Knee: spontaneous osteonecrosis: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Orthopaedics · Knee: spontaneous osteonecrosis

Sample item

A 65-year-old woman has sudden severe medial knee pain at night and tenderness over the medial femoral condyle. Radiographs are normal and MRI shows marrow oedema with a subchondral low-signal line. What is the initial management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Protected weight bearing with analgesia

Sudden onset of focal medial condylar pain in an older woman with marrow oedema and a subchondral lesion suggests spontaneous osteonecrosis, now regarded as a subchondral insufficiency fracture. Early treatment is protected weight bearing and analgesia, with surgery reserved for collapse and failure of conservative care. Normal radiographs early do not exclude it.

Option by option

  • A. Arthroscopic meniscectomy

    Meniscectomy does not address the subchondral lesion.

  • B. Immediate total knee replacement

    Replacement is for advanced collapse with failed conservative care.

  • C. Protected weight bearing with analgesia (correct)

    Correct. Offloading and analgesia are the first step.

  • D. High-dose antibiotics

    There is no infection to treat.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Orthopaedics questions

Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Protected weight bearing with analgesia. Sudden onset of focal medial condylar pain in an older woman with marrow oedema and a subchondral lesion suggests spontaneous osteonecrosis, now regarded as a subchondral insufficiency fracture.

Why is "Arthroscopic meniscectomy" not the answer?

Meniscectomy does not address the subchondral lesion.

Why is "Immediate total knee replacement" not the answer?

Replacement is for advanced collapse with failed conservative care.

Why is "High-dose antibiotics" not the answer?

There is no infection to treat.

What concept does this question test?

It tests Knee: spontaneous osteonecrosis in Orthopaedics. Early treatment is protected weight bearing and analgesia, with surgery reserved for collapse and failure of conservative care. Normal radiographs early do not exclude it.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Knee: spontaneous osteonecrosis?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.