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Knee Sports MCQs

Practice Set 8 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 141

Topic: Knee Sports

In posterior cruciate ligament (PCL) reconstruction, the tibial inlay technique was developed primarily to avoid which of the following complications associated with the transtibial technique?

. Popliteal artery injury
. Anterior knee pain
. "Killer turn" graft attenuation
. Tibial nerve palsy
. Graft-tunnel mismatch

Correct Answer & Explanation

. "Killer turn" graft attenuation

Explanation

The tibial inlay technique avoids the acute angle (the "killer turn") that the graft makes as it exits the posterior tibial tunnel in a transtibial reconstruction. This reduces graft abrasion and attenuation.

Question 142

Topic: Knee Sports
A 25-year-old athlete undergoes Matrix-Induced Autologous Chondrocyte Implantation (MACI) for a 3 cm² focal chondral defect on the medial femoral condyle. What is the primary histologic composition of the target repaired tissue?
. Pure Type I collagen
. Hyaline-like cartilage rich in Type II collagen
. Fibrocartilage rich in Type III collagen
. Pure Type I and Type X collagen
. Calcified cartilage with disorganized Type II collagen

Correct Answer & Explanation

. Hyaline-like cartilage rich in Type II collagen

Explanation

Unlike microfracture which predominantly produces fibrocartilage (Type I collagen), MACI aims to produce hyaline-like cartilage, which is rich in Type II collagen and aggrecan, providing superior wear characteristics.

Question 143

Topic: Knee Sports

The primary restraint to lateral patellar translation at 0 to 30 degrees of knee flexion is the:

. Medial patellofemoral ligament
. Medial patellotibial ligament
. Medial retinaculum
. Vastus medialis obliquus
. Lateral trochlear ridge

Correct Answer & Explanation

. Medial patellofemoral ligament

Explanation

The medial patellofemoral ligament (MPFL) provides approximately 50-60% of the restraint to lateral patellar translation in early flexion. Beyond 30 degrees, the patella engages the trochlear groove, and bony stability becomes the primary restraint.

Question 144

Topic: Knee Sports

The most common anatomic location for Osteochondritis Dissecans (OCD) lesions in the knee is the:

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central trochlear groove
. Inferior pole of the patella
. Weight-bearing surface of the medial tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

Approximately 70-80% of knee OCD lesions occur on the lateral aspect of the medial femoral condyle. This area corresponds to the classic location evaluated during the Wilson test.

Question 145

Topic: Knee Sports

Concurrent anterior cruciate ligament (ACL) reconstruction at the time of meniscus repair is known to improve meniscus healing rates. This biological enhancement is primarily attributed to:

. Decreased post-operative weight-bearing
. Release of bone marrow elements into the joint during tunnel drilling
. Immediate restoration of normal knee kinematics
. Post-operative use of continuous passive motion (CPM)
. Avoidance of post-operative NSAID use

Correct Answer & Explanation

. Release of bone marrow elements into the joint during tunnel drilling

Explanation

Drilling femoral and tibial tunnels during ACL reconstruction releases bone marrow elements, stem cells, and growth factors into the intra-articular environment. This creates a biologically favorable hemarthrosis that significantly enhances meniscal healing.

Question 146

Topic: Knee Sports

The "killer turn" in Posterior Cruciate Ligament (PCL) reconstruction refers to the acute angle the graft must negotiate at the:

. Femoral tunnel aperture
. Tibial tunnel aperture
. Intercondylar notch
. Medial femoral condyle articular margin
. Tibial spine

Correct Answer & Explanation

. Tibial tunnel aperture

Explanation

In a transtibial PCL reconstruction, the graft must make an acute 90-degree turn as it exits the posterior tibial tunnel aperture to reach the femoral attachment. This "killer turn" can lead to increased graft abrasion and attenuation over time.

Question 147

Topic: Knee Sports

When performing an anatomic posterolateral corner (PLC) reconstruction of the knee, which three primary structures are typically reconstructed to restore varus and external rotation stability?

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament
. Fibular collateral ligament, biceps femoris tendon, and iliotibial band
. Popliteus tendon, lateral collateral ligament, and lateral meniscus root
. Arcuate ligament, fabellofibular ligament, and popliteofibular ligament
. Lateral collateral ligament, anterior lateral ligament, and popliteus tendon

Correct Answer & Explanation

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

Anatomic PLC reconstruction aims to recreate the three major static stabilizers of the posterolateral knee. These are the fibular collateral ligament (FCL), the popliteus tendon (PLT), and the popliteofibular ligament (PFL).

Question 148

Topic: Knee Sports

Which of the following statements accurately describes the biomechanical role of the anteromedial (AM) bundle of the anterior cruciate ligament?

. It is tightest in full extension
. It primarily resists anterior tibial translation in flexion
. It primarily controls rotatory stability in extension
. It has a femoral origin posterior to the posterolateral bundle
. It is smaller and weaker than the posterolateral bundle

Correct Answer & Explanation

. It primarily resists anterior tibial translation in flexion

Explanation

The AM bundle is tightest in flexion and is the primary restraint to anterior tibial translation at 90 degrees of flexion. The posterolateral (PL) bundle is tightest in extension and primarily controls rotatory stability.

Question 149

Topic: Knee Sports
During reconstruction of the medial patellofemoral ligament (MPFL), the femoral tunnel must be placed accurately at Schöttle's point. Where is this radiographic point located on a true lateral radiograph?
. Anterior to the posterior cortical line and proximal to the posterior medial condyle
. Anterior to the posterior cortical line and distal to the Blumensaat line
. Posterior to the posterior cortical line and proximal to the Blumensaat line
. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior border of the medial condyle, and proximal to the level of the posterior point of the Blumensaat line
. Centered exactly on the adductor tubercle

Correct Answer & Explanation

. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior border of the medial condyle, and proximal to the level of the posterior point of the Blumensaat line

Explanation

Schöttle's point is located 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior border of the medial condyle origin, and proximal to the posterior extent of Blumensaat's line. Proper placement is crucial to avoid graft anisometry.

Question 150

Topic: Knee Sports

When performing an isolated single-bundle posterior cruciate ligament (PCL) reconstruction using an anterolateral bundle equivalent, what is the optimal knee flexion angle for securing the graft?

. 0 degrees (full extension)
. 30 degrees
. 60 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 90 degrees

Explanation

An isolated single-bundle PCL reconstruction typically recreates the stronger anterolateral (AL) bundle. Because the AL bundle is tightest in flexion, the graft is optimally tensioned and fixed at 90 degrees of knee flexion while applying an anterior drawer force.

Question 151

Topic: Knee Sports

In posterior cruciate ligament (PCL) anatomy and biomechanics, which of the following statements most accurately describes the function of its distinct bundles?

. The anterolateral bundle is tight in extension and lax in flexion.
. The posteromedial bundle is the primary restraint to posterior translation at 90 degrees of flexion.
. The anterolateral bundle is tight in flexion and is the primary restraint to posterior translation at 90 degrees.
. Both bundles exhibit uniform tension throughout the entire arc of knee motion.
. The posteromedial bundle primarily resists external rotation of the tibia at 30 degrees of flexion.

Correct Answer & Explanation

. The anterolateral bundle is tight in flexion and is the primary restraint to posterior translation at 90 degrees.

Explanation

The PCL consists of the anterolateral (AL) and posteromedial (PM) bundles. The larger AL bundle is tight in flexion, providing the primary restraint to posterior tibial translation at 90 degrees, while the PM bundle is tight in extension.

Question 152

Topic: Knee Sports

Biomechanical studies have demonstrated that a medial meniscus posterior root tear alters knee joint contact mechanics in a manner most biomechanically equivalent to which of the following?

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

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A medial meniscus posterior root tear completely disrupts the circumferential hoop stresses of the meniscus. Biomechanically, this results in increased peak contact pressures and decreased contact area equivalent to a total medial meniscectomy.

Question 153

Topic: Knee Sports
During anatomic reconstruction of the medial patellofemoral ligament (MPFL), identifying the correct femoral attachment (Schöttle's point) is critical for restoring normal patellar kinematics. Radiographically, where is this point located on a strict lateral view of the knee?
. Anterior to the posterior cortex extension line, proximal to the posterior medial femoral condyle articular surface, and distal to the adductor tubercle
. Posterior to the posterior cortex extension line, proximal to the posterior medial femoral condyle articular surface, and distal to the adductor tubercle
. Anterior to the posterior cortex extension line, distal to the Blumensaat line, and proximal to the adductor tubercle
. Posterior to the posterior cortex extension line, distal to the Blumensaat line, and anterior to the medial epicondyle
. Directly over the medial epicondyle, anterior to the adductor tubercle

Correct Answer & Explanation

. Posterior to the posterior cortex extension line, proximal to the posterior medial femoral condyle articular surface, and distal to the adductor tubercle

Explanation

Schöttle's point is radiographically defined as 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior medial epicondyle.

Question 154

Topic: Knee Sports

A 22-year-old football player sustains a posterolateral corner (PLC) injury. During clinical evaluation, increased varus gapping is noted at 30 degrees of knee flexion, but not at 0 degrees. Which structure is the primary restraint being tested at 30 degrees of flexion?

. Popliteofibular ligament
. Fibular collateral ligament (FCL)
. Popliteus tendon
. Iliotibial band
. Lateral capsule

Correct Answer & Explanation

. Fibular collateral ligament (FCL)

Explanation

The fibular collateral ligament (FCL) is the primary restraint to varus stress at 30 degrees of knee flexion. If varus gapping is present at 0 degrees, it typically indicates combined cruciate and FCL injuries.

Question 155

Topic: Knee Sports

During the 'screw-home' mechanism of the knee in terminal extension, there is an obligatory external rotation of the tibia relative to the femur. This is primarily driven by which anatomical feature?

. The increased length and curvature of the medial femoral condyle compared to the lateral femoral condyle
. The active contraction of the popliteus muscle
. The geometry of the lateral meniscus
. The tension provided by the anterior cruciate ligament in extension
. The attachment of the iliotibial band on Gerdy's tubercle

Correct Answer & Explanation

. The increased length and curvature of the medial femoral condyle compared to the lateral femoral condyle

Explanation

The 'screw-home' mechanism is passively driven by the asymmetry of the femoral condyles; the medial femoral condyle has a longer articular surface. This dictates external tibial rotation as the knee locks into full extension.

Question 156

Topic: Knee Sports

All of the following represent mechanisms of injury to the posterior cruciate ligament except:

. Posteriorly directed force on the anterior aspect of the flexed knee
. Fall onto a flexed knee
. Valgus force applied to a flexed and externally rotated knee
. Hyperflexion
. Hyperextension

Correct Answer & Explanation

. Valgus force applied to a flexed and externally rotated knee

Explanation

All of the above except application of valgus force to a flexed and externally rotated knee have been described in posterior cruciate ligament injuries. Application of a valgus force to a flexed and externally rotated knee would more likely result in an anterior cruciate ligament injury.

Question 157

Topic: Knee Sports

Which of the following statements correctly describes the functional biomechanics of the anterior cruciate ligament (ACL) bundles?

. The anteromedial bundle is tight in extension and the posterolateral bundle is tight in flexion
. The posterolateral bundle is tight in flexion and is the primary restraint to anterior translation at 90 degrees
. The anteromedial bundle is tight in flexion and the posterolateral bundle is tight in extension
. Both bundles exhibit isometric tension throughout the full arc of motion
. The anteromedial bundle controls rotatory stability near extension

Correct Answer & Explanation

. The anteromedial bundle is tight in flexion and the posterolateral bundle is tight in extension

Explanation

The ACL is composed of two main bundles: the anteromedial (AM) and posterolateral (PL). The AM bundle tightens in flexion and is the primary anterior restraint at 90 degrees, while the PL bundle tightens in extension and resists rotatory loads.

Question 158

Topic: Knee Sports

A 24-year-old male presents with a locked knee after a twisting injury during a soccer match. An MRI is obtained as shown below.

What is the most likely diagnosis?

. Complete anterior cruciate ligament rupture
. Bucket-handle tear of the medial meniscus
. Posterior cruciate ligament avulsion
. Discoid lateral meniscus
. Patellar tendon rupture

Correct Answer & Explanation

. Bucket-handle tear of the medial meniscus

Explanation

The clinical presentation of a locked knee following a twisting injury is classic for a bucket-handle meniscus tear. On sagittal MRI, a displaced meniscal fragment lying anterior to the posterior cruciate ligament creates the classic "double PCL" sign.

Question 159

Topic: Knee Sports

The posterolateral corner (PLC) of the knee, consisting primarily of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament, functions as the primary restraint to which of the following combined forces?

. Valgus and external rotation
. Valgus and internal rotation
. Varus and external rotation
. Varus and internal rotation
. Anterior translation and varus

Correct Answer & Explanation

. Varus and external rotation

Explanation

The posterolateral corner (PLC) structures work together to resist varus gapping, external tibial rotation, and posterior tibial translation. Injury to the PLC is best assessed clinically with the dial test at 30 and 90 degrees.

Question 160

Topic: Knee Sports
During reconstruction of the medial patellofemoral ligament (MPFL), identifying the correct femoral origin is critical to ensure appropriate graft isometry. Radiographically, the anatomic femoral attachment (Schöttle's point) is located where?
. Distal to the medial epicondyle and anterior to Blumensaat's line
. Between the adductor tubercle and the medial epicondyle
. Directly on the medial epicondyle
. Proximal to the adductor tubercle along the posterior cortex
. Distal to the joint line on the anteromedial tibia

Correct Answer & Explanation

. Between the adductor tubercle and the medial epicondyle

Explanation

The anatomic femoral origin of the MPFL lies in a saddle-shaped sulcus between the adductor tubercle proximally and the medial epicondyle distally. Radiographically, Schöttle's point represents this location slightly anterior to the posterior femoral cortex line.

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