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Knee Sports MCQs

Practice Set 80 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 1581

Topic: Knee Sports

Microfracture for the treatment of full-thickness articular cartilage defects of the knee is most suitable for which of the following lesion characteristics?

. Defects greater than 4 cm^2
. Defects sized 3 to 4 cm^2
. Contained defects less than 2 cm^2
. Kissing lesions of the tibiofemoral joint
. Uncontained osteochondritis dissecans lesions

Correct Answer & Explanation

. Contained defects less than 2 cm^2

Explanation

Microfracture is indicated for small, contained, full-thickness cartilage defects (typically less than 2 cm^2) in young, active patients. Larger lesions or uncontained lesions have unacceptably high failure rates and are better managed with techniques like osteochondral autograft or MACI.

Question 1582

Topic: Knee Sports

Which of the following graft choices for ACL reconstruction has the highest initial ultimate tensile load?

. Single-strand hamstring
. Bone-patellar tendon-bone (10 mm)
. Quadrupled hamstring
. Native anterior cruciate ligament
. Iliotibial band

Correct Answer & Explanation

. Quadrupled hamstring

Explanation

A quadrupled hamstring graft has an ultimate tensile load of approximately 4000 N, which is the highest among common autografts and significantly stronger than the native ACL (approx. 2160 N) or a 10 mm bone-patellar tendon-bone graft (approx. 2977 N).

Question 1583

Topic: Knee Sports

A 25-year-old male complains of knee instability after receiving a blow to the anteromedial tibia. Physical examination reveals an isolated increase in external rotation of 15 degrees compared to the contralateral knee when tested at 30 degrees of knee flexion. There is no asymmetry in external rotation at 90 degrees of flexion. Which structure is most likely injured?

. Posterior cruciate ligament
. Popliteofibular ligament
. Anterolateral ligament
. Medial patellofemoral ligament
. Superficial medial collateral ligament

Correct Answer & Explanation

. Popliteofibular ligament

Explanation

An isolated increase in external rotation at 30 degrees of flexion, with symmetric rotation at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. The popliteofibular ligament is a primary static stabilizer of the PLC.

Question 1584

Topic: Knee Sports

A 52-year-old male presents with acute medial knee pain after rising from a deep squat. MRI reveals a complete radial tear of the medial meniscus posterior root. Biomechanically, this injury is most similar to which of the following conditions?

. Total medial meniscectomy
. Anterior cruciate ligament deficiency
. Isolated medial collateral ligament tear
. Bucket-handle meniscus tear
. Chondromalacia patellae

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A complete tear of the posterior root of the medial meniscus disrupts the circumferential hoop stresses, leading to extrusion of the meniscus. Biomechanically, this results in peak contact pressures equivalent to a total meniscectomy.

Question 1585

Topic: Knee Sports

A 45-year-old female presents with acute onset of medial knee pain after squatting. MRI shows a complete radial tear of the posterior horn of the medial meniscus at its root attachment. Which of the following best describes the biomechanical consequence of this injury?

. Increased contact area and decreased peak contact pressure
. Decreased contact area and increased peak contact pressure
. Complete loss of medial compartment stability requiring collateral ligament repair
. Increased lateral compartment peak contact pressure
. Decreased medial compartment anterior translation

Correct Answer & Explanation

. Decreased contact area and increased peak contact pressure

Explanation

Medial meniscal root tears severely disrupt hoop stresses, functioning biomechanically like a total meniscectomy. This results in decreased contact area and significantly increased peak contact pressures in the medial compartment.

Question 1586

Topic: Knee Sports
A 16-year-old female experiences recurrent lateral patellar dislocations. She has failed conservative management. Imaging reveals a tibial tubercle-trochlear groove (TT-TG) distance of 14 mm, normal patellar height, and a dysplastic trochlea. Reconstruction of the medial patellofemoral ligament (MPFL) is planned. The femoral footprint of the MPFL is anatomically located:
. Anterior to the adductor tubercle and proximal to the medial epicondyle
. Posterior to the adductor tubercle and distal to the medial epicondyle
. Distal to the adductor tubercle and posterior to the medial epicondyle
. Anterior to the medial epicondyle and distal to the adductor tubercle
. At the center of the medial epicondyle

Correct Answer & Explanation

. Anterior to the adductor tubercle and proximal to the medial epicondyle

Explanation

The Schöttle point for the femoral origin of the MPFL is located anterior to the adductor tubercle, proximal to the medial epicondyle, and distal to the medial physis.

Question 1587

Topic: Knee Sports

A 28-year-old male sustains a traumatic knee dislocation. Following reduction, his pedal pulses are symmetric, but he has an inability to dorsiflex his ankle or extend his toes. Which of the following ligamentous injuries is most commonly associated with this neurologic deficit?

. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Medial collateral ligament (MCL)
. Posterolateral corner (PLC)
. Medial patellofemoral ligament (MPFL)

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

Common peroneal nerve palsy is highly associated with posterolateral corner (PLC) injuries due to the anatomic proximity of the nerve to the fibular head and the severe varus/hyperextension traction forces involved.

Question 1588

Topic: Knee Sports

A 14-year-old female gymnast complains of lateral elbow pain, clicking, and a 15-degree extension block. MRI demonstrates a 12 mm unstable osteochondritis dissecans (OCD) lesion of the capitellum with loose bodies. What is the most appropriate surgical treatment?

. Arthroscopic drilling of the intact lesion in situ
. Open reduction and internal fixation of the capitellum
. Arthroscopic loose body removal and microfracture of the defect
. Total elbow arthroplasty
. Ulnar nerve transposition

Correct Answer & Explanation

. Arthroscopic loose body removal and microfracture of the defect

Explanation

In an unstable capitellar OCD lesion with loose bodies and a defect, the standard of care is arthroscopic removal of the loose body followed by debridement and microfracture of the base. Drilling in situ is reserved for stable, intact lesions.

Question 1589

Topic: Knee Sports

A 25-year-old soccer player sustains a hyperextension varus knee injury. Examination shows a positive dial test at 30 degrees of flexion, but symmetric rotation compared to the contralateral knee at 90 degrees. What isolated structure is most likely injured?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Posterolateral corner
. Medial collateral ligament
. Popliteus tendon only

Correct Answer & Explanation

. Posterolateral corner

Explanation

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

Question 1590

Topic: Knee Sports
A 19-year-old gymnast is scheduled for a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. To avoid altering normal patellofemoral kinematics and restricting flexion, the femoral tunnel must be placed at the anatomic footprint. Where is this point located anatomically?
. Proximal to the adductor tubercle and anterior to the medial epicondyle
. Distal to the medial epicondyle and anterior to the adductor tubercle
. On the medial joint line deep to the superficial MCL
. Between the medial epicondyle and the adductor tubercle
. Directly over the center of the medial femoral condyle articular cartilage

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle

Explanation

The anatomic femoral footprint of the MPFL (the Schöttle point) is located just proximal and posterior to the medial epicondyle, and distal to the adductor tubercle. Non-anatomic placement leads to graft mal-tensioning, abnormal tracking, and loss of knee flexion.

Question 1591

Topic: Knee Sports

A 26-year-old running back sustains a direct blow to the anteromedial tibia. Examination reveals increased varus laxity at 30 degrees of knee flexion. A dial test demonstrates 15 degrees of increased external rotation at 30 degrees of flexion compared to the uninjured side, but symmetric external rotation at 90 degrees. What is the most likely diagnosis?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

The dial test measures external tibial rotation to evaluate the PLC and PCL. An asymmetry of >10 degrees at 30 degrees of flexion, but symmetric rotation at 90 degrees, is diagnostic of an isolated posterolateral corner (PLC) injury. Combined PLC and PCL injuries show asymmetry at both 30 and 90 degrees.

Question 1592

Topic: Knee Sports

A 9-year-old boy (Tanner stage 1) sustains a complete anterior cruciate ligament (ACL) tear. He experiences recurrent instability episodes despite 3 months of physical therapy. Which surgical option minimizes the risk of growth arrest?

. Nonoperative management until skeletal maturity
. Transphyseal ACL reconstruction using bone-patellar tendon-bone autograft
. All-epiphyseal physeal-sparing ACL reconstruction
. Extra-articular tenodesis alone
. Primary suture repair of the ACL

Correct Answer & Explanation

. All-epiphyseal physeal-sparing ACL reconstruction

Explanation

In prepubescent children (Tanner stage 1) with recurrent instability, an all-epiphyseal or extra-articular physeal-sparing reconstruction minimizes the risk of premature growth arrest. Delaying surgery until skeletal maturity significantly increases the risk of secondary meniscal and chondral damage.

Question 1593

Topic: Knee Sports
A 10-year-old girl falls while skiing and sustains a completely displaced (Meyers and McKeever Type III) fracture of the anterior tibial spine. Attempted closed reduction is unsuccessful. During arthroscopic management, what structure is most commonly found entrapped, blocking anatomic reduction?
. Medial meniscus
. Lateral meniscus
. Anterior cruciate ligament
. Posterior cruciate ligament
. Transverse intermeniscal ligament

Correct Answer & Explanation

. Medial meniscus

Explanation

The anterior horn of the medial meniscus is the most common soft-tissue structure to become entrapped beneath a displaced Type III tibial eminence fracture. This interposition prevents anatomic closed reduction and necessitates arthroscopic or open reduction.

Question 1594

Topic: Knee Sports

A 13-year-old boy presents with vague anterior knee pain and intermittent catching. Radiographs reveal an osteochondritis dissecans (OCD) lesion. Where is the most common anatomical location for this lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Lateral aspect of the lateral femoral condyle
. Medial aspect of the lateral femoral condyle
. Central articular surface of the patella

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. It accounts for approximately 70-80% of all knee OCD lesions.

Question 1595

Topic: Knee Sports

A 13-year-old boy has an osteochondritis dissecans (OCD) lesion of the medial femoral condyle. MRI shows a 1.5 cm lesion with intact overlying cartilage and no high T2 signal behind the fragment. His distal femoral physis is wide open. What is the best initial management?

. Arthroscopic transarticular drilling
. Subchondral bone grafting
. Excision of the fragment with microfracture
. Autologous chondrocyte implantation
. Non-weight bearing and restriction of athletic activities

Correct Answer & Explanation

. Non-weight bearing and restriction of athletic activities

Explanation

Stable OCD lesions in skeletally immature patients with open physes have a high rate of spontaneous healing. Initial management should be conservative, prioritizing activity restriction and protected weight bearing.

Question 1596

Topic: Knee Sports

A 28-year-old woman has persistent anterolateral ankle pain after a severe sprain 6 months ago. MRI shows a 12-mm osteochondral lesion of the anterolateral talar dome with intact cartilage but subchondral cystic changes. After failed conservative treatment, what is the best surgical option?

. Osteochondral autograft transfer (OATS)
. Arthroscopic bone marrow stimulation (microfracture)
. Ankle arthrodesis
. Matrix-induced autologous chondrocyte implantation (MACI)
. Total ankle arthroplasty

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

Arthroscopic microfracture is the standard initial surgical treatment for symptomatic, small to medium-sized (<1.5 cm diameter) osteochondral lesions of the talus.

Question 1597

Topic: Knee Sports

In understanding the biomechanics of the native anterior cruciate ligament (ACL), the anteromedial (AM) bundle is most taut in which of the following knee positions?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 degrees of flexion
. 120 degrees of flexion

Correct Answer & Explanation

. 90 degrees of flexion

Explanation

The anteromedial (AM) bundle of the ACL is most taut in flexion (approximately 90 degrees) and is the primary restraint to anterior tibial translation in this position. The posterolateral (PL) bundle is taut in extension and provides rotatory stability.

Question 1598

Topic: Knee Sports

During knee flexion, what is the normal biomechanical tension pattern of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL)?

. Both bundles become tight
. Both bundles become lax
. AM bundle tightens and PL bundle becomes lax
. AM bundle becomes lax and PL bundle tightens
. AM bundle tightens in early flexion then becomes lax

Correct Answer & Explanation

. AM bundle tightens and PL bundle becomes lax

Explanation

The ACL is composed of two distinct bundles. During knee flexion, the anteromedial (AM) bundle tightens while the posterolateral (PL) bundle becomes lax, whereas in extension the PL bundle is tight.

Question 1599

Topic: Knee Sports

The ligaments of Humphry and Wrisberg are accessory meniscofemoral ligaments. The ligament of Wrisberg is characterized anatomically as running from the:

. Posterior horn of the medial meniscus passing anterior to the PCL
. Posterior horn of the lateral meniscus passing anterior to the PCL
. Posterior horn of the lateral meniscus passing posterior to the PCL
. Anterior horn of the medial meniscus passing posterior to the ACL
. Anterior horn of the lateral meniscus passing anterior to the ACL

Correct Answer & Explanation

. Posterior horn of the lateral meniscus passing posterior to the PCL

Explanation

The meniscofemoral ligaments originate from the posterior horn of the lateral meniscus and insert onto the medial femoral condyle. Humphry passes Anterior to the PCL, while Wrisberg passes Posterior to the PCL (mnemonic: 'Humphry is High/Ahead, Wrisberg is in the Wake/Behind').

Question 1600

Topic: Knee Sports

The meniscofemoral ligaments of the knee are anatomically associated with the posterior cruciate ligament (PCL). What is the specific anatomic course of the ligament of Wrisberg?

. It passes anterior to the PCL
. It passes posterior to the PCL
. It passes anterior to the ACL
. It passes posterior to the ACL
. It connects the anterior horns of the medial and lateral menisci

Correct Answer & Explanation

. It passes posterior to the PCL

Explanation

The ligament of Wrisberg passes posterior to the posterior cruciate ligament (PCL). The ligament of Humphry passes anterior to the PCL.

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