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Knee Sports MCQs

Practice Set 88 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 1741

Topic: Knee Sports
A 25-year-old male sustains a dashboard injury during a motor vehicle collision. Physical examination reveals a grade III posterior sag sign. A posterior cruciate ligament (PCL) reconstruction is planned. What distinct biomechanical advantage does the tibial inlay technique offer over the traditional transtibial technique for PCL reconstruction?
. Avoids violation of the anterior tibial cortex
. Reduces the acute angle ('killer turn') at the posterior tibial aperture
. Preserves the meniscofemoral ligaments of Humphry and Wrisberg
. Allows for a purely all-inside technique without an accessory incision
. Eliminates the need for posteromedial portal placement

Correct Answer & Explanation

. Reduces the acute angle ('killer turn') at the posterior tibial aperture

Explanation

The primary biomechanical advantage of the tibial inlay technique over the transtibial technique in PCL reconstruction is the elimination of the 'killer turn.' In a transtibial reconstruction, the graft must make a sharp acute angle as it exits the posterior tibial tunnel to reach the femoral footprint. This acute angle can lead to graft abrasion, attenuation, and eventual failure over time. The tibial inlay technique involves an open posterior approach where a bone block is fixed directly to the posterior tibial footprint, avoiding this sharp turn.

Question 1742

Topic: Knee Sports

A 22-year-old collegiate soccer player is evaluated for a knee injury. The dial test demonstrates 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the uninjured contralateral side, but symmetric external rotation at 90 degrees of knee flexion. Which of the following is the most likely isolated injured structure?

. Isolated Posterolateral Corner (PLC) injury
. Isolated Posterior Cruciate Ligament (PCL) injury
. Combined PCL and PLC injury
. Isolated Anterior Cruciate Ligament (ACL) injury
. Combined ACL and PLC injury

Correct Answer & Explanation

. Isolated Posterolateral Corner (PLC) injury

Explanation

The dial test is utilized to differentiate between isolated posterolateral corner (PLC) injuries and combined PCL/PLC injuries. Increased external rotation of greater than 10 degrees (compared to the normal knee) at 30 degrees of flexion, with normal rotation at 90 degrees, indicates an isolated PLC injury. If the external rotation is increased at both 30 and 90 degrees, it suggests a combined PLC and PCL injury, as the PCL is a secondary restraint to external rotation at 90 degrees.

Question 1743

Topic: Knee Sports
A 16-year-old female presents with recurrent lateral patellar dislocations. Surgical stabilization with medial patellofemoral ligament (MPFL) reconstruction is indicated. Based on the classic anatomical layers of the medial knee described by Warren and Marshall, the native MPFL is located in which layer?
. Layer I
. Layer II
. Layer III
. Layer IV
. It is an intra-articular, extra-synovial structure

Correct Answer & Explanation

. Layer II

Explanation

According to the classic anatomical description by Warren and Marshall, the medial side of the knee is divided into three layers. Layer I is the superficial layer (sartorius fascia). Layer II contains the superficial medial collateral ligament (sMCL), medial patellofemoral ligament (MPFL), and the posterior oblique ligament (POL). Layer III is the deep layer, containing the joint capsule and deep MCL. Therefore, the MPFL is located in Layer II.

Question 1744

Topic: Knee Sports

A 40-year-old male sustains a severe hyperflexion injury to his knee and is diagnosed with a posterior medial meniscal root tear. Which of the following statements best describes the in vivo biomechanical consequence of this specific injury?

. It is biomechanically equivalent to a 20% partial meniscectomy
. It increases resistance to anterior tibial translation
. It results in a complete loss of meniscal hoop stresses
. It preferentially shifts contact forces to the lateral compartment
. It decreases peak articular cartilage contact pressures

Correct Answer & Explanation

. It is biomechanically equivalent to a 20% partial meniscectomy

Explanation

A complete radial tear at the meniscal root functionally detaches the meniscus from its bony tibial anchor. This prevents the conversion of axial loads into circumferential hoop stresses, leading to a complete loss of meniscal hoop stresses. Biomechanically, a medial meniscal root tear is equivalent to a total medial meniscectomy, leading to significantly increased peak contact pressures in the medial compartment and rapid progression of osteoarthritis if left untreated.

Question 1745

Topic: Knee Sports
A 25-year-old professional basketball player presents with persistent medial knee pain. MRI reveals an isolated, unipolar, full-thickness (Outerbridge Grade IV) chondral defect on the weight-bearing surface of the medial femoral condyle, measuring 4.5 cm². The subchondral bone is completely intact without cysts or edema. He has failed nonoperative treatment. Which cartilage restoration procedure is most appropriate?
. Arthroscopic debridement and marrow stimulation (Microfracture)
. Matrix-induced autologous chondrocyte implantation (MACI)
. Osteochondral autograft transfer system (OATS)
. High tibial osteotomy alone
. Unicompartmental knee arthroplasty

Correct Answer & Explanation

. Matrix-induced autologous chondrocyte implantation (MACI)

Explanation

The treatment of focal chondral defects depends on the size of the lesion and the status of the subchondral bone. Microfracture and OATS are generally reserved for smaller lesions (< 2.0 to 2.5 cm²). For a large isolated chondral defect (4.5 cm²) with intact subchondral bone, an autologous chondrocyte implantation (such as MACI) is indicated.

Question 1746

Topic: Knee Sports

A 14-year-old male presents with knee pain and catching. Radiographs demonstrate a classical osteochondritis dissecans (OCD) lesion.

What is the most common anatomical location for this lesion in the knee?

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

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for osteochondritis dissecans (OCD) of the knee is the lateral aspect of the medial femoral condyle (accounting for 70-80% of all knee OCD lesions), classically remembered by the mnemonic LAME (Lateral Aspect Medial Epicondyle/condyle).

Question 1747

Topic: Knee Sports

During an arthroscopic posterior cruciate ligament (PCL) reconstruction using a single-bundle technique, the tibial tunnel is prepared.

Which of the following describes the correct anatomic trajectory of the PCL tibial guide pin to optimize footprint coverage while avoiding neurovascular injury?

. Just proximal to the "killer turn" on the anterior tibia
. 7 mm anterior to the posterior tibial cortex, in the distal aspect of the PCL facet
. Directly through the posterior horn of the medial meniscus
. Medial to the medial tibial spine
. Directly adjacent to the popliteal artery

Correct Answer & Explanation

. Just proximal to the "killer turn" on the anterior tibia

Explanation

The anatomic tibial footprint of the PCL is located in the posterior aspect of the tibia (PCL facet). The guide pin should be placed approximately 7 mm anterior to the posterior tibial cortex. This ensures a complete cortical rim remains for tunnel integrity and minimizes the risk of posterior pin penetration injuring the popliteal neurovascular bundle.

Question 1748

Topic: Knee Sports

A 16-year-old female dancer experiences her first episode of acute lateral patellar dislocation. Radiographs show no osteochondral loose bodies. MRI confirms an isolated full-thickness tear of the medial patellofemoral ligament (MPFL).

What is the most common site of MPFL injury in an acute lateral patellar dislocation?

. Patellar insertion
. Mid-substance of the ligament
. Femoral origin
. Tibial insertion
. Junction with the vastus medialis obliquus (VMO)

Correct Answer & Explanation

. Patellar insertion

Explanation

In the setting of an acute primary lateral patellar dislocation, the medial patellofemoral ligament (MPFL) most commonly tears at its femoral origin, which is located in the saddle region between the adductor tubercle and the medial epicondyle.

Question 1749

Topic: Knee Sports

A 45-year-old male feels a pop in his posterior knee while squatting. MRI shows a medial meniscus posterior root tear. What is the primary biomechanical consequence of leaving this specific lesion untreated?

. Decreased contact area and increased peak contact pressures, equivalent to a total meniscectomy.
. Increased anterior translation of the tibia, equivalent to an anterior cruciate ligament tear.
. Increased valgus laxity, secondary to medial collateral ligament attenuation.
. Decreased peak contact pressures, leading to disuse osteopenia of the medial compartment.
. No significant biomechanical change, as the anterior root remains intact.

Correct Answer & Explanation

. Decreased contact area and increased peak contact pressures, equivalent to a total meniscectomy.

Explanation

A posterior root tear of the medial meniscus disrupts hoop stresses, leading to meniscal extrusion. Biomechanically, this failure is equivalent to a total meniscectomy, causing significantly increased peak contact pressures and rapid articular cartilage degeneration.

Question 1750

Topic: Knee Sports

During an arthroscopic anterior cruciate ligament (ACL) reconstruction, the femoral tunnel is inadvertently placed too anteriorly within the intercondylar notch. What is the most likely clinical consequence during postoperative rehabilitation?

. Excessive anterior knee laxity in deep flexion.
. Loss of full knee flexion due to graft tensioning.
. Loss of full knee extension due to impingement.
. Persistent anterior knee pain resembling patellar tendinopathy.
. Development of a postoperative patellar clunk syndrome.

Correct Answer & Explanation

. Excessive anterior knee laxity in deep flexion.

Explanation

An anteriorly placed femoral tunnel causes the ACL graft to tighten excessively as the knee transitions into flexion. This over-tensioning captures the joint, leading to a restricted arc of motion and a significant loss of full knee flexion.

Question 1751

Topic: Knee Sports

A 25-year-old football player presents with an acute knee injury. The Dial test demonstrates 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side, but symmetric external rotation at 90 degrees of flexion. What is the most likely injury pattern?

. Isolated Posterior Cruciate Ligament (PCL) injury.
. Isolated Posterolateral Corner (PLC) injury.
. Combined PCL and PLC injury.
. Isolated Medial Collateral Ligament (MCL) injury.
. Combined ACL and PLC injury.

Correct Answer & Explanation

. Isolated Posterior Cruciate Ligament (PCL) injury.

Explanation

Increased external tibial rotation at 30 degrees of flexion, which normalizes at 90 degrees, is the hallmark of an isolated posterolateral corner (PLC) injury. If external rotation is increased at both 30 and 90 degrees, it strongly suggests a combined PLC and PCL injury.

Question 1752

Topic: Knee Sports
When performing a medial patellofemoral ligament (MPFL) reconstruction, accurate placement of the femoral attachment is critical to prevent graft anisometry. Based on Schöttle's anatomic landmarks, where is the correct femoral footprint of the MPFL located?
. Distal to the medial epicondyle.
. Proximal to the adductor tubercle.
. In the saddle-like depression between the adductor tubercle and the medial epicondyle.
. Anterior to the medial collateral ligament origin on the femoral condyle.
. On the medial aspect of the patellar tendon insertion.

Correct Answer & Explanation

. In the saddle-like depression between the adductor tubercle and the medial epicondyle.

Explanation

The native MPFL femoral footprint is anatomically located in the saddle-like groove between the adductor tubercle (proximally) and the medial epicondyle (distally). Non-anatomic placement, particularly too proximal, leads to graft tightening in knee flexion and patellofemoral overload.

Question 1753

Topic: Knee Sports

In a cruciate-retaining (CR) total knee arthroplasty, the posterior cruciate ligament (PCL) is preserved. If the PCL is left excessively tight during the procedure, what kinematic abnormality is most likely to occur?

. Excessive anterior rollback of the femur in flexion
. Paradoxical anterior slide of the femur in early flexion
. Excessive posterior rollback of the femur leading to limited flexion
. Patella baja
. Hyperextension instability

Correct Answer & Explanation

. Excessive anterior rollback of the femur in flexion

Explanation

In a CR TKA, an excessively tight PCL will pull the femur excessively posterior during flexion (excessive posterior rollback), which can lead to limited knee flexion, excessive wear on the posterior aspect of the polyethylene insert, and lift-off of the anterior tibial tray. Paradoxical anterior slide is typically seen when the PCL is deficient or incompetent in a CR knee.

Question 1754

Topic: Knee Sports

A 29-year-old male sustains a 'floating knee' injury (ipsilateral femur and tibia fractures) in a motor vehicle collision. Which of the following associated local injuries has the highest incidence of initially being missed in this patient?

. Popliteal artery occlusion
. Cruciate and collateral ligament tears
. Meniscal root avulsions
. Common peroneal nerve palsy

Correct Answer & Explanation

. Popliteal artery occlusion

Explanation

Ligamentous injuries to the knee (especially ACL and collateral ligaments) are present in up to 50% of floating knee injuries but are frequently missed during initial evaluation due to the overriding long bone instability.

Question 1755

Topic: Knee Sports

Six months following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, a patient complains of a progressive loss of terminal knee extension accompanied by an audible clunk at the end of range of motion. MRI reveals a nodular mass in the anterior intercondylar notch. Histological examination of this mass would most likely show:

. Disorganized hyaline cartilage
. Fibrovascular scar tissue
. Giant cell tumor of tendon sheath
. Synovial chondromatosis
. Gouty tophi with giant cell reaction

Correct Answer & Explanation

. Disorganized hyaline cartilage

Explanation

The scenario describes 'Cyclops syndrome', a form of localized anterior arthrofibrosis that mechanically blocks terminal knee extension after ACL reconstruction. The 'cyclops lesion' itself is composed primarily of fibrovascular scar tissue, which proliferates in the anterior notch.

Question 1756

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon uses fluoroscopy to determine the anatomic femoral attachment site. According to Schöttle's method, where should the femoral tunnel be placed on a true lateral radiograph?
. Anterior to the posterior cortical line and superior to Blumensaat's line
. Posterior to the posterior cortical line and inferior to Blumensaat's line
. 1 mm anterior to the posterior cortical extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line
. Just distal to the adductor tubercle and anterior to the medial epicondyle
. In the center of the trochlear groove

Correct Answer & Explanation

. 1 mm anterior to the posterior cortical extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line

Explanation

Schöttle's point is a radiographic landmark on a true lateral radiograph of the knee used to identify the anatomic femoral origin of the MPFL. It is located 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 posterior extension of Blumensaat's line.

Question 1757

Topic: Knee Sports

During biomechanical testing of the knee's posterolateral corner (PLC), sequential sectioning of the structures is performed. Which of the following describes the primary restraint to varus angulation at 30 degrees of knee flexion?

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

Correct Answer & Explanation

. Popliteofibular ligament

Explanation

The fibular collateral ligament (FCL), also known as the lateral collateral ligament (LCL), is the primary restraint to varus opening of the knee, particularly at 30 degrees of knee flexion. The popliteus tendon and popliteofibular ligament primarily act as the primary restraints to external tibial rotation. Understanding these specific biomechanical contributions is critical for diagnosing and reconstructing PLC injuries.

Question 1758

Topic: Knee Sports

In the evaluation of a painful TKA, a patient is found to have paradoxical anterior translation of the femur on the tibia during knee flexion. Which of the following scenarios is most likely responsible for this kinematic abnormality?

. A cruciate-retaining (CR) femoral component with an incompetent posterior cruciate ligament (PCL)
. A posterior-stabilized (PS) femoral component with an incompetent PCL
. A constrained condylar knee (CCK) insert
. An excessively thick asymmetric polyethylene insert
. An ultracongruent insert with an intact PCL

Correct Answer & Explanation

. A cruciate-retaining (CR) femoral component with an incompetent posterior cruciate ligament (PCL)

Explanation

Paradoxical anterior translation of the femur during flexion typically occurs in a CR knee if the PCL is deficient or excessively loose, leading to altered kinematics and poor flexion.

Question 1759

Topic: Knee Sports

Following the initial bone cuts in a cruciate-retaining total knee arthroplasty, the surgeon assesses the gaps with spacer blocks. The knee is tight in flexion and symmetric in extension. Which of the following is the most appropriate next step to balance the knee?

. Recut the distal femur to remove more bone
. Downsize the femoral component and augment the posterior aspect
. Decrease the posterior slope of the tibial cut
. Release the posterior cruciate ligament (PCL)
. Increase the size of the polyethylene insert

Correct Answer & Explanation

. Recut the distal femur to remove more bone

Explanation

A knee that is tight in flexion but balanced in extension indicates an isolated tight flexion gap. In a CR knee, an excessively tight PCL can tether the flexion gap. Appropriate interventions include releasing or recessing the PCL, downsizing the femoral component, or increasing the posterior tibial slope.

Question 1760

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. Which statement accurately describes the tensioning pattern of these bundles during knee range of motion?

. The anteromedial bundle is tight in extension, and the posterolateral bundle is tight in flexion.
. The anteromedial bundle is tight in flexion, and the posterolateral bundle is tight in extension.
. Both bundles are tight in flexion and lax in extension.
. Both bundles are tight in extension and lax in flexion.
. The tension of both bundles remains constant throughout the entire range of motion.

Correct Answer & Explanation

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

Explanation

The ACL consists of the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle is primarily tight in flexion and controls anterior translation. The PL bundle is primarily tight in extension and provides rotational stability. Mnemonic: AM is tight in flexion, PL is tight in extension.

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