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Question 3221

Topic: Knee Sports

During an anatomic posterolateral corner reconstruction of the knee, the surgeon identifies the normal femoral attachment of the fibular collateral ligament (FCL). Where is this specific attachment located relative to the lateral epicondyle?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly on the lateral epicondyle

Correct Answer & Explanation

. Proximal and posterior


Explanation

The femoral footprint of the fibular collateral ligament is located proximal and posterior to the lateral epicondyle. In contrast, the popliteus tendon inserts proximal and anterior to the lateral epicondyle.

Question 3222

Topic: Shoulder & Hip Sports

A 50-year-old woman undergoes arthroscopic shoulder stabilization for recurrent instability. The surgeon carefully evaluates and addresses pathology within the rotator interval. Which of the following structures is considered a standard normal content of the rotator interval?

. Supraspinatus tendon (inferior border)
. Subscapularis tendon (superior border)
. Coracohumeral ligament (content)
. Middle glenohumeral ligament (superior border)
. Infraspinatus tendon (posterior border)

Correct Answer & Explanation

. Subscapularis tendon (superior border)


Explanation

The rotator interval is bordered superiorly by the supraspinatus and inferiorly by the subscapularis. Its contents classically include the long head of the biceps tendon, the coracohumeral ligament, and the superior glenohumeral ligament.

Question 3223

Topic: Shoulder & Hip Sports

During a surgical dislocation of the hip for femoroacetabular impingement, the surgeon must preserve the primary blood supply to the adult femoral head. Which of the following vessels is the most critical to protect?

. Ascending branch of the medial femoral circumflex artery
. Deep branch of the medial femoral circumflex artery
. Descending branch of the lateral femoral circumflex artery
. Artery of the ligamentum teres
. Inferior gluteal artery

Correct Answer & Explanation

. Deep branch of the medial femoral circumflex artery


Explanation

The deep branch of the medial femoral circumflex artery (MFCA) is the primary blood supply to the adult femoral head. It courses posterior to the obturator externus and anterior to the short external rotators.

Question 3224

Topic: Knee Sports

The anteromedial (AM) bundle of the anterior cruciate ligament (ACL) is tightest in which of the following positions, and what is its primary function?

. Tightest in flexion and controls anterior tibial translation
. Tightest in extension and controls anterior tibial translation
. Tightest in flexion and controls rotational stability
. Tightest in extension and controls rotational stability
. Tightest in mid-flexion and controls valgus laxity

Correct Answer & Explanation

. Tightest in flexion and controls anterior tibial translation


Explanation

The AM bundle of the ACL is tightest in knee flexion and primarily restrains anterior tibial translation. The posterolateral (PL) bundle is tightest in extension and provides rotational stability.

Question 3225

Topic: Shoulder & Hip Sports

A professional volleyball player presents with isolated atrophy and weakness of the infraspinatus muscle, with normal supraspinatus strength and bulk. Where is the most likely site of nerve compression?

. Suprascapular notch
. Spinoglenoid notch
. Quadrangular space
. Triangular space
. Coracoid process

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus muscle. Compression more proximally at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 3226

Topic: Knee Sports

A 24-year-old football player sustains a direct blow to the anteromedial aspect of his knee, resulting in a posterolateral corner (PLC) injury. Which of the following structures is considered one of the three primary static stabilizers of the PLC?

. Biceps femoris tendon
. Iliotibial band
. Popliteus tendon
. Lateral gastrocnemius tendon
. Arcuate ligament

Correct Answer & Explanation

. Popliteus tendon


Explanation

The three primary static stabilizers of the posterolateral corner (PLC) are the lateral collateral ligament (LCL), the popliteus tendon, and the popliteofibular ligament. The biceps femoris provides dynamic stability but is not a primary static stabilizer.

Question 3227

Topic: Shoulder & Hip Sports

A patient presents with isolated weakness of the infraspinatus muscle but normal supraspinatus strength. The suprascapular nerve is most likely compressed at which of the following anatomic locations?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Coracohumeral ligament

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

The suprascapular nerve innervates the supraspinatus muscle before passing through the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch bypasses the supraspinatus branch, resulting in isolated infraspinatus weakness.

Question 3228

Topic: Knee Sports

A 24-year-old athlete sustains a knee injury resulting in increased external tibial rotation at both 30 and 90 degrees of knee flexion. Which of the following anatomical structures are most likely completely ruptured?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Popliteus tendon
. Fibular collateral ligament
. Posterior cruciate ligament and posterolateral corner structures

Correct Answer & Explanation

. Posterior cruciate ligament and posterolateral corner structures


Explanation

Isolated posterolateral corner (PLC) injuries typically present with increased external rotation at 30 degrees of flexion but normal rotation at 90 degrees. Increased external rotation at both 30 and 90 degrees of flexion indicates a combined PCL and PLC injury.

Question 3229

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. In full knee extension, what is the anatomical status of the anteromedial (AM) bundle compared to the posterolateral (PL) bundle?

. The AM bundle is taut and the PL bundle is lax
. The AM bundle is relatively lax and the PL bundle is taut
. Both bundles are equally lax
. Both bundles are completely taut
. The AM bundle crosses anterior to the PL bundle

Correct Answer & Explanation

. The AM bundle is relatively lax and the PL bundle is taut


Explanation

The ACL consists of the anteromedial (AM) and posterolateral (PL) bundles. In full knee extension, the PL bundle is taut and the AM bundle is relatively lax, providing crucial rotational stability.

Question 3230

Topic: Shoulder & Hip Sports

A pitcher complains of right shoulder pain and weakness with overhead activities. Examination reveals isolated wasting of the supraspinatus and infraspinatus. Entrapment of the affected nerve is most likely to occur at which of the following anatomical sites?

. Quadrangular space
. Spinoglenoid notch
. Suprascapular notch
. Scalene triangle
. Spiral groove

Correct Answer & Explanation

. Suprascapular notch


Explanation

The suprascapular nerve innervates both the supraspinatus and infraspinatus muscles. Entrapment at the suprascapular notch affects both muscles, whereas entrapment further distal at the spinoglenoid notch typically causes isolated infraspinatus weakness.

Question 3231

Topic: Shoulder & Hip Sports

A surgeon is performing an open anterior shoulder stabilization and identifies the rotator interval. Which of the following structures is NOT considered a normal anatomical border or content of the rotator interval?

. Coracohumeral ligament
. Superior glenohumeral ligament
. Long head of the biceps tendon
. Subscapularis tendon
. Coracoacromial ligament

Correct Answer & Explanation

. Coracohumeral ligament


Explanation

The rotator interval is a triangular space bordered by the supraspinatus superiorly, subscapularis inferiorly, and the coracoid process medially. Its contents include the coracohumeral ligament, superior glenohumeral ligament, and the long head of the biceps tendon.

Question 3232

Topic: 5. Sports Medicine

During knee arthroscopy, the surgeon visualizes a ligamentous structure originating from the posterior horn of the lateral meniscus and inserting into the lateral aspect of the medial femoral condyle, passing anterior to the PCL. What is this structure?

. Ligament of Wrisberg
. Ligament of Humphrey
. Arcuate ligament
. Oblique popliteal ligament
. Coronary ligament

Correct Answer & Explanation

. Ligament of Humphrey


Explanation

The meniscofemoral ligament of Humphrey passes anterior to the posterior cruciate ligament (PCL). The ligament of Wrisberg passes posterior to the PCL, but both originate from the posterior horn of the lateral meniscus.

Question 3233

Topic: Shoulder & Hip Sports

Figure 28 shows an arthroscopic view of a right shoulder in the lateral position through a posterior portal. What is the area between structure B (biceps) and SS (subscapularis tendon)?

. Inferior glenohumeral ligament
. Superior glenohumeral ligament
. Rotator cuff interval
. Subscapularis recess
. Interior recess

Correct Answer & Explanation

. Rotator cuff interval


Explanation

The rotator cuff interval is located between the supraspinatus and subscapularis and the biceps tendon is deep to the interval. It is a triangular area where the base is the coracoid process and the apex is the transverse humeral ligament at the biceps sulcus. Closure or tightening of this area is often helpful in patients with shoulder instability. Conversely, this area is often contracted in patients with adhesive capsulitis and may need to be released. Selecky MT, Tibone JE, Yang BY, et al: Glenohumeral joint translation after arthroscopic thermal capsuloplasty of the rotator interval. J Shoulder Elbow Surg 2003;12:139-143.

Question 3234

Topic: Knee Sports

In reconstruction of the posterolateral corner of the knee, understanding the popliteus anatomy is crucial. Where does the popliteus tendon insert on the femur relative to the lateral collateral ligament (LCL) femoral attachment?

. Anterior and proximal
. Anterior and distal
. Posterior and proximal
. Posterior and distal
. Directly medial

Correct Answer & Explanation

. Anterior and distal


Explanation

The popliteus tendon inserts into the popliteal sulcus of the lateral femoral condyle. This footprint is located anterior and distal to the femoral attachment of the LCL.

Question 3235

Topic: Knee Sports

The posterolateral corner (PLC) of the knee is a complex arrangement of static and dynamic stabilizers. Which of the following structures is considered a primary static stabilizer of the PLC?

. Popliteus muscle
. Biceps femoris tendon
. Popliteofibular ligament
. Iliotibial band
. Plantaris tendon

Correct Answer & Explanation

. Popliteofibular ligament


Explanation

The primary static stabilizers of the posterolateral corner of the knee include the lateral collateral ligament (LCL), the popliteofibular ligament, and the popliteus tendon. The biceps femoris and popliteus muscle belly act as dynamic stabilizers.

Question 3236

Topic: Knee Sports

The popliteofibular ligament is a crucial static stabilizer of the posterolateral corner of the knee. It originates from the popliteus musculotendinous junction and inserts on the:

. Lateral femoral epicondyle
. Gerdy's tubercle
. Anterior aspect of the fibular head
. Posteromedial aspect of the fibular styloid
. Lateral tibial plateau

Correct Answer & Explanation

. Posteromedial aspect of the fibular styloid


Explanation

The popliteofibular ligament arises from the popliteus tendon and inserts onto the posteromedial aspect of the fibular styloid process. It plays a key role in resisting posterior translation, varus angulation, and external rotation.

Question 3237

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with painless weakness of shoulder external rotation. Atrophy is noted in the infraspinatus fossa, while the supraspinatus fossa is normal. Where is the most likely site of nerve compression?

. Suprascapular notch
. Spinoglenoid notch
. Quadrangular space
. Triangular interval
. Coracoid process

Correct Answer & Explanation

. Spinoglenoid notch


Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus muscle, leading to isolated external rotation weakness. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 3238

Topic: Knee Sports

A 22-year-old football player sustains a complete rupture of the anterior cruciate ligament (ACL). The femoral footprint of the anteromedial (AM) bundle of the ACL is best described as being located:

. High and deep on the medial wall of the lateral femoral condyle
. Low and shallow on the medial wall of the lateral femoral condyle
. High and deep on the lateral wall of the medial femoral condyle
. Low and shallow on the lateral wall of the medial femoral condyle
. Centrally on the intercondylar notch roof

Correct Answer & Explanation

. High and deep on the medial wall of the lateral femoral condyle


Explanation

The AM bundle of the ACL originates high and deep (proximal and posterior) on the medial aspect of the lateral femoral condyle. It is tight in flexion.

Question 3239

Topic: Shoulder & Hip Sports

The rotator interval of the shoulder is a triangular anatomical space. What structures form its superior and inferior borders?

. Supraspinatus and subscapularis
. Infraspinatus and teres minor
. Subscapularis and infraspinatus
. Coracohumeral ligament and superior glenohumeral ligament
. Long head of the biceps and coracoacromial ligament

Correct Answer & Explanation

. Supraspinatus and subscapularis


Explanation

The rotator interval is bounded superiorly by the anterior edge of the supraspinatus and inferiorly by the superior edge of the subscapularis.

Question 3240

Topic: 5. Sports Medicine

When establishing the anterolateral portal for ankle arthroscopy, the superficial peroneal nerve (SPN) is at risk. What is the most reliable external landmark to minimize injury to the SPN during portal placement?

. Place the portal just lateral to the peroneus tertius tendon
. Place the portal just medial to the extensor digitorum longus
. Place the portal just medial to the tibialis anterior
. Place the portal just lateral to the sural nerve
. Place the portal directly over the fibula

Correct Answer & Explanation

. Place the portal just lateral to the peroneus tertius tendon


Explanation

The anterolateral ankle portal is ideally placed just lateral to the peroneus tertius tendon to minimize risk to the superficial peroneal nerve. Transillumination is also frequently used to visualize and avoid the branches of the SPN.