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Knee Sports MCQs

Practice Set 95 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 1881

Topic: Knee Sports

A 25-year-old professional soccer player undergoes an anterior cruciate ligament (ACL) reconstruction. Preoperative MRI revealed a suspicious fluid signal posterior to the medial meniscus. Intraoperatively, the surgeon suspects a 'ramp lesion'. Which of the following arthroscopic approaches provides the most optimal visualization for accurate diagnosis and repair of this specific lesion?

. Standard anteromedial portal
. Standard anterolateral portal
. Posteromedial portal
. Posterolateral portal
. Accessory high anteromedial portal

Correct Answer & Explanation

. Posteromedial portal

Explanation

Ramp lesions are longitudinal meniscocapsular separations of the posterior horn of the medial meniscus, often associated with ACL ruptures. They represent a 'hidden lesion' that is frequently missed if the posterior compartments are not specifically evaluated. Viewing through an intercondylar trans-notch approach or utilizing a direct posteromedial portal is essential for accurate diagnosis and subsequent surgical repair.

Question 1882

Topic: Knee Sports

During a double-bundle posterior cruciate ligament (PCL) reconstruction, understanding the reciprocal tension pattern of the native PCL bundles is critical. Which of the following accurately describes the biomechanical behavior of the native PCL bundles during knee motion?

. The anterolateral bundle is tight in extension and the posteromedial bundle is tight in flexion
. The anterolateral bundle is tight in flexion and the posteromedial bundle is tight in extension
. Both bundles are maximally tight in deep flexion
. Both bundles are maximally tight in full extension
. The anterolateral bundle primarily resists external rotation throughout the arc of motion

Correct Answer & Explanation

. The anterolateral bundle is tight in flexion and the posteromedial bundle is tight in extension

Explanation

The native PCL consists of two primary bundles: the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. Biomechanically, the AL bundle is maximally tight in flexion, whereas the PM bundle is tight in extension. This reciprocal tension pattern must be recreated during a double-bundle PCL reconstruction to restore normal knee kinematics.

Question 1883

Topic: Knee Sports

A 19-year-old female presents with a history of recurrent lateral patellar dislocations. Non-operative management has failed. Advanced imaging demonstrates an intact patellofemoral cartilage profile but reveals an elevated tibial tubercle-trochlear groove (TT-TG) distance. Above what specific TT-TG threshold is a medializing tibial tubercle osteotomy generally indicated?

. 10 mm
. 12 mm
. 15 mm
. 20 mm
. 30 mm

Correct Answer & Explanation

. 20 mm

Explanation

The tibial tubercle-trochlear groove (TT-TG) distance is traditionally measured on axial CT or MRI scans. A normal TT-TG distance is generally considered to be less than 15 mm. A distance of 15-20 mm is borderline, while a distance greater than 20 mm is considered highly abnormal and is a primary indication for an anteromedializing tibial tubercle osteotomy (e.g., Fulkerson osteotomy) to correct the extensor mechanism alignment.

Question 1884

Topic: Knee Sports

A 55-year-old female reports a sudden, sharp pain in the back of her knee while descending stairs. MRI of the knee demonstrates a classic 'ghost sign'. This specific radiographic sign is most indicative of which of the following pathologies?

. Posterior medial meniscal root tear on sagittal MRI
. Posterolateral corner injury on coronal MRI
. Anterior cruciate ligament tibial avulsion on lateral radiograph
. Osteochondritis dissecans of the medial femoral condyle on a notch view radiograph
. Discoid lateral meniscus on an axial MRI

Correct Answer & Explanation

. Posterior medial meniscal root tear on sagittal MRI

Explanation

The 'ghost sign' is classically seen on sagittal MRI sequences and refers to the absence of the normal low-signal 'bow-tie' appearance of the posterior horn of the meniscus. This is highly indicative of a meniscal root tear. Medial meniscal posterior root tears disrupt circumferential hoop stresses, leading to functional meniscectomy, meniscal extrusion, and rapid progression of unicompartmental osteoarthritis.

Question 1885

Topic: Knee Sports

A 30-year-old male presents to the clinic after a hyperextension knee injury. During physical examination, the Dial test reveals 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. However, at 90 degrees of knee flexion, the external rotation is symmetric bilaterally. This clinical finding isolated to 30 degrees of flexion primarily implicates injury to which of the following structures?

. Posterolateral corner (popliteus, LCL, popliteofibular ligament)
. Posterior cruciate ligament (PCL) and Posterolateral corner combined
. Anterior cruciate ligament (ACL) and Medial collateral ligament (MCL)
. Posteromedial corner (posterior oblique ligament, semimembranosus)
. Isolated Posterior cruciate ligament (PCL)

Correct Answer & Explanation

. Posterolateral corner (popliteus, LCL, popliteofibular ligament)

Explanation

The Dial test evaluates for posterolateral corner (PLC) and posterior cruciate ligament (PCL) injuries. A positive test (generally defined as >10 degrees of increased external rotation compared to the normal side) at 30 degrees of knee flexion, but symmetric at 90 degrees, indicates an isolated injury to the PLC structures (LCL, popliteus tendon, popliteofibular ligament). If the test is positive at both 30 and 90 degrees, it indicates a combined injury to both the PLC and the PCL.

Question 1886

Topic: Knee Sports
A surgeon is performing a medial patellofemoral ligament (MPFL) reconstruction on an 18-year-old female. Precise anatomic location of the femoral attachment is critical to avoid graft anisometry. Radiographically identified by Schöttle's point, where is the true anatomic femoral footprint of the MPFL located?
. In the saddle region between the adductor tubercle and the medial epicondyle
. Directly 2 cm proximal to the adductor tubercle
. Directly on the anterior aspect of the medial epicondyle
. On the medial joint line at the insertion of the deep MCL
. On the supracondylar ridge posterior to the medial intermuscular septum

Correct Answer & Explanation

. In the saddle region between the adductor tubercle and the medial epicondyle

Explanation

The anatomic femoral origin of the MPFL is located in a 'saddle' or sulcus on the medial aspect of the distal femur, specifically between the adductor tubercle (proximal and posterior) and the medial epicondyle (distal and anterior). Radiographically, Schöttle's point is used on a perfect lateral fluoroscopic image to identify this footprint. Non-anatomic placement, particularly placing the graft too proximal or anterior, leads to excessive graft tension during knee flexion.

Question 1887

Topic: Knee Sports

A 25-year-old football player sustains a knee hyperextension injury. On physical examination, the dial test reveals a 15-degree increase in external rotation at 30 degrees of knee flexion compared to the contralateral side. However, at 90 degrees of knee flexion, external rotation is symmetric bilaterally. What is the most likely diagnosis?

. Isolated anterior cruciate ligament (ACL) injury
. Isolated posterior cruciate ligament (PCL) injury
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injury
. Combined ACL and PLC injury

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

The dial test measures external rotation of the tibia. An increase of 10-15 degrees or more compared to the normal knee is positive. Increased external rotation at 30 degrees of flexion with symmetry at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If external rotation is increased at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.

Question 1888

Topic: Knee Sports

A 19-year-old female presents with recurrent lateral patellar dislocations. Evaluation reveals a tibial tubercle-trochlear groove (TT-TG) distance of 22 mm and a Caton-Deschamps index of 1.0. The trochlea shows mild dysplasia. What is the most appropriate surgical management?

. Isolated MPFL reconstruction
. MPFL reconstruction with medializing tibial tubercle osteotomy
. MPFL reconstruction with distalizing tibial tubercle osteotomy
. Lateral retinacular release
. Trochleoplasty

Correct Answer & Explanation

. MPFL reconstruction with medializing tibial tubercle osteotomy

Explanation

An abnormal TT-TG distance >20 mm generally warrants a medializing tibial tubercle osteotomy (TTO) to correct the lateralized extensor mechanism vector. Because the patellar height is normal (Caton-Deschamps ~1.0), distalization is not needed. This should be combined with an MPFL reconstruction to restore the primary soft-tissue restraint to lateral translation.

Question 1889

Topic: Knee Sports

A 14-year-old gymnast complains of lateral elbow pain and catching. MRI of the elbow shows an osteochondritis dissecans (OCD) lesion of the capitellum with intact articular cartilage, but there is a rim of T2-hyperintense fluid behind the lesion. What is the best initial surgical management?

. Nonoperative management with rest and immobilization
. In situ arthroscopic drilling
. Arthroscopic fixation
. Osteochondral autograft transfer (OATS)
. Fragment excision and microfracture

Correct Answer & Explanation

. Arthroscopic fixation

Explanation

Fluid behind the OCD lesion on MRI indicates an unstable fragment. Because the articular cartilage is still intact, the best treatment is salvage of the native cartilage via arthroscopic internal fixation. Nonoperative management is generally reserved for stable lesions in patients with open physes. Drilling alone is for stable lesions.

Question 1890

Topic: Knee Sports

A 45-year-old female felt a 'pop' in the back of her knee while squatting. MRI demonstrates a complete posterior root tear of the medial meniscus with 4 mm of meniscal extrusion, but no significant osteoarthritis. Mechanical alignment is neutral. What is the recommended treatment?

. Arthroscopic partial meniscectomy
. Transtibial pull-out root repair
. Inside-out meniscal repair
. All-inside meniscal repair
. Nonoperative management

Correct Answer & Explanation

. Transtibial pull-out root repair

Explanation

Meniscal root tears eliminate hoop stresses, acting biomechanically similar to a total meniscectomy and leading to rapid joint degeneration. In an active patient without advanced arthritis or malalignment, anatomical repair via a transtibial pull-out technique (or suture anchor repair) is the gold standard to restore hoop tension and slow progression to osteoarthritis.

Question 1891

Topic: Knee Sports

A 'ramp lesion' of the knee is frequently encountered during anterior cruciate ligament (ACL) reconstruction. This pathology specifically refers to a tear located in which of the following anatomic zones?

. Anterior horn of the lateral meniscus
. Posterior horn of the lateral meniscus near the meniscofemoral ligaments
. Meniscocapsular junction of the posterior horn of the medial meniscus
. Radial mid-body tear of the medial meniscus
. Anterior root of the medial meniscus

Correct Answer & Explanation

. Meniscocapsular junction of the posterior horn of the medial meniscus

Explanation

A meniscal ramp lesion is defined as a disruption of the meniscocapsular junction or the peripheral attachment of the posterior horn of the medial meniscus. It is highly associated with ACL tears and can be missed on standard anterior portal viewing, often requiring a posteromedial portal for adequate visualization and repair.

Question 1892

Topic: Knee Sports

During a single-bundle posterior cruciate ligament (PCL) reconstruction, the femoral tunnel is positioned to anatomically reconstruct the dominant bundle. Which specific bundle is reconstructed, and at what degree of knee flexion should the graft typically be tensioned?

. Posteromedial bundle, tensioned at 90 degrees
. Anterolateral bundle, tensioned at 90 degrees
. Posteromedial bundle, tensioned at 0 degrees (full extension)
. Anterolateral bundle, tensioned at 0 degrees
. Anteromedial bundle, tensioned at 30 degrees

Correct Answer & Explanation

. Anterolateral bundle, tensioned at 90 degrees

Explanation

The PCL consists of the larger, stronger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. Single-bundle reconstructions aim to replace the dominant AL bundle. The AL bundle is tightest in flexion; therefore, the graft is typically tensioned and fixed at 90 degrees of knee flexion.

Question 1893

Topic: Knee Sports
An MPFL reconstruction is planned for a 17-year-old female with recurrent lateral patellar dislocations. To prevent postoperative patellofemoral over-constraint, where must the femoral tunnel be positioned relative to radiographic landmarks (Schöttle's point)?
. Anterior to the posterior femoral cortex line
. Distal to the posterior aspect of Blumensaat's line
. Proximal to the posterior aspect of Blumensaat's line
. Directly on the medial epicondyle
. Anterior and distal to the adductor tubercle

Correct Answer & Explanation

. Proximal to the posterior aspect of Blumensaat's line

Explanation

Schöttle's point is located 1 mm anterior to the posterior femoral cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the posterior aspect of Blumensaat's line. Anatomic placement ensures the graft does not over-tension during knee flexion.

Question 1894

Topic: Knee Sports

During an anatomic posterolateral corner (PLC) reconstruction, accurate placement of the fibular collateral ligament (FCL) graft is critical. Where is the native FCL femoral attachment located relative to the popliteus sulcus?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly within the anterior half of the sulcus

Correct Answer & Explanation

. Proximal and posterior

Explanation

The native FCL femoral footprint is located 18.5 mm proximal and slightly posterior to the popliteus tendon attachment on the lateral femoral epicondyle. Non-anatomic placement can lead to graft capturing and restriction of normal knee range of motion.

Question 1895

Topic: Knee Sports
A 30-year-old runner with a focal 3 cm² full-thickness chondral defect on the medial femoral condyle undergoes Matrix-induced autologous chondrocyte implantation (MACI). What is the primary histological goal of the repair tissue generated by MACI compared to microfracture?
. Production of predominantly Type I collagen
. Production of predominantly Type III collagen
. Production of predominantly Type II collagen
. Production of predominantly Type IX collagen
. Creation of an acellular fibrin clot

Correct Answer & Explanation

. Production of predominantly Type II collagen

Explanation

Microfracture primarily stimulates a marrow healing response resulting in fibrocartilage, which is rich in Type I collagen. Cell-based therapies like MACI aim to regenerate hyaline-like cartilage, which possesses superior biomechanical properties and is composed predominantly of Type II collagen.

Question 1896

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, accurate femoral tunnel placement is crucial. Using fluoroscopy, where is the anatomic femoral origin of the MPFL located relative to Schöttle's point?
. Anterior to the posterior cortical line and proximal to the Blumensaat line
. Posterior to the posterior cortical line and distal to the Blumensaat line
. Between the medial epicondyle and adductor tubercle
. Distal to the medial collateral ligament origin
. Anterior to the Blumensaat line and proximal to the joint line

Correct Answer & Explanation

. Posterior to the posterior cortical line and distal to the Blumensaat line

Explanation

The anatomic femoral origin of the MPFL lies in the saddle between the medial epicondyle and the adductor tubercle. Radiographically, Schöttle's point is 1 mm anterior to the posterior cortical line and 2.5 mm distal to the posterior border of Blumensaat's line.

Question 1897

Topic: Knee Sports

A 14-year-old male presents with knee pain. MRI reveals a 2x2 cm osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. Which MRI finding is most indicative of lesion instability requiring surgical fixation rather than non-operative management?

. Intact overlying articular cartilage
. High T2 signal rim surrounding the lesion
. Bone marrow edema in the adjacent condyle
. Lesion size greater than 1 cm
. Sclerotic margins on T1 imaging

Correct Answer & Explanation

. High T2 signal rim surrounding the lesion

Explanation

A high T2 signal rim surrounding the osteochondral fragment indicates synovial fluid tracking behind the lesion. This is the most reliable MRI sign of instability, necessitating surgical stabilization rather than conservative care.

Question 1898

Topic: Knee Sports

A 45-year-old female presents with acute posterior knee pain after a deep squat. MRI reveals a complete radial tear at the posterior horn of the medial meniscus, 2 mm from its root attachment. What is the expected biomechanical consequence if this lesion is left untreated?

. Decreased peak contact pressure in the medial compartment
. Increased peak contact pressure by approximately 25%
. Loss of hoop stresses making it biomechanically equivalent to a total meniscectomy
. Medial shift of the mechanical axis by 5 degrees
. Increased tension on the anterior cruciate ligament during extension

Correct Answer & Explanation

. Loss of hoop stresses making it biomechanically equivalent to a total meniscectomy

Explanation

A medial meniscus root tear or a complete radial tear near the root disrupts the circumferential fibers. This leads to a complete loss of hoop stresses, which is biomechanically equivalent to a total meniscectomy and rapidly accelerates osteoarthritis.

Question 1899

Topic: Knee Sports

During reconstruction of the medial patellofemoral ligament (MPFL), identifying the correct femoral footprint is critical for graft isometry. According to Schottle's radiographic landmarks, where is the optimal femoral attachment located on a strictly lateral radiograph?

. Anterior to the posterior cortical line and distal to the posterior intersecting line
. Posterior to the posterior cortical line and proximal to the Blumensaat line
. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior border of the medial femoral condyle articular surface, and proximal to Blumensaat's line
. Anterior to the posterior femoral cortex line, between Blumensaat's line and the posterior intersecting line
. Posterior to the posterior cortical line, distal to Blumensaat's line

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior border of the medial femoral condyle articular surface, and proximal to Blumensaat's line

Explanation

The Schottle point is the radiographic center of the MPFL femoral footprint. It is defined as 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior border of the medial femoral condyle articular surface, and proximal to the level of Blumensaat's line.

Question 1900

Topic: Knee Sports

A 25-year-old football player sustains a contact injury to his knee. Clinical examination reveals increased external rotation of the tibia at 30 degrees of knee flexion compared to the contralateral side, but equal external rotation at 90 degrees. Which structure is most likely injured?

. Posterior cruciate ligament only
. Posterolateral corner only
. Combined posterior cruciate ligament and posterolateral corner
. Anterior cruciate ligament and posterolateral corner
. Medial collateral ligament and posterior oblique ligament

Correct Answer & Explanation

. Posterolateral corner only

Explanation

A positive dial test (increased external rotation of 10 degrees or more) isolated to 30 degrees of flexion 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.

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