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Question 4021

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. In which position is the anteromedial (AM) bundle under the greatest tension?

. Extension
. Flexion
. Internal rotation
. External rotation
. Valgus stress

Correct Answer & Explanation

. Extension


Explanation

The anteromedial (AM) bundle of the ACL is tightest in knee flexion and primarily controls anterior tibial translation. Conversely, the posterolateral (PL) bundle is tightest in extension and controls rotatory stability.

Question 4022

Topic: Shoulder & Hip Sports

Which of the following structures is NOT a border or content of the rotator interval?

. Coracohumeral ligament
. Superior glenohumeral ligament
. Long head of the biceps tendon
. Teres minor tendon
. Supraspinatus tendon

Correct Answer & Explanation

. Coracohumeral ligament


Explanation

The rotator interval is bounded by the supraspinatus (superiorly) and subscapularis (inferiorly). It contains the coracohumeral ligament, superior glenohumeral ligament, and the long head of the biceps tendon.

Question 4023

Topic: Shoulder & Hip Sports

Which of the following structures form the borders of the quadrilateral space in the shoulder?

. Teres minor, teres major, long head of triceps, humerus
. Teres minor, teres major, lateral head of triceps, humerus
. Infraspinatus, subscapularis, long head of triceps, humerus
. Teres minor, teres major, coracobrachialis, humerus
. Supraspinatus, teres major, long head of triceps, scapula

Correct Answer & Explanation

. Teres minor, teres major, long head of triceps, humerus


Explanation

The quadrilateral space is bordered by the teres minor (superior), teres major (inferior), long head of the triceps (medial), and surgical neck of the humerus (lateral). It contains the axillary nerve and posterior circumflex humeral artery.

Question 4024

Topic: Shoulder & Hip Sports

The suprascapular nerve passes through the suprascapular notch and then the spinoglenoid notch. At the spinoglenoid notch, it is accompanied by which blood vessel?

. Suprascapular artery
. Transverse cervical artery
. Posterior circumflex humeral artery
. Circumflex scapular artery
. Dorsal scapular artery

Correct Answer & Explanation

. Suprascapular artery


Explanation

The suprascapular nerve and artery travel together through the spinoglenoid notch to supply the infraspinatus. Notably, at the suprascapular notch, the artery travels over the transverse scapular ligament while the nerve travels under it.

Question 4025

Topic: Knee Sports



When evaluating injuries to the posterolateral corner of the knee, understanding the intricate capsuloligamentous anatomy is paramount. Which specific structure directly attaches the fibular head to the lateral meniscus?

. Arcuate ligament
. Popliteofibular ligament
. Lateral collateral ligament
. Coronary ligament
. Meniscofibular ligament

Correct Answer & Explanation

. Arcuate ligament


Explanation

The meniscofibular ligament attaches the inferior peripheral margin of the lateral meniscus directly to the fibular head. It is an integral component of the posterolateral corner, contributing to lateral meniscal stability.

Question 4026

Topic: Knee Sports

The posterolateral corner (PLC) of the knee provides critical rotatory stability. Which structure is the primary restraint to external rotation of the tibia at 30 degrees of knee flexion?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Lateral collateral ligament
. Popliteus complex
. Iliotibial band

Correct Answer & Explanation

. Anterior cruciate ligament


Explanation

The popliteus complex (including the popliteofibular ligament) is the primary restraint to external rotation of the tibia at 30 degrees of flexion. The LCL is the primary restraint to varus stress.

Question 4027

Topic: Shoulder & Hip Sports

A 28-year-old overhead athlete presents with isolated weakness in external rotation of the shoulder. An MRI reveals a paralabral cyst in the spinoglenoid notch. Which muscle is predominantly denervated?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Deltoid

Correct Answer & Explanation

. Supraspinatus


Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch results in isolated infraspinatus weakness.

Question 4028

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with insidious onset of vague posterior shoulder pain and profound weakness in external rotation, with preserved abduction. At what anatomical site is the injured nerve most likely compressed?

. Quadrilateral space
. Spinoglenoid notch
. Suprascapular notch
. Spiral groove
. Cubital tunnel

Correct Answer & Explanation

. Quadrilateral space


Explanation

Isolated weakness of the infraspinatus (external rotation) with preserved supraspinatus function (abduction) suggests suprascapular nerve entrapment at the spinoglenoid notch. Entrapment at the suprascapular notch would affect both muscles.

Question 4029

Topic: Shoulder & Hip Sports
Figure 30 demonstrates the osseous landmarks of the scapula. The coracoacromial ligament attaches to the acromion and the coracoid process. Which variation of the acromion morphology is most strongly associated with full-thickness rotator cuff tears?
. Type I (flat)
. Type II (curved)
. Type III (hooked)
. Type IV (convex)
. Os acromiale

Correct Answer & Explanation

. Type III (hooked)


Explanation

The Bigliani Type III (hooked) acromion reduces the subacromial space significantly. It is highly associated with subacromial impingement and full-thickness rotator cuff tears.

Question 4030

Topic: 5. Sports Medicine

A 24-year-old athlete requires surgical reconstruction for a posterolateral corner knee injury. Identifying and protecting the common peroneal nerve is critical. Which of the following describes its most reliable anatomical position in the posterolateral knee?

. Anterior to the biceps femoris tendon
. Posterior and medial to the biceps femoris tendon
. Anterior to the lateral head of the gastrocnemius
. Passing through the lateral joint capsule
. Medial to the plantaris muscle

Correct Answer & Explanation

. Anterior to the biceps femoris tendon


Explanation

The common peroneal nerve courses distally along the posterior and medial border of the biceps femoris tendon. It then wraps around the fibular neck to enter the anterior and lateral compartments of the leg.

Question 4031

Topic: Knee Sports

A 10-year-old male Tanner stage 1 soccer player sustains a complete anterior cruciate ligament (ACL) tear. Which of the following surgical techniques minimizes the risk of iatrogenic growth arrest in this patient?

. Iliotibial band extra-articular tenodesis alone
. All-epiphyseal ACL reconstruction
. Transphyseal reconstruction with 10-mm bone blocks
. Nonoperative management with a hinged knee brace
. Primary ACL repair without augmentation

Correct Answer & Explanation

. Iliotibial band extra-articular tenodesis alone


Explanation

In a Tanner stage 1 patient with significant remaining growth, an all-epiphyseal or physeal-sparing extra-articular reconstruction minimizes the risk of physeal arrest. Transphyseal techniques carry a higher risk of growth disturbance in prepubescent children.

Question 4032

Topic: Knee Sports
A 45-year-old female experiences a popping sensation in her posterior knee while descending stairs. MRI demonstrates a complete medial meniscus posterior root tear. Biomechanically, this injury is most equivalent to which of the following conditions?
. Anterior cruciate ligament deficiency
. Total meniscectomy
. Partial meniscectomy
. Grade III medial collateral ligament tear
. Chondromalacia patellae

Correct Answer & Explanation

. Total meniscectomy


Explanation

A medial meniscus posterior root tear disrupts the circumferential hoop stresses of the meniscus. Biomechanically, this results in altered load transmission equivalent to a total meniscectomy, leading to rapid articular cartilage wear.

Question 4033

Topic: Knee Sports

A 22-year-old male presents with a knee injury after a tackling collision. The dial test demonstrates 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side, but symmetric external rotation at 90 degrees. This finding indicates an isolated injury to which structure?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Posterolateral corner
. Combined posterior cruciate ligament and posterolateral corner
. Medial collateral ligament

Correct Answer & Explanation

. Anterior cruciate ligament


Explanation

An increase of >10 degrees of external rotation at 30 degrees of flexion, with symmetric rotation at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. If external rotation is increased at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.

Question 4034

Topic: Knee Sports

During an ACL reconstruction, arthroscopic evaluation of the posteromedial compartment reveals a longitudinal tear at the meniscocapsular junction of the posterior horn of the medial meniscus. This specific pathology is commonly referred to as a:

. Radial tear
. Horizontal cleavage tear
. Ramp lesion
. Bucket-handle tear
. Parrot-beak tear

Correct Answer & Explanation

. Radial tear


Explanation

A ramp lesion is a longitudinal tear of the peripheral meniscocapsular attachment of the posterior horn of the medial meniscus. It is highly associated with ACL tears and often requires posteromedial portal visualization for accurate diagnosis and repair.

Question 4035

Topic: Knee Sports

During a double-bundle posterior cruciate ligament (PCL) reconstruction, the anterolateral bundle is biomechanically optimized when tensioned and fixed at what angle of knee flexion?

. Full extension
. 30 degrees of flexion
. 90 degrees of flexion
. 120 degrees of flexion
. 15 degrees of hyperextension

Correct Answer & Explanation

. Full extension


Explanation

The PCL consists of a larger anterolateral bundle and a smaller posteromedial bundle. During double-bundle reconstruction, the anterolateral bundle is typically tensioned and fixed at 90 degrees of flexion, while the posteromedial bundle is tensioned in extension.

Question 4036

Topic: 5. Sports Medicine

A 22-year-old athlete presents with recurrent instability 1 year after an ACL reconstruction. Radiographs reveal that the femoral tunnel was placed vertically at the 12 o'clock position in the intercondylar notch. What is the most likely clinical consequence of this tunnel malposition?

. Anterior translation instability in full extension only
. Residual rotational instability and a positive pivot shift
. Loss of terminal knee extension
. Patellofemoral tracking abnormalities
. Severe arthrofibrosis

Correct Answer & Explanation

. Anterior translation instability in full extension only


Explanation

A vertically placed femoral tunnel in ACL reconstruction controls sagittal plane translation but fails to adequately restore rotational stability. Clinically, this manifests as a persistent positive pivot shift test despite a negative Lachman test.

Question 4037

Topic: Knee Sports

A 30-year-old runner presents with a palpable, tender mass along the lateral joint line of the knee. MRI shows a multiloculated cystic structure associated with the lateral meniscus. This condition is most strongly associated with which type of meniscal tear?

. Radial tear
. Vertical longitudinal tear
. Horizontal cleavage tear
. Bucket-handle tear
. Meniscal root tear

Correct Answer & Explanation

. Radial tear


Explanation

Meniscal cysts most commonly present on the lateral side of the knee and are strongly associated with horizontal cleavage tears. The tear acts as a one-way valve, allowing synovial fluid to accumulate and form a parameniscal cyst.

Question 4038

Topic: 5. Sports Medicine

A 24-year-old female athlete tears her anterior cruciate ligament (ACL) while playing soccer. During surgical reconstruction, the surgeon specifically aims to restore the posterolateral (PL) bundle. Biomechanically, restoring the PL bundle is most critical for controlling which of the following specific motions?

. Anterior translation in deep flexion
. Anterior translation in near full extension and rotatory stability
. Posterior translation in flexion
. Valgus instability in extension
. Varus instability in flexion

Correct Answer & Explanation

. Anterior translation in deep flexion


Explanation

The ACL consists of two main bundles: the anteromedial (AM) and posterolateral (PL). The PL bundle is tightest in near full extension and is the primary restraint to anterior translation and rotatory loads (pivot shift) in this position.

Question 4039

Topic: Knee Sports

A 32-year-old male undergoes a posterior cruciate ligament (PCL) reconstruction. The surgeon opts for an open tibial inlay technique rather than a traditional transtibial tunnel technique. The primary biomechanical and anatomical advantage of the inlay technique is:

. Decreased risk of popliteal artery injury
. Avoidance of the 'killer turn' at the posterior tibial aperture
. Shorter overall surgical time
. Superior restoration of the posteromedial bundle
. Elimination of the need for an anterior tibial incision

Correct Answer & Explanation

. Decreased risk of popliteal artery injury


Explanation

The tibial inlay technique avoids the acute angle, or 'killer turn,' present at the posterior exit of a transtibial tunnel. This acute angle can lead to graft attenuation, abrasion, and ultimate failure over time.

Question 4040

Topic: Knee Sports

A 55-year-old woman feels a pop in her posterior knee while deep squatting. MRI reveals an extruded medial meniscus and a complete defect at the posterior horn root. Biomechanically, an unrepaired complete medial meniscus posterior root tear is equivalent to:

. A 50% partial meniscectomy
. A total meniscectomy
. A posterior horn radial tear
. Normal contact mechanics due to an intact anterior root
. A longitudinal tear in the red-red zone

Correct Answer & Explanation

. A 50% partial meniscectomy


Explanation

A complete meniscal root tear disrupts the meniscus's ability to convert axial loads into circumferential hoop stresses. Biomechanical studies have shown this is functionally and kinematically equivalent to a total meniscectomy, leading to accelerated cartilage wear.