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Knee Sports MCQs

Practice Set 78 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 1541

Topic: Knee Sports

During surgical reconstruction of a multiligament knee injury, the surgeon isolates the fibular collateral ligament (FCL) to recreate its native anatomy.

Where is the correct anatomical location of the native FCL femoral attachment?

. Slightly proximal and posterior to the lateral epicondyle
. Distal and anterior to the lateral epicondyle
. Proximal and anterior to the lateral epicondyle
. Directly on the lateral epicondyle
. Posterior to the popliteus sulcus

Correct Answer & Explanation

. Slightly proximal and posterior to the lateral epicondyle

Explanation

The femoral attachment of the fibular collateral ligament (FCL) is situated approximately 1.4 mm proximal and 3.1 mm posterior to the lateral epicondyle. Accurate tunnel placement here is critical to restore native posterolateral corner kinematics.

Question 1542

Topic: Knee Sports
A 45-year-old female experiences a sudden pop in the back of her knee while squatting. MRI reveals a posterior root tear of the medial meniscus with 4 mm of meniscal extrusion. Biomechanical studies demonstrate that this specific injury pattern alters tibiofemoral contact pressures equivalent to which of the following?
. Partial meniscectomy
. Total meniscectomy
. Anterior cruciate ligament (ACL) deficiency
. Posterior cruciate ligament (PCL) deficiency
. Grade III medial collateral ligament (MCL) tear

Correct Answer & Explanation

. Total meniscectomy

Explanation

A posterior root tear of the medial meniscus completely disrupts the circumferential hoop stresses of the meniscus. This biomechanical failure leads to increased peak contact pressures that are equivalent to those seen after a total meniscectomy.

Question 1543

Topic: Knee Sports

A 17-year-old female presents with her first episode of lateral patellar dislocation. An MRI confirms rupture of the medial patellofemoral ligament (MPFL).

Where is the native femoral footprint of the MPFL located in relation to the medial epicondyle and adductor tubercle?

. Proximal to the adductor tubercle
. Distal to the medial epicondyle
. Anterior to the medial epicondyle
. In the saddle between the medial epicondyle and adductor tubercle
. On the medial joint line

Correct Answer & Explanation

. In the saddle between the medial epicondyle and adductor tubercle

Explanation

The native femoral footprint of the MPFL (Schottle's point) is anatomically located in the groove or saddle between the medial epicondyle distally and the adductor tubercle proximally.

Question 1544

Topic: Knee Sports

A 13-year-old gymnast complains of vague, activity-related anterior knee pain. Imaging reveals an osteochondritis dissecans (OCD) lesion with intact overlying cartilage.

What is the most common anatomical location for this pathology in the knee?

. Medial aspect of the lateral femoral condyle
. Lateral aspect of the medial femoral condyle
. Central trochlear groove
. Inferior pole of the patella
. Posterior aspect of the medial tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for an osteochondritis dissecans (OCD) lesion in the knee is the lateral aspect of the medial femoral condyle (LAME). This accounts for approximately 70% of all knee OCD lesions.

Question 1545

Topic: Knee Sports

A 22-year-old soccer player undergoes an anatomic single-bundle anterior cruciate ligament (ACL) reconstruction. Which of the following is the most likely consequence of placing the femoral tunnel too far anteriorly (shallow) in the intercondylar notch?

. The graft will be tight in extension and loose in flexion.
. The graft will be loose in extension and tight in flexion.
. The graft will be loose in both extension and flexion.
. The graft will be excessively tight in both extension and flexion.
. The graft will result in increased rotational laxity but normal AP laxity.

Correct Answer & Explanation

. The graft will be loose in extension and tight in flexion.

Explanation

An anteriorly placed (shallow) femoral tunnel in ACL reconstruction results in a graft that is loose in extension and tight in flexion. This non-anatomic placement often leads to a loss of terminal knee flexion and potential graft stretching or failure.

Question 1546

Topic: Knee Sports
A 17-year-old female presents with recurrent lateral patellar dislocations. Imaging shows a TT-TG distance of 14 mm, normal patellar height, and a torn medial patellofemoral ligament (MPFL). She undergoes isolated MPFL reconstruction. Where is the anatomic femoral attachment of the MPFL located?
. Anterior to the posterior cortex line and proximal to Blumensaat's line
. Posterior to the posterior cortex line and distal to Blumensaat's line
. In the saddle region between the medial epicondyle and adductor tubercle
. Distal to the superficial medial collateral ligament femoral origin
. Anterior to the adductor tubercle

Correct Answer & Explanation

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

Explanation

The anatomic femoral footprint of the MPFL is located in the saddle region between the adductor tubercle proximally and the medial epicondyle distally. Radiographically, this correlates closely with Schöttle's point.

Question 1547

Topic: Knee Sports

A 45-year-old woman sustains a posterior root tear of the medial meniscus. Biomechanically, this injury alters the joint contact pressures to be most equivalent to which of the following scenarios?

. A small peripheral longitudinal tear
. A radial tear involving the inner one-third of the meniscus
. A bucket-handle meniscus tear
. A total meniscectomy
. A horizontal cleavage tear

Correct Answer & Explanation

. A total meniscectomy

Explanation

A complete posterior root tear of the medial meniscus disrupts the hoop stresses, leading to functional extrusion of the meniscus. Biomechanically, this results in increased articular contact pressures equivalent to a total meniscectomy, accelerating joint degeneration.

Question 1548

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the femoral attachment must be accurately positioned. Which of the following describes the correct radiographic landmark (Schöttle's point) for the femoral footprint on a true lateral view?
. Anterior to the posterior femoral cortex line and distal to the Blumensaat line
. Anterior to the posterior femoral cortex line and proximal to the Blumensaat line
. Posterior to the posterior femoral cortex line and proximal to the Blumensaat line
. Posterior to the posterior femoral cortex line and distal to the Blumensaat line
. Directly over the adductor tubercle

Correct Answer & Explanation

. Anterior to the posterior femoral cortex line and proximal to the Blumensaat line

Explanation

Schöttle's point identifies the anatomic femoral footprint of the MPFL. It is located approximately 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 the Blumensaat line.

Question 1549

Topic: Knee Sports

A 30-year-old male sustains a severe varus and hyperextension injury to his knee. Examination reveals a positive dial test (increased external rotation) at 30 degrees of knee flexion, but the external rotation normalizes to match the contralateral knee at 90 degrees of flexion. What is the primary injured structure?

. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Posterolateral corner (PLC)
. Medial collateral ligament (MCL)
. Iliotibial band

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

A positive dial test at 30 degrees of flexion that normalizes at 90 degrees indicates an isolated injury to the posterolateral corner (PLC). If the test remains positive at both 30 and 90 degrees, it suggests a combined PLC and PCL injury.

Question 1550

Topic: Knee Sports

During clinical examination of a multiligamentous knee injury, the dial test is performed. At 30 degrees of knee flexion, the primary restraint to external rotation of the tibia is the:

. Popliteofibular ligament
. Lateral collateral ligament (LCL)
. Iliotibial band
. Anterior cruciate ligament (ACL)
. Biceps femoris tendon

Correct Answer & Explanation

. Popliteofibular ligament

Explanation

The popliteofibular ligament (PFL) and popliteus complex are the primary restraints to external tibial rotation at 30 degrees of flexion. The LCL is the primary restraint to varus stress.

Question 1551

Topic: Knee Sports

If a femoral tunnel is placed too anteriorly (high in the notch in extension) during an anterior cruciate ligament (ACL) reconstruction, what is the resulting biomechanical effect on the graft?

. Loose in flexion and tight in extension
. Tight in flexion and loose in extension
. Tight in both flexion and extension
. Loose in both flexion and extension
. Impingement on the posterior cruciate ligament (PCL)

Correct Answer & Explanation

. Tight in flexion and loose in extension

Explanation

An anteriorly placed femoral tunnel (anterior to the anatomic footprint) creates a graft that is excessively tight in flexion and loose in extension, often leading to restricted knee flexion and eventual graft failure.

Question 1552

Topic: Knee Sports

Biomechanical studies show that a complete, unrepaired tear of the posterior root of the medial meniscus alters knee contact mechanics equivalent to:

. Total medial meniscectomy
. A normal knee with intact menisci
. Anterior cruciate ligament deficiency
. Isolated partial medial meniscectomy
. Posterior cruciate ligament deficiency

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A medial meniscus posterior root tear destroys the meniscal hoop stresses, allowing radial extrusion of the meniscus. Biomechanically, this results in peak tibiofemoral contact pressures identical to a total medial meniscectomy.

Question 1553

Topic: Knee Sports

When performing a single-bundle posterior cruciate ligament (PCL) reconstruction, which native bundle is recreated to restore primary restraint against posterior tibial translation in flexion?

. Anteromedial bundle
. Anterolateral bundle
. Posteromedial bundle
. Posterolateral bundle
. Central core bundle

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The native PCL consists of two distinct bundles. The anterolateral bundle is the larger of the two, is tight in flexion, and is the primary target for single-bundle PCL reconstructions.

Question 1554

Topic: Knee Sports

A 17-year-old female experiences recurrent lateral patellar instability and is scheduled for a medial patellofemoral ligament (MPFL) reconstruction. Where is the exact anatomical location of the femoral origin of the MPFL (Schottle's point)?

. Anterior to the medial epicondyle and distal to the adductor tubercle
. Posterior to the medial epicondyle and proximal to the adductor tubercle
. Between the medial epicondyle and the adductor tubercle
. Directly on the medial collateral ligament superficial fibers
. Anterior to the adductor tubercle

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle

Explanation

The anatomic femoral origin of the MPFL lies in a saddle-shaped depression between the medial epicondyle and the adductor tubercle. Proper isometric graft placement at this location is critical to prevent abnormal patellofemoral tracking.

Question 1555

Topic: Knee Sports

A 24-year-old football player sustained a direct blow to the anteromedial aspect of his knee. Physical examination reveals increased external tibial rotation of 15 degrees compared to the contralateral side at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees. What is the most likely injury pattern?

. Isolated posterior cruciate ligament tear
. Isolated posterolateral corner injury
. Combined ACL and posterolateral corner injury
. Combined PCL and posterolateral corner injury
. Isolated medial collateral ligament tear

Correct Answer & Explanation

. Isolated posterolateral corner injury

Explanation

The dial test evaluates for excessive external rotation. Increased rotation at 30 degrees only indicates an isolated posterolateral corner (PLC) injury, whereas increased rotation at both 30 and 90 degrees indicates a combined PLC and PCL injury.

Question 1556

Topic: Knee Sports



In Medial Patellofemoral Ligament (MPFL) reconstruction, placing the femoral tunnel too proximal will result in which of the following kinematic abnormalities?

. The graft will be tight in extension and loose in flexion.
. The graft will be tight in flexion and loose in extension.
. The patella will subluxate medially in extension.
. The graft will prevent terminal extension.
. The patella will ride high (patella alta).

Correct Answer & Explanation

. The graft will be tight in flexion and loose in extension.

Explanation

Proximal placement of the femoral tunnel in MPFL reconstruction causes the graft to overtighten during knee flexion. This non-anatomic placement increases patellofemoral contact pressures and can restrict terminal range of motion.

Question 1557

Topic: Knee Sports
When reconstructing the medial patellofemoral ligament (MPFL) for recurrent patellar instability, identifying the correct femoral attachment (Schöttle's point) is critical. Where is this anatomic point located radiographically?
. Anterior to the medial epicondyle and proximal to the adductor tubercle
. Between the medial epicondyle and the adductor tubercle
. Distal to the joint line on the medial tibial condyle
. Directly over the center of the medial femoral condyle
. Posterior to the adductor tubercle and distal to the Blumensaat line

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle

Explanation

The MPFL femoral origin is located in a saddle-like depression situated between the medial epicondyle distally and the adductor tubercle proximally.

Question 1558

Topic: Knee Sports

A 30-year-old male sustains a severe knee injury. On physical examination, the Dial test demonstrates 15 degrees of increased external rotation of the tibia compared to the contralateral leg at 30 degrees of flexion, and 18 degrees of increased external rotation at 90 degrees of flexion. This pattern most strongly suggests injury to which structures?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

The Dial test evaluates external tibial rotation. Increased rotation (>10 degrees compared to the normal side) at 30 degrees only indicates an isolated PLC injury. Increased rotation at both 30 and 90 degrees indicates combined PLC and PCL injuries.

Question 1559

Topic: Knee Sports

A 25-year-old male sustains a direct blow to the proximal tibia with the knee flexed. Examination reveals a posterior sag sign and posterior translation of 8 mm at 90 degrees of flexion with a firm endpoint. What is the most appropriate initial management?

. Immediate PCL reconstruction
. Immobilization in extension for 2-4 weeks followed by rehab
. High tibial osteotomy
. Immobilization in 90 degrees of flexion
. Primary PCL repair

Correct Answer & Explanation

. Immobilization in extension for 2-4 weeks followed by rehab

Explanation

This represents a Grade II isolated posterior cruciate ligament (PCL) injury (5-10 mm translation). Isolated Grade I and II PCL injuries are best managed non-operatively with brief immobilization in extension to reduce the posterior sag, followed by progressive quadriceps strengthening.

Question 1560

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, identifying the correct femoral attachment is crucial. According to Schöttle's method, where is the radiographic femoral footprint located on a strict lateral radiograph?
. Anterior to the posterior cortex line and distal to Blumensaat's line
. Anterior to the posterior cortex line and proximal to the posterior femoral condyle origin
. Posterior to the posterior cortex line and distal to the adductor tubercle
. On the medial epicondyle exactly
. At the distal pole of the patella

Correct Answer & Explanation

. Anterior to the posterior cortex line and proximal to the posterior femoral condyle origin

Explanation

The Schöttle point for MPFL femoral insertion is located radiographically 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior portion of Blumensaat's line.

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