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Knee Sports MCQs

Practice Set 90 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 1781

Topic: Knee Sports

A 26-year-old male sustains a dashboard injury resulting in an isolated PCL tear. He undergoes conservative treatment but continues to have posterior instability. If PCL reconstruction is performed, which bundle of the PCL is the primary restraint to posterior tibial translation at 90 degrees of knee flexion, and should be the primary focus of an anatomic single-bundle reconstruction?

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

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The PCL consists of the anterolateral (AL) and posteromedial (PM) bundles. The AL bundle is larger, is tight in flexion, and provides the primary restraint to posterior translation at 90 degrees of flexion. It is the bundle targeted in single-bundle PCL reconstructions. The PM bundle is tight in extension.

Question 1782

Topic: Knee Sports

A 14-year-old male presents with vague knee pain and intermittent catching. Radiographs show a well-circumscribed radiolucency in the typical location for an OCD lesion of the knee. What is the most common anatomical location for an Osteochondritis Dissecans (OCD) lesion in the knee?

. Lateral aspect of the medial femoral condyle.
. Medial aspect of the medial femoral condyle.
. Central portion of the lateral femoral condyle.
. Inferior pole of the patella.
. Lateral tibial plateau.

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle.

Explanation

The most common location for an OCD lesion in the knee is the lateral aspect of the medial femoral condyle (often remembered by the acronym LAME - Lateral Aspect Medial Epicondyle/condyle), accounting for approximately 70-80% of all cases in the knee.

Question 1783

Topic: Knee Sports

A 28-year-old football player sustains a contact injury to the anteromedial aspect of his knee, forcing it into hyperextension and varus. He has a positive dial test at 30 degrees of flexion, but it is equal to the contralateral side at 90 degrees. Which structure is primarily injured?

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

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

The dial test measures external rotation of the tibia relative to the femur. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion but normal rotation at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If it is positive at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 1784

Topic: Knee Sports

A 25-year-old patient has a symptomatic 3 cm^2 focal full-thickness chondral defect on the medial femoral condyle. You are considering Matrix-induced Autologous Chondrocyte Implantation (MACI). Which of the following is an absolute contraindication for MACI?

. Body Mass Index (BMI) of 28.
. Uncorrected mechanical malalignment (varus deformity).
. Age 25 years.
. Defect size > 2 cm^2.
. Previous microfracture surgery.

Correct Answer & Explanation

. Body Mass Index (BMI) of 28.

Explanation

Uncorrected mechanical malalignment (e.g., varus alignment with a medial compartment defect) is an absolute contraindication for any advanced cartilage restoration procedure, including MACI. The uncorrected abnormal contact forces will lead to early failure of the graft. The malalignment must be corrected concurrently (e.g., High Tibial Osteotomy) or prior to the cartilage procedure.

Question 1785

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the femoral attachment is identified. Which of the following best describes the anatomic location of the MPFL origin on the femur?
. Anterior and proximal to the medial epicondyle
. Posterior and proximal to the medial epicondyle and distal to the adductor tubercle
. Anterior and distal to the adductor tubercle
. Distal to the medial epicondyle and anterior to the adductor tubercle
. Directly on the adductor tubercle

Correct Answer & Explanation

. Posterior and proximal to the medial epicondyle and distal to the adductor tubercle

Explanation

The anatomic femoral origin of the MPFL is located in a saddle-like depression between the adductor tubercle (proximal) and the medial epicondyle (distal and anterior). Schöttle's point radiographically defines this attachment, situated just anterior to the posterior cortical line and proximal to the posterior border of Blumensaat's line.

Question 1786

Topic: Knee Sports

When performing an ACL reconstruction, a femoral tunnel placed too anteriorly (shallow in the notch) will result in which of the following graft tension patterns?

. Tight in extension, loose in flexion
. Tight in flexion, tight in extension
. Loose in flexion, loose in extension
. Tight in flexion, loose in extension
. Isometric throughout the range of motion

Correct Answer & Explanation

. Tight in extension, loose in flexion

Explanation

A femoral tunnel placed too anteriorly (in the intercondylar notch, which is high/shallow in arthroscopic position) will cause the ACL graft to be loose in extension and excessively tight in flexion, potentially limiting range of motion. Conversely, a tunnel placed too posterior (deep) results in a graft tight in extension and loose in flexion.

Question 1787

Topic: Knee Sports
The primary static stabilizers of the posterolateral corner (PLC) of the knee include all of the following EXCEPT:
. Lateral collateral ligament (LCL)
. Popliteofibular ligament
. Popliteus tendon
. Biceps femoris tendon
. Arcuate ligament

Correct Answer & Explanation

. Biceps femoris tendon

Explanation

The primary static stabilizers of the PLC are the LCL, popliteus tendon, and popliteofibular ligament. The biceps femoris is an important dynamic stabilizer of the lateral knee, but not considered one of the primary static restraints.

Question 1788

Topic: Knee Sports

A 14-year-old male presents with vague knee pain. Radiographs reveal an osteochondritis dissecans (OCD) lesion. What is the most common anatomic 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 portion of the medial femoral condyle
. Trochlear groove
. Patella

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

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

Question 1789

Topic: Knee Sports

A 45-year-old female presents with acute knee pain after squatting. MRI reveals a medial meniscus posterior root tear. Biomechanically, what is the consequence of this tear if left untreated?

. Increased valgus laxity
. Loss of hoop stresses resulting in joint contact pressures equivalent to a total meniscectomy
. Decreased anterior tibial translation
. Excessive external rotation of the tibia
. Patellofemoral tracking abnormalities

Correct Answer & Explanation

. Increased valgus laxity

Explanation

A meniscal root tear leads to extrusion of the meniscus and a complete loss of circumferential hoop stresses. This functionally unloads the compartment, resulting in altered joint kinematics and increased peak contact pressures that are biomechanically equivalent to those seen after a total meniscectomy. Early osteoarthritis is a known sequela.

Question 1790

Topic: Knee Sports

When performing a transtibial posterior cruciate ligament (PCL) reconstruction, the graft is subjected to high stress at the acute angle where it exits the posterior tibial tunnel and heads anteriorly to the femoral footprint. This phenomenon is known as the 'killer turn'. Which surgical technique was developed specifically to avoid this issue?

. Single-bundle transtibial technique
. Double-bundle transtibial technique
. Tibial inlay technique
. All-inside suspensory technique
. Remnant-preserving technique

Correct Answer & Explanation

. Single-bundle transtibial technique

Explanation

The tibial inlay technique involves a posterior approach to the knee and fixing the bone block of a bone-patellar tendon-bone graft directly into a trough at the posterior tibial anatomic footprint of the PCL. This avoids the acute angle ('killer turn') at the posterior aperture of a transtibial tunnel, which can cause graft abrasion and attenuation.

Question 1791

Topic: Knee Sports
A 25-year-old professional football player sustains a contact injury to his knee. On physical examination, the Dial test demonstrates 15 degrees of increased external rotation on the injured side compared to the contralateral side at 30 degrees of knee flexion. However, at 90 degrees of knee flexion, the external rotation is symmetric bilaterally. Based on these findings, which of the following structures is most likely INTACT?
. Popliteus tendon
. Lateral collateral ligament (LCL)
. Popliteofibular ligament
. Posterior cruciate ligament (PCL)
. Biceps femoris tendon

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

The Dial test is used to evaluate posterolateral corner (PLC) and posterior cruciate ligament (PCL) injuries. An increase of >10 degrees of external rotation at 30 degrees of flexion compared to the uninjured side indicates an isolated PLC injury. If the asymmetry is present at both 30 degrees and 90 degrees of flexion, it indicates a combined PLC and PCL injury. Since the test is symmetric at 90 degrees, the PCL is intact.

Question 1792

Topic: Knee Sports

A 50-year-old female presents with acute medial knee pain after feeling a 'pop' while squatting. An MRI is obtained.

Imaging confirms a medial meniscus posterior root tear. What is the primary biomechanical consequence of this specific injury if left untreated?

. Loss of hoop stresses leading to contact pressures equivalent to a total meniscectomy
. Increased anterior tibial translation during early flexion
. Medial compartment distraction with valgus stress
. Decreased patellofemoral joint reaction forces
. Isolated overload of the anterior horn of the medial meniscus

Correct Answer & Explanation

. Loss of hoop stresses leading to contact pressures equivalent to a total meniscectomy

Explanation

Meniscal root tears disrupt the circumferential continuity of the meniscus, leading to a loss of hoop stresses. This results in meniscal extrusion and alters the knee's biomechanics, effectively increasing tibiofemoral contact pressures to levels equivalent to a total meniscectomy, predisposing the patient to rapid osteoarthritis.

Question 1793

Topic: Knee Sports

A 18-year-old female with recurrent patellar instability is undergoing medial patellofemoral ligament (MPFL) reconstruction. When identifying the femoral attachment radiographically using the Schottle point, where should the origin be placed on a true lateral radiograph?

. 1 mm posterior to the posterior cortex extension line and distal to the Blumensaat line
. Anterior to the posterior cortex line and proximal to the Blumensaat line
. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the posterior medial epicondyle
. Directly on the medial epicondyle, 5 mm distal to the adductor tubercle
. 3 mm posterior to the Blumensaat line and 5 mm proximal to the adductor tubercle

Correct Answer & Explanation

. 1 mm posterior to the posterior cortex extension line and distal to the Blumensaat line

Explanation

Schottle's point describes the radiographic anatomy of the femoral insertion of the MPFL on a true lateral radiograph. It is located 1 mm anterior to a line extending from the posterior femoral cortex, 2.5 mm distal to a perpendicular line intersecting the posterior origin of the medial femoral condyle, and proximal to the level of the posterior medial epicondyle.

Question 1794

Topic: Knee Sports

A 25-year-old male presents with symptomatic instability 3 years after primary ACL reconstruction. Radiographs and CT scan demonstrate a well-placed femoral tunnel but substantial widening of the tibial tunnel, measuring 16 mm in diameter. What is the most appropriate management strategy?

. Single-stage revision ACL reconstruction using a bone-patellar tendon-bone autograft
. Single-stage revision ACL reconstruction with interference screw fixation stacked with cancellous chips
. Two-stage revision with initial bone grafting of the tunnel, followed by ACL reconstruction 4-6 months later
. High tibial osteotomy (HTO) alone to change the posterior tibial slope
. Extra-articular tenodesis without revision of the intra-articular graft

Correct Answer & Explanation

. Single-stage revision ACL reconstruction using a bone-patellar tendon-bone autograft

Explanation

In revision ACL reconstruction, tunnel widening greater than 14 mm is generally an indication for a two-stage procedure. The first stage involves removing the old hardware and bone grafting the enlarged tunnels. The second stage, performed 4-6 months later after graft incorporation, involves the new ACL reconstruction. Single-stage revision with a 16 mm tunnel poses a high risk of poor graft fixation and failure.

Question 1795

Topic: Knee Sports
A 24-year-old football player sustains a high-energy knee injury. Evaluation reveals global instability of the knee. According to the Schenck classification of knee dislocations, a KD-III-M injury specifically involves tears of which of the following ligamentous structures?
. ACL, PCL, and LCL
. ACL, PCL, and MCL
. ACL, MCL, and LCL
. PCL, MCL, and LCL
. ACL, PCL, MCL, and LCL

Correct Answer & Explanation

. ACL, PCL, and MCL

Explanation

The Schenck classification describes knee dislocations based on the pattern of ligamentous injury. KD-I is a single cruciate (usually ACL or PCL) with collateral injury. KD-II involves both ACL and PCL with intact collaterals. KD-III involves both cruciates and one collateral (KD-III-M involves the MCL; KD-III-L involves the LCL/PLC). KD-IV involves all four major ligaments. KD-V includes a periarticular fracture.

Question 1796

Topic: Knee Sports

A 22-year-old soccer player sustains a twisting injury to his left knee. Physical examination reveals a positive Dial test, demonstrating 15 degrees of increased external rotation compared to the contralateral knee at 30 degrees of flexion, but symmetric external rotation at 90 degrees of flexion. Which structure is unequivocally injured?

. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Medial collateral ligament (MCL)
. Posterolateral corner (PLC)
. Posteromedial corner (PMC)

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

The Dial test evaluates external rotation of the tibia relative to the femur. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion, with normal rotation at 90 degrees, indicates an isolated injury to the posterolateral corner (PLC). If external rotation is increased at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 1797

Topic: Knee Sports

A 17-year-old female presents with recurrent lateral patellar dislocations. Nonoperative management has failed. MRI evaluation of her knee demonstrates a normal trochlear depth but reveals a tibial tubercle-trochlear groove (TT-TG) distance of 22 mm. What is the most appropriate surgical intervention to correct this specific anatomic risk factor?

. Isolated medial patellofemoral ligament (MPFL) reconstruction
. Lateral retinacular release
. Tibial tubercle anteromedialization (Fulkerson osteotomy)
. Trochleoplasty
. Distal femoral varus osteotomy

Correct Answer & Explanation

. Isolated medial patellofemoral ligament (MPFL) reconstruction

Explanation

A TT-TG distance >20 mm is considered an absolute indication for a medializing tibial tubercle osteotomy (such as a Fulkerson anteromedialization osteotomy) to correct the severe lateral vector force on the patella. While MPFL reconstruction is often performed concurrently, isolated MPFL reconstruction in the setting of a TT-TG >20 mm has a high failure rate.

Question 1798

Topic: Knee Sports

Regarding the biomechanics of the native anterior cruciate ligament (ACL), the posterolateral (PL) bundle reaches its maximum tension at which of the following knee positions?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 degrees of flexion
. 120 degrees of flexion

Correct Answer & Explanation

. Full extension

Explanation

The ACL is composed of two main bundles: the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle is tightest in flexion and is the primary restraint to anterior tibial translation at 90 degrees. The PL bundle is tightest in full extension and plays a primary role in rotational stability.

Question 1799

Topic: Knee Sports
The anterior cruciate ligament (ACL) possesses a poor intrinsic healing capacity compared to the medial collateral ligament (MCL). This is primarily attributed to the intra-articular environment, specifically due to the upregulation of which molecule that dissolves the provisional fibrin clot?
. Plasmin
. Thrombin
. Fibrinogen
. Factor XIII
. Matrix Metalloproteinase-13

Correct Answer & Explanation

. Plasmin

Explanation

Synovial fluid contains high levels of plasminogen and plasminogen activators (like uPA), which convert plasminogen into plasmin. Plasmin prematurely degrades the fibrin clot necessary for a scaffold during the initial inflammatory phase of ligament healing.

Question 1800

Topic: Knee Sports

Following a meniscus tear, the potential for healing is greatest in the peripheral third. This is primarily due to blood supply derived from which of the following structures?

. Middle genicular artery
. Perimeniscal capillary plexus
. Popliteal artery direct branches
. Cruciate ligament anastomoses
. Synovial fluid diffusion

Correct Answer & Explanation

. Middle genicular artery

Explanation

The peripheral 10-30% of the meniscus (red-red zone) is vascularized by the perimeniscal capillary plexus. This plexus arises from the medial and lateral superior and inferior genicular arteries.

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