Meniscal Injuries — MCQs
Meniscal tears usually result from which of the following circumstances?
Which MRI finding is suggestive of a torn meniscus in the knee?
An athlete sustained an injury around the knee joint, suspecting cartilage damage. Which of the following is the investigation of choice?
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?
While playing football, a 19-year-old college student receives a twisting injury to his knee when being tackled from the lateral side. Which of the following conditions most likely has occurred?
A 65-year-old lady presented with a swollen and painful knee. On examination, she was found to have grade III osteoarthritic changes. What is the best course of action?
What is the most effective management strategy for hemarthrosis?
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 young athlete complains of pain in the groin and weakness in the hip following a sports injury. An MRI shows a tear in which muscle that is commonly associated with groin injuries?
Pivot shift test is positive with
Meniscal Injuries Indian Medical PG Practice Questions and MCQs
Question 1: Meniscal tears usually result from which of the following circumstances?
- A. Flexion and rotation (Correct Answer)
- B. Hyperextension
- C. Simple hyperflexion
- D. Compression
Explanation: ***Flexion and rotation*** - **Flexion and rotation** of the knee create significant shear and compressive forces on the meniscus, leading to tears, especially when the foot is planted. - This mechanism is common in sports that involve sudden changes in direction or twisting movements. *Hyperextension* - **Hyperextension** of the knee primarily stresses the anterior knee structures, such as the quadriceps tendon and anterior cruciate ligament (ACL), leading to sprains or tears in these structures rather than meniscal tears. - While severe hyperextension can potentially damage the meniscus, it is not the most common direct cause of meniscal tears. *Simple hyperflexion* - **Simple hyperflexion** primarily compresses the posterior aspects of the menisci but is less likely to cause a significant tear unless combined with a rotational force or extreme mechanical stress. - Deep squats or prolonged kneeling can cause discomfort or minor meniscal irritation but rarely result in acute tears in isolation. *Compression* - While **compression** is a component of the forces involved in meniscal tears, it alone is usually insufficient to cause a tear. - Significant tears most often result from a combination of **compression** with **rotational** or **shear forces**.
Question 2: Which MRI finding is suggestive of a torn meniscus in the knee?
- A. Loss of cartilage
- B. Increased signal intensity in the meniscus (Correct Answer)
- C. Effusion
- D. Bone marrow edema
Explanation: ***Increased signal intensity in the meniscus*** A torn meniscus on MRI typically shows **increased signal intensity** within the meniscal substance that **extends to at least one articular surface**, which is the key diagnostic criterion. This high signal indicates **fluid within the tear** or degenerative changes. The signal must reach the surface to differentiate a true tear from intrasubstance degeneration, which shows signal that does not reach the surface. *Loss of cartilage* **Cartilage loss** is characteristic of **osteoarthritis** or chronic degenerative joint disease, not specifically an acute meniscal tear. While it can coexist with meniscal tears as part of degenerative joint disease, it is not a direct indicator of a tear within the meniscus itself. *Effusion* A **knee effusion** (fluid within the joint) is a general sign of joint irritation or injury and can be present with various conditions, including meniscal tears, ligament injuries, and arthritis. However, it is a **non-specific finding** and does not directly confirm a meniscal tear. *Bone marrow edema* **Bone marrow edema** is often seen with **bone bruises**, stress fractures, or osteonecrosis. It indicates stress or injury to the bone rather than soft tissue injury, and is not directly indicative of a meniscal tear.
Question 3: An athlete sustained an injury around the knee joint, suspecting cartilage damage. Which of the following is the investigation of choice?
- A. Clinical examination
- B. Arthroscopy (Correct Answer)
- C. Arthrotomy
- D. X-ray
Explanation: ***Arthroscopy*** - **Arthroscopy** is the definitive investigation for **cartilage damage** as it allows for direct visualization of the knee joint's internal structures. - It not only confirms the diagnosis but can also facilitate simultaneous **repair or débridement** of damaged cartilage. *X-ray* - **X-rays** are primarily used to assess **bone structures** and detect fractures or significant joint space narrowing, not soft tissue injuries like cartilage. - They are generally **insufficient** for diagnosing subtle or early cartilage damage. *Clinical examination* - A **clinical examination** is crucial for initial assessment and suspicion of cartilage injury, but it cannot definitively diagnose the extent or type of cartilage damage. - It helps guide further investigations but is **not specific enough** to confirm cartilage integrity. *Arthrotomy* - **Arthrotomy** involves a larger incision to open the joint, which is more **invasive** than arthroscopy and typically reserved for open surgical repairs or complex reconstructions, not as a primary diagnostic tool for cartilage. - It carries a **higher risk of complications**, such as infection and prolonged recovery, compared to arthroscopy.
Question 4: 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 5: While playing football, a 19-year-old college student receives a twisting injury to his knee when being tackled from the lateral side. Which of the following conditions most likely has occurred?
- A. Tear of the medial meniscus (Correct Answer)
- B. Ruptured fibular collateral ligament
- C. Tenderness on pressure along the fibular collateral ligament
- D. Injured posterior cruciate ligament
Explanation: **Tear of the medial meniscus** - A **twisting injury** to the knee, especially when tackled from the lateral side (which can force the leg into valgus stress), commonly causes a **tear of the medial meniscus**. - The **medial meniscus** is less mobile and more firmly attached than the lateral meniscus, making it more susceptible to injury during twisting forces. *Ruptured fibular collateral ligament* - A rupture of the **fibular collateral ligament (FCL)**, also known as the **lateral collateral ligament (LCL)**, typically results from a **varus stress** (a blow to the medial side of the knee), which is contrary to a tackle from the lateral side. - While twisting can contribute to knee injuries, isolate FCL tears from a lateral-side tackle are less likely than meniscal damage. *Tenderness on pressure along the fibular collateral ligament* - Tenderness along the **fibular collateral ligament** would indicate an injury to this structure, but a twisting injury from the lateral side is less likely to directly damage the FCL compared to the medial structures. - This symptom alone does not fully explain the mechanism of injury and the common resulting pathology in this scenario. *Injured posterior cruciate ligament* - The **posterior cruciate ligament (PCL)** is most commonly injured by a direct blow to the anterior tibia when the knee is flexed (a **dashboard injury**) or by a hyperflexion injury. - A twisting injury from the lateral side is a less common mechanism for isolated PCL injury.
Question 6: A 65-year-old lady presented with a swollen and painful knee. On examination, she was found to have grade III osteoarthritic changes. What is the best course of action?
- A. Conservative management
- B. Total knee replacement (Correct Answer)
- C. Arthroscopic washing
- D. Partial knee replacement
Explanation: ***Total knee replacement*** - For **grade III osteoarthritis** in a 65-year-old, a total knee replacement is the most definitive and effective treatment to relieve pain and restore function in a severely damaged joint. - This procedure addresses widespread cartilage loss and structural changes typical of advanced osteoarthritis. *Conservative management* - This approach is typically favored for **mild to moderate osteoarthritis**, involving physical therapy, NSAIDs, and lifestyle modifications. - For **grade III changes** with significant pain and swelling, conservative measures are unlikely to provide sufficient relief or halt disease progression effectively. *Arthroscopic washing* - **Arthroscopic lavage** and debridement are rarely recommended for osteoarthritis as they have not shown sustained benefits for pain or function. - It is sometimes used for specific mechanical symptoms, but it does not address the underlying cartilage loss and structural damage in severe osteoarthritis. *Partial knee replacement* - A **partial knee replacement** is suitable when osteoarthritis is confined to a single compartment of the knee, and the other compartments are healthy. - Given the indication of "grade III osteoarthritic changes" without specifying a single compartment, a total knee replacement is generally more appropriate for widespread disease.
Question 7: What is the most effective management strategy for hemarthrosis?
- A. Immobilization with a P.O.P. cast
- B. Application of a compression bandage
- C. Needle aspiration to remove excess blood (Correct Answer)
- D. All of the options
Explanation: ***Needle aspiration to remove excess blood*** - **Aspirating the blood** from the joint effectively reduces intra-articular pressure, pain, and inflammation. - This procedure also helps prevent **synovial hypertrophy** and **cartilage damage** caused by the presence of blood in the joint. *Application of a compression bandage* - While helpful for reducing swelling and providing support, a **compression bandage alone** does not remove the accumulated blood. - It may alleviate some discomfort but does not address the underlying issue of **intra-articular blood accumulation**. *Immobilization with a P.O.P. cast* - **Immobilization** can help rest the joint and reduce pain, but it does not remove the blood from the joint space. - Prolonged immobilization can lead to **joint stiffness** and **muscle atrophy**, which are undesirable outcomes. *All of the options* - While compression and immobilization can be supportive measures, they are not the **most effective primary strategy** for managing hemarthrosis. - The direct removal of blood via **aspiration** is crucial for alleviating pressure and preventing long-term joint damage.
Question 8: 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 9: A young athlete complains of pain in the groin and weakness in the hip following a sports injury. An MRI shows a tear in which muscle that is commonly associated with groin injuries?
- A. Adductor longus (Correct Answer)
- B. Iliopsoas
- C. Rectus femoris
- D. Gluteus medius
Explanation: ***Adductor longus*** - The **adductor longus** is a primary **groin muscle** involved in hip adduction and commonly injured during sports activities requiring sudden changes in direction or kicking. - A tear in this muscle is a frequent cause of **groin pain** and weakness in athletes. *Iliopsoas* - The **iliopsoas** is a powerful hip flexor, and while injuries can cause pain in the groin region, a tear typically manifests as weakness in **hip flexion**, not primarily adduction. - Pain from an iliopsoas injury is often felt deeper in the groin or hip, sometimes radiating down the thigh. *Rectus femoris* - The **rectus femoris** is one of the quadriceps muscles that crosses both the hip and knee joints; tears cause pain and weakness in **hip flexion** and **knee extension**. - Injuries are more common with activities involving sprinting or kicking, but the primary pain location is usually more anterior thigh rather than deep groin. *Gluteus medius* - The **gluteus medius** is a primary hip abductor and stabilizer; injuries typically cause pain on the **lateral aspect of the hip** or buttock, not the groin. - Weakness in this muscle would primarily affect hip abduction and stability during weight-bearing.
Question 10: 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.
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