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Knee Sports MCQs

Practice Set 77 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 1521

Topic: Knee Sports

A 10-year-old prepubescent girl sustains a complete anterior cruciate ligament (ACL) tear. Her bone age confirms she has substantial growth remaining. Which of the following reconstructive techniques is most appropriate to minimize physeal injury?

. Transphyseal reconstruction using bone-patellar tendon-bone autograft
. Iliotibial band extra-articular tenodesis alone
. Physeal-sparing all-epiphyseal reconstruction
. Transphyseal reconstruction with an 11 mm tunnel
. Non-operative management until skeletal maturity

Correct Answer & Explanation

. Physeal-sparing all-epiphyseal reconstruction

Explanation

For patients with significant growth remaining (Tanner stage 1 or 2), a physeal-sparing all-epiphyseal or extra-articular ACL reconstruction is recommended to prevent growth arrest. Transphyseal tunnels crossing the open physis carry a high risk of growth disturbance.

Question 1522

Topic: Knee Sports

A 30-year-old patient presents with knee instability. The dial test demonstrates increased external rotation at 30 degrees of knee flexion compared to the contralateral side, but symmetric rotation at 90 degrees. Which structure(s) are isolatedly injured?

. Popliteofibular ligament and PCL
. Posterior cruciate ligament only
. Anterior cruciate ligament only
. LCL, popliteus tendon, and popliteofibular ligament
. Superficial and deep medial collateral ligaments

Correct Answer & Explanation

. LCL, popliteus tendon, and popliteofibular ligament

Explanation

Increased external rotation isolated to 30 degrees of flexion indicates an injury strictly to the posterolateral corner (PLC) structures (LCL, popliteus, popliteofibular ligament). If the test were positive at both 30 and 90 degrees, it would indicate a combined PLC and PCL injury.

Question 1523

Topic: Knee Sports

During a surgical reconstruction of the posterolateral corner of the knee, the surgeon isolates the fibular collateral ligament. This structure attaches to the fibular head in close proximity to which of the following tendons?

. Semimembranosus
. Popliteus
. Biceps femoris
. Iliotibial band
. Plantaris

Correct Answer & Explanation

. Biceps femoris

Explanation

The fibular collateral ligament (FCL) acts as the primary static stabilizer against varus stress. It inserts onto the lateral aspect of the fibular head, intimately associated with the biceps femoris tendon insertion, forming a conjoined tendon in some anatomical variants.

Question 1524

Topic: Knee Sports

During an anatomic reconstruction of the posterolateral corner (PLC) of the knee, accurate tunnel placement is essential. On which specific portion of the fibula does the popliteofibular ligament primarily attach?

. Anterior aspect of the fibular head
. Posteromedial aspect of the fibular styloid
. Lateral aspect of the fibular neck
. Posterolateral aspect of the fibular styloid
. Anteromedial aspect of the fibular head

Correct Answer & Explanation

. Posteromedial aspect of the fibular styloid

Explanation

The popliteofibular ligament arises from the popliteus musculotendinous junction and inserts on the posteromedial down-slope of the fibular styloid. It acts as a critical static stabilizer against posterolateral rotation.

Question 1525

Topic: Knee Sports

When performing a surgical reconstruction of the posterolateral corner (PLC) of the knee, the femoral footprint of the lateral collateral ligament (LCL) is located in which relation to the lateral epicondyle?

. Proximal and posterior
. Distal and anterior
. Directly on the epicondyle
. Proximal and anterior
. Distal and posterior

Correct Answer & Explanation

. Proximal and posterior

Explanation

The femoral attachment of the LCL is situated slightly proximal and posterior to the lateral femoral epicondyle. In contrast, the popliteus tendon inserts distal and anterior to the LCL attachment on the lateral femur.

Question 1526

Topic: Knee Sports

A 22-year-old football player sustains a direct blow to the anteromedial tibia. Clinical examination demonstrates asymmetric varus laxity at 30 degrees of knee flexion, but symmetrical stability at 0 degrees. Which of the following structures is the primary restraint to varus opening at 30 degrees of flexion?

. Popliteofibular ligament
. Anterior cruciate ligament
. Lateral collateral ligament
. Posterolateral capsule
. Iliotibial band

Correct Answer & Explanation

. Lateral collateral ligament

Explanation

The lateral collateral ligament (LCL) is the primary restraint to varus stress at 30 degrees of knee flexion. At full extension (0 degrees), the posterior cruciate ligament and posterolateral capsule act as secondary restraints, masking an isolated LCL injury.

Question 1527

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction of the knee, the surgeon must anatomically restore the femoral footprints of the lateral collateral ligament (LCL) and the popliteus tendon. What is the spatial relationship of the LCL origin relative to the popliteus origin on the lateral femoral condyle?

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

Correct Answer & Explanation

. Proximal and posterior

Explanation

On the lateral femoral condyle, the origin of the LCL is situated proximal and posterior to the popliteus insertion. Recognizing this relationship is critical for isometric graft placement during PLC reconstruction.

Question 1528

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction of the knee, anatomic femoral tunnels must be created. What is the correct position of the popliteus tendon femoral insertion relative to the lateral collateral ligament (LCL) origin?

. Posterior and proximal
. Anterior and proximal
. Anterior and inferior
. Posterior and inferior
. Directly deep to the LCL origin

Correct Answer & Explanation

. Anterior and inferior

Explanation

The popliteus tendon originates on the lateral femoral epicondyle an average of 18.5 mm anterior and inferior to the origin of the lateral collateral ligament (LCL). Recognizing this relationship is crucial for anatomic PLC reconstructions.

Question 1529

Topic: Knee Sports

A 35-year-old patient requires reconstruction of the posterolateral corner of the knee following a multiligamentous knee injury. Accurate anatomical tunnel placement is critical to restore proper joint kinematics. Relative to the lateral epicondyle, where is the normal anatomic femoral attachment of the fibular collateral ligament (FCL) located?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly on the articular margin

Correct Answer & Explanation

. Proximal and posterior

Explanation

The anatomic femoral attachment of the fibular collateral ligament (FCL) is located slightly proximal and posterior to the lateral epicondyle. Placing the femoral tunnel incorrectly alters tensioning across the flexion-extension arc.

Question 1530

Topic: Knee Sports

During surgical reconstruction of the posterolateral corner (PLC) of the knee, understanding the layered anatomy is essential. Which of the following structures are located in the superficial layer (Layer 1) of the lateral side of the knee?

. Lateral collateral ligament
. Biceps femoris and iliotibial band
. Popliteus tendon
. Popliteofibular ligament
. Fabellofibular ligament

Correct Answer & Explanation

. Biceps femoris and iliotibial band

Explanation

According to Seebacher's anatomical classification, the lateral aspect of the knee has three layers. Layer 1 (superficial) consists of the iliotibial band and the biceps femoris.

Question 1531

Topic: Knee Sports

During reconstruction of the posterolateral corner (PLC) of the knee, the anatomic insertion of the popliteus tendon on the femur is located:

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

Correct Answer & Explanation

. Distal and anterior to the lateral epicondyle

Explanation

The popliteus tendon inserts in the popliteal sulcus on the lateral femoral condyle. This location is distinctly distal and anterior to the lateral epicondyle.

Question 1532

Topic: Knee Sports

The popliteofibular ligament is a crucial stabilizer of the posterolateral corner of the knee. From which structure does it originate and where does it insert?

. Originates from the popliteus tendon and inserts on the fibular styloid
. Originates from the lateral femoral condyle and inserts on the fibular head
. Originates from the fibular head and inserts on the posterior tibia
. Originates from the lateral meniscus and inserts on the fibular head
. Originates from the tibia and inserts on the popliteus muscle

Correct Answer & Explanation

. Originates from the popliteus tendon and inserts on the fibular styloid

Explanation

The popliteofibular ligament originates from the musculotendinous junction of the popliteus and inserts onto the posteromedial aspect of the fibular styloid. It acts as a primary static stabilizer against external rotation of the knee.

Question 1533

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary anatomic bundles. When the knee is in full extension, what is the relative tension state of these bundles?

. Anteromedial bundle is tight, posterolateral bundle is lax
. Anteromedial bundle is lax, posterolateral bundle is tight
. Both bundles are equally tight
. Both bundles are equally lax
. Anteromedial bundle is tight, posteromedial bundle is tight

Correct Answer & Explanation

. Anteromedial bundle is lax, posterolateral bundle is tight

Explanation

The posterolateral (PL) bundle of the ACL is tight in knee extension and provides rotational stability. Conversely, the anteromedial (AM) bundle is tight in flexion and provides primary anteroposterior stability.

Question 1534

Topic: Knee Sports

During reconstruction of the posterolateral corner (PLC) of the knee, identifying the insertion of the popliteofibular ligament is critical. To which specific anatomical aspect of the fibula does this ligament attach?

. Anterolateral fibular head
. Posteromedial aspect of the fibular styloid
. Anteromedial fibular styloid
. Posterolateral fibular head
. Tip of the fibular styloid

Correct Answer & Explanation

. Posteromedial aspect of the fibular styloid

Explanation

The popliteofibular ligament originates from the musculotendinous junction of the popliteus and attaches to the posteromedial aspect of the fibular styloid (apex). It is a crucial static stabilizer against external rotation.

Question 1535

Topic: Knee Sports

During surgical reconstruction of the posterolateral corner (PLC) of the knee, the surgeon isolates the popliteofibular ligament. Which of the following accurately describes its true anatomic attachments?

. From the lateral femoral epicondyle to the fibular styloid
. From the popliteus musculotendinous junction to the posteromedial aspect of the fibular head
. From the lateral meniscus to the posterolateral fibular head
. From the lateral tibial plateau to the anterior fibular head
. From the popliteus tendon to the anterolateral aspect of the fibular head

Correct Answer & Explanation

. From the popliteus musculotendinous junction to the posteromedial aspect of the fibular head

Explanation

The popliteofibular ligament (PFL) originates from the musculotendinous junction of the popliteus. It attaches distally to the posteromedial aspect of the fibular head, acting as a crucial stabilizer against external rotation.

Question 1536

Topic: Knee Sports

Biomechanical understanding of the anterior cruciate ligament (ACL) is critical for anatomic reconstruction. The ACL is divided into the anteromedial (AM) and posterolateral (PL) bundles. During normal knee kinematics, when is the AM bundle tightest?

. Full extension
. Deep flexion
. Internal rotation at 0 degrees
. External rotation at 0 degrees
. Valgus stress at 30 degrees

Correct Answer & Explanation

. Full extension

Explanation

The anteromedial (AM) bundle of the ACL tightens primarily in knee flexion, thereby resisting anterior tibial translation in the flexed position. The posterolateral (PL) bundle is tightest in extension and resists rotatory loads.

Question 1537

Topic: Knee Sports

When evaluating a posterior cruciate ligament (PCL) injury on MRI, a radiologist must closely inspect its origin and insertion. Which of the following describes the correct anatomic femoral origin of the PCL?

. Posteromedial aspect of the lateral femoral condyle
. Anterolateral aspect of the medial femoral condyle
. Anterior intercondylar eminence of the tibia
. Posterior intercondylar area of the tibia
. Medial epicondyle of the femur

Correct Answer & Explanation

. Anterolateral aspect of the medial femoral condyle

Explanation

The PCL originates on the anterolateral aspect of the medial femoral condyle and inserts on the posterior aspect of the tibial plateau, approximately 1 cm below the articular surface.

Question 1538

Topic: Knee Sports

When reconstructing the posterolateral corner (PLC) of the knee, a surgeon isolates the primary static restraint to varus opening at 30 degrees of knee flexion. What are the origin and insertion of this structure?

. Lateral femoral epicondyle to the anterolateral tibia
. Lateral femoral epicondyle to the fibular head
. Popliteus sulcus to the posteromedial tibia
. Posterior fibular head to the lateral meniscus
. Gerdy's tubercle to the lateral femoral epicondyle

Correct Answer & Explanation

. Lateral femoral epicondyle to the fibular head

Explanation

The lateral collateral ligament (LCL) is the primary restraint to varus stress at 30 degrees of flexion. It originates on the lateral femoral epicondyle and inserts on the fibular head.

Question 1539

Topic: Knee Sports

A patient requires reconstruction of the posterolateral corner (PLC) of the knee. Regarding the femoral insertions of these structures, where does the popliteus tendon insert relative to the fibular collateral ligament (FCL)?

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

Correct Answer & Explanation

. Distal and anterior

Explanation

On the lateral femoral epicondyle, the popliteus tendon inserts distal and anterior to the origin of the fibular collateral ligament. Understanding this footprint relationship is critical for anatomical PLC reconstruction.

Question 1540

Topic: Knee Sports

A 26-year-old male sustains an isolated posterior cruciate ligament (PCL) rupture in a motorcycle accident and fails nonoperative management. A single-bundle PCL reconstruction is planned.

To correctly recreate the anterolateral (AL) bundle, the femoral tunnel should be placed at which of the following locations?

. High in the intercondylar notch at the 12 o'clock position
. Anterolateral aspect of the medial femoral condyle
. Posteromedial aspect of the lateral femoral condyle
. Directly on the adductor tubercle
. Center of the femoral trochlea

Correct Answer & Explanation

. Anterolateral aspect of the medial femoral condyle

Explanation

In single-bundle PCL reconstruction, the stronger anterolateral (AL) bundle is typically reconstructed. The native femoral footprint of the AL bundle is located on the anterolateral aspect of the medial femoral condyle within the notch.

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