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5. Sports Medicine MCQs

Practice Set 111 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 2201

Topic: 5. Sports Medicine

A 22-year-old collegiate football running back hyper-extends his great toe during a tackle. Examination reveals exquisite tenderness at the plantar aspect of the first metatarsophalangeal (MTP) joint, swelling, and ecchymosis. MRI demonstrates a complete disruption of the plantar plate and capsuloligamentous complex with proximal retraction of the sesamoids. What is the most appropriate management for this athlete?

. Immobilization in a stiff-soled shoe and return to play as tolerated
. Intra-articular corticosteroid injection and dynamic taping
. Surgical repair of the plantar plate and capsuloligamentous complex
. First MTP arthrodesis
. Complete sesamoidectomy

Correct Answer & Explanation

. Surgical repair of the plantar plate and capsuloligamentous complex

Explanation

This describes a Grade 3 "turf toe" injury, defined as a complete tear of the plantar plate and MTP capsuloligamentous complex, evidenced by proximal migration of the sesamoids. In an elite competitive athlete, nonoperative management of a Grade 3 injury often results in chronic pain, loss of push-off strength, and progressive hallux valgus or rigidus. Surgical repair of the plantar plate is indicated to restore anatomy and function. Arthrodesis is a salvage procedure, and complete sesamoidectomy disrupts the intrinsic flexor mechanics.

Question 2202

Topic: 5. Sports Medicine

A 40-year-old male fell from a ladder 6 weeks ago. He presents now with an inability to actively extend his knee. Radiographs reveal patella alta and no fractures. MRI confirms a complete, chronically retracted patellar tendon rupture. If primary surgical repair is attempted, what adjunctive soft-tissue procedure is most likely required due to the chronicity of the injury?

. High tibial osteotomy
. V-Y quadricepsplasty or autograft/allograft augmentation
. Medial patellofemoral ligament (MPFL) reconstruction
. Distal femoral varus osteotomy
. Patellectomy

Correct Answer & Explanation

. High tibial osteotomy

Explanation

In chronic or delayed (>2-6 weeks) patellar tendon ruptures, the quadriceps muscle contracts significantly, pulling the patella proximally (patella alta). During surgery, it is often impossible to mobilize the patella distally enough to achieve a tension-free primary repair. Therefore, an extensive release or a V-Y quadriceps lengthening (quadricepsplasty) is often required. Additionally, due to poor tendon tissue quality, augmentation with allograft or autograft (e.g., hamstrings) is usually necessary to protect the repair.

Question 2203

Topic: 5. Sports Medicine
A 25-year-old football player sustains a valgus blow to his right knee. Examination reveals pain along the medial joint line, 5 mm of medial opening at 30 degrees of knee flexion with a firm endpoint, and no opening at 0 degrees of flexion. MRI confirms an isolated tear of the superficial medial collateral ligament (MCL). What is the recommended treatment?
. Acute surgical repair of the MCL using suture anchors
. Hinged knee brace and early functional rehabilitation
. Long leg cast in 30 degrees of flexion for 6 weeks
. Arthroscopic debridement of the medial compartment
. MCL reconstruction using hamstring autograft

Correct Answer & Explanation

. Hinged knee brace and early functional rehabilitation

Explanation

The patient has a Grade II injury to the MCL (laxity at 30 degrees with a firm endpoint, stable at 0 degrees). Isolated Grade I, II, and even most Grade III MCL injuries have excellent healing potential and are best treated nonoperatively. The standard of care is a hinged knee brace to protect against valgus stress while allowing early range of motion and weight-bearing as tolerated, combined with a structured physical therapy program.

Question 2204

Topic: Knee Sports

A 14-year-old male presents with vague knee pain and occasional catching. Radiographs reveal a 1.5 cm osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. MRI confirms the lesion is completely intact with no high T2 fluid signal behind the fragment. His distal femoral physes remain wide open. What is the initial treatment of choice?

. Arthroscopic transarticular drilling of the lesion
. Non-weight bearing and activity modification for 3 to 6 months
. Arthroscopic fixation with bioabsorbable screws
. Osteochondral autograft transfer (OATS)
. Autologous chondrocyte implantation (ACI)

Correct Answer & Explanation

. Arthroscopic transarticular drilling of the lesion

Explanation

This is a case of juvenile osteochondritis dissecans (JOCD) characterized by open physes and a stable lesion on MRI (no fluid behind the fragment, intact overlying cartilage). Stable JOCD lesions have a very high rate of spontaneous healing (up to 70-80%) with conservative management. The initial treatment is strict activity modification and weight-bearing restriction. Surgical intervention (drilling, fixation, or cartilage restoration) is indicated only if the lesion is unstable (fluid behind fragment), if the fragment is detached, or if there is failure of 6 months of nonoperative management.

Question 2205

Topic: Knee Sports

Regarding the native anterior cruciate ligament (ACL), which of the following statements correctly describes the biomechanical function of its two distinct bundles?

. The anteromedial (AM) bundle is tight in extension and primarily controls rotational stability.
. The posterolateral (PL) bundle is tight in flexion and primarily controls anterior translation.
. The AM bundle is tight in flexion and primarily resists anterior tibial translation.
. The PL bundle is tight in flexion and primarily resists rotational instability.
. Both bundles maintain equal tension throughout the entire range of motion.

Correct Answer & Explanation

. The anteromedial (AM) bundle is tight in extension and primarily controls rotational stability.

Explanation

The native ACL has two main bundles: the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle is tight in flexion and is the primary restraint to anterior tibial translation. The PL bundle is tight in extension and is the primary restraint to rotational instability.

Question 2206

Topic: Knee Sports

A 16-year-old female presents with recurrent lateral patellar dislocations. MRI evaluation of the knee demonstrates a tibial tubercle-trochlear groove (TT-TG) distance of 24 mm. In addition to a medial patellofemoral ligament (MPFL) reconstruction, which of the following procedures is most indicated to correct her underlying pathoanatomy?

. Lateral retinacular release
. Trochleoplasty
. Distal femoral varus osteotomy
. Tibial tubercle medialization osteotomy
. Proximal tibial valgus osteotomy

Correct Answer & Explanation

. Lateral retinacular release

Explanation

A TT-TG distance > 20 mm is considered pathologic and a significant risk factor for patellar instability. An MPFL reconstruction alone in the setting of a highly elevated TT-TG has a high risk of failure. A tibial tubercle osteotomy (medialization) is indicated to correct the lateralized extensor mechanism pull and normalize patellofemoral tracking.

Question 2207

Topic: Knee Sports
A 22-year-old male sustains an acute knee dislocation resulting in disruption of the ACL, PCL, and the posterolateral corner (Schenck KD III-L). Which of the following physical exam findings must be carefully evaluated due to its high incidence in this specific injury pattern?
. Absent dorsalis pedis pulse
. Inability to actively extend the hallux
. Decreased sensation over the medial aspect of the foot
. Weakness in ankle plantarflexion
. Inability to invert the foot

Correct Answer & Explanation

. Inability to actively extend the hallux

Explanation

A KD III-L injury (ACL, PCL, and lateral/PLC disruption) has a high association with common peroneal nerve injury (up to 40% in posterolateral corner injuries). The common peroneal nerve innervates the anterior compartment (deep peroneal), which is responsible for ankle dorsiflexion and great toe extension via the extensor hallucis longus (EHL).

Question 2208

Topic: Knee Sports

A 24-year-old male sustains an isolated posterior cruciate ligament (PCL) tibial avulsion fracture. Surgical fixation is planned via an open posteromedial approach (Burks and Schaffer). Which internervous or intermuscular interval is utilized in this specific surgical approach?

. Between the medial head of the gastrocnemius and the semimembranosus
. Between the lateral head of the gastrocnemius and the biceps femoris
. Between the popliteus and the soleus
. Between the plantaris and the lateral head of the gastrocnemius
. Between the semitendinosus and the gracilis

Correct Answer & Explanation

. Between the medial head of the gastrocnemius and the semimembranosus

Explanation

The classic posteromedial approach to the knee, as described by Burks and Schaffer, utilizes the interval between the medial head of the gastrocnemius and the semimembranosus. This provides excellent exposure to the posteromedial corner and the tibial attachment of the PCL while protecting the neurovascular bundle laterally.

Question 2209

Topic: 5. Sports Medicine
A 22-year-old professional football player sustains a severe hyperextension injury to his first metatarsophalangeal (MTP) joint. Clinical examination reveals significant ecchymosis and gross instability. MRI confirms a complete rupture of the plantar plate with proximal migration of the sesamoids. What is the most appropriate management for this injury?
. Taping, stiff-soled shoe, and return to play as tolerated
. Immobilization in a short leg cast for 6 weeks
. Primary surgical repair of the plantar plate and soft tissues
. First MTP joint arthrodesis
. Surgical excision of both sesamoids

Correct Answer & Explanation

. Primary surgical repair of the plantar plate and soft tissues

Explanation

This is a Grade III turf toe injury. In high-level athletes, Grade III injuries (complete plantar plate tear with capsular disruption and proximal sesamoid migration) generally require primary surgical repair to restore the push-off strength and stability of the first MTP joint.

Question 2210

Topic: Shoulder & Hip Sports

A 28-year-old male hockey player presents with anterior groin pain worsened by hip flexion, adduction, and internal rotation. Radiographs reveal a "pistol grip" deformity of the proximal femur. An alpha angle is measured on the lateral radiograph to quantify the cam lesion. In the context of Femoroacetabular Impingement (FAI), an alpha angle greater than what value is traditionally considered the threshold for abnormal?

. 30 degrees
. 40 degrees
. 55 degrees
. 75 degrees
. 85 degrees

Correct Answer & Explanation

. 30 degrees

Explanation

An alpha angle greater than 50 to 55 degrees on a lateral radiograph or axial MRI is traditionally considered indicative of a cam deformity. This angle measures the loss of sphericity of the anterior femoral head-neck junction.

Question 2211

Topic: Knee Sports

During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, accurate placement of the femoral tunnel is critical to ensure proper graft isometry. According to Schottle's point, where should the optimal femoral attachment be positioned on a true lateral radiograph?

. Anterior to the posterior cortex line and distal to Blumensaat's line
. Posterior to the posterior cortex line and proximal to Blumensaat's line
. Exactly at the geometric center of the medial femoral epicondyle
. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line
. 5 mm anterior to the adductor tubercle and directly on Blumensaat's line

Correct Answer & Explanation

. Anterior to the posterior cortex line and distal to Blumensaat's line

Explanation

Schottle described a radiographic landmark for the femoral origin of the MPFL on a true lateral radiograph: 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior aspect of Blumensaat's line.

Question 2212

Topic: Knee Sports
A 52-year-old male undergoes MRI of the knee after a deep squatting injury, which reveals a complete posterior medial meniscal root tear. Biomechanical studies have demonstrated that a complete tear of the medial meniscus posterior root is mechanically equivalent to which of the following conditions regarding tibiofemoral contact pressures?
. An isolated complete anterior cruciate ligament tear
. A total medial meniscectomy
. A partial medial meniscectomy preserving the peripheral rim
. A complete posterior cruciate ligament tear
. A medial collateral ligament grade III sprain

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A complete tear of the posterior root of the medial meniscus results in an inability of the meniscus to convert axial loads into hoop stresses. The meniscus essentially extrudes, leading to a profound increase in contact pressures equivalent to a total medial meniscectomy.

Question 2213

Topic: Knee Sports

The posterior cruciate ligament (PCL) provides primary restraint against posterior tibial translation. It is composed of two main functional bundles. During knee range of motion, how do the tension patterns of these bundles behave?

. The anterolateral bundle is tightest in full extension, and the posteromedial bundle is tightest in deep flexion
. The anterolateral bundle is tightest in flexion, and the posteromedial bundle is tightest in extension
. Both bundles demonstrate uniform tension throughout the entire arc of motion
. Both bundles are maximally loose at 90 degrees of flexion
. Both bundles are tightest in full extension

Correct Answer & Explanation

. The anterolateral bundle is tightest in full extension, and the posteromedial bundle is tightest in deep flexion

Explanation

The PCL consists of the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. Biomechanically, the AL bundle is tightest in knee flexion, whereas the PM bundle is tightest in knee extension.

Question 2214

Topic: Knee Sports

A 28-year-old male sustains a knee injury during a soccer match. On physical examination, the dial test reveals 15 degrees of increased external rotation on the injured side compared to the normal side when tested at 30 degrees of knee flexion. When tested at 90 degrees of knee flexion, the external rotation is symmetric between both knees. Which of the following is the most likely diagnosis?

. Isolated posterolateral corner (PLC) injury
. Isolated posterior cruciate ligament (PCL) injury
. Combined PCL and PLC injury
. Isolated anterior cruciate ligament (ACL) injury
. Posteromedial corner injury

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

A positive dial test at 30 degrees of flexion with symmetry at 90 degrees of flexion indicates an isolated posterolateral corner (PLC) injury. If asymmetry is present at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 2215

Topic: Knee Sports
A 22-year-old female undergoes a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. Postoperatively, she complains of a severe loss of knee flexion, and examination reveals a tight graft in deeper degrees of flexion. Which of the following femoral tunnel malpositions is the most likely cause of this complication?
. Placement too anterior and distal
. Placement too proximal
. Placement too deep in the trochlear groove
. Placement on the medial epicondyle
. Placement at the adductor tubercle

Correct Answer & Explanation

. Placement too proximal

Explanation

The isometric point for the MPFL femoral origin (Schöttle's point) is strictly defined. Placement of the femoral tunnel too proximal results in a graft that becomes excessively tight in knee flexion, leading to a flexion deficit and increased medial patellofemoral cartilage pressures.

Question 2216

Topic: 5. Sports Medicine

A 26-year-old male athlete presents with deep anterior groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate a pistol-grip deformity and an alpha angle of 65 degrees. During hip arthroscopy for this condition, where is the most common anatomic location of articular cartilage damage?

. Posterosuperior acetabulum
. Anterosuperior acetabulum
. Anteroinferior acetabulum
. Central acetabular fossa
. Posterior femoral head

Correct Answer & Explanation

. Anterosuperior acetabulum

Explanation

The patient has Cam-type femoroacetabular impingement (FAI), characterized by an aspherical femoral head lacking normal offset. The classic pattern of injury is sheer force causing chondral delamination at the anterosuperior aspect of the acetabulum.

Question 2217

Topic: Knee Sports

A 12-year-old gymnast complains of poorly localized knee pain. Radiographs demonstrate a well-circumscribed osteochondral defect with a stable subchondral bone fragment. In juvenile osteochondritis dissecans (JOCD) of the knee, what is the most common anatomical location of the lesion?

. Central aspect of the lateral femoral condyle
. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Anterior aspect of the medial femoral condyle
. Trochlear groove

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for osteochondritis dissecans (OCD) in the knee is the lateral aspect of the medial femoral condyle. Initial management for a stable lesion in a patient with open physes is typically non-operative.

Question 2218

Topic: 5. Sports Medicine
A concussion diagnosis is made when there is:
. a 20% decrease in the neurocognitive score from baseline.
. a brain MRI with abnormal findings.
. a loss of consciousness for longer than 15 seconds.
. evidence of a traumatic brain injury that alters the way the brain functions.

Correct Answer & Explanation

. evidence of a traumatic brain injury that alters the way the brain functions.

Explanation

Neurocognitive testing is a helpful tool in the management of concussions, but testing does not independently determine if an athlete has experienced a concussion or when he or she can return to play. Neuroimaging findings typically are normal in concussive injury. Loss of consciousness occurs in fewer than 10% of patients with concussions. A concussion diagnosis is difficult to determine because of the lack of objective clinical and/or imaging findings. In general, a concussion is a disturbance in brain function caused by a direct or indirect force to the head.

Question 2219

Topic: Knee Sports
A 22-year-old female presents with recurrent patellar instability. You plan a medial patellofemoral ligament (MPFL) reconstruction. Intraoperatively, fluoroscopy is used to determine the exact femoral tunnel position. According to Schöttle's criteria, which of the following radiographic landmarks best describes the correct anatomical femoral attachment of the MPFL on a true lateral radiograph?
. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior articular border of the medial femoral condyle, and proximal to Blumensaat's line.
. 1 mm anterior to the posterior cortical line, 2.5 mm proximal to the posterior articular border of the medial femoral condyle, and proximal to Blumensaat's line.
. 1 mm posterior to the posterior cortical line, 2.5 mm proximal to the posterior articular border of the medial femoral condyle, and distal to Blumensaat's line.
. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior articular border of the medial femoral condyle, and distal to Blumensaat's line.
. 1 mm posterior to the posterior cortical line, 2.5 mm distal to the posterior articular border of the medial femoral condyle, and proximal to Blumensaat's line.

Correct Answer & Explanation

. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior articular border of the medial femoral condyle, and proximal to Blumensaat's line.

Explanation

Schöttle's point is a reliable fluoroscopic landmark for anatomical MPFL femoral tunnel placement. It is located 1 mm anterior to the posterior cortical line extension, 2.5 mm distal to the posterior articular border of the medial femoral condyle, and proximal to the intersection of Blumensaat's line and the posterior cortical line.

Question 2220

Topic: Knee Sports

A 25-year-old male presents with a posterolateral corner (PLC) knee injury. During anatomical reconstruction, the surgeon must aim to recreate the primary static stabilizers to restore normal kinematics. What are the three primary static stabilizers of the PLC?

. Popliteus tendon, popliteofibular ligament, lateral collateral ligament
. Iliotibial band, popliteus tendon, lateral collateral ligament
. Biceps femoris tendon, popliteofibular ligament, lateral collateral ligament
. Popliteus tendon, arcuate ligament, lateral collateral ligament
. Fabellofibular ligament, popliteofibular ligament, lateral collateral ligament

Correct Answer & Explanation

. Popliteus tendon, popliteofibular ligament, lateral collateral ligament

Explanation

The posterolateral corner (PLC) of the knee is a complex arrangement of structures providing restraint against varus opening, external tibial rotation, and posterior translation. The three primary static stabilizers that are most crucial for surgical reconstruction are the lateral collateral ligament (LCL), the popliteus tendon (PLT), and the popliteofibular ligament (PFL).

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