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Knee Sports MCQs

Practice Set 93 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 1841

Topic: Knee Sports

In reconstructing the posterolateral corner (PLC) of the knee, precise anatomical placement of the popliteus tendon graft is crucial. What is the correct anatomical footprint of the popliteus tendon on the lateral femur relative to the lateral collateral ligament (LCL) origin?

. Anterior and superior to the LCL origin
. Anterior and inferior to the LCL origin
. Posterior and superior to the LCL origin
. Posterior and inferior to the LCL origin
. Directly medial to the LCL origin

Correct Answer & Explanation

. Anterior and superior to the LCL origin

Explanation

The popliteus tendon inserts on the lateral femoral condyle anterior and inferior to the origin of the lateral collateral ligament (LCL). Understanding this relationship is critical for anatomical PLC reconstructions.

Question 1842

Topic: Knee Sports

The posterior horn of the lateral meniscus is stabilized by the meniscofemoral ligaments. What is the correct anatomical course of the ligament of Wrisberg in relation to the posterior cruciate ligament (PCL)?

. It courses anterior to the PCL
. It courses posterior to the PCL
. It courses superior to the ACL
. It courses inferior to the popliteus tendon
. It runs longitudinally through the central substance of the PCL

Correct Answer & Explanation

. It courses anterior to the PCL

Explanation

The meniscofemoral ligaments connect 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. A helpful mnemonic is alphabetical: Humphrey is Anterior, Wrisberg is Posterior.

Question 1843

Topic: Knee Sports

The popliteofibular ligament is a crucial component of the posterolateral corner (PLC) of the knee, acting as a primary restraint to external rotation. From its origin at the popliteus musculotendinous junction, where does it anatomically insert?

. Anterior aspect of the fibular head
. Lateral epicondyle of the femur
. Posteromedial aspect of the fibular styloid
. Gerdy's tubercle
. Lateral rim of the lateral meniscus

Correct Answer & Explanation

. Anterior aspect of the fibular head

Explanation

The popliteofibular ligament (PFL) is a key structure in the posterolateral corner of the knee. It arises from the popliteus tendon at its musculotendinous junction and courses inferiorly and laterally to insert on the posteromedial aspect of the fibular styloid process. It plays a major role in resisting external tibial rotation and varus opening.

Question 1844

Topic: Knee Sports

The lateral meniscus of the knee is more mobile and less prone to injury than the medial meniscus. Which of the following anatomical features is unique to the lateral meniscus compared to the medial meniscus?

. It is firmly attached to the lateral collateral ligament
. It receives direct tendinous attachment from the semimembranosus
. It lacks vascular supply in its peripheral third
. It has attachments to the meniscofemoral ligaments (Humphrey and Wrisberg)
. It is C-shaped with widely separated anterior and posterior horns

Correct Answer & Explanation

. It is firmly attached to the lateral collateral ligament

Explanation

The lateral meniscus is more circular (O-shaped) and has more closely approximated horns. Unlike the medial meniscus, which is firmly attached to the deep MCL, the lateral meniscus has no attachment to the LCL (separated by the popliteus tendon). Unique to the lateral meniscus are the meniscofemoral ligaments of Humphrey (anterior to PCL) and Wrisberg (posterior to PCL), which attach its posterior horn to the medial femoral condyle.

Question 1845

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary functional bundles: the anteromedial (AM) and the posterolateral (PL). Which statement accurately describes their dynamic biomechanical tensioning throughout knee range of motion?

. The AM bundle is tightest in extension; the PL bundle is tightest in flexion.
. The AM bundle is tightest in flexion; the PL bundle is tightest in extension.
. Both bundles are maximally tensioned evenly at 90 degrees of flexion.
. The PL bundle is the primary restraint to anterior tibial translation at 90 degrees of flexion.
. The AM bundle acts strictly as a rotary stabilizer in full extension.

Correct Answer & Explanation

. The AM bundle is tightest in extension; the PL bundle is tightest in flexion.

Explanation

The anteromedial (AM) bundle of the ACL is tighter in flexion and provides the primary restraint to anterior tibial translation at 90 degrees. The posterolateral (PL) bundle is tighter in extension and is the primary restraint to rotatory loads (pivot shift) near full extension.

Question 1846

Topic: Knee Sports
A 24-year-old football player sustains a direct blow to the proximal anterior tibia while his knee is flexed. A dial test is performed, which shows >10 degrees of increased external rotation at 90 degrees of knee flexion compared to the contralateral side, but symmetric external rotation at 30 degrees of flexion. This physical examination finding is most consistent with an isolated injury to which structure?
. Posterolateral corner (PLC)
. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Both PCL and PLC
. Lateral collateral ligament (LCL) isolated

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

The dial test evaluates for posterolateral instability. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion only indicates an isolated Posterolateral Corner (PLC) injury. Increased external rotation at 90 degrees of flexion only indicates an isolated PCL injury. Increased external rotation at both 30 and 90 degrees implies combined PLC and PCL injuries.

Question 1847

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, placement of the femoral tunnel too far anteriorly (shallow) will result in which of the following graft tensioning patterns?

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

Correct Answer & Explanation

. Tight in flexion and tight in extension

Explanation

A femoral tunnel placed too far anteriorly (shallow) in the intercondylar notch causes the graft to be excessively tight in flexion and loose in extension. This can lead to a loss of knee flexion and eventual stretching or failure of the graft.

Question 1848

Topic: Knee Sports

When evaluating knee kinematics, which of the following properties is a primary design characteristic of a posterior-stabilized (PS) total knee arthroplasty compared to a cruciate-retaining (CR) design?

. Paradoxical anterior femoral translation in deep flexion
. Decreased patellofemoral contact forces in deep flexion
. Forced posterior femoral rollback dictated by the cam-post mechanism
. Reliance on the PCL for late flexion rollback
. Higher risk of anterior instability in extension

Correct Answer & Explanation

. Forced posterior femoral rollback dictated by the cam-post mechanism

Explanation

In a posterior-stabilized (PS) knee, the cam-post mechanism engages (typically at 60-70 degrees of flexion) to enforce posterior femoral rollback. This is a mechanical substitution for the excised PCL, unlike CR knees which rely on native PCL tension.

Question 1849

Topic: Knee Sports

During a cruciate-retaining (CR) total knee arthroplasty, the surgeon notes that the anterior aspect of the tibial tray lifts off the baseplate during deep flexion, and there is excessive posterior femoral rollback. What is the most likely cause of this kinematic abnormality?

. A loose posterior cruciate ligament (PCL)
. A tight posterior cruciate ligament (PCL)
. An oversized femoral component
. A tight extension gap
. A loose medial collateral ligament (MCL)

Correct Answer & Explanation

. A tight posterior cruciate ligament (PCL)

Explanation

A tight PCL in a CR-TKA acts as a tether during knee flexion, causing excessive femoral rollback. As the femur is pulled forcefully posterior on the tibia, it creates a 'teeter-totter' effect that can cause the anterior aspect of the tibial component to lift off. This requires PCL recession or release.

Question 1850

Topic: Knee Sports

During a cruciate-retaining (CR) TKA, the surgeon notices that the knee 'books open' anteriorly as it is flexed, and the femoral component rolls paradoxically anteriorly on the tibia during deep flexion. What is the primary cause of this kinematic abnormality?

. A deficient or over-released posterior cruciate ligament
. A posterior cruciate ligament that is too tight
. Oversizing the femoral component
. Excessive posterior slope of the tibial baseplate
. Impingement of the anterior intercondylar notch

Correct Answer & Explanation

. A posterior cruciate ligament that is too tight

Explanation

Paradoxical anterior rolling of the femur on the tibia during flexion in a CR TKA is a classic sign of a tight posterior cruciate ligament (PCL). A tight PCL forces the femur to rock back or hinge, causing the anterior portion of the joint to open like a book and driving the femur forward on the tibial plateau. Management involves incrementally releasing the PCL or increasing the posterior tibial slope to loosen the flexion space and PCL.

Question 1851

Topic: Knee Sports

During a cruciate-retaining (CR) total knee arthroplasty, the surgeon notices that the tibial tray repeatedly lifts off anteriorly (book-opening) when the knee is brought into deep flexion. What is the most likely technical cause of this intraoperative finding?

. The flexion gap is excessively loose compared to the extension gap
. The posterior cruciate ligament (PCL) is excessively tight
. The anterior cruciate ligament was not completely resected
. The femoral component was placed in excessive extension
. The patellar tendon was completely avulsed

Correct Answer & Explanation

. The posterior cruciate ligament (PCL) is excessively tight

Explanation

In a CR TKA, if the PCL is retained but is excessively tight, it acts as an unyielding tether during flexion. This forces the femur to roll back excessively on the tibia, applying increased pressure on the posterior lip of the tibial polyethylene and causing the anterior aspect of the tibial tray to lift off ('book opening').

Question 1852

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction of the knee, surgical dissection near the fibular head places the common peroneal nerve at risk. What is the normal anatomic relationship of the common peroneal nerve as it crosses the knee joint?

. It runs posterior and medial to the biceps femoris tendon before wrapping anteriorly around the fibular neck
. It runs directly anterior to the biceps femoris tendon, deep to the iliotibial band
. It courses directly through the substance of the fibular collateral ligament
. It runs anterior to the lateral head of the gastrocnemius, crossing over the patellar tendon
. It pierces the biceps femoris muscle belly 5 cm proximal to the fibular head

Correct Answer & Explanation

. It runs posterior and medial to the biceps femoris tendon before wrapping anteriorly around the fibular neck

Explanation

The common peroneal nerve descends in the lateral aspect of the popliteal fossa, coursing posterior and medial to the tendon of the biceps femoris. It then travels distally and laterally to wrap around the neck of the fibula, deep to the peroneus longus muscle, making it highly susceptible to injury during PLC reconstruction or fibular head avulsions.

Question 1853

Topic: Knee Sports
A 22-year-old collegiate football player sustains a combined complete anterior cruciate ligament (ACL) tear and a grade III medial collateral ligament (MCL) tear of his left knee. What is the most widely accepted treatment strategy for this injury pattern?
. Immediate simultaneous reconstruction of the ACL and MCL
. Nonoperative management of both injuries with long-term bracing
. Hinged knee brace for 4-6 weeks to allow MCL healing, followed by delayed ACL reconstruction
. ACL reconstruction within 1 week, followed by open MCL repair
. MCL reconstruction within 1 week, followed by ACL reconstruction at 6 months

Correct Answer & Explanation

. Hinged knee brace for 4-6 weeks to allow MCL healing, followed by delayed ACL reconstruction

Explanation

The gold standard treatment for a combined ACL and isolated grade III MCL injury is initial conservative management of the MCL using a hinged knee brace. This allows the MCL to heal and the patient to regain full range of motion. Delayed ACL reconstruction is then performed. Acute simultaneous reconstruction significantly increases the risk of post-operative arthrofibrosis (stiffness).

Question 1854

Topic: Knee Sports

In a patient with an acute traumatic knee injury, an MRI demonstrates a "double PCL" sign. Which of the following associated injuries is most likely to be present on further evaluation?

. ACL tear
. Medial meniscus bucket-handle tear
. Lateral meniscus radial tear
. Posterolateral corner injury
. Patellar tendon rupture

Correct Answer & Explanation

. Medial meniscus bucket-handle tear

Explanation

The "double PCL" sign on a sagittal MRI of the knee occurs when a bucket-handle tear of the medial meniscus displaces into the intercondylar notch. The displaced fragment lies anterior and parallel to the posterior cruciate ligament (PCL).

Question 1855

Topic: Knee Sports

A 48-year-old female presents with acute medial knee pain after a minor pivoting episode. MRI demonstrates a medial meniscus posterior root tear with 4 mm of meniscal extrusion. Which of the following best describes the biomechanical consequence of this specific injury if left untreated?

. Decreased anterior tibial translation under anterior shear loads
. Biomechanical equivalence to a total medial meniscectomy regarding peak contact pressures
. Increased tension on the anterior cruciate ligament but preserved hoop stresses
. Shift of peak contact forces to the lateral compartment
. Increased patellofemoral contact pressures during deep flexion

Correct Answer & Explanation

. Biomechanical equivalence to a total medial meniscectomy regarding peak contact pressures

Explanation

A posterior root tear of the medial meniscus completely disrupts the meniscal hoop stresses. Biomechanical studies have shown that this loss of hoop tension results in peak tibiofemoral contact pressures that are statistically equivalent to those seen after a total medial meniscectomy, drastically accelerating medial compartment arthrosis.

Question 1856

Topic: Knee Sports

A 28-year-old male sustains a severe knee injury during a rugby tackle. The dial test demonstrates 15 degrees of increased external rotation compared to the contralateral knee at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees of knee flexion. Which injury pattern does this specifically indicate?

. Isolated posterior cruciate ligament (PCL) injury
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injuries
. Combined ACL and PLC injuries
. Medial collateral ligament (MCL) and posteromedial corner injury

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

The dial test evaluates for posterolateral instability. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion, but returning to symmetry at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. If the asymmetry is present at BOTH 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 1857

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, identifying the anatomic femoral insertion is critical. According to Schöttle's radiographic landmarks on a strict lateral radiograph, where is the femoral origin of the MPFL located?
. Anterior to the posterior femoral cortical line and proximal to Blumensaat's line
. Posterior to the posterior femoral cortical line and distal to Blumensaat's line
. Anterior to the posterior femoral cortical line and distal to Blumensaat's line
. Directly on the medial epicondyle
. 1 cm distal to the adductor tubercle

Correct Answer & Explanation

. Anterior to the posterior femoral cortical line and distal to Blumensaat's line

Explanation

Schöttle's point defines the radiographic femoral origin of the MPFL on a true lateral view. 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 1858

Topic: Knee Sports
A 22-year-old soccer player undergoes microfracture for a 1.5 cm^2 full-thickness chondral defect on the medial femoral condyle. Which of the following best describes the predominant histological composition of the reparative tissue generated by this procedure?
. Type II collagen with high proteoglycan content
. Type I collagen organized into fibrocartilage
. Type X collagen indicating endochondral ossification
. Hyaline cartilage identical to the surrounding native tissue
. Type III collagen primarily consisting of woven bone

Correct Answer & Explanation

. Type I collagen organized into fibrocartilage

Explanation

Microfracture stimulates the release of marrow elements to form a super clot over a chondral defect. The resulting reparative tissue is predominantly fibrocartilage, which is composed primarily of Type I collagen. This is mechanically inferior to the native articular hyaline cartilage, which is composed primarily of Type II collagen.

Question 1859

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the femoral tunnel is inadvertently placed 1 cm proximal to Schöttle's point. Which of the following describes the most likely biomechanical consequence of this non-anatomic graft placement?
. The graft will be overly tight in flexion and loose in extension, leading to a loss of knee flexion.
. The graft will be overly tight in extension and loose in flexion, leading to lateral subluxation in deep flexion.
. The graft will be globally loose throughout the entire range of motion.
. The graft will be tight in both extension and flexion, causing patellofemoral arthrosis.
. The graft kinematics remain normal, but the pull angle induces a pathologic patellar tilt.

Correct Answer & Explanation

. The graft will be overly tight in flexion and loose in extension, leading to a loss of knee flexion.

Explanation

Non-anatomic placement of the femoral tunnel during MPFL reconstruction profoundly alters graft kinematics. Schöttle's point defines the anatomic radiographic landmark for the femoral origin of the MPFL. If the femoral tunnel is placed too proximal, the distance between the patellar and femoral attachments increases as the knee flexes, causing the graft to become overly tight in flexion and loose in extension. This typically presents clinically as postoperative stiffness and a loss of terminal knee flexion.

Question 1860

Topic: Knee Sports

A surgeon is performing a posterior cruciate ligament (PCL) reconstruction using a transtibial tunnel technique. This technique is classically associated with the 'killer turn' at the posterior tibial aperture. Which of the following is the most frequent complication directly resulting from this specific anatomical geometry?

. Graft elongation and attenuation over time
. Iatrogenic popliteal artery injury during tunnel reaming
. Premature osteolysis of the tibial tunnel
. Early hardware pull-out at the femoral fixation site
. Postoperative posterior horn medial meniscus impingement

Correct Answer & Explanation

. Graft elongation and attenuation over time

Explanation

The 'killer turn' refers to the acute angle the PCL graft must take as it exits the posterior tibial tunnel to travel superiorly to the medial femoral condyle in a transtibial PCL reconstruction. This sharp turn creates high friction and repetitive abrasion on the graft, making it highly susceptible to gradual attenuation, elongation, and ultimate clinical failure. This biomechanical disadvantage is the primary rationale for many surgeons preferring the tibial inlay technique, which avoids this acute angle.

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