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Knee Sports MCQs

Practice Set 92 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 1821

Topic: Knee Sports
A 19-year-old female presents with recurrent lateral patellar instability. Imaging reveals a TT-TG distance of 14 mm, normal patellar height, and no significant trochlear dysplasia. She is scheduled for an isolated Medial Patellofemoral Ligament (MPFL) reconstruction. Which of the following best describes the correct anatomic femoral attachment site for the MPFL graft?
. Anterior to the medial epicondyle and distal to the adductor tubercle
. Posterior to the medial epicondyle and proximal to the adductor tubercle
. Between the medial epicondyle and the adductor tubercle
. Directly on the medial epicondyle
. Distal to the joint line on the anteromedial tibia

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle

Explanation

The anatomic femoral origin of the MPFL is located in a saddle-like depression between the adductor tubercle (which is proximal) and the medial epicondyle (which is distal). Radiographically, this is identified using the Schöttle point, located approximately 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior articular border, and proximal to the level of the posterior medial epicondyle.

Question 1822

Topic: Knee Sports

A 28-year-old skier sustains an isolated complete posterior cruciate ligament (PCL) injury. The PCL consists of two distinct functional bundles. Which statement accurately describes the biomechanics of the PCL bundles?

. The posteromedial bundle is larger and tight in extension
. The anterolateral bundle is larger and tight in flexion
. The posteromedial bundle is larger and tight in flexion
. The anterolateral bundle is smaller and tight in extension
. Both bundles are equally tight in full extension

Correct Answer & Explanation

. The posteromedial bundle is larger and tight in extension

Explanation

The PCL is composed of two main bundles: the anterolateral (AL) and the posteromedial (PM). The AL bundle is the larger and stiffer of the two, and it is tight in flexion. The PM bundle is smaller and is tightest in extension.

Question 1823

Topic: Knee Sports

A 26-year-old male requires posterolateral corner (PLC) reconstruction following a severe knee injury. The surgeon must understand the biomechanics of the individual structures. Which of the following structures constitutes the primary static restraint to varus opening at 30 degrees of knee flexion?

. Popliteus tendon
. Popliteofibular ligament
. Fibular collateral ligament (LCL)
. Iliotibial band
. Biceps femoris tendon

Correct Answer & Explanation

. Popliteus tendon

Explanation

The posterolateral corner has three major static stabilizers: the fibular collateral ligament (LCL), the popliteus tendon, and the popliteofibular ligament. The LCL is the primary static restraint to varus stress, and this is best isolated clinically by performing the varus stress test at 30 degrees of knee flexion (which relaxes the cruciate ligaments).

Question 1824

Topic: Knee Sports

A 45-year-old female felt a pop in the back of her knee while descending stairs. MRI demonstrates a complete radial tear at the posterior horn of the medial meniscus root, with 4 mm of meniscal extrusion. Which of the following best describes the primary biomechanical consequence of this specific injury?

. Loss of circumferential hoop stresses leading to increased peak contact pressures
. Increased anterior tibial translation during terminal extension
. Decreased tibiofemoral peak contact pressures in the medial compartment
. Increased varus alignment of the mechanical axis
. Incompetence of the posterior oblique ligament

Correct Answer & Explanation

. Loss of circumferential hoop stresses leading to increased peak contact pressures

Explanation

A complete meniscal root tear is biomechanically equivalent to a total meniscectomy. It disrupts the circumferential fibers of the meniscus, causing a loss of hoop stresses. This allows the meniscus to extrude radially and significantly increases peak articular contact pressures, predisposing the joint to rapid chondrolysis and osteoarthritis.

Question 1825

Topic: Knee Sports

A 19-year-old female presents with recurrent lateral patellar dislocations. CT imaging reveals a tibial tubercle-trochlear groove (TT-TG) distance of 23 mm. The trochlear depth and morphology are within normal limits. Which of the following is the most appropriate surgical management?

. Medial patellofemoral ligament (MPFL) reconstruction alone
. MPFL reconstruction combined with tibial tubercle anteromedialization
. Lateral retinacular release alone
. Trochleoplasty
. Distal femoral varus producing osteotomy

Correct Answer & Explanation

. Medial patellofemoral ligament (MPFL) reconstruction alone

Explanation

A TT-TG distance of greater than 20 mm is considered pathologic and predisposes the patella to lateral maltracking and instability. In the setting of recurrent dislocations with a TT-TG >20 mm, MPFL reconstruction alone has a high failure rate. The standard of care is to combine an MPFL reconstruction with a bony procedure, such as a tibial tubercle osteotomy (anteromedialization), to correct the vector mechanics.

Question 1826

Topic: Knee Sports

During surgical reconstruction of a multi-ligament knee injury involving the posterolateral corner (PLC), the surgeon attempts to accurately locate the femoral footprint of the popliteus tendon. Where is the anatomic femoral attachment of the popliteus tendon located relative to the lateral collateral ligament (LCL) femoral attachment?

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

Correct Answer & Explanation

. Proximal and posterior

Explanation

Anatomic knowledge of the posterolateral corner is critical for successful reconstruction. The popliteus tendon inserts on the lateral femoral condyle in a sulcus that is situated anterior and distal to the femoral attachment of the lateral collateral ligament (LCL).

Question 1827

Topic: Knee Sports

Which of the following is the primary biomechanical advantage of utilizing the tibial inlay technique compared to the transtibial technique for a Posterior Cruciate Ligament (PCL) reconstruction?

. Decreased risk of iatrogenic popliteal artery injury
. Avoidance of the 'killer turn' and reduced graft attenuation
. Superior preservation of the meniscofemoral ligaments
. Elimination of the need for a femoral tunnel
. Earlier return to unrestricted weight-bearing and full extension

Correct Answer & Explanation

. Decreased risk of iatrogenic popliteal artery injury

Explanation

The primary biomechanical advantage of the tibial inlay technique is the avoidance of the 'killer turn'—the acute angle at the posterior aspect of the tibial plateau. In a transtibial PCL reconstruction, the graft is forced around this sharp angle, which can lead to graft abrasion, attenuation, and ultimately failure. The tibial inlay technique allows the graft to rest anatomically without this acute angle.

Question 1828

Topic: Knee Sports

During the evaluation of a patient with a suspected multiligamentous knee injury, the Dial test is performed. Which of the following findings classically indicates an isolated injury to the posterolateral corner (PLC)?

. Increased external rotation at 30 degrees of flexion, but normal at 90 degrees
. Increased external rotation at 90 degrees of flexion, but normal at 30 degrees
. Increased external rotation symmetrically at both 30 and 90 degrees
. Increased internal rotation at 30 degrees of flexion
. Decreased external rotation at both 30 and 90 degrees

Correct Answer & Explanation

. Increased external rotation at 30 degrees of flexion, but normal at 90 degrees

Explanation

The Dial test measures external rotation of the tibia. An isolated injury to the posterolateral corner (PLC) results in more than 10 degrees of increased external rotation (compared to the contralateral side) at 30 degrees of knee flexion, but not at 90 degrees, because an intact PCL becomes the primary restraint to external rotation at 90 degrees. Increased external rotation at both 30 and 90 degrees indicates a combined PCL and PLC injury.

Question 1829

Topic: Knee Sports

A 13-year-old gymnast presents with anterior knee pain. Radiographs and an MRI demonstrate a 1.5 cm osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. The physes are widely open, and the MRI shows intact cartilage with no fluid behind the bony lesion. What is the most appropriate initial management?

. Arthroscopic transarticular drilling of the lesion
. Bioabsorbable pin fixation of the lesion
. Osteochondral autograft transfer (OATS)
. Activity modification and protected weight-bearing
. Microfracture

Correct Answer & Explanation

. Arthroscopic transarticular drilling of the lesion

Explanation

In juvenile patients with widely open physes, stable OCD lesions (intact overlying cartilage, no high T2 fluid signal behind the lesion on MRI) have a very high rate of spontaneous healing. The standard of care is an initial 3 to 6 month trial of non-operative management, consisting of activity modification and restricted weight-bearing.

Question 1830

Topic: Knee Sports

A 28-year-old male sustains an isolated Posterior Cruciate Ligament (PCL) injury. After failing non-operative management, he undergoes a single-bundle PCL reconstruction. To optimally restore the primary restraint to posterior tibial translation, the graft should be placed in the anatomic footprint of the anterolateral (AL) bundle. At what knee flexion angle should the AL bundle graft be tensioned and fixated?

. 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 PCL consists of the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle is tightest in flexion (90 degrees) and is the primary restraint to posterior translation. Single-bundle reconstructions typically recreate the AL bundle and are therefore tensioned at 90 degrees of knee flexion to optimally restore AP stability.

Question 1831

Topic: Knee Sports

A 45-year-old active female presents with acute onset posteromedial knee pain after a deep squat. MRI reveals a complete radial tear at the posterior root of the medial meniscus with 4 mm of meniscal extrusion. Biomechanically, if left untreated, this injury most closely approximates the contact pressures of which of the following scenarios?

. An isolated ACL rupture
. A longitudinal tear of the medial meniscus
. A total medial meniscectomy
. A bucket-handle medial meniscus tear
. A posterior horn lateral meniscus root tear

Correct Answer & Explanation

. An isolated ACL rupture

Explanation

Posterior medial meniscus root tears disrupt the hoop stresses of the meniscus, leading to meniscal extrusion. Biomechanical studies have shown that a complete medial meniscus posterior root tear results in a significant decrease in contact area and increased peak contact pressures, which are biomechanically equivalent to a total medial meniscectomy. Early repair is indicated to prevent rapid progression to osteoarthritis.

Question 1832

Topic: Knee Sports

A 13-year-old male with open physes presents with knee pain. MRI reveals a 1.5 cm osteochondritis dissecans (OCD) lesion with an intact overlying articular cartilage on the lateral aspect of the medial femoral condyle. Initial non-operative management fails after 6 months. What is the most appropriate next step in management?

. Osteochondral autograft transfer (OATS)
. Arthroscopic transarticular drilling
. Microfracture of the lesion
. Fixation with bioabsorbable screws
. Autologous chondrocyte implantation (ACI)

Correct Answer & Explanation

. Osteochondral autograft transfer (OATS)

Explanation

For a stable OCD lesion (intact articular cartilage) in a skeletally immature patient (open physes) that has failed 3-6 months of non-operative management, arthroscopic drilling (either transarticular or retroarticular) is the gold standard. Drilling penetrates the sclerotic margin, promoting revascularization and healing of the subchondral bone. Internal fixation or cartilage restoration procedures (OATS, ACI) are reserved for unstable or detached lesions.

Question 1833

Topic: Knee Sports

A 30-year-old male with chronic posterior knee instability undergoes a single-bundle Posterior Cruciate Ligament (PCL) reconstruction. To optimally restore primary restraint against posterior tibial translation, the graft should replicate which native bundle of the PCL, and at what knee flexion angle should it be conventionally tensioned?

. Anterolateral bundle, tensioned at 90 degrees of flexion
. Anterolateral bundle, tensioned at full extension
. Posteromedial bundle, tensioned at 90 degrees of flexion
. Posteromedial bundle, tensioned at full extension
. Posteromedial bundle, tensioned at 30 degrees of flexion

Correct Answer & Explanation

. Anterolateral bundle, tensioned at 90 degrees of flexion

Explanation

The anterolateral (AL) bundle of the PCL is the primary restraint to posterior tibial translation at 90 degrees of knee flexion, whereas the posteromedial (PM) bundle is tighter in extension. In a standard single-bundle PCL reconstruction, the AL bundle is reconstructed. To restore maximum stability, the graft is conventionally tensioned at 90 degrees of knee flexion, where the native AL bundle is under its maximum physiological tension.

Question 1834

Topic: Knee Sports

A 26-year-old athlete sustains a traumatic knee injury. On examination, there is an increase of 15 degrees of external rotation of the tibia on the femur at 30 degrees of knee flexion compared to the uninjured side. However, at 90 degrees of knee flexion, the external rotation is symmetric between both knees. Which of the following structures is most likely injured?

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

Correct Answer & Explanation

. Isolated Posterior Cruciate Ligament (PCL)

Explanation

The Dial test evaluates for injuries to the Posterolateral Corner (PLC) and the PCL. An isolated PLC injury is characterized by an increase of >10 degrees of external rotation at 30 degrees of flexion, but not at 90 degrees, due to the secondary stabilizing effect of an intact PCL at 90 degrees. If the Dial test is positive at both 30 and 90 degrees, a combined PCL and PLC injury is indicated.

Question 1835

Topic: Knee Sports

A 14-year-old male presents with knee pain. MRI shows a 1.5 cm x 1.5 cm osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. The overlying articular cartilage is intact, but there is high T2 signal behind the lesion indicating lack of osseous integration. The patient's physes remain open. He has failed 4 months of strict non-weight bearing and rest. What is the most appropriate next step in surgical management?

. Osteochondral autograft transfer (OATS)
. Autologous chondrocyte implantation (ACI)
. Arthroscopic drilling of the lesion
. Bioabsorbable pin or screw fixation
. Microfracture of the subchondral bone

Correct Answer & Explanation

. Osteochondral autograft transfer (OATS)

Explanation

In a skeletally immature patient with a stable OCD lesion (intact overlying articular cartilage) that has failed a prolonged trial of conservative management, the standard of care is arthroscopic drilling (trans-articular or retro-articular). This creates channels into the viable subchondral bone, stimulating bleeding, vascular ingrowth, and subsequent osseous healing without violating the stable cartilage surface with fixation devices.

Question 1836

Topic: Knee Sports

A 23-year-old skier presents to the emergency department after a twisting knee injury. Plain radiographs reveal an elliptic avulsion fracture of the lateral tibial plateau, known as a Segond fracture. Which ligamentous structure is most intimately associated with this bony avulsion, and what major intra-articular injury is virtually pathognomonic with this finding?

. Iliotibial band; Posterior Cruciate Ligament (PCL)
. Biceps femoris tendon; Posterolateral Corner (PLC)
. Anterolateral Ligament (ALL) complex; Anterior Cruciate Ligament (ACL)
. Popliteus tendon; Anterior Cruciate Ligament (ACL)
. Medial patellofemoral ligament; Patellar dislocation

Correct Answer & Explanation

. Iliotibial band; Posterior Cruciate Ligament (PCL)

Explanation

A Segond fracture is an avulsion fracture of the lateral tibial plateau that occurs with internal rotation and varus stress. The avulsed fragment represents the tibial attachment of the anterolateral complex, particularly the anterolateral ligament (ALL) and lateral capsule. This radiographic finding is virtually pathognomonic (up to 75-100% association) for a concurrent tear of the Anterior Cruciate Ligament (ACL).

Question 1837

Topic: Knee Sports

A 45-year-old female presents with acute medial joint line pain after squatting. MRI reveals a complete radial tear of the medial meniscus at its posterior root attachment, accompanied by 4 mm of meniscal extrusion. If treated non-operatively, what is the most likely biomechanical consequence within the knee?

. Increased tibiofemoral contact area
. Decreased peak contact pressures
. Biomechanical equivalent of a total meniscectomy
. Increased circumferential hoop stresses
. Medial shift of the mechanical axis of the lower extremity

Correct Answer & Explanation

. Increased tibiofemoral contact area

Explanation

A complete meniscal root tear disrupts the ability to convert axial loads into hoop stresses. Biomechanically, this results in peak contact pressures equivalent to those seen after a total meniscectomy.

Question 1838

Topic: Knee Sports

During a posterior cruciate ligament (PCL) reconstruction, the surgeon aims to accurately recreate the native biomechanics of the ligament. Which bundle of the PCL is the largest, and in what position of knee flexion is it under the most tension?

. Anterolateral bundle; tightest in flexion
. Anterolateral bundle; tightest in extension
. Posteromedial bundle; tightest in flexion
. Posteromedial bundle; tightest in extension
. Meniscofemoral ligaments; tightest in internal rotation

Correct Answer & Explanation

. Anterolateral bundle; tightest in flexion

Explanation

The PCL consists of two main bundles. The anterolateral bundle is larger and is tightest in knee flexion, whereas the smaller posteromedial bundle is tightest in knee extension.

Question 1839

Topic: Knee Sports

A 22-year-old soccer player sustains a twisting knee injury. Radiographs reveal a small avulsion fracture of the lateral tibial plateau. This radiographic finding is pathognomonic for an injury to which of the following structures?

. Medial collateral ligament
. Posterior cruciate ligament
. Anterior cruciate ligament
. Lateral meniscus
. Posterolateral corner

Correct Answer & Explanation

. Medial collateral ligament

Explanation

A Segond fracture is an avulsion fracture of the lateral tibial plateau at the insertion of the anterolateral ligament (ALL) and lateral capsular ligament. It is highly associated (pathognomonic) with an anterior cruciate ligament (ACL) tear.

Question 1840

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction of the knee, anatomical placement of the fibular collateral ligament (LCL) graft on the femur is critical to avoid graft isometry mismatch. What is the native anatomical relationship of the LCL origin on the lateral femoral condyle relative to the popliteus tendon origin?

. LCL origin is proximal and posterior to the popliteus origin
. LCL origin is distal and anterior to the popliteus origin
. LCL origin is proximal and anterior to the popliteus origin
. LCL origin is distal and posterior to the popliteus origin
. They share a conjoined origin at the lateral epicondyle

Correct Answer & Explanation

. LCL origin is proximal and posterior to the popliteus origin

Explanation

Anatomical studies (such as those by LaPrade et al.) have established that the native femoral attachment of the fibular collateral ligament (LCL) is located proximal and posterior to the popliteus tendon attachment on the lateral femoral condyle. The LCL origin is slightly proximal and posterior to the lateral epicondyle, while the popliteus originates anterior and distal to the LCL in the popliteal sulcus.

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