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Knee Sports MCQs

Practice Set 79 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 1561

Topic: Knee Sports

During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, identifying the anatomic femoral footprint is critical. According to Schottle's method on a true lateral radiograph, where is the femoral attachment of the MPFL located?

. Anterior to the posterior cortical line and proximal to the posterior border of the Blumensaat line
. Anterior to the posterior cortical line and distal to the posterior border of the Blumensaat line
. Posterior to the posterior cortical line and proximal to the posterior border of the Blumensaat line
. Anterior to the posterior cortical line and intersecting the Blumensaat line
. Posterior to the posterior cortical line and distal to the posterior border of the Blumensaat line

Correct Answer & Explanation

. Anterior to the posterior cortical line and proximal to the posterior border of the Blumensaat line

Explanation

The Schottle point indicates the anatomic femoral origin of the MPFL. It is located 1 mm anterior to the posterior cortical line of the femur and proximal to the level of the posterior Blumensaat line.

Question 1562

Topic: Knee Sports

A 24-year-old gymnast presents with chronic lateral elbow pain. She has pain with valgus stress and a 15-degree extension deficit. Radiographs demonstrate a radiolucent lesion in the capitellum with a sclerotic margin. MRI shows a 12mm osteochondral defect with a detached fragment and fluid behind the fragment. What is the most appropriate definitive management?

. Six weeks of rest and throwing restriction
. Arthroscopic debridement and microfracture
. Corticosteroid injection and physical therapy
. Ulnar collateral ligament reconstruction
. Open reduction and internal fixation of the fragment

Correct Answer & Explanation

. Arthroscopic debridement and microfracture

Explanation

This patient has an unstable osteochondritis dissecans (OCD) of the capitellum, indicated by fluid behind the fragment. For small to moderate unstable lesions that are chronic, arthroscopic debridement and marrow stimulation (microfracture) is indicated.

Question 1563

Topic: Knee Sports

A 50-year-old male presents with acute severe pain in the posterior knee after stepping off a curb. MRI demonstrates a complete radial tear of the posterior root of the medial meniscus with 4 mm of meniscal extrusion. If left untreated, this injury biomechanically behaves most similarly to:

. A complete anterior cruciate ligament (ACL) rupture
. An isolated medial collateral ligament (MCL) sprain
. A total medial meniscectomy
. A bucket-handle medial meniscus tear
. A discoid lateral meniscus

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus disrupts the circumferential hoop stresses, leading to functional incompetence and meniscal extrusion. Biomechanically, it is equivalent to a total medial meniscectomy.

Question 1564

Topic: Knee Sports

A 25-year-old athlete sustains a posterolateral corner (PLC) injury of the knee. During a surgical reconstruction of the PLC using a fibular-based technique, care must be taken to avoid injury to the common peroneal nerve. Where does the common peroneal nerve typically cross in relation to the fibular head?

. It runs strictly anterior to the fibular head and neck
. It runs posterior to the biceps femoris tendon and wraps around the fibular neck
. It penetrates the medial head of the gastrocnemius before crossing the fibula
. It courses medial to the popliteus tendon
. It passes superior to the lateral collateral ligament origin

Correct Answer & Explanation

. It runs posterior to the biceps femoris tendon and wraps around the fibular neck

Explanation

The common peroneal nerve courses posterior to the long head of the biceps femoris tendon and wraps around the fibular neck from posterior to anterior, making it highly vulnerable during PLC reconstruction.

Question 1565

Topic: Knee Sports

Which of the following statements regarding the anatomy and biomechanics of the posterior cruciate ligament (PCL) is true?

. The posteromedial bundle is tight in flexion.
. The anterolateral bundle is tight in extension.
. The anterolateral bundle is the primary restraint to posterior tibial translation in flexion.
. The PCL originates on the lateral femoral condyle.
. The posteromedial bundle is larger than the anterolateral bundle.

Correct Answer & Explanation

. The anterolateral bundle is tight in extension.

Explanation

The PCL consists of the larger anterolateral bundle (tight in flexion) and the smaller posteromedial bundle (tight in extension). The anterolateral bundle provides the primary restraint to posterior tibial translation at 90 degrees of knee flexion.

Question 1566

Topic: Knee Sports
A 17-year-old female undergoes medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar dislocations. If the femoral tunnel is placed too proximal and anterior to Schöttle's point, what is the expected clinical consequence?
. Increased graft tension in flexion
. Increased graft tension in extension
. Patella baja
. Medial patellar subluxation in extension
. Graft laxity throughout the entire range of motion

Correct Answer & Explanation

. Increased graft tension in flexion

Explanation

Non-anatomic placement of the MPFL femoral tunnel too proximal and anterior causes the graft to act non-isometrically, becoming overly tight as the knee moves into flexion. This can lead to stiffness, pain, and increased patellofemoral contact pressures.

Question 1567

Topic: Knee Sports

A 14-year-old male gymnast presents with lateral elbow pain and catching. MRI shows an unstable osteochondritis dissecans (OCD) lesion of the capitellum with an intra-articular loose body. What is the most appropriate definitive management?

. Casting for 6 weeks
. Loose body removal and marrow stimulation (microfracture)
. Ulnar collateral ligament reconstruction
. Physical therapy focusing on the flexor-pronator mass
. Radial head excision

Correct Answer & Explanation

. Loose body removal and marrow stimulation (microfracture)

Explanation

In adolescents with an unstable capitellar OCD lesion and mechanical symptoms, nonoperative management typically fails. Operative treatment involves loose body removal and microfracture or osteochondral grafting to promote fibrocartilage healing.

Question 1568

Topic: Knee Sports
A 45-year-old female experiences a sudden pop in her posterior knee while deep squatting. MRI reveals a >3 mm medial meniscus extrusion and a complete radial tear at the posterior root. Which of the following best describes the biomechanical consequence of this untreated injury?
. It maintains 80% of normal meniscal hoop stresses
. It results in tibiofemoral contact pressures equivalent to a total meniscectomy
. It primarily leads to isolated patellofemoral osteoarthritis
. It causes paradoxical anterior subluxation of the femur during extension
. It does not significantly alter knee kinematics or contact mechanics

Correct Answer & Explanation

. It results in tibiofemoral contact pressures equivalent to a total meniscectomy

Explanation

A posterior meniscal root tear completely disrupts the hoop stresses of the meniscus. Biomechanically, this results in peak contact pressures and contact areas identical to a total meniscectomy, leading to rapid joint degeneration if left untreated.

Question 1569

Topic: Knee Sports

A 28-year-old male sustains a dashboard injury to his right knee. Physical examination reveals a positive posterior drawer test. The dial test shows 15 degrees of increased external rotation on the injured side compared to the normal side at 30 degrees of flexion, but symmetric external rotation at 90 degrees of flexion. What is the most likely diagnosis?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

An increase in external rotation of >10 degrees at 30 degrees of flexion, with symmetric rotation at 90 degrees, is indicative of an isolated posterolateral corner (PLC) injury. Combined PLC and PCL injuries show increased external rotation at both 30 and 90 degrees.

Question 1570

Topic: Knee Sports

An 18-year-old female presents with recurrent lateral patellar dislocations. Advanced imaging reveals a normal patellar height (Caton-Deschamps index 1.0) but a tibial tubercle-trochlear groove (TT-TG) distance of 23 mm. What is the most appropriate surgical treatment?

. Isolated medial patellofemoral ligament (MPFL) reconstruction
. Isolated lateral retinacular release
. Tibial tubercle anteromedialization combined with MPFL reconstruction
. Medial reefing and lateral release
. Trochleoplasty alone

Correct Answer & Explanation

. Tibial tubercle anteromedialization combined with MPFL reconstruction

Explanation

A TT-TG distance >20 mm is a pathologic finding indicating significant lateralization of the tibial tubercle. Optimal treatment requires addressing the bony malalignment with a tibial tubercle transfer (anteromedialization) alongside an MPFL reconstruction.

Question 1571

Topic: Knee Sports

A post-operative lateral radiograph of a 22-year-old male following an ACL reconstruction reveals that the femoral tunnel was placed significantly anterior to the anatomic footprint. What is the expected clinical and biomechanical consequence of this tunnel malposition?

. The graft will be tight in flexion and loose in extension.
. The graft will be tight in extension and loose in flexion.
. The graft will remain isometric but experience earlier failure.
. The graft will be excessively loose in both flexion and extension.
. The patient will experience a fixed flexion contracture.

Correct Answer & Explanation

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

Explanation

A femoral tunnel placed too far anteriorly results in a non-anatomic graft that is excessively tight in flexion and loose in extension. This commonly leads to a loss of terminal knee flexion and gradual stretching of the graft over time.

Question 1572

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon inadvertently places the femoral tunnel 10 mm proximal to the Schöttle point. What graft tensioning mismatch is expected during the knee arc of motion?
. The graft will be excessively tight in extension and loose in flexion.
. The graft will be excessively tight in flexion and loose in extension.
. The graft will maintain isometric tension throughout the full arc of motion.
. The graft will be loose in both flexion and extension.
. The patella will dislocate medially during terminal extension.

Correct Answer & Explanation

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

Explanation

If the MPFL femoral attachment is placed too proximal to the anatomic footprint (Schöttle point), the distance between the patellar and femoral attachments increases as the knee bends. This causes the graft to become excessively tight in flexion, risking medial patellar overload or graft failure.

Question 1573

Topic: Knee Sports

A 30-year-old male is evaluated for knee pain 6 months following a motor vehicle collision. With the patient supine and the knee flexed to 90 degrees, the tibia rests in a posteriorly subluxated position. When the patient is asked to actively slide his foot forward on the exam table, the tibia translates anteriorly into an anatomic position. This examination finding is diagnostic for an injury to which structure?

. Anterior cruciate ligament.
. Posterolateral corner.
. Posterior cruciate ligament.
. Medial patellofemoral ligament.
. Anterolateral ligament.

Correct Answer & Explanation

. Posterior cruciate ligament.

Explanation

The scenario describes the quadriceps active test. In a posterior cruciate ligament (PCL) deficient knee, the tibia rests in a posteriorly sagged position; active contraction of the quadriceps pulls the tibia anteriorly, confirming PCL insufficiency.

Question 1574

Topic: Knee Sports

A 25-year-old football player sustains a knee injury. On examination, the dial test reveals 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the uninjured side. However, at 90 degrees of knee flexion, the external rotation is equal bilaterally. What is the most likely injured structure?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

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

Question 1575

Topic: Knee Sports

A 55-year-old active female feels a pop in her posterior knee while squatting. MRI reveals a complete posterior root tear of the medial meniscus. If left untreated, the biomechanical consequences of this injury most closely resemble which of the following?

. Isolated anterior cruciate ligament deficiency
. Total medial meniscectomy
. Partial medial meniscectomy
. Posterior cruciate ligament deficiency
. Patellofemoral cartilage loss

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A meniscal root tear disrupts the circumferential hoop stresses of the meniscus, causing it to extrude under load. This results in altered contact mechanics functionally equivalent to a total meniscectomy, leading to rapid joint degeneration.

Question 1576

Topic: Knee Sports
In medial patellofemoral ligament (MPFL) reconstruction, placing the femoral attachment too proximal and anterior relative to Schöttle's point will result in which of the following kinematic abnormalities?
. Excessive graft tension in early flexion
. Excessive graft tension in deep flexion
. Graft laxity in extension
. Increased patellar tilt in deep flexion
. Patella baja

Correct Answer & Explanation

. Excessive graft tension in deep flexion

Explanation

A femoral tunnel placed too proximal to Schöttle's point leads to increased distance between the attachment sites during knee flexion. This causes excessive graft tension in deep flexion and a potential loss of motion.

Question 1577

Topic: Knee Sports

Which of the following biomechanical consequences most accurately describes an unhealed posterior medial meniscal root tear?

. Decreased contact pressure in the medial compartment
. Anterior translation of the medial meniscus during flexion
. Biomechanical equivalence to a total medial meniscectomy
. Decreased tension in the anterior cruciate ligament (ACL)
. Increased varus laxity at 30 degrees of flexion

Correct Answer & Explanation

. Biomechanical equivalence to a total medial meniscectomy

Explanation

A posterior medial meniscal root tear disrupts the hoop stresses of the meniscus, leading to extrusion and altered kinematics. Biomechanically, it is equivalent to a total medial meniscectomy, significantly increasing tibiofemoral peak contact pressures.

Question 1578

Topic: Knee Sports

A 50-year-old female experiences an acute pop in her posterior knee while squatting. MRI reveals a complete radial tear of the medial meniscus posterior root. Which of the following is the most likely biomechanical consequence of this untreated injury?

. Decreased anterior tibial translation
. Decreased peak contact pressures in the medial compartment
. Loss of hoop stresses leading to rapid articular cartilage degeneration
. Increased varus alignment of the knee during swing phase
. Hypertrophy of the medial collateral ligament

Correct Answer & Explanation

. Loss of hoop stresses leading to rapid articular cartilage degeneration

Explanation

A posterior medial meniscal root tear results in the complete loss of circumferential hoop stresses, rendering the meniscus biomechanically equivalent to a total meniscectomy. This leads to significantly increased contact pressures and rapid progression of osteoarthritis.

Question 1579

Topic: Knee Sports

During a medial patellofemoral ligament (MPFL) reconstruction, the femoral tunnel is being drilled. To reproduce native isometry, the ideal femoral attachment site should be located:

. Proximal and anterior to the medial epicondyle
. Proximal and posterior to the medial epicondyle
. Distal and anterior to the adductor tubercle
. Distal and posterior to the adductor tubercle
. Directly on the gastrocnemius tubercle

Correct Answer & Explanation

. Proximal and posterior to the medial epicondyle

Explanation

Schottle's point defines the radiographic femoral footprint of the MPFL, which is located just proximal and posterior to the medial epicondyle, and distal to the adductor tubercle. Non-anatomic placement leads to graft tension mismatch and potential failure.

Question 1580

Topic: Knee Sports

A "ramp lesion" of the knee is most commonly associated with which of the following injury patterns?

. Acute PCL tear
. Acute ACL tear
. Isolated medial collateral ligament sprain
. Patellar dislocation
. Posterolateral corner injury

Correct Answer & Explanation

. Acute ACL tear

Explanation

Ramp lesions represent tears of the peripheral meniscocapsular attachment of the posterior horn of the medial meniscus. They are highly associated with acute ACL tears and can lead to increased anterior tibial translation if left unrepaired.

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