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5. Sports Medicine MCQs

Practice Set 126 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 2501

Topic: Knee Sports
A 28-year-old male suffers a high-energy knee dislocation. Vascular examination is normal with an Ankle-Brachial Index (ABI) of 1.1. Post-reduction MRI reveals complete rupture of the ACL, PCL, and posterolateral corner (PLC) structures. Which nerve is most commonly injured in this specific injury pattern, and what is its primary motor deficit?
. Tibial nerve; ankle plantarflexion
. Deep peroneal nerve; ankle plantarflexion
. Common peroneal nerve; ankle dorsiflexion and eversion
. Saphenous nerve; knee extension
. Femoral nerve; knee extension

Correct Answer & Explanation

. Common peroneal nerve; ankle dorsiflexion and eversion

Explanation

This injury pattern is a KD-IIIL (dislocation with ACL, PCL, and lateral-sided/PLC disruption). Due to the traction force on the lateral aspect of the knee, the common peroneal nerve is highly susceptible to stretch injury, resulting in a foot drop (loss of ankle dorsiflexion and eversion).

Question 2502

Topic: Knee Sports

During a single-bundle anterior cruciate ligament (ACL) reconstruction, if the surgeon inadvertently places the femoral tunnel too anteriorly (high in the notch at the 12 o'clock position) rather than in the anatomic footprint, what biomechanical consequence will the graft exhibit?

. Tight in flexion and loose in extension
. Loose in flexion and tight in extension
. Excessively tight in both flexion and extension
. Excessively loose in both flexion and extension
. Isotonic tension throughout the full range of motion

Correct Answer & Explanation

. Tight in flexion and loose in extension

Explanation

A non-anatomic femoral tunnel placed too anteriorly (high in the intercondylar notch) results in an ACL graft that becomes excessively tight in flexion, significantly limiting knee flexion, and becomes excessively loose in extension, failing to control anterior translation near extension.

Question 2503

Topic: Knee Sports

During an isolated posterior cruciate ligament (PCL) reconstruction using an anterolateral (AL) bundle single-bundle technique, at what knee flexion angle should the graft classically be tensioned to optimally restore its primary biomechanical function?

. 90 degrees of flexion
. Full extension (0 degrees)
. 30 degrees of flexion
. 120 degrees of flexion
. 45 degrees of flexion

Correct Answer & Explanation

. 90 degrees of flexion

Explanation

The native PCL consists of a larger anterolateral (AL) bundle and a smaller posteromedial (PM) bundle. The AL bundle is tightest in flexion and is the primary restraint to posterior tibial translation at 90 degrees. Therefore, single-bundle AL reconstructions are traditionally tensioned and fixed at 90 degrees of knee flexion.

Question 2504

Topic: Knee Sports

In anatomic reconstruction of the posterolateral corner (PLC) of the knee, precisely understanding the attachments to the fibular head is critical. Which of the following accurately describes the insertions of the fibular collateral ligament (FCL) and the popliteofibular ligament (PFL)?

. FCL inserts on the anterolateral aspect; PFL inserts on the posteromedial aspect of the fibular styloid
. FCL inserts on the posteromedial aspect; PFL inserts on the anterolateral aspect
. Both insert conjointly on the anterior aspect of the fibular head
. FCL inserts on the tip of the fibular styloid; PFL inserts on the lateral neck
. FCL inserts on the fibular neck; PFL inserts on the anterior crest

Correct Answer & Explanation

. FCL inserts on the anterolateral aspect; PFL inserts on the posteromedial aspect of the fibular styloid

Explanation

For anatomic PLC reconstruction (e.g., the LaPrade technique), the exact footprint locations are essential. The FCL (LCL) attaches to a depression on the anterolateral aspect of the proximal fibular head. The popliteofibular ligament (PFL) attaches at the posteromedial aspect of the fibular styloid tip.

Question 2505

Topic: Knee Sports

During an anatomic reconstruction of the posterolateral corner (PLC) of the knee, the surgeon is preparing the femoral tunnels for the popliteus tendon and the fibular collateral ligament (FCL). What is the anatomic relationship of the popliteus insertion relative to the FCL insertion on the lateral femoral epicondyle?

. Popliteus is proximal and posterior to the FCL
. Popliteus is distal and anterior to the FCL
. Popliteus is proximal and anterior to the FCL
. Popliteus is distal and posterior to the FCL
. Popliteus and FCL share a common footprint

Correct Answer & Explanation

. Popliteus is distal and anterior to the FCL

Explanation

On the lateral femoral epicondyle, the popliteus tendon inserts in the anterior fifth of the popliteal sulcus, which is located 18.5 mm distal and anterior to the insertion of the fibular collateral ligament (FCL).

Question 2506

Topic: 5. Sports Medicine
A 22-year-old male presents with persistent mechanical knee pain. MRI reveals a 4 cm² full-thickness osteochondral defect on the weight-bearing surface of the medial femoral condyle with an uncontained, loose fragment. He is very active and wishes to return to high-impact sports. Which of the following surgical interventions offers the most durable long-term outcome for this specific defect?
. Microfracture
. Osteochondral allograft transplantation
. Osteochondral autograft transfer (OATS)
. Debridement and marrow stimulation
. Autologous chondrocyte implantation (ACI)

Correct Answer & Explanation

. Osteochondral allograft transplantation

Explanation

For a large (>2-3 cm²), uncontained, full-thickness osteochondral defect (involving bone loss) in an active, skeletally mature patient, osteochondral allograft transplantation is the most appropriate treatment. It restores both the articular cartilage and the subchondral bone with mature, viable hyaline cartilage in a single stage.

Question 2507

Topic: 5. Sports Medicine

A 38-year-old male presents with a chronic, retracted patellar tendon rupture sustained 3 months ago. Primary repair is attempted but the tendon ends cannot be apposed without excessive tension, and the tissue is heavily degenerated. Which of the following is the most reliable reconstructive technique for restoring the extensor mechanism in this setting?

. Primary repair with transpatellar cerclage wire augmentation only
. V-Y quadricepsplasty followed by primary tendon repair
. Hamstring autograft (semitendinosus and gracilis) reconstruction woven through the patella
. Achilles tendon allograft with a calcaneal bone block fixed to the tibial tubercle
. Gastrocnemius rotational flap coverage

Correct Answer & Explanation

. Achilles tendon allograft with a calcaneal bone block fixed to the tibial tubercle

Explanation

Chronic, retracted patellar tendon ruptures present a significant challenge due to soft tissue contracture, quadriceps atrophy, and poor quality of the residual tendon. Primary repair frequently fails. The gold standard for reconstructing a massive defect or chronic retraction is an Achilles tendon allograft with a calcaneal bone block fixed into a trough in the tibial tubercle. The tendon is then woven through or sutured to the patella and quadriceps tendon.

Question 2508

Topic: Knee Sports

During reconstruction of the medial patellofemoral ligament (MPFL) for recurrent patellar instability, the surgeon inadvertently places the femoral tunnel 5 mm proximal and anterior to the anatomic footprint (Schottle point). What is the expected clinical consequence of this technical error?

. The graft will be tight in extension and loose in flexion
. The graft will be loose in extension and overly tight in flexion
. The graft will maintain isometric tension but the patella will subluxate laterally
. The patella will subluxate medially during terminal extension
. The risk of patella baja is significantly increased postoperatively

Correct Answer & Explanation

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

Explanation

A femoral tunnel placed proximal and anterior to the anatomic MPFL footprint results in non-isometric graft behavior. The graft will be relatively loose in extension and excessively tight in flexion, leading to restricted knee flexion and increased medial patellofemoral cartilage pressure.

Question 2509

Topic: Knee Sports

A 24-year-old athlete sustains a multi-ligament knee injury involving the posterolateral corner (PLC). Based on clinical biomechanics, which of the following structures acts as the primary restraint to varus stress when the knee is tested at 30 degrees of flexion?

. Popliteofibular ligament
. Lateral collateral ligament (LCL)
. Popliteus tendon
. Posterior cruciate ligament (PCL)
. Biceps femoris tendon

Correct Answer & Explanation

. Lateral collateral ligament (LCL)

Explanation

The lateral collateral ligament (LCL) is the primary restraint to varus stress at all angles of knee flexion. However, it is most accurately isolated and tested clinically at 30 degrees of flexion, where the cruciate ligaments are relatively relaxed.

Question 2510

Topic: Knee Sports

A 40-year-old female presents with isolated advanced lateral patellofemoral arthritis, a tibial tubercle-trochlear groove (TT-TG) distance of 22 mm, and patella alta (Caton-Deschamps index of 1.4). Which tibial tubercle osteotomy modification is most appropriate to optimize patellofemoral tracking and contact pressures?

. Anteromedialization (Fulkerson osteotomy)
. Straight anterior elevation (Maquet procedure)
. Medialization and distalization
. Lateralization and elevation
. Medialization and proximalization

Correct Answer & Explanation

. Medialization and distalization

Explanation

In the setting of lateral tracking (TT-TG > 20 mm) and patella alta (Caton-Deschamps > 1.2) with isolated patellofemoral arthritis, a medializing and distalizing tibial tubercle osteotomy is indicated. This combination corrects the lateral vector and normalizes patellar height, effectively unloading the lateral facet.

Question 2511

Topic: 5. Sports Medicine

A 72-year-old male sustains a complete patellar tendon rupture off the tibial tubercle 6 weeks following a primary total knee arthroplasty. Primary repair attempts have failed due to poor tissue quality. What is the most reliable reconstructive option that demonstrates the highest clinical success rate for extensor mechanism continuity?

. Hamstring autograft reconstruction
. Achilles tendon allograft reconstruction
. Synthetic mesh (e.g., Marlex) reconstruction
. Hinged knee brace locked in extension for 12 weeks
. Gastrocnemius rotational flap without tendon augmentation

Correct Answer & Explanation

. Synthetic mesh (e.g., Marlex) reconstruction

Explanation

Synthetic mesh (Marlex) reconstruction of the extensor mechanism has demonstrated superior long-term survivorship, lower complication rates, and more reliable functional outcomes compared to allograft reconstructions in the setting of chronic post-TKA disruption.

Question 2512

Topic: Knee Sports

During a medial opening-wedge high tibial osteotomy (HTO), the surgeon realizes the anterior gap is inadvertently opened wider than the posterior gap. What is the direct biomechanical consequence of this asymmetric opening?

. Decreased posterior tibial slope and increased extension deficit
. Increased posterior tibial slope and risk of anterior cruciate ligament (ACL) strain
. Decreased posterior tibial slope and risk of posterior cruciate ligament (PCL) strain
. Unaltered sagittal alignment but increased valgus overcorrection
. Increased patellar height leading to patella alta

Correct Answer & Explanation

. Increased posterior tibial slope and risk of anterior cruciate ligament (ACL) strain

Explanation

Opening the anterior aspect of a medial opening-wedge HTO more than the posterior aspect increases the posterior tibial slope. This shifts the resting position of the tibia anteriorly, placing increased strain on the anterior cruciate ligament (ACL).

Question 2513

Topic: 5. Sports Medicine

A 68-year-old patient presents with a chronic, complete patellar tendon rupture 2 years after a primary TKA. The patient is unable to perform a straight leg raise. What is the most reliable surgical option?

. Primary end-to-end tendon repair
. Reconstruction with synthetic mesh or an extensor mechanism allograft
. Revision to a posterior-stabilized (PS) TKA
. Cortical button repair with hamstring autograft
. Isolated tibial polyethylene insert exchange

Correct Answer & Explanation

. Reconstruction with synthetic mesh or an extensor mechanism allograft

Explanation

Direct primary repair of a chronic patellar tendon rupture post-TKA has an unacceptably high failure rate. Reconstruction utilizing synthetic mesh (e.g., Marlex) or a complete extensor mechanism allograft is the preferred treatment.

Question 2514

Topic: 5. Sports Medicine
A patient with no history of patellar instability sustains a traumatic lateral patellar dislocation. What structure most likely has been torn?
. Vastus medialis obliquus
. Medial patellofemoral ligament
. Medial patellotibial ligament
. Medial retinaculum
. Quadriceps tendon

Correct Answer & Explanation

. Medial patellofemoral ligament

Explanation

Any of the above structures may be involved in a lateral patellar dislocation. However, biomechanic studies have found that the medial patellofemoral ligament is the major soft-tissue static restraint of lateral patellar displacement, providing at least 50% of this function.

Question 2515

Topic: 5. Sports Medicine

Recent high-quality randomized controlled trials (e.g., Willits et al.) comparing operative to nonoperative treatment of acute Achilles tendon ruptures, when utilizing early weight-bearing and functional rehabilitation protocols in both groups, have demonstrated which of the following?

. Significantly lower re-rupture rates in the operative group
. Significantly higher plantar flexion strength in the operative group
. Higher rates of deep vein thrombosis in the nonoperative group
. No significant difference in re-rupture rates or functional outcomes
. Faster return to professional sports in the nonoperative group

Correct Answer & Explanation

. No significant difference in re-rupture rates or functional outcomes

Explanation

Historically, nonoperative treatment using prolonged cast immobilization was associated with higher re-rupture rates. However, modern high-quality RCTs have shown that when accelerated functional rehabilitation (early weight-bearing and early ROM) is employed in both groups, there is no significant difference in re-rupture rates, range of motion, or functional outcomes between operative and nonoperative management, though surgery carries a risk of wound complications.

Question 2516

Topic: Shoulder & Hip Sports

A 24-year-old male hockey player presents with insidious onset groin pain exacerbated by hip flexion and internal rotation. Radiographs reveal a pistol grip deformity of the proximal femur and an alpha angle of 75 degrees. Which of the following intra-articular pathologies is most commonly associated with this specific type of femoroacetabular impingement (FAI)?

. Avulsion of the ligamentum teres
. Circumferential crushing of the acetabular labrum
. Chondral delamination at the anterosuperior acetabulum
. Global retroversion of the acetabulum
. Ossification of the reflected head of the rectus femoris

Correct Answer & Explanation

. Chondral delamination at the anterosuperior acetabulum

Explanation

The clinical picture describes Cam-type FAI (pistol grip deformity, high alpha angle). Cam impingement generates shear forces at the chondrolabral junction of the anterosuperior acetabulum, classically causing inside-out chondral delamination while leaving the labrum relatively intact initially. In contrast, Pincer FAI (e.g., global retroversion) typically causes direct, often circumferential crushing and degeneration of the labrum.

Question 2517

Topic: 5. Sports Medicine

A 35-year-old recreational athlete sustains an acute mid-substance Achilles tendon rupture. He inquires about the differences between operative and non-operative treatment. Based on recent high-level evidence utilizing early functional rehabilitation protocols, which of the following is true?

. Operative management significantly reduces the re-rupture rate compared to functional non-operative management.
. Non-operative management with a functional bracing protocol has a similar re-rupture rate to operative management, with fewer soft-tissue complications.
. Non-operative treatment results in a 30% decrease in plantar flexion strength compared to operative treatment at 1 year.
. Operative treatment allows for an earlier return to full weight-bearing than functional bracing protocols.
. The use of functional rehabilitation has increased the rate of deep vein thrombosis in non-operative patients.

Correct Answer & Explanation

. Non-operative management with a functional bracing protocol has a similar re-rupture rate to operative management, with fewer soft-tissue complications.

Explanation

Recent high-level randomized controlled trials (e.g., Willits et al.) have demonstrated that when an early functional rehabilitation protocol (early weight-bearing and active range of motion in a brace) is employed, non-operative management of acute Achilles tendon ruptures yields a re-rupture rate similar to operative management. Non-operative management also avoids surgical complications such as infection and sural nerve injury.

Question 2518

Topic: Shoulder & Hip Sports

A 25-year-old male hockey player presents with chronic anterior groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate a lateral center edge angle (LCEA) of 30 degrees and an alpha angle of 75 degrees. Which morphological abnormality is most likely responsible for his symptoms?

. Pincer impingement secondary to acetabular retroversion
. Cam impingement secondary to decreased anterior femoral head-neck offset
. Pincer impingement secondary to coxa profunda
. Subspine impingement secondary to an AIIS osteophyte
. Ischiofemoral impingement

Correct Answer & Explanation

. Cam impingement secondary to decreased anterior femoral head-neck offset

Explanation

An alpha angle greater than 50-55 degrees on a lateral or Dunn view radiograph is diagnostic of Cam morphology, which represents an aspherical femoral head with decreased head-neck offset (typically anterosuperiorly). This leads to cam-type femoroacetabular impingement (FAI). His LCEA of 30 degrees is normal (25-39 degrees), making pincer impingement (overcoverage) less likely.

Question 2519

Topic: Shoulder & Hip Sports

A 45-year-old female presents with insidious onset groin pain. Radiographs reveal a 'cross-over sign' and an alpha angle of 45 degrees. These findings are most characteristic of which of the following?

. Cam-type femoroacetabular impingement
. Pincer-type femoroacetabular impingement
. Developmental dysplasia of the hip
. Legg-Calve-Perthes disease
. Slipped capital femoral epiphysis

Correct Answer & Explanation

. Pincer-type femoroacetabular impingement

Explanation

The 'cross-over sign' on an AP pelvis radiograph indicates acetabular retroversion or focal anterior overcoverage, which is the hallmark of Pincer-type femoroacetabular impingement (FAI). An alpha angle of 45 degrees is within normal limits (typically < 50-55 degrees), making a Cam lesion (femoral-sided abnormality) less likely.

Question 2520

Topic: Shoulder & Hip Sports

In a patient with cam-type femoroacetabular impingement (FAI), where is the primary site of articular cartilage damage most commonly located?

. Anterosuperior acetabulum
. Posteroinferior acetabulum
. Medial femoral head
. Fovea capitis
. Posterior femoral neck

Correct Answer & Explanation

. Anterosuperior acetabulum

Explanation

Cam-type FAI is caused by an aspherical femoral head (often with a decreased head-neck offset or increased alpha angle). During hip flexion and internal rotation, this prominent cam lesion engages the acetabulum, causing shear forces. The resulting chondral damage typically occurs at the anterosuperior aspect of the acetabulum, frequently causing cartilage delamination at the chondrolabral junction.

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