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5. Sports Medicine MCQs

Practice Set 104 of 360

This practice set contains high-yield board review questions covering key concepts in 5. Sports Medicine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 2061

Topic: Knee Sports
According to the Schenck classification system for knee dislocations, an injury resulting in complete tears of the ACL, PCL, and medial collateral ligament (MCL), with an intact posterolateral corner (PLC), is classified as:
. KD I
. KD II
. KD III-M
. KD III-L
. KD IV

Correct Answer & Explanation

. KD III-M

Explanation

The Schenck classification: KD I = single cruciate + collaterals; KD II = ACL + PCL (intact collaterals); KD III-M = ACL + PCL + MCL; KD III-L = ACL + PCL + LCL/PLC; KD IV = ACL + PCL + MCL + LCL/PLC. Since the MCL is involved, it is KD III-M.

Question 2062

Topic: Knee Sports

A 25-year-old male is evaluated for a knee injury. On physical examination, the 'dial test' reveals 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. However, at 90 degrees of knee flexion, the external rotation is symmetric bilaterally. This examination finding is most indicative of an isolated injury to the:

. Posterior cruciate ligament (PCL)
. Posterolateral corner (PLC)
. Anterior cruciate ligament (ACL)
. Medial collateral ligament (MCL)
. Posteromedial corner (PMC)

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

The dial test assesses combined PLC and PCL injuries. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion indicates an isolated Posterolateral Corner (PLC) injury. If external rotation is increased at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 2063

Topic: Knee Sports

A 19-year-old female sustains a traumatic lateral patellar dislocation. Which of the following structures is the primary soft-tissue restraint to lateral patellar translation at 0 to 20 degrees of knee flexion?

. Medial patellofemoral ligament (MPFL)
. Medial collateral ligament (MCL)
. Lateral retinaculum
. Quadriceps tendon
. Vastus medialis obliquus (VMO)

Correct Answer & Explanation

. Medial patellofemoral ligament (MPFL)

Explanation

The Medial Patellofemoral Ligament (MPFL) is the primary static restraint to lateral translation of the patella, particularly in early flexion (0-20 degrees) before the patella fully engages in the trochlear groove. It contributes 50-60% of the restraining force.

Question 2064

Topic: Knee Sports
In anatomic reconstruction of the medial patellofemoral ligament (MPFL), establishing the correct femoral attachment (Schöttle's point) is critical. On a strict lateral radiograph, Schöttle's point is located:
. Anterior to the posterior femoral cortical line and proximal to Blumensaat's line
. Anterior to the posterior femoral cortical line and distal to Blumensaat's line
. Posterior to the posterior femoral cortical line and proximal to Blumensaat's line
. Posterior to the posterior femoral cortical line and distal to Blumensaat's line
. Anterior to the posterior femoral cortical line and exactly on Blumensaat's line

Correct Answer & Explanation

. Anterior to the posterior femoral cortical line and proximal to Blumensaat's line

Explanation

According to Schöttle et al., the radiographic landmark for the femoral origin of the MPFL on a true lateral x-ray is: 1 mm anterior to the posterior femoral cortical extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior point of Blumensaat's line.

Question 2065

Topic: Knee Sports
A 24-year-old male presents with a KD-III (ACL, PCL, and PMC torn) knee dislocation after a fall from height. The knee is grossly reduced. Pulses are symmetrically palpable in the dorsalis pedis and posterior tibial arteries. The Ankle-Brachial Index (ABI) is measured at 0.85. What is the most appropriate next step in management?
. Immediate surgical exploration of the popliteal artery
. CT angiography of the lower extremity
. Observation and serial ABIs every 4 hours
. MRI of the knee to evaluate ligamentous injury
. Duplex ultrasound of the superficial femoral artery

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

In the setting of a knee dislocation, an ABI < 0.9 is a strong indicator of a potential occult arterial injury, even if palpable pulses are present. A CT angiogram (CTA) is indicated to definitely evaluate the popliteal artery. Immediate surgical exploration is reserved for hard signs of vascular injury (e.g., active hemorrhage, absent pulses, expanding hematoma, or obvious ischemia).

Question 2066

Topic: Knee Sports

A 25-year-old male sustains an isolated, displaced bony avulsion fracture of the posterior cruciate ligament (PCL) from its tibial footprint (dashboard injury). Open reduction and internal fixation is planned via a direct posterior approach to the knee. Which surgical interval is used for this classic Burks and Schaffer approach?

. Between the lateral head of the gastrocnemius and the biceps femoris
. Between the plantaris and the lateral head of the gastrocnemius
. Between the medial head of the gastrocnemius and the semimembranosus
. Through the midline of the gastrocnemius aponeurosis
. Between the popliteus and the posterior capsule

Correct Answer & Explanation

. Between the lateral head of the gastrocnemius and the biceps femoris

Explanation

The Burks and Schaffer approach (a modified posteromedial approach) provides excellent exposure to the tibial PCL attachment. The interval is between the medial head of the gastrocnemius (which is retracted laterally, protecting the midline neurovascular structures) and the semimembranosus (retracted medially).

Question 2067

Topic: Knee Sports

During a routine anterior cruciate ligament (ACL) reconstruction, an unrecognized posterior root tear of the medial meniscus is left unrepaired. Biomechanically, what is the consequence of leaving a meniscal root tear unrepaired?

. Decreased peak contact pressures in the medial compartment
. Increased joint space width of the medial compartment under load
. Joint contact pressures and hoop stress loss equivalent to a total meniscectomy
. Medial compartment gapping during terminal extension
. Increased resistance to anterior tibial translation

Correct Answer & Explanation

. Decreased peak contact pressures in the medial compartment

Explanation

The meniscal roots anchor the meniscus to the tibial plateau, allowing the meniscus to convert axial loads into circumferential hoop stresses. A radial tear at the root disrupts this continuous ring, rendering the meniscus completely non-functional under load. Biomechanically, an unrepaired posterior root tear is equivalent to a total meniscectomy in terms of peak contact pressures and loss of hoop stress.

Question 2068

Topic: 5. Sports Medicine

A 22-year-old athlete sustains a non-contact twisting injury to the knee. An AP radiograph shows an avulsion fracture of the lateral tibial plateau (Segond fracture). This pathognomonic finding is most strongly associated with avulsion of which capsuloligamentous structure?

. Biceps femoris
. Iliotibial band
. Anterolateral ligament (ALL) / lateral capsule
. Lateral collateral ligament (LCL)
. Popliteofibular ligament

Correct Answer & Explanation

. Biceps femoris

Explanation

A Segond fracture is an avulsion of the anterolateral capsule and the anterolateral ligament (ALL) from the lateral aspect of the proximal tibia, just distal to the joint line. It is highly specific for an associated ACL tear. It should not be confused with a reverse Segond fracture (medial avulsion associated with PCL tears) or an arcuate sign (fibular head avulsion of the posterolateral corner).

Question 2069

Topic: Knee Sports

A 19-year-old female presents with recurrent lateral patellar dislocations. Advanced imaging reveals a tibial tubercle-trochlear groove (TT-TG) distance of 23 mm and minimal patellofemoral arthritis. Which of the following surgical interventions is most appropriate in addition to a medial patellofemoral ligament (MPFL) reconstruction?

. Medializing tibial tubercle osteotomy
. Anteromedializing tibial tubercle osteotomy (Fulkerson osteotomy)
. Lateralizing tibial tubercle osteotomy
. Distalizing tibial tubercle osteotomy
. Trochleoplasty

Correct Answer & Explanation

. Medializing tibial tubercle osteotomy

Explanation

A normal TT-TG distance is less than 15 mm. A TT-TG distance > 20 mm is a pathologic lateralized pull of the extensor mechanism and is a primary indication for a medializing tibial tubercle osteotomy (Elmslie-Trillat) to correct the anatomic tracking anomaly. Anteromedialization (Fulkerson) is preferred if there is concurrent distal/lateral patellofemoral arthritis to offload the joint, but pure medialization is standard for isolated instability without arthritis.

Question 2070

Topic: Knee Sports

During a retrograde intramedullary nailing of a supracondylar distal femur fracture, the surgeon is selecting the ideal intra-articular starting point to avoid damaging the cruciate ligaments and to ensure proper axial alignment. What is the correct starting point in the intercondylar notch?

. Just posterior to the origin of the posterior cruciate ligament (PCL)
. At the top of the intercondylar notch, just anterior to the origin of the PCL
. In the exact center of the trochlear groove
. Directly at the femoral attachment of the anterior cruciate ligament (ACL)
. 2 cm proximal to Blumensaat's line within the medullary canal

Correct Answer & Explanation

. Just posterior to the origin of the posterior cruciate ligament (PCL)

Explanation

The proper starting point for a retrograde femoral nail is located in the top (anterior apex) of the intercondylar notch, perfectly in line with the medullary canal in both AP and lateral planes. On the lateral view, this corresponds to a point just anterior to Blumensaat's line (the roof of the notch and origin of the PCL). A start point too far posterior will damage the PCL, while a start point too far anterior will damage the patellofemoral articular surface.

Question 2071

Topic: 5. Sports Medicine

A 28-year-old male presents 14 days after an uncomplicated ACL reconstruction using a bone-patellar tendon-bone (BTB) autograft. He complains of fevers, severe knee pain, and restricted range of motion. Examination reveals a large, erythematous knee effusion. Aspiration yields turbid fluid with 80,000 WBCs/hpf (90% neutrophils). What is the standard of care for this patient?

. Urgent open arthrotomy, complete graft removal, and placement of an antibiotic spacer
. Urgent arthroscopic irrigation and debridement, retention of the graft, and intravenous antibiotics
. Oral broad-spectrum antibiotics and serial in-office aspirations
. Arthroscopic irrigation and debridement with immediate exchange to an allograft
. A single intra-articular injection of vancomycin and ceftriaxone, followed by oral antibiotics

Correct Answer & Explanation

. Urgent arthroscopic irrigation and debridement, retention of the graft, and intravenous antibiotics

Explanation

In the setting of acute septic arthritis following ACL reconstruction (typically presenting 2-3 weeks post-op), the standard of care is urgent arthroscopic irrigation and debridement with retention of the graft, followed by culture-directed intravenous antibiotics. Graft removal is reserved for cases where the infection cannot be controlled after multiple I&Ds or if the graft is visibly necrotic and structurally incompetent.

Question 2072

Topic: Knee Sports

A patient complains of a lack of terminal knee extension six months after an ACL reconstruction. Lateral radiographs show that the tibial tunnel is positioned entirely anterior to Blumensaat's line with the knee in full extension. What is the mechanism of this patient's extension loss?

. The graft becomes excessively taut in flexion, preventing full extension.
. The graft impinges posteriorly against the PCL.
. The graft impinges anteriorly against the intercondylar notch roof during extension.
. The graft acts as a physical block within the trochlear groove.
. The patella tracks laterally causing a mechanical block.

Correct Answer & Explanation

. The graft impinges anteriorly against the intercondylar notch roof during extension.

Explanation

Anterior placement of the tibial tunnel is a classic technical error in ACL reconstruction. If the tibial tunnel is placed anterior to the slope of the intercondylar roof (Blumensaat's line in full extension), the graft will impinge against the roof of the notch as the knee extends (notch impingement). This leads to a mechanical loss of terminal extension, graft abrasion, and eventual graft failure.

Question 2073

Topic: Knee Sports

A patient undergoes surgical reconstruction of a severe posterolateral corner (PLC) injury. Postoperatively, the patient is noted to have a foot drop and numbness over the dorsum of the foot. During the dissection, which three major static stabilizing structures of the PLC were identified and reconstructed, placing the peroneal nerve at highest risk during exposure?

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament
. Lateral collateral ligament, biceps femoris tendon, and iliotibial band
. Popliteus tendon, anterolateral ligament, and arcuate ligament
. Lateral collateral ligament, anterior cruciate ligament, and oblique popliteal ligament
. Popliteofibular ligament, lateral gastrocnemius tendon, and fabellofibular ligament

Correct Answer & Explanation

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

The three major static stabilizing structures of the posterolateral corner (PLC) of the knee are the Lateral Collateral Ligament (LCL), the Popliteus tendon, and the Popliteofibular ligament (PFL). Reconstruction of these structures requires dissection near the fibular head and neck, which places the common peroneal nerve at high risk of iatrogenic injury.

Question 2074

Topic: Knee Sports

A 22-year-old professional soccer player undergoes an ACL reconstruction and concurrent repair of a longitudinal tear in the red-white zone of the medial meniscus. It is well-documented that meniscal repairs performed concurrently with ACL reconstruction have a higher healing rate than isolated meniscal repairs. What is the primary biological reason for this phenomenon?

. The ACL reconstruction restricts post-operative range of motion more rigidly.
. The reconstruction immediately restores native tibiofemoral contact mechanics to decrease shear.
. Notch osteoplasty and tunnel drilling release marrow-derived stem cells and growth factors into the joint.
. The graft completely eliminates all rotational forces on the healing meniscus.
. The vascularity of the white-white zone is directly re-established by the infrapatellar fat pad.

Correct Answer & Explanation

. Notch osteoplasty and tunnel drilling release marrow-derived stem cells and growth factors into the joint.

Explanation

Concurrent ACL reconstruction significantly enhances meniscal healing. The biologic rationale is that the osseous trauma from tunnel drilling and notch preparation releases a bone marrow-rich 'hemarthrosis' into the joint space. This fluid is packed with mesenchymal stem cells (MSCs) and growth factors (e.g., PDGF, TGF-beta) which provide a potent biologic stimulus that augments the healing of the meniscal repair.

Question 2075

Topic: Knee Sports

A surgeon opts to perform a posterior cruciate ligament (PCL) reconstruction using the tibial inlay technique rather than the traditional transtibial tunnel technique. What is the primary biomechanical and clinical advantage proposed for the tibial inlay technique?

. It completely eliminates the need for femoral tunnel drilling.
. It allows for immediate post-operative full weight-bearing.
. It avoids the 'killer turn' and subsequent graft abrasion at the posterior tibial aperture.
. It preserves the posterior horn of the medial meniscus anatomically.
. It reliably prevents iatrogenic popliteal artery injury during drilling.

Correct Answer & Explanation

. It avoids the 'killer turn' and subsequent graft abrasion at the posterior tibial aperture.

Explanation

In the traditional transtibial PCL reconstruction, the graft must make an acute angle as it exits the posterior tibial tunnel and courses towards the medial femoral condyle. This acute angle is known as the 'killer turn' and is a known site for graft abrasion, stretching, and eventual failure. The tibial inlay technique secures the graft directly to the anatomic tibial footprint via a posterior approach, completely avoiding the killer turn and minimizing graft attenuation.

Question 2076

Topic: Knee Sports

During a posterior cruciate ligament (PCL) reconstruction, the surgeon aims to accurately recreate the native biomechanics of the knee. Which specific bundle of the native PCL is tight in flexion and serves as the primary restraint to posterior tibial translation at 90 degrees of knee flexion?

. Anterolateral bundle
. Posteromedial bundle
. Anteromedial bundle
. Posterolateral bundle
. Central meniscofemoral bundle

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The native PCL consists of two main bundles: the anterolateral bundle (ALB) and the posteromedial bundle (PMB). The ALB is larger, tightens in flexion, and is the primary restraint to posterior translation at 90 degrees of knee flexion.

Question 2077

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction, the popliteofibular ligament must be addressed. This ligament originates from the popliteus musculotendinous junction and inserts onto the fibular styloid. It primarily resists which abnormal tibiofemoral motion?

. Anterior tibial translation
. Posterior tibial translation
. Valgus gapping
. External tibial rotation
. Internal tibial rotation

Correct Answer & Explanation

. External tibial rotation

Explanation

The popliteofibular ligament is a key static stabilizer of the posterolateral corner of the knee. It provides significant restraint to external tibial rotation, particularly at higher degrees of knee flexion.

Question 2078

Topic: 5. Sports Medicine
A 28-year-old recreational athlete sustains an acute KD-III-M knee dislocation. Vascular status is entirely normal. Assuming no skin compromise or open wounds, what is the optimal surgical timing for a multiligamentous knee reconstruction to best balance the risks of stiffness and functional outcome?
. Within the first 48 hours
. 2 to 3 weeks post-injury
. 6 to 8 weeks post-injury
. 3 to 4 months post-injury
. Greater than 6 months post-injury

Correct Answer & Explanation

. 2 to 3 weeks post-injury

Explanation

Early reconstruction within 2 to 3 weeks is generally favored. This delay allows capsular healing (decreasing the risk of fluid extravasation during arthroscopy) while avoiding the higher rates of severe arthrofibrosis seen with acute (less than 1 week) intervention.

Question 2079

Topic: Knee Sports

A 24-year-old athlete undergoes reconstruction of the posterolateral corner (PLC) of the knee. To correctly recreate the normal anatomic footprints on the lateral femur, what is the spatial relationship of the lateral collateral ligament (LCL) attachment relative to the popliteus tendon attachment?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly anterior

Correct Answer & Explanation

. Proximal and posterior

Explanation

On the lateral femoral epicondyle, the LCL footprint is located slightly proximal and posterior to the popliteus tendon footprint. Accurately reproducing this relationship is crucial for restoring proper isometry and kinematics during PLC reconstruction.

Question 2080

Topic: 5. Sports Medicine
A 30-year-old male presents with a KD III-M knee dislocation with a normal vascular exam. He requires multiligament knee reconstruction (ACL, PCL, and MCL). What is the optimal timing for this surgical intervention?
. Immediate emergency reconstruction within 24 hours
. Within 3 to 5 days to prevent severe arthrofibrosis
. Between 2 to 3 weeks post-injury
. At 6 weeks to ensure complete resolution of swelling
. At 3 months to allow native healing of the cruciates

Correct Answer & Explanation

. Between 2 to 3 weeks post-injury

Explanation

The optimal timing for multiligament knee reconstruction is typically 2-3 weeks post-injury. This allows capsular healing (minimizing the risk of fluid extravasation and compartment syndrome during arthroscopy) while avoiding the severe scarring seen with delayed surgery.

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