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Self-Assessment Questions

Orthopaedic Sports Medicine

Problems Related to the Patellofemoral Joint: Review Questions

Patrick E. Greis, MD

Dr. Greis is an associate professor, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.


Choose the single best answer for each question.

1. Which of the following soft tissue stabilizers of the patella provides the most restraint to lateral patellar displacement at 20 degrees of knee flexion?
  1. Lateral facet of the trochlea
  2. Lateral retinaculum
  3. Medial patella meniscal ligament
  4. Medial patellofemoral ligament
  5. Medial retinaculum
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2. An 18-year-old soccer player dislocates his patella during soccer practice. The patella reduces with knee extension. Subsequent radiographs demonstrate no fracture and a reduced patella on Merchant view. This is the first incident of patellar dislocation for this patient who has no history of contralateral knee problems. Based on epidemiologic studies, what is the approximate risk of recurrence of instability symptoms for this patient if he is treated nonoperatively?

  1. 5%
  2. 15%
  3. 35%
  4. 50%
  5. 80%
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3. A 20-year-old woman with longstanding patellofemoral symptoms remains symptomatic despite 3 years of physical therapy and a strengthening program. For this patient, in which of the following clinical scenarios is surgical treatment with arthroscopy and isolated lateral retinacular release most reasonable?

  1. Patellofemoral pain with recurrent subluxation
  2. Patellofemoral pain with recurrent dislocation
  3. Patellofemoral pain with negative passive patellar tilt
  4. A palpable medial defect with excessive lateral translation
  5. Patellofemoral pain, crepitation, andligamentous laxity
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4. A 12-year-old boy presents to the emergency department with a swollen knee following a patellar dislocation playing baseball; the dislocation was reduced when the coach straightened the patient’ leg. Radiographic examination shows a skeletally immature knee, significant subluxation of the patella on Merchant view, and a 2 × 3-cm osteochondral fragment in the intracondylar notch. Physical examination demonstrates a knee effusion, a negative Lachman test, tenderness around the medial patella, and a range of motion of 20/70 degrees. Which of the following is the most appropriate treatment for this patient?
  1. Immobilization in 20 degrees of flexion for 4 weeks
  2. Arthroscopy, removal of the fragment, and early motion
  3. Attempted repair of the osteochondral fragment and direct repair of the medial structures
  4. Attempted repair of the osteochondral fragment and medialization of the tibial tubercle
  5. Arthroscopic lateral release
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