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5. Sports Medicine MCQs

Practice Set 149 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 2961

Topic: Knee Sports

The femoral footprint of the anterolateral (AL) bundle of the posterior cruciate ligament (PCL) is anatomically located in which area of the intercondylar notch?

. Shallow (anterior) on the lateral aspect of the medial femoral condyle
. Deep (posterior) on the lateral aspect of the medial femoral condyle
. Shallow (anterior) on the medial aspect of the lateral femoral condyle
. Deep (posterior) on the medial aspect of the lateral femoral condyle
. Directly at the apex (roof) of the intercondylar notch

Correct Answer & Explanation

. Shallow (anterior) on the lateral aspect of the medial femoral condyle

Explanation

The PCL originates on the lateral aspect of the medial femoral condyle. Its anterolateral (AL) bundle is located shallower (more anteriorly toward the articular cartilage edge) and higher (more proximally/superiorly), whereas the posteromedial (PM) bundle is located deeper (more posteriorly) and inferiorly.

Question 2962

Topic: Knee Sports

A 24-year-old rugby player sustains a twisting knee injury. On physical examination, the 'dial test' reveals 15 degrees of increased external rotation of the tibia at 30 degrees of knee flexion compared to the uninjured side. However, at 90 degrees of knee flexion, the external rotation is symmetric bilaterally. What is the most likely diagnosis?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) tear

Explanation

The dial test assesses external rotation of the tibia on the femur. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion but not at 90 degrees indicates an isolated injury to the posterolateral corner (PLC). If increased external rotation is present at both 30 degrees and 90 degrees of flexion, it indicates a combined injury to both the PLC and the posterior cruciate ligament (PCL).

Question 2963

Topic: Knee Sports

When comparing the independent anteromedial (AM) portal technique to the traditional transtibial technique for femoral tunnel drilling in anterior cruciate ligament (ACL) reconstruction, the AM portal technique typically results in a femoral tunnel that is:

. More vertical and higher in the femoral notch
. More horizontal and closer to the anatomic footprint
. Identical in position but with a shorter tunnel length
. Anterior to the resident's ridge
. Associated with a higher risk of PCL impingement

Correct Answer & Explanation

. More horizontal and closer to the anatomic footprint

Explanation

The independent anteromedial (AM) portal technique allows the surgeon to place the femoral tunnel independent of the tibial tunnel's trajectory. This typically results in a more horizontal femoral tunnel that is positioned lower in the notch, which better replicates the anatomic footprint of the native ACL. The transtibial technique often forces a more vertical, non-anatomic 'high noon' placement.

Question 2964

Topic: Knee Sports

The medial patellofemoral ligament (MPFL) provides the primary soft tissue restraint against lateral patellar translation. At what degree of knee flexion does the MPFL contribute the greatest percentage of restraining force?

. 0 to 30 degrees
. 30 to 60 degrees
. 60 to 90 degrees
. 90 to 120 degrees
. Greater than 120 degrees

Correct Answer & Explanation

. 0 to 30 degrees

Explanation

The MPFL provides approximately 50-60% of the restraint to lateral patellar displacement in the first 0 to 30 degrees of knee flexion. Beyond 30 degrees of flexion, the patella typically engages the trochlear groove, and bony architecture (the lateral trochlear facet) becomes the primary stabilizer against lateral translation. Therefore, MPFL insufficiency is most clinically evident in early flexion/extension.

Question 2965

Topic: Knee Sports
A 55-year-old female experiences sudden posteromedial knee pain while deeply squatting. MRI confirms a posterior root tear of the medial meniscus. From a biomechanical perspective, the loss of hoop stress transmission in this condition most closely replicates the tibiofemoral contact mechanics of which of the following?
. Anterior cruciate ligament rupture
. Complete radial tear of the anterior horn
. Total medial meniscectomy
. Isolated grade III medial collateral ligament tear
. Focal grade III chondral defect

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

The meniscal roots are essential for anchoring the meniscus and converting axial tibiofemoral compressive loads into circumferential 'hoop stresses.' A complete tear or avulsion of the posterior meniscal root completely disrupts this mechanism, allowing the meniscus to extrude radially. Biomechanical studies have demonstrated that a medial meniscal root tear alters joint contact areas and peak pressures to a degree equivalent to a total medial meniscectomy, leading to rapid compartmental osteoarthritis if left untreated.

Question 2966

Topic: 5. Sports Medicine
A 25-year-old overhead throwing athlete undergoes shoulder arthroscopy. A superior labral tear is identified where the superior labrum and biceps anchor are completely detached from the superior glenoid. According to the Snyder classification, what type of SLAP tear is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

Type I: fraying of the superior labrum but intact biceps anchor. Type II: detachment of the superior labrum and biceps anchor from the superior glenoid. Type III: bucket-handle tear of the superior labrum with an intact biceps anchor. Type IV: bucket-handle tear of the superior labrum extending into the biceps tendon.

Question 2967

Topic: 5. Sports Medicine

In the basic science of anterior cruciate ligament (ACL) reconstruction using an autograft, the term 'ligamentization' refers to the biological remodeling of the graft. During which postoperative timeframe is the graft typically at its weakest mechanically?

. 0 to 2 weeks
. 4 to 6 months
. 6 to 12 weeks
. 8 to 10 months
. 12 to 14 months

Correct Answer & Explanation

. 6 to 12 weeks

Explanation

The ligamentization process involves early necrosis, revascularization, cellular repopulation, and remodeling. The graft undergoes a phase of necrosis and cellular infiltration between 6 and 12 weeks, during which it is structurally and mechanically at its weakest.

Question 2968

Topic: 5. Sports Medicine

A 24-year-old professional football player undergoes ACL reconstruction using a bone-patellar tendon-bone (BTB) autograft. Compared to a hamstring autograft, the BTB autograft is statistically associated with a higher incidence of which of the following postoperative complications?

. Graft rupture within the first 2 years
. Deep vein thrombosis
. Anterior knee pain
. Deep infection
. Hardware failure

Correct Answer & Explanation

. Anterior knee pain

Explanation

Bone-patellar tendon-bone (BTB) autografts are associated with a higher incidence of donor-site morbidity, specifically anterior knee pain and pain with kneeling, when compared to hamstring autografts. Infection, DVT, and hardware failure rates are similar.

Question 2969

Topic: Shoulder & Hip Sports

During an arthroscopic anterior stabilization (Bankart repair) for recurrent shoulder instability, a 'remplissage' procedure is added. This procedure involves tenodesis of which structure into a Hill-Sachs lesion?

. Long head of the biceps tendon
. Subscapularis tendon
. Infraspinatus tendon and posterior capsule
. Supraspinatus tendon
. Middle glenohumeral ligament

Correct Answer & Explanation

. Infraspinatus tendon and posterior capsule

Explanation

Remplissage (French for 'to fill in') is used to address large, engaging Hill-Sachs lesions. It involves capsulotenodesis of the posterior capsule and infraspinatus tendon into the humeral head defect, rendering it extra-articular and preventing it from engaging the anterior glenoid rim.

Question 2970

Topic: Knee Sports

When performing an anterior cruciate ligament (ACL) reconstruction, placing the femoral tunnel too far anteriorly (shallow) in the intercondylar notch will result in which of the following biomechanical consequences?

. The graft will be tight in extension and loose in flexion
. The graft will be tight in flexion and loose in extension
. The graft will be tight in both flexion and extension
. The graft will impinge on the PCL
. The graft will fail to control varus-valgus laxity

Correct Answer & Explanation

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

Explanation

Placing the femoral tunnel too anteriorly (shallow) is a common technical error in ACL reconstruction. This results in the graft being loose in extension and becoming excessively tight as the knee moves into flexion, often leading to limited knee flexion or graft rupture. Conversely, placing the tunnel too vertically fails to control rotational stability.

Question 2971

Topic: 5. Sports Medicine

A 22-year-old athlete sustains an acute tear of the medial meniscus. The tear is located in the peripheral 3 mm of the meniscus (the red-red zone). Which blood vessels provide the primary vascular supply to this region, making it amenable to surgical repair?

. Anterior and posterior tibial recurrent arteries
. Branches of the medial and lateral inferior and superior genicular arteries
. Middle genicular artery exclusively
. Sural arteries and their terminal branches
. Descending genicular artery

Correct Answer & Explanation

. Branches of the medial and lateral inferior and superior genicular arteries

Explanation

The blood supply to the menisci originates predominantly from a perimeniscal capillary plexus supplied by the superior and inferior branches of the medial and lateral genicular arteries. (The middle genicular artery supplies the vascularity to the meniscal horns). This plexus supplies the peripheral 10% to 30% of the menisci (the red-red zone), providing a good healing potential for repairs.

Question 2972

Topic: Shoulder & Hip Sports

A 22-year-old rugby player has recurrent anterior shoulder instability. A 3D CT scan reveals a 25% anterior glenoid bone loss along with a large, engaging Hill-Sachs lesion. What is the most appropriate surgical treatment to effectively restore stability and prevent future dislocations?

. Arthroscopic Bankart repair with remplissage
. Arthroscopic Bankart repair alone
. Latarjet procedure
. Putti-Platt procedure
. Arthroscopic capsular plication

Correct Answer & Explanation

. Latarjet procedure

Explanation

In the setting of significant anterior glenoid bone loss (>20-25%), soft tissue stabilization (Bankart repair) alone has an unacceptably high failure rate. Bony augmentation, such as the Latarjet procedure (coracoid transfer), is the standard of care. It restores the anterior glenoid arc and provides dynamic stability via the 'sling effect' of the conjoint tendon. Remplissage can address an engaging Hill-Sachs lesion but does not replace missing glenoid bone.

Question 2973

Topic: 5. Sports Medicine

A 25-year-old soccer player sustains a knee injury. Clinical examination reveals a positive posterior sag sign and a positive posterior drawer test. The tibia subluxates posteriorly at rest but reduces with an anterior drawer maneuver. Which of the following mechanisms of injury is most classically associated with this specific ligamentous injury?

. Non-contact pivoting with a firmly planted foot
. A direct blow to the anterior proximal tibia while the knee is flexed
. Hyperextension with sudden internal rotation
. Valgus stress applied to a partially flexed knee
. Varus stress applied to a fully extended knee

Correct Answer & Explanation

. A direct blow to the anterior proximal tibia while the knee is flexed

Explanation

The patient's physical exam findings (posterior sag, positive posterior drawer) are diagnostic of a posterior cruciate ligament (PCL) injury. The classic mechanism of injury for a PCL tear is a direct, high-energy blow to the anterior aspect of the proximal tibia with the knee in a flexed position. This drives the tibia posteriorly, rupturing the PCL. This is frequently seen in dashboard injuries during motor vehicle accidents or falling onto a flexed knee in sports.

Question 2974

Topic: 5. Sports Medicine

In comparing bone-patellar tendon-bone (BTB) autograft to hamstring autograft for primary Anterior Cruciate Ligament (ACL) reconstruction, which of the following is a statistically higher risk specifically associated with the BTB graft?

. Higher risk of graft rupture in the first 2 years
. Higher incidence of deep intra-articular infection
. Increased residual laxity on pivot-shift testing
. Higher incidence of anterior knee pain and kneeling pain
. Slower rate of graft incorporation in the bony tunnels

Correct Answer & Explanation

. Higher incidence of anterior knee pain and kneeling pain

Explanation

Bone-patellar tendon-bone (BTB) autografts are historically known for excellent bony incorporation and stability but carry a well-documented, statistically significant higher risk of harvest-site morbidity, specifically anterior knee pain and discomfort while kneeling, compared to hamstring autografts.

Question 2975

Topic: Knee Sports

Which of the following biological or surgical factors provides the best prognosis for the successful healing of an isolated meniscal repair?

. Patient age over 40 years
. Complex, multi-planar tear pattern
. Tear location strictly within the avascular white-white zone
. Concomitant anterior cruciate ligament (ACL) reconstruction
. Delayed repair performed more than 6 months post-injury

Correct Answer & Explanation

. Concomitant anterior cruciate ligament (ACL) reconstruction

Explanation

Meniscal repair performed concurrently with ACL reconstruction has a higher healing rate than isolated meniscal repair. This is attributed to the intra-articular bleeding and marrow elements (containing stem cells and growth factors) released during the creation of the femoral and tibial tunnels, which biologically augment the meniscal healing environment.

Question 2976

Topic: 5. Sports Medicine

A 16-year-old high school female soccer player undergoes primary anterior cruciate ligament (ACL) reconstruction. Which of the following graft choices carries the highest risk of post-operative graft rupture in this specific demographic?

. Bone-patellar tendon-bone autograft
. Quadrupled hamstring autograft
. Quadriceps tendon autograft
. Tibialis anterior allograft
. Contralateral hamstring autograft

Correct Answer & Explanation

. Tibialis anterior allograft

Explanation

Numerous studies and registries have demonstrated that the use of allograft tissue in young, highly active patients (typically < 25 years old) has a significantly higher failure rate (up to 3-4 times higher) compared to autograft tissue.

Question 2977

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction, the femoral tunnel must be placed accurately to ensure isometry. The Schöttle point is a radiographic landmark for this attachment. Which of the following accurately describes its location on a true lateral radiograph?
. Anterior to the posterior cortex line, distal to the Blumensaat line
. Anterior to the posterior cortex line, proximal to the Blumensaat line
. Anterior to the posterior cortex line, at the intersection of Blumensaat line
. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle
. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior border of Blumensaat line

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior border of Blumensaat line

Explanation

The Schöttle point is a reliable radiographic landmark for the femoral origin of the MPFL. It is located 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior border of Blumensaat line, and proximal to the posterior origin of the medial femoral condyle.

Question 2978

Topic: Shoulder & Hip Sports

During physical examination for shoulder pain, a patient has a positive 'bear hug' test and a positive 'belly press' test, but a negative 'lift-off' test. This combination of clinical findings most strongly suggests a tear involving which portion of the subscapularis tendon?

. The entire footprint
. The superior one-third
. The inferior one-third
. The musculotendinous junction
. The lesser tuberosity avulsion

Correct Answer & Explanation

. The superior one-third

Explanation

The 'bear hug' and 'belly press' tests are highly sensitive for upper (superior) subscapularis tears. The 'lift-off' test primarily isolates the inferior portion of the subscapularis. A positive belly press and negative lift-off typically indicate a partial tear involving the superior subscapularis tendon.

Question 2979

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. In full knee extension, what is the relative tension and orientation of the anteromedial (AM) and posterolateral (PL) bundles?

. Both bundles are lax
. AM bundle is tight, PL bundle is lax
. PL bundle is tight, AM bundle is moderately lax
. Both bundles cross each other tightly
. AM bundle is tight, PL bundle is tight

Correct Answer & Explanation

. PL bundle is tight, AM bundle is moderately lax

Explanation

The ACL consists of the AM and PL bundles. In full extension, the posterolateral (PL) bundle is tight and provides essential rotational stability, while the anteromedial (AM) bundle is relatively lax. In flexion, the AM bundle tightens to control anterior translation, and the PL bundle becomes lax.

Question 2980

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, the femoral tunnel is inadvertently placed too anteriorly (shallow) in the intercondylar notch. What is the expected biomechanical consequence on the graft during knee range of motion?

. The graft will be tight in extension and lax in flexion
. The graft will be tight in flexion and lax in extension
. The graft will experience excessive rotational instability only
. The graft will impinge against the PCL
. The graft will undergo immediate failure due to stretching in extension

Correct Answer & Explanation

. The graft will be tight in flexion and lax in extension

Explanation

A femoral tunnel placed too anteriorly (shallow, non-isometric) results in the distance between the tibial and femoral tunnels increasing as the knee flexes. Consequently, the graft becomes inappropriately tight in flexion (causing loss of flexion/capture) and lax in extension (resulting in an extension lag or instability).

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