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Knee Sports MCQs

Practice Set 87 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 1721

Topic: Knee Sports

To anatomically reconstruct the posterolateral corner of the knee, understanding the spatial relationship on the lateral femoral epicondyle is critical. What is the relative position of the origin of the fibular collateral ligament (FCL) compared to the popliteus tendon insertion?

. FCL is anterior and inferior to the popliteus
. FCL is posterior and superior to the popliteus
. FCL is directly medial to the popliteus
. FCL is directly inferior to the popliteus
. FCL is anterior and superior to the popliteus

Correct Answer & Explanation

. FCL is anterior and inferior to the popliteus

Explanation

On the lateral aspect of the lateral femoral condyle, the origin of the fibular collateral ligament (LCL) is located proximal (superior) and posterior to the insertion footprint of the popliteus tendon. An easy way to remember this is that the popliteus is anterior and distal to the FCL origin.

Question 1722

Topic: Knee Sports

A coronal MRI of the knee is reviewed prior to posterolateral corner reconstruction.

What is the precise femoral attachment site of the fibular collateral ligament (FCL) relative to the popliteus tendon insertion?

. Proximal and posterior
. Distal and anterior
. Proximal and anterior
. Distal and posterior
. Directly medial

Correct Answer & Explanation

. Proximal and posterior

Explanation

On the lateral femoral epicondyle, the fibular collateral ligament (FCL) attaches proximal and posterior to the insertion of the popliteus tendon. This relationship is critical for anatomical reconstruction of the posterolateral corner.

Question 1723

Topic: Knee Sports

A sagittal MRI of the knee highlights the meniscofemoral ligaments originating from the posterior horn of the lateral meniscus.

The ligament of Wrisberg passes in what anatomical relationship to the posterior cruciate ligament (PCL)?

. Anterior to the PCL
. Posterior to the PCL
. Superior to the ACL
. Inferior to the lateral meniscus
. Medial to the MCL

Correct Answer & Explanation

. Anterior to the PCL

Explanation

The meniscofemoral ligaments attach the posterior horn of the lateral meniscus to the medial femoral condyle. The ligament of Humphrey passes anterior to the PCL, whereas the ligament of Wrisberg passes posterior to the PCL.

Question 1724

Topic: Knee Sports

Reviewing a sagittal MRI of the knee, the normal anatomy of the posterior cruciate ligament (PCL) is best visualized. Which bundle of the PCL becomes tightest as the knee goes into deep flexion?

. Anterolateral bundle
. Posteromedial bundle
. Anteromedial bundle
. Posterolateral bundle
. Meniscofemoral ligament of Wrisberg

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The PCL consists of two primary bundles. The larger anterolateral bundle tightens in flexion, while the smaller posteromedial bundle tightens in extension.

Question 1725

Topic: Knee Sports

During a posterolateral corner reconstruction of the knee, understanding the exact anatomic footprint on the fibular head is crucial. What is the relationship of the lateral collateral ligament (LCL) footprint to the popliteofibular ligament (PFL) footprint on the fibular head?

. The LCL footprint is medial to the PFL footprint.
. The LCL footprint is anterior and distal to the PFL footprint.
. The LCL footprint is posterior and proximal to the PFL footprint.
. The PFL footprint is anterior and distal to the LCL footprint.
. They share the exact same footprint on the fibular styloid.

Correct Answer & Explanation

. The LCL footprint is medial to the PFL footprint.

Explanation

On the fibular head, the LCL inserts anteriorly and distally relative to the popliteofibular ligament (PFL) footprint. The PFL attaches to the posterior and medial aspect of the fibular styloid.

Question 1726

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of the anteromedial (AM) and posterolateral (PL) bundles. During biomechanical testing, which of the following accurately describes the tensioning pattern of these bundles?

. The AM bundle is tight in extension and controls rotatory stability; the PL bundle is tight in flexion and controls anterior translation.
. The AM bundle is tight in flexion and controls anterior translation; the PL bundle is tight in extension and controls rotatory stability.
. Both bundles are equally tight throughout the entire arc of motion.
. The AM bundle restrains posterior translation while the PL bundle restrains anterior translation.
. The AM and PL bundles cross each other in extension and uncoil in flexion.

Correct Answer & Explanation

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

Explanation

The ACL has two distinct bundles named for their tibial insertion sites. The anteromedial (AM) bundle is tightest in knee flexion and provides the primary restraint to anterior tibial translation. The posterolateral (PL) bundle is tightest in extension and provides the primary restraint to rotatory loads.

Question 1727

Topic: Knee Sports

During surgical reconstruction of the posterolateral corner (PLC) of the knee, careful dissection must be carried out around the lateral collateral ligament (LCL). Which vascular structure courses horizontally and immediately deep to the LCL at the level of the joint line and must be protected?

. Superior lateral genicular artery
. Inferior lateral genicular artery
. Anterior tibial recurrent artery
. Descending branch of the lateral circumflex femoral artery
. Popliteal artery

Correct Answer & Explanation

. Superior lateral genicular artery

Explanation

The inferior lateral genicular artery courses horizontally along the joint line, lying deep to the lateral collateral ligament (LCL) and superficial to the lateral meniscus. It must be carefully isolated and protected or ligated during lateral approaches to the knee, meniscus repairs, and PLC reconstructions.

Question 1728

Topic: Knee Sports

Which of the following structures is considered the primary restraint to external rotation of the tibia at 30 degrees of knee flexion?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Popliteofibular ligament
. Medial collateral ligament
. Oblique popliteal ligament

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

The posterolateral corner (PLC) consists primarily of the lateral collateral ligament (LCL), popliteus tendon, and popliteofibular ligament (PFL). The popliteofibular ligament and the popliteus complex serve as the primary restraint to external tibial rotation at 30 degrees of knee flexion.

Question 1729

Topic: Knee Sports

A 19-year-old football player undergoes an anterior cruciate ligament (ACL) reconstruction. The surgeon wishes to replicate the native anatomy of the ACL bundles. Which statement correctly describes the femoral footprint of the ACL bundles with the knee in extension?

. The anteromedial (AM) bundle originates distal and anterior to the posterolateral (PL) bundle.
. The anteromedial (AM) bundle originates proximal and posterior to the posterolateral (PL) bundle.
. Both bundles originate vertically with the PL bundle being strictly superior.
. The PL bundle originates high in the notch, while the AM bundle originates on the medial condyle.
. The bundles run perfectly parallel without crossing at any degree of flexion.

Correct Answer & Explanation

. The anteromedial (AM) bundle originates distal and anterior to the posterolateral (PL) bundle.

Explanation

On the lateral femoral condyle, the anteromedial (AM) bundle originates high (proximal) and posterior, whereas the posterolateral (PL) bundle originates lower (distal) and anterior. The bundles cross as the knee moves into flexion.

Question 1730

Topic: Knee Sports

Anatomic ACL reconstruction relies on identifying the femoral footprint. The lateral intercondylar ridge (Resident's ridge) serves as a key surgical landmark.

Where is the native ACL femoral footprint located relative to this ridge when the knee is viewed at 90 degrees of flexion?

. Anterior to the ridge
. Posterior to the ridge
. Proximal to the ridge
. Superior to the ridge
. Directly on the ridge

Correct Answer & Explanation

. Anterior to the ridge

Explanation

The native ACL footprint is posterior to the lateral intercondylar ridge (Resident's ridge) and anterior to the lateral bifurcate ridge (which separates the AM and PL bundles) when the knee is viewed in 90 degrees of flexion. Placing the tunnel anterior to Resident's ridge results in a non-anatomic, vertical graft that fails to control rotational stability.

Question 1731

Topic: Knee Sports

During a Medial Patellofemoral Ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon inadvertently places the femoral tunnel proximal to the anatomic insertion site.

What is the expected biomechanical consequence during knee range of motion?

. The graft will be loose in flexion and tight in extension
. The graft will be tight in flexion and tight in extension
. The graft will be tight in flexion and loose in extension
. The graft will be loose in flexion and loose in extension
. The graft will maintain isometric tension throughout the arc of motion

Correct Answer & Explanation

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

Explanation

If the femoral tunnel in an MPFL reconstruction is placed too proximal, the distance between the patellar and femoral attachments increases as the knee flexes. This causes the graft to become excessively tight in flexion (leading to loss of flexion and medial patellofemoral overload) and relatively loose in extension.

Question 1732

Topic: Knee Sports

A 30-year-old runner has an isolated, full-thickness 3.5 cm^2 chondral defect on the medial femoral condyle. The surgeon considers Matrix-induced Autologous Chondrocyte Implantation (MACI).

Which of the following represents an absolute or strong relative contraindication to MACI for this patient?

. Age under 40 years
. Defect size greater than 3 cm^2
. Corresponding bipolar 'kissing' lesion on the medial tibial plateau
. Intact meniscal volume in the medial compartment
. Location of the defect on the weight-bearing surface

Correct Answer & Explanation

. Age under 40 years

Explanation

MACI is indicated for symptomatic, unipolar, full-thickness cartilage defects in the knee in young, active patients. Bipolar ('kissing') lesions, uncorrected malalignment, uncorrected ligamentous instability, and advanced osteoarthritis are significant contraindications due to unacceptably high failure rates.

Question 1733

Topic: Knee Sports

A 28-year-old football player sustains a multiligamentous knee injury. Physical exam reveals a positive posterior drawer test and increased external tibial rotation at 30 degrees of knee flexion compared to the contralateral side. However, at 90 degrees of knee flexion, the external tibial rotation is symmetric bilaterally. What is the most likely injury pattern?

. Isolated Posterior Cruciate Ligament (PCL) tear
. Isolated Posterolateral Corner (PLC) injury
. Combined PCL and PLC injury
. Combined ACL and PLC injury
. Isolated Posteromedial Corner (PMC) injury

Correct Answer & Explanation

. Isolated Posterior Cruciate Ligament (PCL) tear

Explanation

The Dial test measures external tibial rotation at 30 and 90 degrees of flexion. An increase of >10 degrees of external rotation at 30 degrees only indicates an isolated PLC injury. An increase at both 30 and 90 degrees indicates a combined PLC and PCL injury.

Question 1734

Topic: Knee Sports

A 14-year-old female gymnast complains of lateral elbow pain, clicking, and a loss of 15 degrees of extension. Radiographs and MRI demonstrate a 12mm osteochondral defect of the capitellum with subchondral fluid and a loose cartilaginous flap.

What is the most appropriate surgical intervention?

. Non-operative management with 6 weeks of immobilization
. Arthroscopic in situ drilling of the capitellum
. Ulnar collateral ligament reconstruction
. Arthroscopic debridement, loose body removal, and microfracture
. Open reduction and internal fixation with headless compression screws

Correct Answer & Explanation

. Non-operative management with 6 weeks of immobilization

Explanation

Osteochondritis dissecans (OCD) of the capitellum affects young throwing athletes and gymnasts. Indications for surgery include unstable lesions (fluid behind the fragment, cartilaginous flap, loose bodies) or failure of non-operative management. For fragmented, unsalvageable lesions, arthroscopic debridement and marrow stimulation (microfracture) is indicated. In situ drilling is reserved for intact lesions.

Question 1735

Topic: Knee Sports

A 22-year-old female with an isolated ACL deficiency and genu varum is scheduled for an ACL reconstruction and an opening-wedge high tibial osteotomy (HTO). What is the potential biomechanical consequence of a standard medial opening-wedge HTO on the sagittal plane of the knee, and how does it affect the ACL graft?

. Increases posterior tibial slope, which increases anterior tibial translation and strain on the ACL graft
. Decreases posterior tibial slope, which increases anterior tibial translation and strain on the ACL graft
. Increases posterior tibial slope, which decreases anterior tibial translation and protects the ACL graft
. Decreases posterior tibial slope, which decreases anterior tibial translation and protects the ACL graft
. Does not affect sagittal plane slope, acting only in the coronal plane

Correct Answer & Explanation

. Increases posterior tibial slope, which increases anterior tibial translation and strain on the ACL graft

Explanation

A standard medial opening-wedge HTO tends to inadvertently increase the posterior tibial slope because the anterior aspect of the proximal tibia is narrower than the posterior aspect. An increased posterior slope exacerbates anterior tibial translation during weight-bearing, placing higher stress on an ACL graft. Surgeons must intentionally adjust the gap to avoid this in ACL-deficient knees.

Question 1736

Topic: Knee Sports
A 23-year-old professional soccer player presents with anterior knee pain and swelling. MRI reveals a 4.5 cm² full-thickness osteochondral defect with a 6 mm deep subchondral bone cyst on the weight-bearing surface of the medial femoral condyle. He has previously undergone a failed microfracture procedure. What is the most appropriate definitive surgical treatment?
. Repeat microfracture
. Osteochondral autograft transfer (OATS)
. Matrix-induced autologous chondrocyte implantation (MACI)
. Fresh osteochondral allograft transplantation
. Partial medial meniscectomy

Correct Answer & Explanation

. Fresh osteochondral allograft transplantation

Explanation

Fresh osteochondral allograft (OCA) transplantation is the treatment of choice for large (>2-3 cm²) osteochondral defects, especially when associated with subchondral bone loss or cysts. OATS is typically reserved for smaller defects (<2 cm²) due to donor site morbidity. MACI is excellent for large (>2 cm²) purely chondral defects but does not address significant subchondral bone loss unless performed as a 'sandwich' technique with bone grafting, making OCA the more direct and preferred single-stage option for large bony defects.

Question 1737

Topic: Knee Sports

During the evaluation of a patient with a multiligamentous knee injury, the examiner performs the Dial test. The test demonstrates 15 degrees of increased external rotation of the tibia relative to the femur at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of knee flexion, the external rotation is symmetric bilaterally. This clinical finding most likely indicates an isolated injury to which of the following?

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

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

The Dial test evaluates external rotation of the tibia. Asymmetry of >10-15 degrees compared to the normal knee indicates injury. An increase in external rotation at 30 degrees of flexion, but symmetric at 90 degrees, indicates an isolated injury to the posterolateral corner (PLC). If the increase is present at both 30 and 90 degrees, it indicates a combined injury to the PLC and the PCL.

Question 1738

Topic: Knee Sports
A 16-year-old female presents with recurrent patellar dislocations. Imaging reveals a ruptured medial patellofemoral ligament (MPFL). If the surgeon plans a reconstruction, the anatomic femoral attachment of the MPFL (Schöttle point) should be located in relation to which osseous landmarks on a true lateral radiograph?
. Anterior to the posterior femoral cortical line and proximal to the posterior aspect of Blumensaat's line
. Posterior to the posterior femoral cortical line and proximal to the posterior aspect of Blumensaat's line
. Anterior to the posterior femoral cortical line and distal to the posterior aspect of Blumensaat's line
. Between the medial epicondyle and the adductor tubercle, directly on the posterior femoral cortical line
. At the direct center of the medial epicondyle

Correct Answer & Explanation

. Anterior to the posterior femoral cortical line and proximal to the posterior aspect of Blumensaat's line

Explanation

The Schöttle point represents the radiographic femoral origin of the MPFL. On a true lateral radiograph, it is situated 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior aspect of Blumensaat's line. Clinically, it lies in the saddle between the adductor tubercle and the medial epicondyle.

Question 1739

Topic: Knee Sports

A 55-year-old patient undergoes an arthroscopic partial meniscectomy for an isolated posterior horn tear of the medial meniscus. Intraoperatively, the tear is identified as a complete radial tear located 2 mm from the posterior bony attachment. Which of the following correctly describes the biomechanical consequence of leaving this root tear un-repaired?

. Normal hoop stresses are maintained, leading to a good long-term prognosis
. It is biomechanically equivalent to a total meniscectomy
. It causes increased stress purely on the lateral compartment
. It primarily destabilizes the anterior cruciate ligament in translation
. It causes an increase in patellofemoral contact pressures

Correct Answer & Explanation

. Normal hoop stresses are maintained, leading to a good long-term prognosis

Explanation

A complete medial meniscus posterior root tear disrupts the circumferential hoop fibers, completely un-tethering the meniscus. Biomechanical studies have shown this renders the meniscus non-functional, equating the contact pressures in the medial compartment to those seen following a total medial meniscectomy. This often leads to rapid articular cartilage wear and spontaneous osteonecrosis or insufficiency fractures if not repaired.

Question 1740

Topic: Knee Sports

A 14-year-old male presents with non-specific knee pain. Imaging reveals Osteochondritis Dissecans (OCD) of the knee. What is the most common anatomical location for an OCD lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central weight-bearing surface of the medial femoral condyle
. Patellar articular surface
. Tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location (accounting for roughly 70-80% of cases) for an OCD lesion in the knee is the lateral aspect of the medial femoral condyle (LAME - Lateral Aspect Medial Epicondyle/Condyle). This is thought to be related to repeated impingement from the tibial spine or localized vascular insufficiency.

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