Knee Ligament Injuries — MCQs
Which of the following tests is not done for anterior cruciate ligament injury?
A 18-year-old boy was playing football when he suddenly twisted his knee and fell down. He got up after 10 minutes and resumed playing. The next day, he experienced knee swelling and difficulty moving it. What is the most probable cause?
Pivot shift test is positive with
Lachman's test is performed with the knee in what degree of flexion?
Drawer sign is seen in:
Which one of the following tests will you adopt while examining a knee joint where you suspect an old tear of anterior cruciate ligament?
Tennis elbow is -
Which of the following ligaments is injured in an ankle inversion injury?
A football player experienced a twist in the ankle and knee. Clinically, no bone injury was appreciated. The examiner is performing the test shown in the image. Which test is this?
Which ligament is primarily responsible for anteroposterior stability of the knee?
Knee Ligament Injuries Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following tests is not done for anterior cruciate ligament injury?
- A. Anterior drawer test
- B. Lachman's test
- C. Pivot shift test
- D. Dial test (Correct Answer)
Explanation: ***Dial test*** - The **dial test** is used to assess **posterolateral rotatory instability** of the knee and evaluates the integrity of the **posterior cruciate ligament (PCL)** and **posterolateral corner structures**, not the ACL. - It involves assessing the amount of external rotation of the tibia relative to the femur at different degrees of knee flexion. *Anterior drawer test* - The **anterior drawer test** evaluates the integrity of the **anterior cruciate ligament (ACL)** by attempting to move the tibia anteriorly on the femur. - Excessive anterior translation of the tibia indicates a possible ACL tear. *Lachman's test* - **Lachman's test** is considered one of the most sensitive tests for **ACL injury**, especially acute injuries. - It involves stabilizing the femur and gently pulling the tibia anteriorly with the knee flexed at 20-30 degrees; excessive anterior excursion or a soft end-point indicates a tear. *Pivot shift test* - The **pivot shift test** is highly specific for a torn **ACL** and simulates the subluxation and reduction of the tibia that occurs during dynamic activity. - It involves applying a valgus stress and internal rotation to the knee while moving it from extension to flexion; a palpable or visible "clunk" indicates a positive test.
Question 2: A 18-year-old boy was playing football when he suddenly twisted his knee and fell down. He got up after 10 minutes and resumed playing. The next day, he experienced knee swelling and difficulty moving it. What is the most probable cause?
- A. Posterior cruciate ligament injury
- B. Medial meniscus injury (Correct Answer)
- C. Anterior cruciate ligament injury
- D. Medial collateral ligament injury
Explanation: ***Medial meniscus injury*** - A **twisting injury** in a weight-bearing knee (like during football) combined with delayed swelling points toward a meniscal tear. - The ability to resume playing after initial pain, followed by later swelling and restricted movement, suggests a **meniscal lesion** rather than an immediate, severe ligament rupture. *Posterior cruciate ligament injury* - This typically results from a **direct blow to the anterior tibia** with the knee flexed, not a twisting mechanism. - It often presents with less acute swelling and more **posterior sag** of the tibia. *Anterior cruciate ligament injury* - An **ACL tear** often causes immediate, severe pain and **rapid hemarthrosis** (within hours) due to significant bleeding, making it unlikely for the patient to resume playing quickly. - Often associated with an audible **"pop"** at the time of injury. *Medial collateral ligament injury* - An **MCL injury** usually results from a **valgus stress** (force from the outside of the knee) and typically presents with pain on the medial side of the knee. - While it can cause swelling, a twisting mechanism is less characteristic, and **instability during valgus stress** would be a primary finding.
Question 3: Pivot shift test is positive with
- A. Posterior cruciate ligament tear
- B. Anterior cruciate ligament tear (Correct Answer)
- C. Medial meniscus injury
- D. Lateral meniscus injury
Explanation: **Anterior cruciate ligament tear** - The **pivot shift test** is a specific clinical examination maneuver used to detect **rotary knee instability** caused by an **ACL tear**. - It demonstrates the feeling of the tibia subluxing anteriorly on the femur during knee extension and then reducing with flexion, indicative of ACL insufficiency. *Posterior cruciate ligament tear* - PCL tears are primarily assessed using the **posterior drawer test** or **posterior sag sign**. - The pivot shift test is not designed to evaluate the stability provided by the PCL. *Medial meniscus injury* - Meniscal injuries are typically assessed with tests like **McMurray's test** or **Apley's compression test**, which elicit pain or clicking. - While meniscal tears can contribute to knee instability, the pivot shift test specifically targets rotatory instability associated with ACL deficiency. *Lateral meniscus injury* - Similar to medial meniscus injuries, lateral meniscal tears are identified through specific maneuvers like McMurray's test, focusing on pain and clicking during rotation and flexion/extension. - The pivot shift test is not a primary diagnostic tool for isolated meniscal pathology.
Question 4: Lachman's test is performed with the knee in what degree of flexion?
- A. 5
- B. 20 (Correct Answer)
- C. 70
- D. 90
Explanation: ***20*** - The **Lachman's test** is most accurately performed with the knee in **20-30 degrees of flexion** to better isolate the **anterior cruciate ligament (ACL)**. - This neutral position allows the posterior capsule and other secondary restraints to be relaxed, making an **ACL tear** more evident during anterior translation of the tibia. *5* - Positioning the knee at only **5 degrees of flexion** is not ideal, as it may keep the **posterior capsule** under too much tension, potentially masking an **ACL injury**. - This position does not adequately relax the secondary stabilizers, which can lead to a false negative result for **ACL laxity**. *70* - At **70 degrees of flexion**, the knee is too bent to effectively assess the **ACL**. - In this position, the **menisci** and other structures can block clear anterior translation, and it is more common for other knee stability tests like the **anterior drawer test** to be performed. *90* - With the knee flexed to **90 degrees**, the **anterior drawer test** is typically performed, not the Lachman's test. - In this position, the **posterior horn of the menisci** can interfere with anterior translation, making the Lachman's test less sensitive for detecting an **ACL tear**.
Question 5: Drawer sign is seen in:
- A. Hyperparathyroidism
- B. Perthes' disease
- C. Scurvy
- D. Cruciate ligament injury (Correct Answer)
Explanation: ***Cruciate ligament injury*** - The **drawer test** specifically assesses the integrity of the **anterior and posterior cruciate ligaments** in the knee. - A positive drawer sign indicates excessive forward or backward translation of the tibia relative to the femur, signifying a **ligamentous tear**. *Hyperparathyroidism* - This condition involves **excessive parathyroid hormone**, leading to calcium and phosphate imbalances. - Symptoms are primarily related to **bone demineralization**, kidney stones, and neuromuscular issues, not ligament instability. *Perthes' disease* - An **avascular necrosis of the femoral head** in children, causing hip pain and limping. - It affects the **hip joint**, not the knee, and there is no associated drawer sign. *Scurvy* - Caused by a **deficiency of vitamin C**, which is essential for collagen synthesis. - Manifestations include **bleeding gums**, poor wound healing, and musculoskeletal pain, but not specific ligamentous instability of the knee.
Question 6: Which one of the following tests will you adopt while examining a knee joint where you suspect an old tear of anterior cruciate ligament?
- A. Mc Murray test
- B. Lachman test (Correct Answer)
- C. Pivot shift test
- D. Posterior drawer test
Explanation: ***Lachman test*** - The **Lachman test** is considered the most sensitive and reliable test for detecting an **anterior cruciate ligament (ACL) tear**, especially in the acute setting or for an old tear. - It assesses the **anterior translation of the tibia** on the femur at 20-30 degrees of flexion, minimizing hamstring guarding and improving diagnostic accuracy for subtle instabilities. *Mc Murray test* - The **McMurray test** is primarily used to detect **meniscal tears**, not ACL tears. - It involves internally and externally rotating the tibia while extending the knee to elicit a click or pain due to a torn meniscus. *Pivot shift test* - The **pivot shift test** is highly specific for an **ACL tear** but is often difficult to perform and requires a fully relaxed patient, sometimes necessitating anesthesia. - It detects rotatory instability and gives a clinical indication of the degree of **anterolateral rotatory instability** caused by an ACL tear. *Posterior drawer test* - The **posterior drawer test** is used to assess the integrity of the **posterior cruciate ligament (PCL)**. - It involves pushing the tibia posteriorly on the femur at 90 degrees of knee flexion to check for excessive posterior translation.
Question 7: Tennis elbow is -
- A. Lateral Epicondylitis (Correct Answer)
- B. Radial head subluxation
- C. Ulnar collateral ligament injury
- D. Medial Epicondylitis
Explanation: ***Lateral Epicondylitis*** - **Tennis elbow** is the common term for **lateral epicondylitis**, an overuse injury causing pain on the **outer side of the elbow**. - It is typically caused by repetitive wrist extension and supination movements, leading to **tendinopathy** of the **extensor carpi radialis brevis** muscle origin. *Radial head subluxation* - This condition, commonly known as **nursemaid's elbow**, involves the displacement of the **radial head** from the annular ligament. - It is usually caused by a sudden pull on an outstretched arm, typically in young children, and presents with immediate pain and refusal to move the arm. *Ulnar collateral ligament injury* - An injury to the **ulnar collateral ligament (UCL)**, often seen in overhead throwing athletes, is sometimes called **"Tommy John injury"**. - It involves damage to the ligament on the **inner side of the elbow** and can lead to instability and pain during throwing motions. *Medial Epicondylitis* - This condition, known as **golfer's elbow**, involves pain on the **inner side of the elbow**. - It is caused by overuse of the forearm flexor muscles that originate from the **medial epicondyle**, due to repetitive wrist flexion and pronation.
Question 8: Which of the following ligaments is injured in an ankle inversion injury?
- A. Calcaneofibular ligament
- B. Posterior talofibular ligament
- C. Deltoid ligament
- D. Anterior talofibular ligament (Correct Answer)
Explanation: ***Anterior talofibular ligament*** - The **anterior talofibular ligament (ATFL)** is the most commonly injured ligament in an **ankle inversion sprain** due to its position and weaker structure. - It connects the **fibula** to the **talus** anteriorly, and when the foot inverts, this ligament is stretched and often torn first. *Calcaneofibular ligament* - The **calcaneofibular ligament (CFL)** is also an important lateral ankle ligament that can be injured in **severe inversion sprains**. - It is often damaged in conjunction with the ATFL, but typically only after the ATFL has already been compromised through an ankle inversion injury. *Posterior talofibular ligament* - The **posterior talofibular ligament (PTFL)** is the strongest of the **lateral collateral ligaments** and is rarely injured in isolation. - Injury to the PTFL usually occurs in cases of **severe, high-grade ankle dislocations** or very forceful inversion injuries, often involving other ligaments. *Deltoid ligament* - The **deltoid ligament** is a strong, fan-shaped ligament located on the **medial side of the ankle**. - It resists **eversion** of the ankle, meaning it is more commonly injured in **eversion sprains**, not inversion sprains.
Question 9: A football player experienced a twist in the ankle and knee. Clinically, no bone injury was appreciated. The examiner is performing the test shown in the image. Which test is this?
- A. Posterior drawer for PCL
- B. McMurray
- C. Lachman (Correct Answer)
- D. Anterior drawer for ACL
Explanation: ***Lachman*** - The image shows the examiner holding the distal thigh and proximal tibia, with the knee flexed at a **20-30 degree angle**, applying an **anterior translational force** to the tibia. This specific maneuver is characteristic of the Lachman test. - The Lachman test is highly sensitive for detecting **anterior cruciate ligament (ACL) tears**, particularly in acute injuries, due to the reduced hamstring spasm compared to the anterior drawer test. *Posterior drawer for PCL* - The posterior drawer test involves flexing the knee to **90 degrees** and applying a **posterior force** to the tibia to assess the integrity of the **posterior cruciate ligament (PCL)**. - The position of the knee in the image (flexed at a shallower angle) and the direction of the applied force (anteriorly towards the femur) do not match the technique for a posterior drawer test. *McMurray* - The McMurray test is performed to evaluate **meniscal tears** by flexing, extending, and rotating the knee while applying a varus or valgus stress. - The maneuver in the image, involving direct anterior translation of the tibia with the knee in slight flexion, is not consistent with the McMurray test. *Anterior drawer for ACL* - While also testing the **ACL**, the anterior drawer test typically involves flexing the knee to **90 degrees** and sitting on the foot, then pulling the tibia anteriorly. - The knee flexion angle in the image is much shallower than 90 degrees, making it inconsistent with the standard anterior drawer test.
Question 10: Which ligament is primarily responsible for anteroposterior stability of the knee?
- A. Medial collateral ligament (MCL)
- B. Anterior Cruciate Ligament (ACL) (Correct Answer)
- C. Lateral collateral ligament (LCL)
- D. Patellar ligament
Explanation: ***Anterior Cruciate Ligament (ACL)*** - The **ACL** is crucial for preventing the **anterior translation of the tibia** relative to the femur, thus providing significant **anteroposterior stability**. - It also plays a role in limiting **rotational stability** of the knee joint. *Medial collateral ligament (MCL)* - The **MCL** is located on the inner side of the knee and primarily resists **valgus stress** (force from the outside inward), preventing the knee from bending too far inward. - Its main function is to provide **medial stability**, not anteroposterior stability. *Lateral collateral ligament (LCL)* - The **LCL** is situated on the outer side of the knee and primarily resists **varus stress** (force from the inside outward), preventing the knee from bending too far outward. - It contributes to **lateral stability** of the knee. *Patellar ligament* - The **patellar ligament** connects the **patella** to the **tibial tuberosity** and is an extension of the quadriceps tendon. - Its primary role is in **knee extension**, acting as part of the extensor mechanism, and it does not directly contribute to anteroposterior or rotational stability.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free