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Knee Sports MCQs

Practice Set 9 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 161

Topic: Knee Sports

The posterior cruciate ligament (PCL) provides the primary restraint to posterior tibial translation and is composed of two functional bundles. Which statement accurately describes the tension pattern of the anterolateral (AL) bundle?

. Tight in extension and lax in flexion
. Tight in flexion and lax in extension
. Tight in both terminal flexion and terminal extension equally
. Isometric across the entire range of motion
. Primary restraint against varus angulation

Correct Answer & Explanation

. Tight in flexion and lax in extension

Explanation

The PCL has a larger anterolateral (AL) bundle and a smaller posteromedial (PM) bundle. The AL bundle is tight in flexion and lax in extension, whereas the PM bundle is tight in extension.

Question 162

Topic: Knee Sports
Unlike the medial collateral ligament (MCL), the anterior cruciate ligament (ACL) possesses a notoriously poor intrinsic healing capacity following complete rupture. Which biological factor is a primary driver of this clinical observation?
. Complete lack of vascular supply to the ligament substance
. Upregulation of plasmin in synovial fluid which dissolves the fibrin clot
. High concentrations of type III collagen preventing cross-linking
. Absolute absence of fibroblasts within the normal ligament stroma
. The intra-articular environment maintains a core temperature too low for angiogenesis

Correct Answer & Explanation

. Upregulation of plasmin in synovial fluid which dissolves the fibrin clot

Explanation

The ACL has an inadequate healing response because synovial fluid continuously bathes the torn ends. The upregulation of plasminogen activators converts plasminogen to plasmin, which prematurely dissolves the provisional fibrin clot necessary for organized healing.

Question 163

Topic: Knee Sports

The primary restraint to varus stress at 30 degrees of knee flexion is the:

. Fibular collateral ligament
. Popliteus tendon
. Popliteofibular ligament
. Iliotibial band
. Anterior cruciate ligament

Correct Answer & Explanation

. Fibular collateral ligament

Explanation

The fibular collateral ligament (LCL) is the primary restraint to varus stress at 30 degrees of knee flexion. The popliteus complex provides secondary varus stability but is the primary restraint to external rotation.

Question 164

Topic: Knee Sports

The anterolateral bundle of the posterior cruciate ligament (PCL) is most taut in which position?

. 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 anterolateral bundle of the PCL is the larger of the two bundles and is most taut in flexion (around 80-90 degrees). Conversely, the posteromedial bundle is tightest in full extension.

Question 165

Topic: Knee Sports

Evaluate the following image of a knee stress radiograph.

In an isolated posterior cruciate ligament (PCL) injury, the maximum posterior tibial translation observed at 90 degrees of flexion is typically:

. 1-2 mm
. 3-5 mm
. 10-12 mm
. Greater than 15 mm
. Zero translation

Correct Answer & Explanation

. 10-12 mm

Explanation

An isolated PCL injury typically results in 10-12 mm of posterior translation on stress radiographs. Translation significantly greater than 12 mm suggests a combined injury, usually involving the posterolateral corner.

Question 166

Topic: Knee Sports

During anterior cruciate ligament (ACL) reconstruction, non-anatomic anterior placement of the femoral tunnel will most likely result in a graft that is:

. Isometrically tensioned throughout the range of motion
. Over-tensioned in flexion and lax in extension
. Lax in flexion and over-tensioned in extension
. Over-tensioned in both flexion and extension
. Impinging on the posterior cruciate ligament (PCL)

Correct Answer & Explanation

. Over-tensioned in flexion and lax in extension

Explanation

A femoral tunnel placed too anteriorly (high in the notch) will result in a graft that is overly tight in flexion and loose in extension. This can lead to a loss of knee flexion and stretching or failure of the graft over time.

Question 167

Topic: Knee Sports

Which of the following components of the posterolateral corner (PLC) of the knee is the primary restraint to external tibial rotation at 30 degrees of knee flexion?

. Posterior oblique ligament
. Fibular collateral ligament (FCL)
. Popliteofibular ligament
. Anterolateral ligament (ALL)
. Oblique popliteal ligament

Correct Answer & Explanation

. Popliteofibular ligament

Explanation

The popliteofibular ligament and the popliteus tendon are the primary restraints to external rotation of the tibia. The FCL is the primary restraint to varus stress, not external rotation.

Question 168

Topic: Knee Sports

The anteromedial (AM) bundle of the anterior cruciate ligament (ACL) can be biomechanically differentiated from the posterolateral (PL) bundle by which of the following characteristics?

. The AM bundle is tighter in extension and controls rotatory stability
. The AM bundle is tighter in flexion and controls anterior translation
. The PL bundle is tighter in flexion and controls anterior translation
. The PL bundle is the primary restraint to posterior translation
. Both bundles exhibit identical tension throughout the arc of motion

Correct Answer & Explanation

. The AM bundle is tighter in extension and controls rotatory stability

Explanation

The ACL is composed of the AM and PL bundles. The AM bundle is tightest in flexion and primarily restricts anterior translation, whereas the PL bundle is tightest in extension and provides rotational stability.

Question 169

Topic: Knee Sports
A 32-year-old male presents with recurrent patellar instability. The primary ligamentous restraint to lateral patellar translation at 0 to 30 degrees of knee flexion originates from a point strictly defined by radiographic landmarks. Where is this femoral origin located?
. Distal to the adductor tubercle and proximal to the medial epicondyle
. Proximal and posterior to the medial epicondyle
. Anterior to the medial collateral ligament origin
. Directly on the medial epicondyle
. At the adductor magnus insertion

Correct Answer & Explanation

. Proximal and posterior to the medial epicondyle

Explanation

The medial patellofemoral ligament (MPFL) originates between the medial epicondyle and the adductor tubercle (often termed Schöttle's point). This point is consistently located proximal and posterior to the medial epicondyle.

Question 170

Topic: Knee Sports

A 21-year-old football player sustains a high-energy knee injury. Clinical examination reveals a positive dial test at 30 degrees of knee flexion but symmetric external rotation at 90 degrees. This pattern is pathognomonic for an isolated injury to which structure?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Posterolateral corner
. Medial collateral ligament
. Posteromedial corner

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

An increase in external rotation of more than 10 degrees compared to the contralateral side at 30 degrees of flexion, but not at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. Combined PLC and PCL injuries demonstrate increased rotation at both 30 and 90 degrees.

Question 171

Topic: Knee Sports

The posterior cruciate ligament (PCL) is the primary restraint to posterior translation of the tibia relative to the femur. At what degree of knee flexion does it provide the maximum percentage of this restraining force?

. 0 degrees
. 30 degrees
. 60 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 0 degrees

Explanation

The PCL provides up to 95% of the total restraining force to posterior translation of the tibia. Its effectiveness as a primary restraint is greatest at 90 degrees of knee flexion.

Question 172

Topic: Knee Sports

The medial patellofemoral ligament (MPFL) is recognized as the primary soft tissue restraint against lateral patellar translation. At what angle of knee flexion does it provide the greatest percentage of this restraining force?

. 0 to 30 degrees
. 45 to 60 degrees
. 70 to 90 degrees
. 90 to 110 degrees
. Beyond 110 degrees

Correct Answer & Explanation

. 0 to 30 degrees

Explanation

The MPFL provides 50-60% of the restraining force against lateral patellar displacement, functioning primarily from 0 to 30 degrees of flexion before the patella fully engages the bony stability of the trochlear groove.

Question 173

Topic: Knee Sports

The primary blood supply to the anterior cruciate ligament (ACL) is derived from which of the following vascular structures?

. Lateral inferior genicular artery
. Medial inferior genicular artery
. Middle genicular artery
. Descending genicular artery
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Lateral inferior genicular artery

Explanation

Both the anterior and posterior cruciate ligaments receive their primary blood supply from the middle genicular artery. This artery branches from the popliteal artery and pierces the posterior capsule to supply the intracapsular structures.

Question 174

Topic: Knee Sports

A 22-year-old female sustains a non-contact pivoting injury to her knee, reporting a loud pop.

Assuming an acute anterior cruciate ligament (ACL) rupture occurred, which associated meniscal injury is most commonly encountered in this acute setting?

. Peripheral tear of the medial meniscus
. Bucket-handle tear of the medial meniscus
. Radial tear of the lateral meniscus
. Longitudinal tear of the lateral meniscus
. Horizontal cleavage tear of the medial meniscus

Correct Answer & Explanation

. Longitudinal tear of the lateral meniscus

Explanation

In the setting of acute ACL ruptures, lateral meniscus tears (especially posterior horn longitudinal tears) are significantly more common due to the characteristic pivoting and subluxation mechanism. Conversely, medial meniscus tears are more frequently associated with chronic ACL-deficient knees.

Question 175

Topic: Knee Sports

Which of the following statements is true concerning the bands of the anterior cruciate ligament:

. The anterolateral band is tightest in flexion.
. The posterolateral band is tightest in flexion.
. The posteromedial band is tightest in extension.
. The anteromedial band is tightest in flexion.
. The anteromedial band is tightest in extension.

Correct Answer & Explanation

. The anterolateral band is tightest in flexion.

Explanation

The anterior cruciate ligament is composed of at least two functional bands. The larger anteromedial band is tightest in flexion and loosest in extension. The smaller posterolateral band is tightest in extension and loosest in flexion. Conventional anterior cruciate ligament reconstruction replaces only the anteromedial band.

Question 176

Topic: Knee Sports

A 10-year-old female gymnast twists her knee on her dismount from the balance beam. She hears a pop and has immediate swelling. She is unable to continue with activity. Physical examination reveals a positive Lachman test and positive pivot shift. She has no joint line tenderness. Radiographs are normal. After an initial period of ice and range of motion exercises, recommended treatment should include:

. Direct repair of the anterior cruciate ligament
. Reconstruction of the anterior cruciate ligament using patellar tendon
. Reconstruction of the anterior cruciate ligament using hamstrings
. Extra-articular reconstruction
. Rehabilitation emphasizing hamstring strengthening

Correct Answer & Explanation

. Direct repair of the anterior cruciate ligament

Explanation

Anterior cruciate ligament injuries in children represent a vexing clinical problem. Standard anterior cruciate ligament reconstructions would involve drilling across an open physis, which may cause a growth disturbance. Results of direct repair or extra-articular reconstruction have been no better in children than in adults. The most reasonable initial treatment is rehabilitation. If despite adequate rehabilitation, the child continues to have instability, it is recommended that the child discontinues the activities that result in instability until skeletal maturity when a standard reconstruction can be performed, or when the child undergoes a physeal sparing reconstruction (i.e., Bergfeld's "tomato stake" reconstruction).

Question 177

Topic: Knee Sports

The most common location of osteochondritis dissecans in the knee is the:

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Medial aspect of the medial femoral condyle
. Lateral facet of the patella
. Lateral aspect of the femoral trochlea

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

Osteochondritis dissecans affects adolescents, and the knee joint is the most commonly affected joint. The most common location in the knee is the lateral aspect of the medial femoral condyle at the intercondylar notch. Treatment varies with the stability of the lesion from observation to operative reduction and fixation.

Question 178

Topic: Knee Sports

Studies have shown that anterior cruciate ligament (AC L) deficiency may result in abnormal meniscal strain found particularly in what region:

. Anterior horn of the lateral meniscus
. Anterior horn of the medial meniscus
. Patellofemoral joint
. Posterior horn of the lateral meniscus
. Posterior horn of the medial meniscus

Correct Answer & Explanation

. Posterior horn of the medial meniscus

Explanation

While acute anterior cruciate ligament (AC L) injury alters the strain patterns in the lateral meniscus, chronic AC L insufficiency increases the strain in the medial meniscus and often results in tears of the posterior horn. In a study of 176 consecutive patients undergoing AC L reconstruction, there was an increasing incidence of meniscal tears as the AC L injury became more chronic with a significant increase in all medial meniscal tears and a relatively constant incidence of lateral meniscal tears.

Question 179

Topic: Knee Sports

When comparing women to men, the NC AA Injury Surveillance System has demonstrated a higher rate of injury to what structure:

. Patellar tendon
. Anterior cruciate ligament (AC L)
. Posterior cruciate ligament (PC L)
. Posterolateral ligament complex
. Medial collateral ligament

Correct Answer & Explanation

. Anterior cruciate ligament (AC L)

Explanation

Anterior cruciate ligament injury has been observed to be 2 to 3 times more common in female basketball players than in their male counterparts. The higher risk of AC L injury in women may be related to laxity, larger Q angles, excessive pronation, increased hamstring flexibility, decreased notch width index, posture (less knee and hip flexion), and possible hormone influences.

Question 180

Topic: Knee Sports

In anterior cruciate ligament (AC L) rehabilitation, closed-chain kinetic exercises are associated with all of the following except:

. Allow for co-contraction of the musculature around the knee
. Stabilize the foot
. Allow hip muscular activity for stability
. Apply physiologic compressive loads to the knee
. Improve aerobic power and endurance in the leg

Correct Answer & Explanation

. Improve aerobic power and endurance in the leg

Explanation

Closed-chain exercises for the lower extremity have been shown to be effective following anterior cruciate ligament reconstruction for several reasons. They allow co-contraction of the muscles crossing the knee, stabilize the foot against resistance, apply compressive loads to the knee, and allow for hip motion for stability. Such exercises have not been shown to have any effect on the aerobic capacity of the leg.

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