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Knee Sports MCQs

Practice Set 75 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 1481

Topic: Knee Sports

The anterolateral (AL) and posteromedial (PM) bundles of the posterior cruciate ligament (PCL) exhibit distinct tension patterns during knee motion. Which of the following accurately describes the biomechanical behavior of these bundles?

. The AL bundle is tight in flexion, and the PM bundle is tight in extension
. The AL bundle is tight in extension, and the PM bundle is tight in flexion
. Both bundles are tight in full extension
. Both bundles are loose in mid-flexion
. The AL bundle provides primary rotational stability, while the PM bundle provides translational stability

Correct Answer & Explanation

. The AL bundle is tight in flexion, and the PM bundle is tight in extension

Explanation

The PCL is composed of two main bundles: the anterolateral (AL) bundle and the posteromedial (PM) bundle. The larger AL bundle is taut in knee flexion and lax in extension, whereas the smaller PM bundle is taut in extension and lax in flexion. This reciprocal tension pattern ensures continuous posterior translational stability throughout the entire arc of motion.

Question 1482

Topic: Knee Sports

A 16-year-old female presents with recurrent lateral patellar instability. She has failed a 6-month trial of physical therapy. Imaging reveals normal patellar height (Caton-Deschamps index 1.0), normal trochlear morphology, and a tibial tubercle-trochlear groove (TT-TG) distance of 23 mm on MRI. What is the most appropriate surgical intervention?

. Isolated Medial Patellofemoral Ligament (MPFL) reconstruction
. MPFL reconstruction combined with tibial tubercle anteromedialization
. Isolated lateral retinacular release
. Trochleoplasty
. MPFL reconstruction combined with a distal femoral osteotomy

Correct Answer & Explanation

. MPFL reconstruction combined with tibial tubercle anteromedialization

Explanation

A TT-TG distance greater than 20 mm is generally considered pathologic and a primary risk factor for patellar instability. In patients with recurrent lateral patellar instability and a TT-TG distance > 20 mm, an isolated MPFL reconstruction is at high risk of failure due to the excessive lateralizing vector forces. Therefore, the addition of a tibial tubercle osteotomy (anteromedialization, such as the Fulkerson osteotomy) is indicated to correct the bony malalignment and offload the reconstructed MPFL.

Question 1483

Topic: Knee Sports

A 52-year-old previously active female experiences a sudden pop in the posterior aspect of her knee while descending into a deep squat. Over the next month, she develops significant medial joint line pain and an effusion. MRI demonstrates a medial meniscus posterior root tear. If left untreated, what is the primary biomechanical consequence of this injury?

. Decreased contact pressures in the medial compartment
. Increased peak contact pressures equivalent to a total meniscectomy
. Medial compartment gapping during terminal extension
. Increased external rotation of the tibia relative to the femur
. Excessive anterior translation of the femur relative to the tibia

Correct Answer & Explanation

. Increased peak contact pressures equivalent to a total meniscectomy

Explanation

The meniscal roots are critical for anchoring the meniscus and converting axial loads into circumferential hoop stresses. A posterior root tear of the medial meniscus completely disrupts this ability to generate hoop stresses, leading to radial extrusion of the meniscus. Biomechanical studies have shown that a medial meniscus root tear results in a significant decrease in contact area and an increase in peak contact pressures that are essentially equivalent to those seen following a total meniscectomy. This leads to rapid progression of osteoarthritis if not surgically repaired.

Question 1484

Topic: Knee Sports

A 6-month post-operative anterior cruciate ligament (ACL) reconstruction patient presents with an inability to achieve terminal extension. The patient describes an anterior knee 'clunk' when attempting to fully extend the knee passively. Sagittal MRI shows a nodular soft tissue mass located anterior to the ACL graft in the intercondylar notch. What is the most appropriate management of this condition?

. Revision ACL reconstruction
. Arthroscopic excision of the lesion
. Closed manipulation under anesthesia
. Intra-articular corticosteroid injection
. Aggressive physical therapy with extension overpressure

Correct Answer & Explanation

. Arthroscopic excision of the lesion

Explanation

The patient has a 'cyclops lesion' (localized anterior arthrofibrosis), which classically presents as an extension block with a painful clunk at terminal extension several months after ACL reconstruction. The MRI finding of a soft tissue nodule anterior to the tibial insertion of the ACL graft confirms the diagnosis. While physical therapy is utilized initially, established symptomatic cyclops lesions typically do not resolve with conservative management and require arthroscopic excision to restore full, pain-free extension.

Question 1485

Topic: Knee Sports

During a physical examination of a football player who sustained a direct blow to the anteromedial aspect of the tibia, you perform the dial test. The patient exhibits 20 degrees of increased external rotation of the tibia compared to the uninjured leg at 30 degrees of knee flexion. However, at 90 degrees of knee flexion, the external rotation is symmetric to the uninjured side. This examination finding is most indicative of an isolated injury to which of the following structures?

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

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

The dial test is used to evaluate the posterolateral corner (PLC) and posterior cruciate ligament (PCL). More than 10 degrees of side-to-side difference in external rotation is considered positive. Increased external rotation at 30 degrees of flexion with normal (symmetric) rotation at 90 degrees of flexion indicates an isolated injury to the PLC. If the external rotation was increased at both 30 degrees and 90 degrees, it would suggest a combined injury to both the PLC and the PCL.

Question 1486

Topic: Knee Sports
A 28-year-old male is brought to the emergency department after a high-velocity knee dislocation involving disruption of the ACL, PCL, and posterolateral corner (KD-III). On physical examination, he demonstrates a profound foot drop and inability to extend his toes. Vascular exam is normal. What is the most common mechanism of injury for the neurological deficit described in this specific clinical scenario?
. Direct contusion to the tibial nerve in the popliteal fossa
. Traction injury to the common peroneal nerve
. Transection of the deep peroneal nerve by the fibular head
. Acute compartment syndrome compressing the superficial peroneal nerve
. Entrapment of the sural nerve within the disrupted posterolateral structures

Correct Answer & Explanation

. Traction injury to the common peroneal nerve

Explanation

In the setting of a multi-ligament knee injury (especially those involving the posterolateral corner and a varus/hyperextension mechanism), the common peroneal nerve is highly susceptible to injury. Due to its rigid tethering as it wraps around the fibular neck, the nerve undergoes severe stretch (traction injury) during the dislocation event. This classically presents as a foot drop and weakness in ankle dorsiflexion and eversion. Direct transection is rare compared to a severe traction neuropraxia or axonotmesis.

Question 1487

Topic: Knee Sports

A 28-year-old female recreational skier injured her knee. MRI (Figure 8) demonstrates an acute anterior cruciate ligament (ACL) tear and an extrusion of the medial meniscus on the coronal sequence with a missing meniscal bow tie sign on the sagittal sequence. Which of the following is the most appropriate management for the meniscus during ACL reconstruction?

. Partial meniscectomy
. Observation
. Transosseous or anchor-based meniscal root repair
. Inside-out repair of the posterior horn
. Meniscal allograft transplantation

Correct Answer & Explanation

. Transosseous or anchor-based meniscal root repair

Explanation

The MRI findings of meniscal extrusion and a 'ghost sign' (missing bow tie) on sagittal images are classic for a meniscal root tear. A medial meniscal root tear eliminates the hoop stresses of the meniscus, altering knee biomechanics similarly to a total meniscectomy. The gold standard treatment, particularly in young patients undergoing concurrent ACL reconstruction, is a transosseous pull-out suture or suture anchor repair of the meniscal root.

Question 1488

Topic: Knee Sports

A 30-year-old man sustains a direct blow to the anteromedial aspect of his knee. Examination reveals a positive dial test with 15 degrees of increased external rotation at both 30 and 90 degrees of knee flexion compared to the contralateral side. He also has a positive posterior drawer test. What is the most likely combination of injured structures?

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

Correct Answer & Explanation

. Posterior cruciate ligament (PCL) and posterolateral corner (PLC)

Explanation

The dial test is used to evaluate the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion with normal rotation at 90 degrees suggests an isolated PLC injury. Increased external rotation at both 30 and 90 degrees indicates a combined PLC and PCL injury. The positive posterior drawer test further confirms the PCL injury.

Question 1489

Topic: Knee Sports

A 45-year-old patient undergoes an MRI for acute posterior knee pain after a deep squat. The MRI reveals a medial meniscus posterior root tear. Biomechanically, leaving this injury untreated is most equivalent to which of the following?

. Total medial meniscectomy
. Partial medial meniscectomy
. Unaltered knee kinematics
. Anterior cruciate ligament deficiency
. Medial collateral ligament deficiency

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A medial meniscus posterior root tear causes a complete loss of circumferential hoop stresses, leading to peak medial compartment contact pressures equivalent to a total meniscectomy.

Question 1490

Topic: Knee Sports
During reconstruction of the medial patellofemoral ligament (MPFL), the femoral tunnel is positioned using strict radiographic landmarks to locate Schöttle's point. Where is this point anatomically located on a true lateral radiograph?
. 1 mm anterior to the posterior femoral cortex line and 2.5 mm distal to the posterior origin of the medial femoral condyle
. 1 mm posterior to the posterior femoral cortex line and 2.5 mm proximal to the medial femoral condyle
. Directly on the Blumensaat line, 5 mm anterior to the posterior femoral cortex
. 2 mm distal to the Blumensaat line and 2 mm posterior to the posterior femoral cortex
. 5 mm anterior to the posterior femoral cortex line and proximal to the Blumensaat line

Correct Answer & Explanation

. 1 mm anterior to the posterior femoral cortex line and 2.5 mm distal to the posterior origin of the medial femoral condyle

Explanation

Schöttle's point is radiographically located 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior contour of the medial femoral condyle, and proximal to the posterior point of Blumensaat's line.

Question 1491

Topic: Knee Sports

A 30-year-old sustains an acute knee injury. On physical examination, the dial test is positive with 15 degrees of increased external rotation at 30 degrees of knee flexion, but symmetric to the contralateral side at 90 degrees of flexion. Which structural injury does this exam finding indicate?

. Isolated posterior cruciate ligament (PCL) injury
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injuries
. Isolated lateral collateral ligament (LCL) injury
. Combined ACL and PLC injuries

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

Increased external rotation isolated to 30 degrees of knee flexion indicates an isolated posterolateral corner (PLC) injury. Combined PCL and PLC injuries demonstrate increased rotation at both 30 and 90 degrees.

Question 1492

Topic: Knee Sports

A 25-year-old basketball player sustains a noncontact twisting knee injury. Radiographs reveal an avulsion fracture of the anterolateral proximal tibia (Segond fracture). This radiographic finding is considered pathognomonic for an injury to which primary structure?

. Posterior cruciate ligament
. Medial collateral ligament
. Anterior cruciate ligament
. Lateral collateral ligament
. Popliteus tendon

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture represents an avulsion of the anterolateral ligament/capsule complex from the tibia and is considered virtually pathognomonic for an anterior cruciate ligament (ACL) tear.

Question 1493

Topic: Knee Sports

A 28-year-old man sustains a direct blow to the anteromedial aspect of his proximal tibia while his knee is flexed. Physical examination demonstrates a positive posterior drawer test. 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. What is the most likely diagnosis?

. Isolated PCL tear
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injury
. Combined ACL and PLC injury
. Isolated MCL tear

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

Increased external rotation on the dial test at 30 degrees of flexion, which normalizes at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. Combined PCL and PLC injuries show increased external rotation at both angles.

Question 1494

Topic: Knee Sports

A 16-year-old female experiences recurrent patellar dislocations. Imaging reveals a tibial tubercle-trochlear groove (TT-TG) distance of 14 mm, a normal Caton-Deschamps index, and a shallow trochlea. What is the primary soft-tissue restraint to lateral patellar translation at 20 degrees of knee flexion that should be reconstructed in this patient?

. Medial patellofemoral ligament (MPFL)
. Medial patellotibial ligament (MPTL)
. Medial collateral ligament (MCL)
. Vastus medialis obliquus (VMO)
. Lateral retinaculum

Correct Answer & Explanation

. Medial patellofemoral ligament (MPFL)

Explanation

The medial patellofemoral ligament (MPFL) provides approximately 50% to 60% of the restraining force against lateral patellar translation from 0 to 30 degrees of knee flexion. Because her TT-TG distance is normal (<20 mm) and patellar height is normal, an isolated MPFL reconstruction is indicated.

Question 1495

Topic: Knee Sports

A 16-year-old female presents with recurrent lateral patellar instability. Imaging shows a tibial tubercle-trochlear groove (TT-TG) distance of 22 mm, a normal TT-PCL distance, and normal trochlear depth. Which of the following is the most appropriate surgical intervention?

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

Correct Answer & Explanation

. MPFL reconstruction combined with medializing tibial tubercle osteotomy

Explanation

A TT-TG distance > 20 mm is a recognized risk factor for patellar instability and a primary indication for a medializing tibial tubercle osteotomy. This is typically combined with an MPFL reconstruction to restore the primary soft-tissue restraint.

Question 1496

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, placing the femoral tunnel too proximal will most likely result in which of the following kinematic abnormalities?
. Increased graft tension in extension and laxity in flexion
. Increased graft tension in flexion and laxity in extension
. Patella alta
. Medial patellar subluxation in full extension
. Increased contact pressures on the lateral patellar facet

Correct Answer & Explanation

. Increased graft tension in flexion and laxity in extension

Explanation

Placing the MPFL femoral tunnel too proximal relative to Schöttle's point causes the graft to tighten excessively as the knee flexes. This leads to a loss of flexion and abnormally high medial patellofemoral cartilage contact pressures.

Question 1497

Topic: Knee Sports

A 22-year-old female collegiate soccer player undergoes anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone autograft. What is the most common technical error leading to late graft failure?

. Femoral tunnel placed too anteriorly
. Femoral tunnel placed too posteriorly
. Tibial tunnel placed too medially
. Tibial tunnel placed too posteriorly
. Graft tensioned in full flexion

Correct Answer & Explanation

. Femoral tunnel placed too anteriorly

Explanation

The most common technical error in ACL reconstruction is non-anatomic tunnel placement, specifically placing the femoral tunnel too anteriorly. This creates a graft that is tight in flexion and loose in extension, leading to loss of motion and early graft rupture.

Question 1498

Topic: Knee Sports

A 45-year-old female presents with sudden onset medial knee pain after deep knee flexion. An MRI reveals the pathology shown in Figure 55.

Assuming this represents a posterior root tear of the medial meniscus, which of the following biomechanical consequences most closely mirrors this injury?

. Total medial meniscectomy
. Partial medial meniscectomy
. Anterior cruciate ligament deficiency
. Posterior cruciate ligament deficiency
. Superficial medial collateral ligament sprain

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus completely disrupts the circumferential hoop stresses of the meniscus. Biomechanical studies have demonstrated that this leads to altered contact areas and peak pressures equivalent to a total meniscectomy.

Question 1499

Topic: Knee Sports
A 22-year-old basketball player undergoes matrix-induced autologous chondrocyte implantation (MACI) for a 3.5 square-centimeter full-thickness osteochondral defect on the medial femoral condyle. What is the primary histological composition of the optimally generated repair tissue?
. Type I collagen
. Type II collagen
. Type III collagen
. Type IX collagen
. Type X collagen

Correct Answer & Explanation

. Type II collagen

Explanation

MACI is designed to generate hyaline-like cartilage, which is primarily composed of Type II collagen. In contrast, marrow stimulation techniques like microfracture produce fibrocartilage, primarily composed of Type I collagen.

Question 1500

Topic: Knee Sports

An 18-year-old football player sustains a bucket-handle meniscal tear in the red-white zone. Which of the following surgical factors most significantly enhances the biological healing potential of this meniscal repair?

. Use of all-inside rather than inside-out repair devices
. Older patient age at the time of injury
. Concomitant anterior cruciate ligament (ACL) reconstruction
. Involvement of the lateral rather than the medial meniscus
. Excision of the adjacent synovial fringe

Correct Answer & Explanation

. Concomitant anterior cruciate ligament (ACL) reconstruction

Explanation

Concomitant ACL reconstruction significantly enhances meniscal healing. The drilling of osseous tunnels releases bone marrow elements, stem cells, and growth factors into the joint, creating a robust biological environment for repair.

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