Ortho 2 Exam 2 Case Studies

A 17-year-old female soccer player reports injuring her right knee during a game. She states she was planting her foot to change direction when she felt a "pop" in her knee and fell to the ground. She describes immediate and significant swelling within the first hour. On examination, you note a 2+ effusion via the Stroke Test, and a positive Lachman's test with a soft end-feel. What is the MOST likely diagnosis?

a) Medial Meniscus Tear

b) Patellar Dislocation

c) Anterior Cruciate Ligament (ACL) Sprain

d) Posterior Cruciate Ligament (PCL) Sprain

c) Anterior Cruciate Ligament (ACL) Sprain

A 45-year-old male reports a twisting injury to his left knee while playing basketball over the weekend. He did not notice much swelling initially, but his knee became swollen and stiff the next morning (about 12 hours later). He complains that his knee feels like it is "catching" and occasionally "locking". Examination reveals tenderness to palpation over the medial joint line and pain with maximum passive knee flexion. What is the MOST likely diagnosis?

a) Articular Cartilage Injury

b) Medial Meniscus Tear

c) Medial Collateral Ligament (MCL) Sprain

d) Osteoarthritis (OA)

b) Medial Meniscus Tear

A 22-year-old female runner presents with a 3-month history of diffuse, aching pain around and behind her right patella. Her pain is worse when running, descending stairs, and after sitting through a movie. Her examination reveals weakness in her hip abductor and external rotator muscles. During a single-leg squat, you observe her right knee diving medially (dynamic valgus). What classification of Patellofemoral Pain (PFP) BEST fits this presentation?

a) PFP with Overuse/Overload

b) PFP with Mobility Impairments

c) PFP with Movement Coordination Deficits

d) PFP with Muscle Performance Deficits

d) PFP with Muscle Performance Deficits

A 25-year-old was involved in a motor vehicle accident where his flexed knee struck the dashboard. He presents with vague posterior knee pain and a feeling of instability when walking downhill. Your objective exam reveals a visible posterior "sag" of the tibia when his hip and knee are flexed to 90 degrees. You also find a positive posterior drawer test. What is the MOST likely diagnosis?

a) Posterior Cruciate Ligament (PCL) Sprain

b) Posterolateral Corner (PLC) Injury

c) Hamstring Tendinopathy

d) Baker's Cyst

a) Posterior Cruciate Ligament (PCL) Sprain

A 14-year-old male who plays basketball reports anterior knee pain that started after a recent growth spurt. The pain is localized specifically to the bony prominence on his shin, just below the kneecap. The pain is aggravated by jumping and running, and palpation of the tibial tuberosity reproduces his symptoms. What is the MOST likely diagnosis?

a) Patellar Tendinopathy

b) Sinding-Larsen-Johansson Syndrome

c) Osgood-Schlatter Disease

d) Infrapatellar Bursitis

c) Osgood-Schlatter Disease

A 30-year-old long-distance runner complains of sharp, burning pain on the outside of his left knee. The pain is predictable, starting around the 2-mile mark of every run and resolving with rest. Your examination reveals significant tenderness to palpation over the lateral femoral epicondyle. Performing a Noble's Compression Test reproduces his symptoms at approximately 30 degrees of knee flexion. What is the MOST likely diagnosis?

a) Lateral Meniscus Tear

b) Lateral Collateral Ligament (LCL) Sprain

c) Iliotibial Band (ITB) Syndrome

d) Biceps Femoris Tendinopathy

c) Iliotibial Band (ITB) Syndrome

A 68-year-old female presents with a primary complaint of deep, aching right knee pain that has been worsening over several years. She reports stiffness in the morning that typically resolves within 20 minutes of moving around. Her pain is worse with weight-bearing activities like walking and climbing stairs. She denies any specific traumatic injury. What is the MOST likely diagnosis?

a) Rheumatoid Arthritis

b) Osteoarthritis (OA)

c) Plica Syndrome

d) Meniscal Tear

b) Osteoarthritis (OA)

A football player sustained a direct blow to the lateral aspect of his right knee from an opponent's helmet. He immediately felt pain on the inner side of his knee. During your exam, you note tenderness along the medial joint line. A valgus stress test performed at 30 degrees of knee flexion reveals increased laxity compared to the uninjured side, but with a firm end-feel. What is the MOST likely diagnosis?

a) Grade I Medial Collateral Ligament (MCL) Sprain

b) Grade II Medial Collateral Ligament (MCL) Sprain

c) Grade III Medial Collateral Ligament (MCL) Sprain

d) "Terrible Triad" Injury

b) Grade II Medial Collateral Ligament (MCL) Sprain

A young athlete undergoes surgery for a focal 3 cm² chondral defect on their femoral condyle. The surgeon chose to harvest bone and cartilage plugs from a non-weight-bearing surface of the patient's own knee to fill the defect. Based on the lesion size and surgical technique, which procedure was MOST likely performed?

a) Microfracture

b) Osteochondral Autograft Transfer (OATs)

c) Autologous Chondrocyte Implantation (ACI)

d) Debridement and Chondroplasty

b) Osteochondral Autograft Transfer (OATs)

A 19-year-old volleyball player presents with anterior knee pain localized to the inferior pole of her patella. She states the pain began gradually and is now present at the beginning of and after activity, but it doesn't yet affect her performance. The pain is load-related, increasing with jumping and squatting. Based on Kennedy's Tendinopathy Stages, how would you classify her condition?

a) Stage 1

b) Stage 2

c) Stage 3

d) Stage 4

b) Stage 2

A 13-year-old overweight male presents with a 2-month history of right knee pain with an insidious onset. His mother notes he has been limping. During your subjective history, he also mentions some groin and thigh pain. In standing, you observe that he holds his right leg in external rotation. Hip ROM is limited and painful, especially with internal rotation and abduction. What condition should be considered a RED FLAG requiring immediate medical referral?

a) Osgood-Schlatter Disease

b) Slipped Capital Femoral Epiphysis (SCFE)

c) Plica Syndrome

d) Legg-Calve-Perthes Disease

b) Slipped Capital Femoral Epiphysis (SCFE)

A patient presents with PFP and your examination reveals the following: a Foot Posture Index score of 7, a difference of 12 mm in midfoot width between non-weight-bearing and weight-bearing, and a positive Patellar Tilt Test indicating a tight lateral retinaculum. Which PFP classification is MOST appropriate?

a) PFP with Mobility Impairments

b) PFP with Muscle Performance Deficits

c) PFP with Movement Coordination Deficits

d) PFP with Overuse/Overload

a) PFP with Mobility Impairments

A patient suffered a Grade III LCL sprain with posterolateral corner (PLC) involvement and underwent surgical reconstruction. In the initial post-operative phase, what is the MOST appropriate position for immobilization to minimize stress on the repaired tissues?

a) Full extension to prevent a flexion contracture

b) 90 degrees of flexion to maximize relaxation

c) 30 degrees of flexion to put the knee in an open-packed position

d) The knee should not be immobilized to promote early ROM

c) 30 degrees of flexion to put the knee in an open-packed position

A patient is 4 days post-Total Knee Arthroplasty (TKA) and complains of new, significant pain and tenderness in their calf. You observe that the entire leg is swollen and there is pitting edema confined to the symptomatic leg. What is the MOST appropriate immediate action?

a) Begin aggressive ankle pump exercises to reduce swelling.

b) Administer the Wells Clinical Prediction Rule to assess the probability of a Deep Vein Thrombosis (DVT).

c) Apply a hot pack to the calf to alleviate pain.

d) Instruct the patient to walk more to improve circulation.

b) Administer the Wells Clinical Prediction Rule to assess the probability of a Deep Vein Thrombosis (DVT).

A patient with PFP reports pain during an open-kinetic chain (OKC) knee extension exercise. The CPG for PFP recommends combined hip and knee-targeted exercises. To modify the OKC knee extension to minimize patellofemoral joint reaction forces (PFJRF), what range of motion should you instruct the patient to work within?

a) 0 to 35 degrees of flexion

b) 35 to 90 degrees of flexion

c) 0 to 45 degrees of flexion

d) 45 to 90 degrees of flexion

b) 35 to 90 degrees of flexion

A 14-year-old soccer player reports anterior knee pain that worsens during sprinting. Exam reveals tenderness at the tibial tuberosity and a visible bump. Which is most likely?
a) Patellar tendinopathy
b) Osgood-Schlatter disease
c) Sinding-Larsen-Johansson syndrome
d) Plica syndrome

b) Osgood-Schlatter disease

A basketball player felt a “pop” in her knee while cutting. She has rapid swelling within 90 minutes and difficulty extending the knee. Which injury is most likely?
a) Meniscal tear
b) PCL tear
c) ACL tear
d) MCL sprain

c) ACL tear

A runner presents with lateral knee pain aggravated by repetitive flexion/extension, tender over lateral femoral condyle, (+) Noble’s test. Which is correct?
a) ITB syndrome – strengthen hip abductors
b) Plica syndrome – correct biomechanics
c) Meniscus tear – surgical consult
d) LCL sprain – bracing

a) ITB syndrome – strengthen hip abductors

After a dashboard injury, a patient has posterior knee pain and a visible “sag sign.” Which muscle group should rehab focus on first?
a) Hamstrings
b) Quadriceps
c) Hip adductors
d) Gluteals

b) Quadriceps

A 28-year-old reports anterior-medial knee pain with snapping when squatting. No trauma history, pain worsens with sitting long periods. Best Dx?
a) Medial meniscus tear
b) Plica syndrome
c) Patellar tendinopathy
d) Pes anserine bursitis

b) Plica syndrome

A football player suffered blunt trauma to his thigh, with pain, swelling, limited knee flexion, and bruising. What complication can result from aggressive massage/stretching too soon?
a) Plica syndrome
b) Myositis ossificans
c) Meniscus tear
d) Osgood-Schlatter disease

b) Myositis ossificans

A patient presents with delayed swelling (12 hours post-injury), reports catching/locking, and has (+) McMurray test. Which is most likely?
a) ACL tear
b) Meniscal tear
c) PCL tear
d) Patellar tendinopathy

b) Meniscal tear

An older adult reports morning stiffness (<30 min), pain with weight-bearing, swelling, and loss of motion. Which intervention is most supported?
a) VMO strengthening only
b) Weight loss + exercise
c) Arthroscopy immediately
d) Continuous passive motion

b) Weight loss + exercise

A rugby player has pain over the medial joint line after valgus stress. Exam: laxity with firm end feel. Which grade and management?
a) Grade I MCL – early return
b) Grade II MCL – hinged brace + progressive ROM
c) Grade III MCL – immediate surgery
d) LCL sprain – brace + proprioception

b) Grade II MCL – hinged brace + progressive ROM

A volleyball player has pain at the inferior pole of the patella that worsens during box jumps. Which intervention is MOST appropriate first?
a) Immediate surgery
b) Start eccentric loading exercises
c) Begin with isometrics, progress to eccentrics
d) Only rest and ice

c) Begin with isometrics, progress to eccentrics