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Knee Sports MCQs

Practice Set 74 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 1461

Topic: Knee Sports

An 18-year-old athlete undergoes an isolated arthroscopic all-inside repair of a vertical longitudinal tear located in the red-white zone of the medial meniscus. To maximize the biological healing potential of this isolated meniscal repair, which of the following intraoperative adjuncts is most strongly supported by current literature?

. Application of an intra-articular corticosteroid at the conclusion of the case
. Marrow venting procedure (e.g., notch microfracture)
. Administration of intra-articular hyaluronic acid
. Utilizing solely absorbable polydioxanone sutures
. Routine limited resection of the adjacent red-red zone to induce bleeding

Correct Answer & Explanation

. Marrow venting procedure (e.g., notch microfracture)

Explanation

Meniscal healing is heavily dependent on a robust biological environment. Isolated meniscal repairs have historically lower healing rates compared to repairs performed concomitantly with ACL reconstruction. To mimic the hemarthrosis and release of bone marrow elements (progenitor cells and growth factors) seen in ACL reconstruction, a marrow venting procedure (such as intercondylar notch microfracture or trephination) is highly recommended as a biological adjunct for isolated meniscal repairs to stimulate a 'super clot' and improve healing rates.

Question 1462

Topic: Knee Sports
A 45-year-old female presents with sudden onset posteromedial knee pain and a palpable 'pop' while squatting. MRI demonstrates a medial meniscus posterior root tear with 4 mm of meniscal extrusion. Biomechanically, a medial meniscus posterior root tear alters knee kinematics and contact pressures equivalently to which of the following?
. Partial medial meniscectomy
. Total medial meniscectomy
. Anterior cruciate ligament rupture
. Posterior cruciate ligament rupture
. Grade III medial collateral ligament sprain

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

Biomechanical studies have definitively demonstrated that a posterior root tear of the medial meniscus completely disrupts the meniscal hoop stresses. This leads to a loss of load-sharing capability and an increase in peak articular contact pressures that is biomechanically equivalent to a total medial meniscectomy, rapidly predisposing the joint to osteoarthritic degeneration.

Question 1463

Topic: Knee Sports
During reconstruction of the medial patellofemoral ligament (MPFL) for recurrent patellar instability, the surgeon utilizes the Schöttle point to establish the femoral tunnel. If the femoral tunnel is inadvertently placed too proximal and anterior to this isometric point, what is the most likely biomechanical consequence?
. Increased graft tension in flexion
. Increased graft tension in extension
. Equal tension throughout the arc of motion
. Patella baja
. Patella alta

Correct Answer & Explanation

. Increased graft tension in flexion

Explanation

The Schöttle point describes the anatomic femoral attachment of the MPFL. If the femoral tunnel is placed too proximal and anterior, the distance between the patellar attachment and the femoral attachment increases as the knee goes into flexion. This causes the graft to inappropriately tighten during knee flexion, which can result in medial patellar facet overload, cartilage wear, and a significant loss of knee flexion.

Question 1464

Topic: Knee Sports

A 30-year-old male is evaluated in the clinic following a severe twisting injury to his left knee. Physical examination reveals a positive dial test with 15 degrees of increased external rotation at 30 degrees of flexion compared to the contralateral side. However, at 90 degrees of knee flexion, the external rotation is symmetric bilaterally. Which structure or combination of structures is most likely injured?

. Isolated Anterior Cruciate Ligament (ACL)
. Isolated Posterior Cruciate Ligament (PCL)
. Isolated Posterolateral Corner (PLC)
. Combined PCL and PLC
. Combined ACL and PLC

Correct Answer & Explanation

. Isolated Posterolateral Corner (PLC)

Explanation

The dial test evaluates for posterolateral rotatory instability. Increased external rotation (>10 degrees compared to the normal knee) isolated to 30 degrees of flexion with normal symmetry at 90 degrees indicates an isolated injury to the posterolateral corner (PLC). If the test demonstrates increased external rotation at both 30 and 90 degrees, it suggests a combined injury to both the PCL and the PLC.

Question 1465

Topic: Knee Sports

A 14-year-old male presents with vague knee pain and intermittent mechanical catching. Radiographs reveal a 2 x 2 cm osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. MRI reveals a high T2 signal rim completely surrounding the osteochondral fragment. His physes remain open.

What is the most appropriate management?

. Non-weight bearing and cylinder cast immobilization
. Arthroscopic drilling of the lesion without fixation
. Arthroscopic fixation with compression screws or bioabsorbable implants
. Osteochondral autograft transfer (OATS)
. Matrix-induced autologous chondrocyte implantation (MACI)

Correct Answer & Explanation

. Arthroscopic fixation with compression screws or bioabsorbable implants

Explanation

While stable osteochondritis dissecans (OCD) lesions in skeletally immature patients are typically managed nonoperatively, an MRI showing a high T2 signal rim completely surrounding the lesion indicates synovial fluid tracking behind the fragment. This defines it as an unstable lesion. Unstable lesions, even in patients with open physes, have a poor healing capacity with conservative care and require surgical intervention, optimally with arthroscopic in situ fixation.

Question 1466

Topic: Knee Sports

A 25-year-old professional football player sustains a contact injury to his right knee. On physical examination, the dial test reveals 20 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral knee. However, at 90 degrees of knee flexion, the external rotation is symmetric bilaterally. Based on these examination findings, which of the following structures is most likely injured?

. Popliteus tendon and lateral collateral ligament (LCL)
. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Popliteus tendon and posterior cruciate ligament (PCL)
. Medial collateral ligament (MCL)

Correct Answer & Explanation

. Popliteus tendon and lateral collateral ligament (LCL)

Explanation

The dial test is used to evaluate the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). Increased external rotation (>10-15 degrees compared to the normal side) at 30 degrees of flexion with symmetric rotation at 90 degrees indicates an isolated injury to the PLC (which includes the popliteus tendon, popliteofibular ligament, and LCL). If increased external rotation is present at both 30 and 90 degrees of flexion, it indicates a combined injury to the PLC and the PCL.

Question 1467

Topic: Knee Sports

A 50-year-old female presents with sudden onset medial-sided knee pain and a "pop" while squatting in her garden. She has no mechanical locking but exhibits an antalgic gait. MRI reveals a 4 mm medial meniscal extrusion and a radial defect directly at the posterior root attachment of the medial meniscus. If left untreated, the biomechanical consequence of this specific injury is most equivalent to which of the following?

. Isolated anterior cruciate ligament tear
. Isolated posterior cruciate ligament tear
. Total medial meniscectomy
. Partial medial meniscectomy
. Medial collateral ligament tear

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior medial meniscal root tear completely disrupts the circumferential hoop stresses of the meniscus. Biomechanical studies have demonstrated that this leads to an inability of the meniscus to absorb load, effectively resulting in contact areas and peak contact pressures within the medial compartment that are equivalent to a total medial meniscectomy. This drastically accelerates the progression of medial compartment osteoarthritis.

Question 1468

Topic: Knee Sports
A 22-year-old female collegiate soccer player presents with localized anterior knee pain and swelling after matches. She has failed 9 months of conservative management. Knee MRI reveals an isolated, full-thickness chondral defect measuring 3.5 cm² on the weight-bearing surface of the medial femoral condyle. Alignment is normal, and there is no meniscal pathology. Which of the following cartilage restoration procedures is most indicated for this patient?
. Arthroscopic microfracture
. Osteochondral autograft transfer system (OATS)
. Matrix-induced autologous chondrocyte implantation (MACI)
. High tibial osteotomy
. Arthroscopic chondroplasty

Correct Answer & Explanation

. Matrix-induced autologous chondrocyte implantation (MACI)

Explanation

Matrix-induced autologous chondrocyte implantation (MACI) is indicated for symptomatic, full-thickness unipolar chondral defects measuring between 2 cm² and 10 cm² in active patients. Microfracture and osteochondral autograft transfer (OATS) are typically reserved for smaller lesions (< 2 cm²) due to the poor durability of fibrocartilage (microfracture) and donor-site morbidity limitations (OATS). Given her normal alignment, a high tibial osteotomy is not indicated.

Question 1469

Topic: Knee Sports

A 28-year-old male suffers a high-energy knee injury resulting in a combined posterior cruciate ligament (PCL) and posterolateral corner (PLC) tear. He undergoes a staged reconstruction. During reconstruction of the posterolateral corner, an anatomic fibular-based technique is planned. Which three primary static stabilizing structures of the PLC are reconstructed in this technique?

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament
. Fibular collateral ligament, biceps femoris tendon, and iliotibial band
. Lateral collateral ligament, anterolateral ligament, and popliteus tendon
. Popliteus tendon, arcuate ligament, and fabellofibular ligament
. Iliotibial band, lateral collateral ligament, and arcuate ligament

Correct Answer & Explanation

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

The anatomic posterolateral corner reconstruction (such as the technique described by LaPrade et al.) aims to recreate the three primary static stabilizers of the PLC: the fibular collateral ligament (FCL), the popliteus tendon (PLT), and the popliteofibular ligament (PFL). Reconstructing these specific structures biomechanically restores varus and external rotatory stability to the knee.

Question 1470

Topic: Knee Sports

When performing an anatomic reconstruction of the posterolateral corner (PLC) of the knee, accurate identification of the femoral attachments of the lateral collateral ligament (LCL) and the popliteus tendon is critical for restoring normal kinematics. What is the correct anatomic relationship of the LCL femoral attachment relative to the popliteus tendon attachment?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly medial

Correct Answer & Explanation

. Distal and anterior

Explanation

The anatomic footprint of the lateral collateral ligament (LCL) on the lateral femoral epicondyle is consistently located proximal and posterior to the attachment of the popliteus tendon. Misplacement of these tunnels during PLC reconstruction alters graft isometry and leads to failure.

Question 1471

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon utilizes fluoroscopy to verify the anatomic femoral origin point (Schöttle's point). On a strictly lateral radiograph of the knee, where is this point correctly located?
. 1 mm anterior to the posterior femoral cortex line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line
. 1 mm posterior to the posterior femoral cortex line, 2.5 mm proximal to the posterior articular border, and distal to Blumensaat's line
. 5 mm anterior to the posterior femoral cortex line, directly on Blumensaat's line
. At the center of the medial femoral condyle, 10 mm distal to the adductor tubercle
. 5 mm posterior to the medial epicondyle, distal to Blumensaat's line

Correct Answer & Explanation

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

Explanation

Schöttle's point serves as the radiographic landmark for the isometric femoral origin of the MPFL. On a perfect lateral radiograph, it is located 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior articular border of the medial femoral condyle, and proximal to Blumensaat's line.

Question 1472

Topic: Knee Sports
A 45-year-old male feels a pop in the posterior aspect of his right knee while squatting to lift a heavy box. He develops a mild effusion and posterior joint line tenderness. Coronal T2-weighted MRI of the affected knee reveals a 'ghost sign' and >3 mm extrusion of the medial meniscus. What is the most likely diagnosis?
. Medial meniscus posterior root tear
. Anterior cruciate ligament tear
. Patellar tendon rupture
. Popliteus tendon avulsion
. Osteochondritis dissecans of the medial femoral condyle

Correct Answer & Explanation

. Medial meniscus posterior root tear

Explanation

Meniscal root tears frequently occur in middle-aged patients during deep flexion activities, such as squatting. The classic MRI findings on coronal T2 imaging include the 'ghost sign' (absence of identifiable meniscal tissue at the root attachment) and meniscal extrusion >3 mm. Biomechanically, a root tear results in a loss of hoop stresses, effectively functioning like a total meniscectomy if left untreated.

Question 1473

Topic: Knee Sports

A 30-year-old male sustains a severe varus blow to his anteromedial tibia. Clinical examination (Dial test) reveals a 15-degree increase in external rotation of the affected tibia at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of knee flexion, the external rotation is symmetric bilaterally. This finding indicates an isolated injury to which of the following structures?

. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Posterolateral corner (PLC)
. Medial collateral ligament (MCL)
. Posteromedial corner (PMC)

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

The Dial test evaluates for posterolateral corner (PLC) and posterior cruciate ligament (PCL) injuries. An increase in external rotation of greater than 10 degrees (compared to the normal knee) at 30 degrees of flexion, but symmetric rotation at 90 degrees, is pathognomonic for an isolated PLC injury. If external rotation is increased at both 30 and 90 degrees, it indicates a combined injury to the PLC and PCL.

Question 1474

Topic: Knee Sports

A 30-year-old male presents with knee pain following a dashboard injury during a motor vehicle collision. On examination, a posterior sag sign is present. To confirm a posterior cruciate ligament (PCL) injury, the examiner performs a quadriceps active test. Which of the following correctly describes a positive finding for this test in a PCL-deficient knee?

. The tibia shifts anteriorly from a subluxated position when the quadriceps contract at 90 degrees of flexion.
. The tibia shifts posteriorly when the quadriceps contract at 90 degrees of flexion.
. The tibia rotates externally when the quadriceps contract.
. The patella subluxates laterally during eccentric contraction.
. The tibia translates medially under varus stress.

Correct Answer & Explanation

. The tibia shifts anteriorly from a subluxated position when the quadriceps contract at 90 degrees of flexion.

Explanation

In a PCL-deficient knee, the tibia rests in a posteriorly subluxated position due to gravity when the knee is flexed to 90 degrees. The quadriceps active test is performed by asking the patient to slide their foot anteriorly against resistance (firing the quadriceps). The pull of the patellar tendon pulls the tibia anteriorly to its reduced anatomical position. This anterior shift is a positive quadriceps active test, diagnostic of PCL deficiency.

Question 1475

Topic: Knee Sports

Figure 8 shows the MRI of a 45-year-old female who felt a pop in her posterior knee while squatting.

Imaging confirms a medial meniscus posterior root tear with 4 mm of meniscal extrusion. Which of the following biomechanical scenarios most closely mimics the contact mechanics of the knee resulting from this injury?

. Partial medial meniscectomy
. Total medial meniscectomy
. Complete ACL deficiency
. Complete PCL deficiency
. Isolated deep MCL rupture

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A medial meniscus posterior root tear disrupts the circumferential fibers of the meniscus, leading to a complete loss of hoop stresses. Biomechanically, this renders the meniscus functionally incompetent. The resultant increase in peak contact pressures and decrease in contact area are nearly equivalent to those seen following a total medial meniscectomy, predisposing the joint to rapid articular cartilage degeneration.

Question 1476

Topic: Knee Sports

A 52-year-old female presents with acute onset medial knee pain after deep squatting. MRI demonstrates a medial meniscus posterior root tear with 4 mm of medial meniscal extrusion. If left completely untreated, the biomechanical consequence of this injury to the knee joint is most equivalent to which of the following?

. Anterior cruciate ligament tear
. Medial collateral ligament sprain
. Partial meniscectomy
. Total meniscectomy
. Isolated chondral defect

Correct Answer & Explanation

. Total meniscectomy

Explanation

A complete medial meniscus posterior root tear disrupts the crucial hoop stresses of the meniscus. Biomechanical studies have unequivocally shown that this leads to altered contact pressures, decreased contact area, and load distributions that are biomechanically equivalent to a total medial meniscectomy. This severely predisposes the patient to rapid progression of osteoarthritis and spontaneous osteonecrosis of the knee (SONK).

Question 1477

Topic: Knee Sports

A 26-year-old soccer player sustains a twisting injury to his right knee. On 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 external rotation is equal bilaterally. What is the most likely diagnosis?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

The Dial test evaluates external rotation asymmetry of the tibia on the femur. An increase of >10 degrees of external rotation compared to the normal knee is considered positive. If the test is positive at 30 degrees but negative (equalizes) 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 1478

Topic: Knee Sports

A 55-year-old active female experiences a sudden 'pop' in her posterior knee while squatting. She presents with posterior knee pain but no mechanical locking. MRI

reveals a medial meniscus posterior root tear with a 3-mm extrusion of the medial meniscus. If left untreated, which of the following biomechanical consequences most closely mimics this injury?

. Total meniscectomy
. Partial meniscectomy
. ACL rupture
. PCL rupture
. MCL sprain

Correct Answer & Explanation

. Total meniscectomy

Explanation

A medial meniscus posterior root tear disrupts the crucial hoop stresses of the meniscus, rendering it biomechanically equivalent to a total meniscectomy. This leads to a significant increase in peak contact pressures and a decreased contact area in the medial compartment, strongly predisposing the joint to rapid-onset osteoarthritis.

Question 1479

Topic: Knee Sports

A 17-year-old female presents with recurrent lateral patellar dislocations. Nonoperative management has failed. Imaging demonstrates a Caton-Deschamps index of 1.1, a sulcus angle of 135 degrees, and a tibial tubercle-trochlear groove (TT-TG) distance of 24 mm on MRI. Which of the following surgical interventions is most appropriate?

. MPFL reconstruction alone
. Lateral retinacular release alone
. Medializing tibial tubercle osteotomy with MPFL reconstruction
. Trochleoplasty
. Distal femoral osteotomy

Correct Answer & Explanation

. Medializing tibial tubercle osteotomy with MPFL reconstruction

Explanation

A TT-TG distance greater than 20 mm is a standard indication for a medializing tibial tubercle osteotomy in the setting of recurrent patellar instability. Because the MPFL is virtually always ruptured or incompetent in lateral patellar dislocations, it should be reconstructed concurrently to restore soft-tissue balance.

Question 1480

Topic: Knee Sports

A 30-year-old male fell from a height, sustaining a multiligamentous knee injury. Physical examination

demonstrates an abnormal dial test at 30 degrees of knee flexion but symmetric external rotation at 90 degrees. These findings indicate an isolated injury to which of the following structures?

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

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

The dial test evaluates external rotation of the tibia relative to the femur. Increased external rotation (>10 degrees compared to the contralateral side) at 30 degrees of flexion, but not at 90 degrees, indicates an isolated injury to the posterolateral corner (PLC). Increased external rotation at both 30 and 90 degrees indicates a combined PLC and PCL injury.

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