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Knee Sports MCQs

Practice Set 86 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 1701

Topic: Knee Sports

In a 14-year-old male with an osteochondritis dissecans (OCD) lesion of the knee, which radiographic location is most classic for this condition?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central trochlea
. Inferior pole of the patella

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for an OCD lesion of the knee is the lateral aspect of the medial femoral condyle (LAME - Lateral Aspect Medial Epicondyle/condyle).

Question 1702

Topic: Knee Sports
A patient sustains a KD-III knee dislocation (ACL, PCL, and PMC/MCL torn, PLC intact). Following acute reduction, vascular examination reveals diminished distal pulses. An ABI is calculated at 0.7. What is the most appropriate next step in management?
. Observation and repeat ABI in 4 hours
. CT angiography
. Immediate exploration by vascular surgery
. Application of a spanning external fixator
. Emergent MRI of the knee

Correct Answer & Explanation

. CT angiography

Explanation

In the setting of a knee dislocation, an Ankle-Brachial Index (ABI) less than 0.9 is highly suspicious for a vascular injury (specifically the popliteal artery). The next best step is a CT angiogram or standard angiogram to delineate the injury, unless the limb is frankly ischemic with hard signs (absent pulses, expanding hematoma, pulsatile bleeding), which would warrant immediate surgical exploration.

Question 1703

Topic: Knee Sports

In a patient undergoing posterior cruciate ligament (PCL) reconstruction using a tibial inlay technique, the patient is placed in the prone position. The approach to the posterior knee involves dissecting between which two structures to access the PCL footprint?

. Medial head of gastrocnemius and semimembranosus
. Lateral head of gastrocnemius and biceps femoris
. Popliteal artery and tibial nerve
. Semitendinosus and gracilis
. Plantaris and popliteus

Correct Answer & Explanation

. Medial head of gastrocnemius and semimembranosus

Explanation

The posteromedial approach to the knee for a tibial inlay PCL reconstruction utilizes the interval between the medial head of the gastrocnemius (which is retracted laterally to protect the neurovascular bundle) and the semimembranosus (retracted medially). This exposes the posterior joint capsule and the tibial footprint of the PCL.

Question 1704

Topic: Knee Sports

During an anatomic single-bundle anterior cruciate ligament (ACL) reconstruction, the surgeon aims to place the femoral tunnel within the native footprint.

Which of the following osseous landmarks designates the anterior border of the native ACL femoral footprint?

. Medial intercondylar ridge
. Lateral intercondylar ridge (Resident's ridge)
. Lateral bifurcate ridge
. Blumensaat's line
. Posterior articular margin

Correct Answer & Explanation

. Medial intercondylar ridge

Explanation

The lateral intercondylar ridge, also known as Resident's ridge, marks the anterior margin of the ACL footprint on the medial aspect of the lateral femoral condyle. The lateral bifurcate ridge separates the anteromedial and posterolateral bundles.

Question 1705

Topic: Knee Sports

The posterior cruciate ligament (PCL) consists of two main functional bundles. Which of the following statements best describes the biomechanics and relative size of the anterolateral (AL) bundle?

. It is smaller than the posteromedial bundle and is maximally tight in extension.
. It is larger than the posteromedial bundle and is maximally tight in extension.
. It is smaller than the posteromedial bundle and is maximally tight in flexion.
. It is larger than the posteromedial bundle and is maximally tight in flexion.
. It is equal in size to the posteromedial bundle and acts exclusively as a secondary restraint.

Correct Answer & Explanation

. It is smaller than the posteromedial bundle and is maximally tight in extension.

Explanation

The anterolateral (AL) bundle is the larger and stiffer of the two PCL bundles. It is maximally tight in knee flexion, whereas the smaller posteromedial (PM) bundle is tight in extension.

Question 1706

Topic: Knee Sports
A 22-year-old female complains of medial knee pain and an inability to flex her knee past 70 degrees following a medial patellofemoral ligament (MPFL) reconstruction. Which of the following surgical errors is the most likely cause of this complication?
. Femoral tunnel placed too distal and posterior
. Femoral tunnel placed too proximal and anterior
. Patellar fixation placed too superiorly
. Over-tensioning of the graft in 90 degrees of flexion
. Failure to repair the lateral retinaculum

Correct Answer & Explanation

. Femoral tunnel placed too proximal and anterior

Explanation

Placement of the femoral tunnel too proximal and anterior to the anatomic Schöttle's point causes the MPFL graft to become excessively tight in flexion. This leads to restricted knee flexion and elevated medial compartment pressures.

Question 1707

Topic: Knee Sports

A patient presents with a suspected multiligamentous knee injury following a motorcycle collision. The Dial test demonstrates 15 degrees of increased external rotation at 30 degrees of flexion compared to the contralateral side, but symmetric external rotation at 90 degrees. This finding is most consistent with an isolated injury to which of the following?

. Posterolateral corner (PLC)
. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Combined PLC and PCL
. Medial collateral ligament (MCL)

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

A positive Dial test (increased external rotation of >10 degrees) at 30 degrees of flexion that reduces at 90 degrees indicates an isolated injury to the posterolateral corner (PLC). If the test is positive at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 1708

Topic: Knee Sports

Which of the following descriptions best defines a 'ramp lesion' in the setting of an acute ACL rupture?

. A radial tear of the lateral meniscus mid-body
. A horizontal cleavage tear of the anterior horn of the medial meniscus
. A disruption of the meniscocapsular attachment of the posterior horn of the medial meniscus
. An avulsion of the posterior root of the lateral meniscus
. A bucket-handle tear of the lateral meniscus

Correct Answer & Explanation

. A radial tear of the lateral meniscus mid-body

Explanation

A ramp lesion is a hidden longitudinal tear or disruption of the meniscocapsular junction at the posterior horn of the medial meniscus. It is highly associated with ACL tears and is best visualized arthroscopically via a posteromedial portal.

Question 1709

Topic: Knee Sports

Which of the following locations is the classic and most common site for osteochondritis dissecans (OCD) lesions within the knee joint?

. Medial aspect of the medial femoral condyle
. Lateral aspect of the medial femoral condyle
. Central weight-bearing dome of the lateral femoral condyle
. Inferior pole of the patella
. Lateral aspect of the lateral femoral condyle

Correct Answer & Explanation

. Medial aspect of the medial femoral condyle

Explanation

The classic location for an OCD lesion of the knee is the lateral aspect of the medial femoral condyle. This accounts for roughly 70-80% of all knee OCD lesions.

Question 1710

Topic: Knee Sports
A trauma patient presents with a Schenck KD III-L multiligament knee injury (disruption of the ACL, PCL, and posterolateral corner). What is the approximate incidence of common peroneal nerve injury associated with this specific injury pattern?
. < 1%
. 5%
. 25%
. 60%
. 90%

Correct Answer & Explanation

. 25%

Explanation

Multiligament knee injuries involving the posterolateral corner (KD III-L or KD IV) carry the highest risk of common peroneal nerve injury. The reported incidence generally ranges from 16% to 30% (averaging around 25%).

Question 1711

Topic: Knee Sports

When evaluating the posterior cruciate ligament (PCL), it is structurally divided into anterolateral (AL) and posteromedial (PM) bundles. Which of the following best describes their biomechanical behavior?

. Both bundles are tightest in full extension.
. The AL bundle is tight in flexion, and the PM bundle is tight in extension.
. The AL bundle is tight in extension, and the PM bundle is tight in flexion.
. Both bundles maintain constant tension throughout the arc of motion.
. The PM bundle provides the primary restraint to posterior translation at 90 degrees of flexion.

Correct Answer & Explanation

. Both bundles are tightest in full extension.

Explanation

The larger AL bundle is tightest in flexion and is the primary restraint to posterior translation at 90 degrees. The smaller PM bundle is tightest in full extension.

Question 1712

Topic: Knee Sports

A patient with recurrent patellar instability is evaluated. Advanced imaging reveals a tibial tubercle to trochlear groove (TT-TG) distance of 24 mm. Which of the following surgical interventions is most appropriate to normalize the extensor mechanism alignment?

. Isolated Medial Patellofemoral Ligament (MPFL) reconstruction
. Lateral retinacular release
. Anteromedialization of the tibial tubercle (Fulkerson osteotomy)
. Distalization of the tibial tubercle
. Trochleoplasty

Correct Answer & Explanation

. Isolated Medial Patellofemoral Ligament (MPFL) reconstruction

Explanation

A TT-TG distance greater than 20 mm is a classic indication for an anteromedial tibial tubercle osteotomy (Fulkerson procedure). This effectively centralizes the patella and decreases lateral translation forces.

Question 1713

Topic: Knee Sports

The posterolateral corner (PLC) of the knee is crucial for resisting varus and external rotation forces. Which three structures are considered the primary static stabilizers of the PLC?

. Iliotibial band, fibular collateral ligament, lateral meniscus
. Fibular collateral ligament, popliteus tendon, popliteofibular ligament
. Biceps femoris, lateral gastrocnemius, popliteus tendon
. Fibular collateral ligament, arcuate ligament, fabellofibular ligament
. Popliteus tendon, arcuate ligament, iliotibial band

Correct Answer & Explanation

. Iliotibial band, fibular collateral ligament, lateral meniscus

Explanation

The primary static stabilizers of the posterolateral corner are the fibular collateral ligament (FCL), the popliteus tendon, and the popliteofibular ligament.

Question 1714

Topic: Knee Sports

During posterior cruciate ligament (PCL) reconstruction, understanding the native anatomy is crucial. The PCL consists of two main bundles. Which of the following best describes their tensioning pattern during knee motion?

. Anterolateral bundle is tight in extension, posteromedial bundle is tight in flexion
. Anterolateral bundle is tight in flexion, posteromedial bundle is tight in extension
. Both bundles are maximally tight in terminal extension
. Both bundles are maximally tight at 90 degrees of flexion
. Anterolateral bundle is tight in internal rotation, posteromedial in external rotation

Correct Answer & Explanation

. Anterolateral bundle is tight in extension, posteromedial bundle is tight in flexion

Explanation

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

Question 1715

Topic: Knee Sports

A patient presents with a suspected posterolateral corner (PLC) injury of the knee. The dial test demonstrates 15 degrees of increased external rotation compared to the contralateral knee at 30 degrees of flexion, but symmetric rotation at 90 degrees of flexion. What is the most likely injury pattern?

. Isolated PCL injury
. Combined PCL and PLC injury
. Isolated PLC injury
. Isolated ACL injury
. Combined ACL and PLC injury

Correct Answer & Explanation

. Isolated PCL injury

Explanation

A positive dial test (>10 degrees of asymmetric external rotation) isolated to 30 degrees of flexion indicates an isolated PLC injury. If the test remains positive at both 30 and 90 degrees, it suggests a combined PLC and PCL injury.

Question 1716

Topic: Knee Sports

During an anatomic anterior cruciate ligament (ACL) reconstruction, the surgeon places the femoral tunnel too anteriorly (high in the notch). Which of the following best describes the resulting graft tension pattern?

. Tight in extension and loose in flexion
. Tight in flexion and loose in extension
. Equally tight throughout the range of motion
. Equally loose throughout the range of motion
. Tight in both terminal extension and deep flexion

Correct Answer & Explanation

. Tight in extension and loose in flexion

Explanation

A femoral tunnel placed too anteriorly results in a graft that becomes tight in flexion and loose in extension. This non-anatomic placement often leads to restricted knee flexion or eventual graft stretching and failure.

Question 1717

Topic: Knee Sports

During a cruciate-retaining (CR) total knee arthroplasty, the surgeon notes that the trial components demonstrate anterior lift-off of the tibial tray during deep flexion. What is the most appropriate management step to resolve this intraoperative finding?

. Downsize the femoral component
. Release the posterior cruciate ligament (PCL)
. Release the superficial medial collateral ligament
. Increase the posterior slope of the tibial cut
. Upsize the tibial polyethylene insert

Correct Answer & Explanation

. Downsize the femoral component

Explanation

Anterior lift-off of the tibial tray during deep flexion in a CR knee is a classic sign of a tight posterior cruciate ligament (PCL). Releasing or recessing the PCL will balance the flexion gap and prevent this paradoxical kinematic issue.

Question 1718

Topic: Knee Sports

An 11-year-old boy complains of intermittent left knee pain after playing basketball. MRI reveals a 1.5 cm stable osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. What is the most important factor predicting successful non-operative healing of this lesion?

. The age of the patient
. The precise size of the lesion
. The location on the medial femoral condyle
. The open status of the distal femoral physis
. The presence of an effusion on examination

Correct Answer & Explanation

. The age of the patient

Explanation

The status of the physes is the most critical prognostic factor for the healing of an OCD lesion. Patients with open physes (juvenile OCD) have a significantly higher rate of spontaneous healing with non-operative management compared to those with closed physes.

Question 1719

Topic: Knee Sports

A 25-year-old male presents with chronic ankle pain. MRI reveals an anterolateral osteochondral lesion of the talus (OLT) measuring 1.1 cm squared. He has failed 6 months of conservative management. What is the most appropriate primary surgical treatment?

. Arthroscopic bone marrow stimulation (microfracture)
. Osteochondral autograft transfer system (OATS)
. Autologous chondrocyte implantation (ACI)
. Open internal fixation of the fragment
. Subtalar arthrodesis

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

For primary, non-cystic osteochondral lesions of the talus smaller than 1.5 cm squared, arthroscopic bone marrow stimulation (microfracture) is the first-line surgical treatment. Larger or previously failed lesions often require structural grafting like OATS.

Question 1720

Topic: Knee Sports

A sagittal MRI of the knee is obtained to evaluate a suspected multi-ligamentous injury.

Which of the following best describes the femoral origin and tibial insertion of the anteromedial (AM) bundle of the anterior cruciate ligament (ACL)?

. Originates proximal and posterior on the medial aspect of the lateral femoral condyle; inserts anteromedially on the tibial footprint
. Originates distal and anterior on the medial aspect of the lateral femoral condyle; inserts posterolaterally on the tibial footprint
. Originates on the lateral wall of the medial femoral condyle; inserts anteromedially on the tibial footprint
. Originates proximal and posterior on the medial aspect of the lateral femoral condyle; inserts posterolaterally on the tibial footprint
. Originates distal and posterior on the lateral wall of the medial femoral condyle; inserts centrally on the tibial footprint

Correct Answer & Explanation

. Originates proximal and posterior on the medial aspect of the lateral femoral condyle; inserts anteromedially on the tibial footprint

Explanation

The ACL has two distinct functional bundles: the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle originates more proximal and posterior on the medial wall of the lateral femoral condyle and inserts anteromedially on the tibial footprint. The AM bundle is tightest in flexion, whereas the PL bundle is tightest in extension.

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