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Knee Sports MCQs

Practice Set 84 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 1661

Topic: Knee Sports

Which physical examination finding is highly specific for a meniscus tear in the knee?

. Positive Lachman test.
. Joint line tenderness with pain on twisting maneuvers (e.g., McMurray test).
. Valgus instability.
. Patellofemoral crepitus.
. Generalized knee effusion.

Correct Answer & Explanation

. Joint line tenderness with pain on twisting maneuvers (e.g., McMurray test).

Explanation

Joint line tenderness combined with pain or a 'click' during specific twisting maneuvers (like the McMurray test) is highly suggestive of a meniscus tear. The McMurray test attempts to trap the torn meniscal fragment between the femur and tibia. A positive Lachman test indicates ACL injury. Valgus instability indicates MCL injury. Patellofemoral crepitus suggests patellofemoral arthritis or chondromalacia. Generalized knee effusion can be present with many knee pathologies.

Question 1662

Topic: Knee Sports

What is the primary role of the anterior cruciate ligament (ACL) in the knee joint?

. Preventing varus stress.
. Preventing valgus stress.
. Preventing anterior translation of the tibia on the femur.
. Preventing posterior translation of the tibia on the femur.
. Preventing excessive knee hyperextension.

Correct Answer & Explanation

. Preventing anterior translation of the tibia on the femur.

Explanation

The anterior cruciate ligament (ACL) is the primary restraint to anterior translation of the tibia on the femur and also limits internal and external rotation of the tibia. It is crucial for knee stability, especially during rotational and pivoting movements. The medial collateral ligament (MCL) prevents valgus stress. The lateral collateral ligament (LCL) prevents varus stress. The posterior cruciate ligament (PCL) prevents posterior translation of the tibia. Hyperextension is limited by various capsular and ligamentous structures.

Question 1663

Topic: Knee Sports

A 14-year-old male football player sustains a valgus stress injury to his knee. Examination reveals pain and laxity with valgus stress at 30 degrees of knee flexion, but stability at 0 degrees. What structure is most likely injured?

. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Medial collateral ligament (MCL)
. Lateral collateral ligament (LCL)
. Medial meniscus

Correct Answer & Explanation

. Medial collateral ligament (MCL)

Explanation

Laxity with valgus stress at 30 degrees of knee flexion, with stability at 0 degrees, is the classic presentation for an isolated medial collateral ligament (MCL) injury (Grade I or II). The MCL is the primary restraint to valgus stress. If there were laxity at 0 degrees, it would suggest a more severe injury involving the posterior oblique ligament and/or ACL. LCL is injured with varus stress. ACL and PCL injuries cause anteroposterior instability. The medial meniscus can be injured with valgus forces, but the primary instability described points to the MCL.

Question 1664

Topic: Knee Sports

Which of the following ligaments is considered the primary static stabilizer against posterior translation of the tibia on the femur?

. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Medial collateral ligament (MCL)
. Lateral collateral ligament (LCL)
. Posterior oblique ligament

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

The Posterior Cruciate Ligament (PCL) is the strongest ligament in the knee and serves as the primary static stabilizer against posterior translation of the tibia on the femur, as well as providing some secondary restraint to varus, valgus, and rotational forces. The ACL is the primary restraint to anterior translation. The MCL and LCL provide valgus and varus stability, respectively. The posterior oblique ligament is part of the posteromedial corner and contributes to valgus stability and external rotation.

Question 1665

Topic: Knee Sports

Which of the following ligaments provides the most significant restraint to external rotation of the tibia on the femur?

. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Medial collateral ligament (MCL)
. Lateral collateral ligament (LCL)
. Oblique popliteal ligament

Correct Answer & Explanation

. Anterior cruciate ligament (ACL)

Explanation

The anterior cruciate ligament (ACL) is the primary restraint to anterior translation of the tibia on the femur, but it also provides a significant secondary restraint to internal and external rotation, particularly preventing excessive external rotation. The PCL restrains posterior translation. The MCL and LCL primarily resist valgus and varus forces, respectively. The oblique popliteal ligament is part of the posteromedial corner and contributes to posterior stability.

Question 1666

Topic: Knee Sports

What is the primary function of the posterior cruciate ligament (PCL)?

. Prevents anterior translation of the tibia on the femur
. Prevents posterior translation of the tibia on the femur
. Resists varus stress to the knee
. Resists valgus stress to the knee
. Limits hyperextension of the knee

Correct Answer & Explanation

. Prevents posterior translation of the tibia on the femur

Explanation

The primary function of the PCL is to prevent posterior translation of the tibia on the femur, especially when the knee is flexed. This is tested clinically with the posterior drawer test. The ACL prevents anterior translation of the tibia. The collateral ligaments resist varus (LCL) and valgus (MCL) stresses. The PCL also helps to limit hyperextension, but its primary role is posterior translation prevention.

Question 1667

Topic: Knee Sports

What is the most common location for osteochondritis dissecans (OCD) in the knee?

. Lateral femoral condyle
. Medial femoral condyle
. Patella
. Tibial plateau
. Trochlear groove

Correct Answer & Explanation

. Medial femoral condyle

Explanation

The medial femoral condyle is the most common location for osteochondritis dissecans (OCD) in the knee, particularly the lateral aspect of the medial femoral condyle. While OCD can occur in other locations, it is significantly less frequent there.

Question 1668

Topic: Knee Sports

Which structure provides the primary static restraint against posterior translation of the tibia in the knee?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Medial collateral ligament
. Lateral collateral ligament
. Posterior horn of the medial meniscus

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

The posterior cruciate ligament (PCL) is the primary static stabilizer that prevents posterior translation of the tibia relative to the femur. This is its defining function, particularly at higher flexion angles. The ACL prevents anterior translation. The collateral ligaments provide varus/valgus stability. The menisci are secondary stabilizers and shock absorbers.

Question 1669

Topic: Knee Sports

Which specific ligament provides the primary restraint against valgus stress to the knee?

. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Lateral collateral ligament (LCL)
. Medial collateral ligament (MCL)
. Posterolateral corner (PLC)

Correct Answer & Explanation

. Medial collateral ligament (MCL)

Explanation

The medial collateral ligament (MCL) is the primary static restraint against valgus stress to the knee. The LCL resists varus stress. The ACL and PCL provide anterior and posterior stability, respectively. The posterolateral corner (PLC) provides rotational and varus stability but is not the primary valgus stabilizer.

Question 1670

Topic: Knee Sports

A 35-year-old male sustains a high-energy traumatic knee dislocation. On examination in the trauma bay, the knee is locked in a slightly flexed position, and there is a distinct transverse furrow or 'puckering' of the skin over the medial joint line (the 'dimple sign'). An attempted closed reduction is unsuccessful. What anatomic structure is primarily responsible for blocking the reduction?

. Medial meniscus
. Medial capsule and retinaculum
. Semitendinosus tendon
. Anterior cruciate ligament stump
. Patellar tendon

Correct Answer & Explanation

. Medial capsule and retinaculum

Explanation

The 'dimple sign' represents a posterolateral knee dislocation in which the medial femoral condyle buttonholes through the anterior medial capsule and retinaculum. The intact capsule prevents the condyle from returning to its anatomical position, rendering the dislocation irreducible by closed means. It requires immediate open reduction. Applying excessive force during closed reduction attempts can cause skin necrosis or further soft tissue damage.

Question 1671

Topic: Knee Sports

A 16-year-old female dancer experiences a primary lateral patellar dislocation. Which of the following ligamentous structures is most likely to be injured and represents the primary soft-tissue restraint to lateral patellar translation at 20 degrees of knee flexion?

. Medial patellotibial ligament
. Medial patellomeniscal ligament
. Medial patellofemoral ligament
. Vastus medialis obliquus
. Lateral retinaculum

Correct Answer & Explanation

. Medial patellofemoral ligament

Explanation

The medial patellofemoral ligament (MPFL) is the primary static stabilizer against lateral patellar translation, providing 50-60% of the restraining force, particularly in early flexion (0-30 degrees) before the patella engages fully in the trochlear groove. It is torn in nearly 100% of acute lateral patellar dislocations, typically avulsing from its femoral attachment (near the adductor tubercle) or its patellar attachment.

Question 1672

Topic: Knee Sports
A 16-year-old female sustains a first-time lateral patellar dislocation, which reduces spontaneously. Subsequent MRI evaluates the medial patellofemoral ligament (MPFL). Where is the most common anatomic location of an MPFL tear in the setting of acute patellar dislocation?
. Tibial tubercle
. Patellar insertion
. Mid-substance
. Femoral origin
. Fibular head

Correct Answer & Explanation

. Femoral origin

Explanation

The Medial Patellofemoral Ligament (MPFL) is the primary restraint to lateral patellar translation at 0-30 degrees of flexion. In an acute lateral patellar dislocation, the MPFL tears in >90% of cases. The most common location of the tear is at its femoral origin (near Schรถttle's point, situated between the medial epicondyle and adductor tubercle).

Question 1673

Topic: Knee Sports

A 26-year-old soccer player sustains a knee injury. Physical exam reveals a positive posterior drawer test and increased external rotation at both 30 and 90 degrees of knee flexion during the Dial test compared to the contralateral side. What combined injury pattern is present?

. ACL and MCL
. PCL and MCL
. PCL and Posterolateral Corner (PLC)
. ACL and PLC
. Isolated PLC

Correct Answer & Explanation

. PCL and Posterolateral Corner (PLC)

Explanation

The Dial test evaluates posterolateral instability. Asymmetry of greater than 10 degrees of external rotation at both 30 and 90 degrees of knee flexion indicates a combined injury to both the PCL and the Posterolateral Corner (PLC).

Question 1674

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. The anteromedial (AM) bundle is tightest in which position of the knee?

. 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 ACL's anteromedial (AM) bundle is tightest in flexion and primarily controls anterior translation in this position, assessed clinically via the anterior drawer test at 90 degrees. The posterolateral (PL) bundle is tightest in extension and provides rotatory stability, tested via the Lachman test at 20-30 degrees.

Question 1675

Topic: Knee Sports

Anatomical reconstruction of the anterior cruciate ligament (ACL) aims to restore the function of its two distinct bundles. Which of the following best describes the native biomechanics of the anteromedial (AM) and posterolateral (PL) bundles?

. AM bundle is tight in flexion and primarily controls anterior translation; PL bundle is tight in extension and primarily controls rotatory stability
. AM bundle is tight in extension and primarily controls anterior translation; PL bundle is tight in flexion and primarily controls rotatory stability
. AM bundle controls posterior translation in extension; PL bundle controls anterior translation in flexion
. Both bundles are maximally tight in full extension to prevent hyperextension
. Both bundles act isometrically throughout the entire arc of knee motion

Correct Answer & Explanation

. AM bundle is tight in flexion and primarily controls anterior translation; PL bundle is tight in extension and primarily controls rotatory stability

Explanation

The ACL consists of two main bundles named for their tibial insertion: the Anteromedial (AM) and Posterolateral (PL) bundles. Biomechanically, the AM bundle is tightest in knee flexion and provides primary restraint against anterior tibial translation. The PL bundle is tightest in full extension and provides primary restraint against rotatory loads (e.g., pivot shift). Understanding this is crucial for anatomic tunnel placement.

Question 1676

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. Which of the following best describes the isolated biomechanical function of the posterolateral (PL) bundle?

. It provides the primary restraint to anterior tibial translation in 90 degrees of knee flexion
. It is tightest in extension and provides primary rotational stability to the knee
. It is the primary restraint to valgus stress when the knee is fully extended
. It is tightest in full flexion and provides primary varus stability
. It acts synergistically with the posterior cruciate ligament to prevent posterior translation

Correct Answer & Explanation

. It is tightest in extension and provides primary rotational stability to the knee

Explanation

The posterolateral (PL) bundle of the ACL is tightest in knee extension and acts as the primary restraint to rotatory loads. Conversely, the anteromedial (AM) bundle is tightest in flexion.

Question 1677

Topic: Knee Sports

During anterior cruciate ligament (ACL) reconstruction, understanding the function of the two primary bundles is critical. The posterolateral (PL) bundle of the ACL is primarily responsible for which of the following biomechanical functions?

. Resisting anterior tibial translation at 90 degrees of flexion.
. Resisting rotatory loads near full extension.
. Resisting posterior tibial translation at 30 degrees of flexion.
. Resisting valgus stress at 90 degrees of flexion.
. Resisting varus stress in full extension.

Correct Answer & Explanation

. Resisting anterior tibial translation at 90 degrees of flexion.

Explanation

The ACL is composed of the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees of knee flexion. The PL bundle is tight in extension and is the primary restraint to rotatory loads (and anterior translation) when the knee is near full extension.

Question 1678

Topic: Knee Sports

During normal knee flexion, the femoral contact point translates posteriorly on the tibial plateau, a phenomenon known as femoral rollback. Which ligament is the primary driver of this kinematic movement?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Medial collateral ligament
. Lateral collateral ligament
. Posterior oblique ligament

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

The Posterior Cruciate Ligament (PCL) tightens during deep knee flexion, drawing the femoral condyles posteriorly on the tibia. This femoral rollback improves the extensor mechanism lever arm and prevents posterior impingement to maximize flexion.

Question 1679

Topic: Knee Sports

The anterior cruciate ligament (ACL) consists of two distinct functional bundles. Which of the following statements correctly describes the primary tension patterns of these bundles during knee range of motion?

. The anteromedial bundle is tight in extension and lax in flexion.
. The posterolateral bundle is tight in flexion and lax in extension.
. The anteromedial bundle is tight in flexion, and the posterolateral bundle is tight in extension.
. Both bundles are equally tight throughout the entire range of motion.
. Both bundles are maximally lax at 90 degrees of flexion.

Correct Answer & Explanation

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

Explanation

The ACL consists of the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle is tight in flexion and primarily controls anterior translation. The PL bundle is tight in extension and provides significant rotational stability. Reconstructive techniques often aim to address both functional requirements.

Question 1680

Topic: Knee Sports

During the physical examination of a patient with a suspected anterior cruciate ligament (ACL) tear, a pivot shift test is performed. Which specific biomechanical function of the ACL is this test primarily designed to assess?

. Anterior translation in high degrees of knee flexion, controlled by the anteromedial bundle.
. Rotational stability, which is primarily provided by the posterolateral bundle in near-extension.
. Varus-valgus stability at 30 degrees of flexion.
. Posterior tibial translation during active quadriceps contraction.
. Anterior translation in internal rotation, controlled by the medial collateral ligament.

Correct Answer & Explanation

. Rotational stability, which is primarily provided by the posterolateral bundle in near-extension.

Explanation

The pivot shift test assesses the dynamic rotational stability of the knee, which is primarily controlled by the posterolateral (PL) bundle of the ACL. The PL bundle is tightest in extension and near-extension, which is the position where the pivot shift phenomenon occurs.

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