roll back posteriorly on the tibia during flexion, which prevents anterior translation of the femur and maximizes the lever arm of the extensor mechanism, aiding in deep flexion. In a posterior-stabilized (PS) TKA, the PCL is excised. To replicate this kinematic function, a cam on the femoral component engages a post on the tibial polyethylene insert during mid-to-deep flexion. This engagement forces mandatory femoral rollback and prevents the femur from translating anteriorly (paradoxical anterior sliding), a phenomenon that can occur in cruciate-retaining knees with a non-functional PCL.

Question 1412

Topic: Knee Sports
A 28-year-old trauma patient undergoes reconstruction of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and posterolateral corner (PLC) following a knee dislocation (KD-III L). During the PLC reconstruction, anatomic placement of the femoral tunnels is essential. Which of the following best describes the anatomic location of the femoral footprint of the popliteus tendon?
. Proximal and posterior to the lateral epicondyle
. Anterior and distal to the lateral epicondyle
. Posterior and distal to the lateral epicondyle
. Proximal and anterior to the lateral epicondyle
. Directly on the prominence of the lateral epicondyle

Correct Answer & Explanation

. Anterior and distal to the lateral epicondyle

Explanation

For an anatomic reconstruction of the posterolateral corner, precise identification of the femoral attachments is critical. Based on anatomic studies by LaPrade et al., the popliteus tendon inserts at the proximal aspect of the popliteus sulcus, which is located 18.5 mm anterior and distal to the fibular collateral ligament (FCL) attachment. Relative to the main osseous landmark (the lateral epicondyle), the popliteus footprint is found anterior and distal. Conversely, the FCL attachment is located slightly proximal and posterior to the lateral epicondyle.

Question 1413

Topic: Knee Sports

A randomized controlled trial compares a new NSAID to a placebo for postoperative pain after ACL reconstruction. The study fails to find a statistically significant difference between the two groups (p = 0.08), despite a true clinically significant difference actually existing in the general population. This scenario represents which of the following, and how could it have been prevented?

. Type I error; decreasing the alpha level
. Type II error; increasing the sample size
. Type I error; using a two-tailed rather than one-tailed test
. Type II error; decreasing the beta level to 0.5
. Confounding bias; strict randomization

Correct Answer & Explanation

. Type II error; increasing the sample size

Explanation

A Type II error (false negative) occurs when a study fails to reject the null hypothesis when it is actually false (i.e., missing a true difference). This typically happens when a study is underpowered. Power is calculated as 1 - Beta (where Beta is the probability of a Type II error). Increasing the sample size is the standard way to increase statistical power and reduce the risk of a Type II error.

Question 1414

Topic: Knee Sports

When evaluating an MRI of the knee to confirm a suspected anterior cruciate ligament (ACL) tear, a specific sequence is chosen wherein the repetition time (TR) is 2500 ms and the echo time (TE) is 100 ms. On this sequence, the joint effusion appears uniformly bright (hyperintense). What type of sequence is being utilized?

. T1-weighted sequence
. T2-weighted sequence
. Proton density sequence
. Short tau inversion recovery (STIR) sequence
. Gradient-recalled echo (GRE) sequence

Correct Answer & Explanation

. T2-weighted sequence

Explanation

A T2-weighted MRI sequence is defined by a long Repetition Time (TR > 2000 ms) and a long Echo Time (TE > 80 ms). On T2-weighted images, tissues with high water content, such as joint effusions, CSF, or edema, appear hyperintense (bright), making it excellent for evaluating pathology. T1 sequences (short TR, short TE) show fat as bright and fluid as dark.

Question 1415

Topic: Knee Sports

A 35-year-old man presents with chronic medial ankle pain. MRI reveals an isolated 1.5 cm osteochondral lesion of the medial talar dome with significant subchondral cystic changes. He has failed 6 months of conservative treatment. What is the most appropriate surgical option?

. Arthroscopic bone marrow stimulation (microfracture)
. Osteochondral autograft transfer (OATS)
. Total ankle replacement
. Tibiotalar arthrodesis
. Subtalar arthrodesis

Correct Answer & Explanation

. Osteochondral autograft transfer (OATS)

Explanation

For larger osteochondral lesions (>1.5 cm) or those with significant subchondral cysts that fail conservative treatment, structural grafting such as OATS is indicated over microfracture due to improved success rates.

Question 1416

Topic: Knee Sports

A 28-year-old female runner presents with persistent deep anterior ankle pain 8 months after a severe inversion injury. An MRI demonstrates a 1.2 cm by 1.0 cm osteochondral lesion on the medial aspect of the talar dome. The overlying articular cartilage appears intact on imaging, but conservative treatment including immobilization and physical therapy has failed. What is the standard first-line surgical management?

. Arthroscopic bone marrow stimulation (microfracture)
. Open osteochondral autograft transfer system (OATS)
. Matrix-induced autologous chondrocyte implantation (MACI)
. Open reduction and internal fixation of the osteochondral fragment
. Distal tibial osteotomy to offload the medial compartment

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

For primary, symptomatic osteochondral lesions of the talus (OLT) that are small to medium-sized (less than 1.5 cm in diameter or 1.5 cm^2 in area) and have failed conservative management, the gold standard first-line surgical treatment is arthroscopic debridement and bone marrow stimulation (microfracture or drilling). This technique promotes the formation of fibrocartilage. OATS and MACI are typically reserved for larger lesions (> 1.5 cm^2), cystic lesions, or lesions that have failed primary microfracture.

Question 1417

Topic: Knee Sports

During a surgical reconstruction of the posterolateral corner of the knee, a surgeon identifies the precise fibular attachments. Which of the following correctly describes the anatomical insertion of the popliteofibular ligament?

. Anterior to the fibular styloid and medial to the biceps femoris tendon
. Posteromedial aspect of the fibular styloid, deep to the fibular collateral ligament
. Anterolateral aspect of the fibular head, superficial to the fibular collateral ligament
. Directly onto the lateral tibial tubercle (Gerdy's tubercle)
. Posterior aspect of the lateral femoral condyle

Correct Answer & Explanation

. Posteromedial aspect of the fibular styloid, deep to the fibular collateral ligament

Explanation

The popliteofibular ligament originates from the musculotendinous junction of the popliteus and inserts on the posteromedial aspect of the fibular styloid. It lies deep and posterior to the fibular collateral ligament insertion.

Question 1418

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, anatomic placement of the femoral tunnel is critical to prevent graft anisometry. According to Schöttle's radiographic point, where should the femoral footprint be located on a strict lateral radiograph?
. Anterior to the posterior cortical line and proximal to the posterior femoral condyle
. 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 level of the Blumensaat line
. Distal to the Blumensaat line and anterior to the posterior cortical line
. Directly on the medial epicondyle
. Posterior to the posterior cortical line and distal to 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, and proximal to the level of the Blumensaat line

Explanation

Schöttle's point defines the radiographic femoral footprint of the MPFL. It is located 1 mm anterior to the posterior femoral cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line.

Question 1419

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction of the knee, anatomic femoral tunnel placement is critical. Where is the normal femoral attachment of the fibular collateral ligament (FCL)?

. Distal and anterior to the lateral epicondyle
. Proximal and posterior to the lateral epicondyle
. Directly on the lateral epicondyle
. Distal and posterior to the popliteus insertion
. Proximal and anterior to the popliteus insertion

Correct Answer & Explanation

. Proximal and posterior to the lateral epicondyle

Explanation

The fibular collateral ligament (FCL) attaches to the lateral femur proximal and posterior to the lateral epicondyle. It is also situated proximal and posterior to the femoral insertion of the popliteus tendon.

Question 1420

Topic: Knee Sports

Biomechanically, the anterior cruciate ligament (ACL) is divided into the anteromedial (AM) and posterolateral (PL) bundles. Which of the following best describes the function and tension pattern of the AM bundle?

. It is tight in extension and primarily controls rotatory stability.
. It is tight in flexion and primarily controls anterior tibial translation.
. It is tight in extension and primarily controls posterior tibial translation.
. It is tight in flexion and primarily controls varus stability.
. It is equally tense throughout the entire range of motion.

Correct Answer & Explanation

. It is tight in flexion and primarily controls anterior tibial translation.

Explanation

The AM bundle of the ACL is relatively tight in flexion and provides the primary restraint to anterior tibial translation. The PL bundle is tight in extension and is the primary restraint to rotatory loads.

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