{"id":5864,"date":"2025-04-02T12:01:51","date_gmt":"2025-04-02T20:01:51","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=5864"},"modified":"2025-10-01T11:38:24","modified_gmt":"2025-10-01T19:38:24","slug":"usmle-step-1-question-of-the-day-left-knee-injury","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-knee-injury","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Left knee injury"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-knee-injury\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-knee-injury\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-knee-injury\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-knee-injury\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-knee-injury\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-knee-injury\/#References\" >References&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your medical knowledge. Today\u2019s case involves a 21-year-old man who injures his left knee during a football game, experiencing a \u201cpop\u201d and medial pain after being tackled. After getting an MRI, can you identify which physical examination maneuver is most likely to support this patient\u2019s diagnosis?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 21-year-old man presents to the emergency department after an injury to the left knee. The patient was running during a football game when he was suddenly tackled and struck in the lateral side of the left knee. The patient heard a \u201cpop\u201d and then felt pain at the medial aspect of his left knee. He was able to walk following the incident but noticed his left knee felt \u201cwobbly.\u201d On physical examination, the left knee is swollen, and there is medial joint line tenderness. The patient subsequently undergoes an MRI of the left knee, and the findings are shown below. <\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"456\" height=\"456\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-3.png\" alt=\"An MRI scan of an injured left knee.\" class=\"wp-image-5867\" style=\"width:456px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-3.png 456w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-3.png?resize=150,150 150w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/04\/image-3.png?resize=300,300 300w\" sizes=\"auto, (max-width: 456px) 100vw, 456px\" \/><figcaption class=\"wp-element-caption\">Source: <a href=\"https:\/\/radiopaedia.org\/cases\/medial-collateral-ligament-full-thickness-tear\" target=\"_blank\" rel=\"noreferrer noopener\">Radiopedia<\/a><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following physical examination maneuvers is most likely to support this patient\u2019s diagnosis?&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Valgus stress test<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Varus stress test<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Lachman test<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Thessaly test<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Posterior drawer test<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Valgus stress test\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct: <\/strong>See Main Explanation.&nbsp;&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Varus stress test<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Varus force applied at the knee joint would demonstrate increased gapping in the setting of a lateral collateral ligament injury. This patient&#8217;s clinical presentation is more consistent with a medial collateral ligament injury.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Lachman test<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Lachman test is used to assess for anterior-cruciate ligament injury. It is not used to evaluate for medial collateral ligament injury. This patient\u2019s medial knee pain and mechanism of injury are more consistent with a medial collateral ligament injury.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Thessaly test<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect: <\/strong>Thessaly test is used to assess for meniscus injury. However, the MRI does not show evidence of meniscal injury.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Posterior drawer test<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> The posterior drawer test identifies injury to the posterior cruciate ligament, which usually occurs from an anterior force applied to a bent knee, not a lateral blow, as seen in this case. The posterior drawer test is not used to evaluate for medial collateral ligament injury, which this patient likely has.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents to the emergency department following an injury that involved a valgus force to the lateral aspect of the knee. Knee MRI demonstrates evidence of injury to the medial collateral ligament. When a valgus stress test is used, and valgus force is applied at the knee, medial gapping and pain would indicate a positive test in the case of a medial collateral ligament injury.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries are common injuries in athletes. These injuries often occur in isolation&#8211;without the involvement of concomitant ligamentous injuries. Injury to the medial collateral ligament is most often caused by a valgus force applied to the knee, such as forceful turning or twisting or direct blow to the lateral aspect of the knee. In contrast, lateral collateral ligament injuries occur due to a varus force on the knee, such as forceful twisting or turning or direct blow to the medial aspect of the knee.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Diagnosis of either injury is often clinical. In MCL injuries, patients will have increased gapping and pain at the medial knee when valgus force is applied. In LCL injuries, patients will have increased gapping and pain at the lateral aspect of the knee when varus force is applied. MRI is the definitive diagnosis and will demonstrate increased signal intensity at the ligaments with partial tears or visible full-thickness tears.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries are common injuries in athletes and occur due to a valgus force on the knee in MCL injuries and varus force on the knee in LCL injuries. Valgus stress test will be positive with an MCL injury and a varus stress test will be positive with an LCL injury.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video:&nbsp;<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Special_tests_for_the_lower_limb\"><strong>Special tests for the lower limb<\/strong><\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Andrews, K., Lu, A., Mckean, L., Ebraheim, N. (2017) Review: Medial collateral ligament injuries. Journal of Orthopedics. 14(4), 550-554. Doi: 10.1016\/j.jor.2017.07.017.<\/li>\n\n\n\n<li>Grawe, B., Schroeder, A.J., Kakazu, R., Messer, M.S. (2018) Lateral collateral ligament injury about the knee: Anatomy, evaluation, and management. The Journal of the American Academy of Orthopaedic Surgeons. 26(6):e120-e127. Doi: 10.5435\/JAAOS-D-16-00028.<\/li>\n\n\n\n<li>Walls, R., Hockberger, R., Gausche-Hill, M. (2017) Rosen&#8217;s emergency medicine: Concepts and clinical practice. New York, NY: Elsevier. ISBN: 978-0323354790.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png\" alt=\"\" class=\"wp-image-4633\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/07\/Blog_Display_Ads_MD2_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis by Elsevier today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Prep for the USMLE\u00ae Step 1 exam by exploring a clinical case involving a 21-year-old man with a left knee injury. Learn to identify the most appropriate physical examination maneuver. Strengthen your clinical assessment skills!<\/p>\n","protected":false},"author":202,"featured_media":5866,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1369,44],"tags":[218,440,265,637,636,245,279,592,638,185],"class_list":["post-5864","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-clinical-skills","tag-emergency-medicine","tag-healthcare-training","tag-knee-injury","tag-medial-collateral-ligament","tag-nursing-education","tag-patient-assessment","tag-physical-exam","tag-sports-medicine","tag-usmle"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day:\u00a0Left knee injury - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-left-knee-injury\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day:\u00a0Left knee injury - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Prep for the USMLE\u00ae Step 1 exam by exploring a clinical case involving a 21-year-old man with a left knee injury. 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