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5. Sports Medicine MCQs

Practice Set 112 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 2221

Topic: 5. Sports Medicine
A 26-year-old athlete reports persistent anterolateral ankle pain after sustaining a severe sprain 6 months ago. MRI identifies a 12 mm x 10 mm osteochondral lesion of the anterolateral talar dome. The overlying cartilage is visually intact with no detachment. After a failed 3-month course of conservative management, which of the following is the most appropriate initial surgical intervention?
. Osteochondral autograft transfer (OATS) from the ipsilateral knee
. Autologous chondrocyte implantation (ACI)
. Arthroscopic bone marrow stimulation (microfracture)
. Open reduction and internal fixation of the fragment
. Primary tibiotalar arthrodesis

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

For primary osteochondral lesions of the talus (OLT) that are smaller than 1.5 cm² (150 mm²) and have failed conservative treatment, arthroscopic bone marrow stimulation (microfracture, drilling) is considered the gold standard initial surgical treatment. It promotes the filling of the defect with fibrocartilage (Type I collagen). Larger lesions (>1.5 cm²), or those that have failed primary marrow stimulation, may require OATS or ACI.

Question 2222

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, the surgeon inadvertently places the femoral tunnel too anteriorly (i.e., too 'shallow' or high in the notch on a lateral radiograph) on the lateral femoral condyle. Which of the following kinematic complications will reliably occur as a result of this error?

. The graft will be excessively tight in flexion and loose in extension.
. The graft will be excessively tight in extension and loose in flexion.
. The graft will chronically impinge on the posterior cruciate ligament (PCL).
. The graft will impinge on the roof of the intercondylar notch in full extension.
. The graft will remain isometric and fail to undergo any length changes during range of motion.

Correct Answer & Explanation

. The graft will be excessively tight in flexion and loose in extension.

Explanation

The anatomical femoral attachment of the ACL is posterior in the notch. Placing the femoral tunnel too anteriorly (too shallow) places it eccentric to the knee's center of rotation. As the knee flexes, the distance between this anteriorly misplaced femoral origin and the tibial insertion increases. Consequently, the graft becomes pathologically tight in flexion (limiting knee flexion or stressing the graft) and loose in extension, failing to control anterior translation near full extension.

Question 2223

Topic: 5. Sports Medicine
A 34-year-old male sustains a severe knee dislocation (Schenck KD III-M, involving ACL, PCL, and MCL) following a high-speed motorcycle crash. His limb is well-perfused, ABIs are 1.1, and compartment pressures are normal. Assuming no absolute contraindications, what is the most appropriate timing and approach for definitive surgical reconstruction?
. Immediate single-stage reconstruction of all injured ligaments within 24 hours.
. Staged reconstruction, addressing the cruciate ligaments at 2 weeks, followed by medial-sided structures at 3 months.
. Nonoperative management in a long leg cast for 6 weeks, followed by delayed isolated ACL reconstruction.
. Single-stage reconstruction of all torn ligaments at 2 to 3 weeks post-injury, once inflammation subsides and range of motion begins to improve.
. Primary direct repair of all ligaments at 6 weeks post-injury.

Correct Answer & Explanation

. Single-stage reconstruction of all torn ligaments at 2 to 3 weeks post-injury, once inflammation subsides and range of motion begins to improve.

Explanation

For multiligament multiligament knee injuries without vascular compromise or impending compartment syndrome, delayed single-stage reconstruction (at 2 to 3 weeks) is currently favored. This brief delay allows the acute inflammatory phase and soft tissue swelling to subside, the joint capsule to seal (preventing massive fluid extravasation during arthroscopy), and early range of motion to commence, which dramatically lowers the risk of severe arthrofibrosis compared to immediate surgery. Waiting beyond 3-4 weeks is not ideal due to tissue retraction and excessive scar tissue formation.

Question 2224

Topic: 5. Sports Medicine

A professional American football player presents with acute, severe pain at the first metatarsophalangeal (MTP) joint after a forced hyperextension injury of the hallux while being tackled. MRI reveals a complete tear of the plantar plate and capsuloligamentous complex with proximal retraction of the sesamoids. What is the grade of this injury, and what is the recommended management for this high-level athlete?

. Grade 1; rigid carbon-fiber orthosis
. Grade 2; taping and progressive weight-bearing
. Grade 3; surgical repair of the plantar plate
. Grade 3; nonoperative management with a walking boot
. Grade 1; intra-articular corticosteroid injection

Correct Answer & Explanation

. Grade 1; rigid carbon-fiber orthosis

Explanation

A 'turf toe' injury involves sprain or tear of the capsuloligamentous complex of the first MTP joint via forced hyperextension. A Grade 3 injury involves a complete tear of the plantar plate, typically demonstrating gross instability and proximal migration of the sesamoids on imaging. In a high-level competitive athlete, a Grade 3 injury with significant retraction and instability is generally an absolute indication for operative surgical repair to restore push-off strength and prevent chronic deformity.

Question 2225

Topic: 5. Sports Medicine

A 24-year-old track athlete complains of severe calf cramping, numbness, and paresthesias that reliably occur after 15 minutes of running and resolve rapidly after 10 minutes of rest. Resting and post-exertional compartment pressure testing is within normal limits. Her resting ankle-brachial index (ABI) is normal, but it drops significantly when she performs active, forceful plantarflexion. What is the most likely pathophysiological mechanism of her condition?

. Hypertrophy of the soleus muscle compressing the tibial nerve in the deep posterior compartment
. Elevated fascial compartment pressures compressing local microvasculature (Chronic Exertional Compartment Syndrome)
. An anomalous relationship between the popliteal artery and the medial head of the gastrocnemius
. Cystic adventitial disease of the popliteal artery
. Atherosclerotic occlusion of the superficial femoral artery

Correct Answer & Explanation

. Hypertrophy of the soleus muscle compressing the tibial nerve in the deep posterior compartment

Explanation

The clinical presentation is classic for popliteal artery entrapment syndrome (PAES). The key diagnostic finding that differentiates PAES from chronic exertional compartment syndrome (CECS) is the drop in the ankle-brachial index (ABI) or obliteration of distal pulses specifically during active plantarflexion (which tightens the gastrocnemius muscle). The most common anatomic variation causing this is an anomalous origin or course of the medial head of the gastrocnemius, which compresses the popliteal artery against the medial femoral condyle during contraction.

Question 2226

Topic: 5. Sports Medicine

A 26-year-old athlete undergoes posterior cruciate ligament (PCL) reconstruction. The surgeon aims to reconstruct the anterolateral (AL) bundle of the PCL. At what knee position is this specific bundle typically the tightest and evaluated for optimal tension during graft fixation?

. 0 degrees (full extension)
. 30 degrees of flexion
. 90 degrees of flexion
. 120 degrees of flexion
. External rotation at 30 degrees

Correct Answer & Explanation

. 0 degrees (full extension)

Explanation

The PCL consists of two main bundles: the anterolateral (AL) and posteromedial (PM). The AL bundle is larger and is tightest in flexion (around 90 degrees), whereas the PM bundle is tightest in extension.

Question 2227

Topic: Knee Sports

A 28-year-old male sustains a multiligamentous knee injury. On examination, a dial test is performed. There is 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of knee flexion, the external rotation is symmetric bilaterally. What injury pattern does this indicate?

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

Correct Answer & Explanation

. Isolated anterior cruciate ligament (ACL) tear

Explanation

An increase in external rotation of >10 degrees at 30 degrees of flexion, but not at 90 degrees, is classic for an isolated posterolateral corner (PLC) injury. If external rotation is increased at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 2228

Topic: Knee Sports

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

. The anteromedial (AM) bundle is tight in extension and provides rotational stability.
. The posterolateral (PL) bundle is tight in flexion and prevents anterior translation.
. The anteromedial (AM) bundle is tight in flexion and primarily controls anterior tibial translation.
. The posterolateral (PL) bundle is tight in flexion and primarily controls rotational stability.
. Both bundles are equally tight in mid-flexion and have no distinct biomechanical roles.

Correct Answer & Explanation

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

Explanation

The ACL has two main bundles: the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle tightens in flexion to resist anterior tibial translation, while the PL bundle tightens in extension to resist rotatory loads.

Question 2229

Topic: Knee Sports

A 12-year-old boy presents with vague knee pain and catching. Radiographs reveal an osteochondritis dissecans (OCD) lesion. What is the most common anatomical location for this lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central weight-bearing dome of the medial femoral condyle
. Trochlear groove
. Inferior pole of the patella

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for an osteochondritis dissecans (OCD) lesion in the knee is the lateral aspect of the medial femoral condyle, accounting for roughly 70-80% of cases.

Question 2230

Topic: 5. Sports Medicine

During arthroscopy for an acute anterior cruciate ligament (ACL) rupture, the surgeon evaluates the posterior horn of the medial meniscus. A longitudinal tear at the meniscocapsular junction is identified, which was not visible from the standard anterior portals until the arthroscope was advanced through the intercondylar notch. What is the specific term for this type of lesion?

. Bucket-handle tear
. Radial tear
. Root avulsion
. Ramp lesion
. Flap tear

Correct Answer & Explanation

. Ramp lesion

Explanation

A longitudinal tear of the peripheral meniscocapsular attachment of the posterior horn of the medial meniscus is known as a "ramp lesion." It is highly associated with ACL tears and is often missed if the posteromedial compartment is not evaluated via an intercondylar notch view or posteromedial portal.

Question 2231

Topic: Knee Sports

A 52-year-old female presents with acute medial knee pain after a deep squat. MRI reveals a complete posterior horn medial meniscus root tear with 4 mm of meniscal extrusion. Biomechanically, this injury is most equivalent to which of the following?

. Total meniscectomy
. Partial meniscectomy
. Anterior cruciate ligament tear
. Isolated medial collateral ligament sprain
. Medial compartment chondral defect

Correct Answer & Explanation

. Total meniscectomy

Explanation

A complete posterior horn medial meniscus root tear disrupts the hoop stresses of the meniscus. Biomechanically, this alters contact pressures to a degree equivalent to a total meniscectomy, leading to rapid chondrolysis.

Question 2232

Topic: Knee Sports

A 24-year-old football player sustains a contact knee injury. On examination, the dial test demonstrates 20 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side, but symmetric external rotation at 90 degrees of flexion. Which structure is most likely injured?

. Isolated posterior cruciate ligament
. Isolated posterolateral corner
. Combined PCL and posterolateral corner
. Isolated anterior cruciate ligament
. Combined ACL and medial collateral ligament

Correct Answer & Explanation

. Isolated posterolateral corner

Explanation

The dial test evaluates for posterolateral corner (PLC) and PCL injuries. Increased external rotation (>10 degrees) at 30 degrees of flexion only indicates an isolated PLC injury, whereas increased rotation at both 30 and 90 degrees indicates a combined PLC and PCL injury.

Question 2233

Topic: Knee Sports

A 24-year-old soccer player undergoes anterior cruciate ligament (ACL) reconstruction. Postoperatively, the patient complains of the knee 'giving way' when pivoting. Examination reveals a firm endpoint on the Lachman test but a positive pivot shift test. What is the most likely technical error made during the surgery?

. Femoral tunnel placed too anteriorly
. Femoral tunnel placed too vertically (high in the notch)
. Tibial tunnel placed too medially
. Tibial tunnel placed too anteriorly
. Inadequate graft tensioning

Correct Answer & Explanation

. Femoral tunnel placed too vertically (high in the notch)

Explanation

A vertically placed femoral tunnel in ACL reconstruction controls anterior-posterior translation (negative Lachman) but fails to adequately control rotational forces, resulting in a persistent pivot shift.

Question 2234

Topic: 5. Sports Medicine

A 52-year-old female experiences a sudden pop in the back of her knee while squatting. MRI demonstrates an extrusion of the medial meniscus by 4 mm and a radial tear at the posterior root attachment. What is the recommended surgical management to halt the progression of rapidly advancing osteoarthritis?

. Arthroscopic partial medial meniscectomy
. Nonoperative management with physical therapy
. Transtibial pull-out meniscal root repair
. Inside-out meniscal repair using non-absorbable sutures
. Osteochondral autograft transfer (OATS)

Correct Answer & Explanation

. Transtibial pull-out meniscal root repair

Explanation

Medial meniscus posterior root tears lead to a loss of hoop stresses and rapid articular degeneration. Transtibial pull-out repair or suture anchor repair anatomically restores the root, re-establishes hoop stresses, and prevents further meniscal extrusion.

Question 2235

Topic: Knee Sports

During a knee examination of a trauma patient, the dial test demonstrates 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. Which structure is injured?

. Isolated anterior cruciate ligament (ACL)
. Isolated posterolateral corner (PLC)
. Combined posterolateral corner (PLC) and posterior cruciate ligament (PCL)
. Isolated posterior cruciate ligament (PCL)
. Medial collateral ligament (MCL) and posterior oblique ligament (POL)

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

An asymmetric increase in external rotation at 30 degrees of flexion that corrects at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If the asymmetry persists or increases at 90 degrees, a combined PLC and PCL injury is present.

Question 2236

Topic: Knee Sports

A 14-year-old male presents with poorly localized knee pain and intermittent mechanical symptoms. Radiographs reveal an osteochondritis dissecans (OCD) lesion. What is the most common anatomical location for this lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central weight-bearing dome of the lateral femoral condyle
. Inferior pole of the patella
. Central trochlear groove

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for osteochondritis dissecans in the knee is the lateral aspect of the medial femoral condyle (often remembered by the mnemonic LAME: Lateral Aspect Medial Epicondyle/condyle).

Question 2237

Topic: 5. Sports Medicine

A professional football player suffers a severe hyperdorsiflexion injury to his great toe. MRI shows a complete tear of the plantar plate with proximal retraction of the sesamoids. What grade of 'Turf Toe' is this, and what is the primary indication for surgical intervention in this specific case?

. Grade 1; Surgery is indicated for rapid return to play
. Grade 2; Surgery is indicated if taping fails after 2 weeks
. Grade 3; Surgery is indicated due to frank instability and sesamoid retraction
. Grade 3; Non-operative management is always preferred first regardless of retraction
. Grade 4; Surgery is indicated due to associated metatarsal fracture

Correct Answer & Explanation

. Grade 3; Surgery is indicated due to frank instability and sesamoid retraction

Explanation

A complete tear of the plantar plate with sesamoid retraction represents a Grade 3 Turf Toe injury. Due to the significant loss of the push-off mechanism and frank instability, surgical repair of the plantar plate is generally indicated in high-level athletes.

Question 2238

Topic: Knee Sports

When performing an anterior cruciate ligament (ACL) reconstruction, placing the femoral tunnel using a traditional transtibial technique rather than an independent anteromedial portal technique most commonly results in a tunnel that is:

. Too anterior and too vertical
. Too posterior and too horizontal
. Too anterior and too horizontal
. Too posterior and too vertical
. Anatomically positioned in the footprint

Correct Answer & Explanation

. Too anterior and too vertical

Explanation

The traditional transtibial technique constrains the femoral tunnel trajectory based on the tibial tunnel, frequently resulting in a femoral tunnel that is placed too vertical and too anterior in the intercondylar notch, failing to control rotational instability.

Question 2239

Topic: 5. Sports Medicine

A 35-year-old recreational athlete sustains an acute Achilles tendon rupture. He elects for non-operative management utilizing an early functional rehabilitation protocol. Compared to operative management, this non-operative approach is most closely associated with:

. Higher rate of sural nerve injury
. Increased rate of deep vein thrombosis
. Decreased risk of wound complications with a similar re-rupture rate
. Significantly higher re-rupture rate
. Greater loss of plantarflexion strength

Correct Answer & Explanation

. Decreased risk of wound complications with a similar re-rupture rate

Explanation

Recent meta-analyses show that non-operative management with early functional rehabilitation yields a re-rupture rate similar to surgical repair, while avoiding the risks of surgical wound complications and nerve injury.

Question 2240

Topic: Knee Sports

The posterior cruciate ligament (PCL) consists of two main bundles. Which of the following best describes the biomechanical behavior of the anterolateral (AL) bundle?

. It is tight in extension and loose in flexion
. It is tight in flexion and loose in extension
. It is the primary restraint to valgus stress at 30 degrees
. It provides primary restraint to external rotation at 90 degrees
. It originates on the medial tibia and inserts on the lateral femur

Correct Answer & Explanation

. It is tight in flexion and loose in extension

Explanation

The PCL has a larger anterolateral (AL) bundle that is tight in flexion and loose in extension, and a smaller posteromedial (PM) bundle that is tight in extension and loose in flexion.

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