Menu

5. Sports Medicine MCQs

Practice Set 22 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 421

Topic: 5. Sports Medicine

A 45-year-old male presents with acute knee pain and an inability to actively extend his knee after a fall. Radiographs show a low-riding patella (patella baja) with an Insall-Salvati ratio of 0.6. Which structure is most likely injured?

. Patellar tendon
. Quadriceps tendon
. Anterior cruciate ligament
. Medial patellofemoral ligament
. Tibial tubercle

Correct Answer & Explanation

. Quadriceps tendon

Explanation

A quadriceps tendon rupture typically results in a low-riding patella (patella baja) due to the unopposed distal pull of the intact patellar tendon. An Insall-Salvati ratio < 0.8 is consistent with this diagnosis.

Question 422

Topic: 5. Sports Medicine

A 30-year-old athlete undergoes an isolated posterior cruciate ligament (PCL) reconstruction. If a single-bundle technique is utilized, which native bundle is typically reconstructed to restore primary posterior stability?

. Posteromedial bundle
. Anterolateral bundle
. Posterolateral bundle
. Anteromedial bundle
. Meniscofemoral ligament

Correct Answer & Explanation

. Anterolateral bundle

Explanation

Single-bundle PCL reconstruction aims to recreate the anterolateral (AL) bundle. The AL bundle is larger, stiffer, and is the primary restraint to posterior tibial translation in the flexed knee.

Question 423

Topic: 5. Sports Medicine

A 24-year-old professional soccer player has a symptomatic 1.5 cm^2 focal osteochondral defect on the medial femoral condyle. Which of the following surgical options is most appropriate as a primary, single-stage procedure yielding hyaline-like cartilage?

. Microfracture
. Autologous chondrocyte implantation (ACI)
. Osteochondral autograft transfer (OATS)
. Fresh osteochondral allograft
. Matrix-induced autologous chondrocyte implantation (MACI)

Correct Answer & Explanation

. Osteochondral autograft transfer (OATS)

Explanation

For small to medium symptomatic lesions (< 2.5 cm^2) in high-demand athletes, OATS is a preferred single-stage procedure that provides mature hyaline cartilage. Microfracture yields fibrocartilage, while ACI/MACI typically require two stages.

Question 424

Topic: Knee Sports

The primary static stabilizers of the posterolateral corner (PLC) of the knee include the fibular collateral ligament (FCL), the popliteus tendon (PT), and which other major structure?

. Biceps femoris tendon
. Arcuate ligament
. Popliteofibular ligament (PFL)
. Fabellofibular ligament
. Oblique popliteal ligament

Correct Answer & Explanation

. Popliteofibular ligament (PFL)

Explanation

The three major static stabilizers of the posterolateral corner are the FCL, popliteus tendon, and popliteofibular ligament (PFL). Surgical reconstruction of the PLC specifically aims to recreate these three core structures.

Question 425

Topic: Knee Sports

A 32-year-old male complains of a palpable, tender mass over the lateral joint line of his knee. MRI reveals a large parameniscal cyst. This finding is most strongly associated with which underlying meniscal pathology?

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

Correct Answer & Explanation

. Horizontal cleavage tear

Explanation

Meniscal cysts are almost exclusively associated with horizontal cleavage tears, which allow synovial fluid to be pumped out of the joint space into the parameniscal tissue. They are more commonly found on the lateral meniscus.

Question 426

Topic: Knee Sports

What is the most common anatomical location for osteochondritis dissecans (OCD) lesions in the adolescent knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Lateral aspect 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 classic and most common location for osteochondritis dissecans (OCD) of the knee is the lateral aspect of the medial femoral condyle. This location accounts for approximately 70-80% of all knee OCD lesions.

Question 427

Topic: 5. Sports Medicine

A patient undergoes anterior cruciate ligament reconstruction using a central third bone-patellar tendon-bone (BPTB) autograft. Postoperatively, what is the most frequently reported complication specific to this graft choice compared to hamstring autograft?

. Increased risk of graft rupture
. Anterior knee pain and pain with kneeling
. Isokinetic hamstring weakness
. Increased risk of deep vein thrombosis
. Greater loss of knee flexion

Correct Answer & Explanation

. Anterior knee pain and pain with kneeling

Explanation

BPTB autografts are highly associated with donor site morbidity, most notably anterior knee pain and discomfort during kneeling. Hamstring grafts tend to avoid this issue but may cause mild deficits in deep knee flexion strength.

Question 428

Topic: Knee Sports

A 26-year-old male sustains a dashboard injury during a motor vehicle collision. Examination reveals a positive posterior tibial sag. The dial test shows 20 degrees of external rotation asymmetry at both 30 and 90 degrees of knee flexion. This indicates injury to which of the following?

. Isolated PCL
. Isolated PLC
. Combined PCL and PLC
. Combined ACL and PLC
. Isolated MCL

Correct Answer & Explanation

. Combined PCL and PLC

Explanation

Increased external rotation asymmetry at both 30 degrees and 90 degrees of knee flexion on the dial test indicates a combined injury to both the posterior cruciate ligament (PCL) and the posterolateral corner (PLC).

Question 429

Topic: Knee Sports
Which nerve injury is most commonly associated with a severe varus and hyperextension multiligamentous knee injury (KD-III)?
. Tibial nerve
. Saphenous nerve
. Common peroneal nerve
. Femoral nerve
. Obturator nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve is highly vulnerable to traction injuries during severe varus and hyperextension trauma, especially in posterolateral corner injuries or frank knee dislocations.

Question 430

Topic: Knee Sports

A 24-year-old male presents with chronic knee instability after a hyperextension injury. Physical examination reveals a positive posterior drawer test. A dial test is performed, which demonstrates 15 degrees of increased external rotation compared to the contralateral knee at both 30 degrees and 90 degrees of knee flexion. Which of the following injury patterns is most consistent with these findings?

. Isolated anterior cruciate ligament tear
. Isolated posterolateral corner injury
. Combined anterior cruciate ligament and posterolateral corner injury
. Combined posterior cruciate ligament and posterolateral corner injury
. Isolated posterior cruciate ligament tear

Correct Answer & Explanation

. Combined posterior cruciate ligament and posterolateral corner injury

Explanation

A positive dial test (asymmetric external rotation >10 degrees) at both 30 and 90 degrees of knee flexion indicates a combined posterior cruciate ligament (PCL) and posterolateral corner (PLC) injury. An isolated PLC injury shows increased external rotation at 30 degrees but not at 90 degrees.

Question 431

Topic: 5. Sports Medicine

When comparing bone-patellar tendon-bone (BTB) autograft to hamstring autograft for primary anterior cruciate ligament (ACL) reconstruction, high-level evidence demonstrates that the BTB autograft is associated with a significantly higher rate of which of the following postoperative complications?

. Anterior knee pain and kneeling pain
. Hamstring weakness in deep flexion
. Increased rate of graft rupture
. Late-onset posterolateral rotatory instability
. Higher rate of contralateral ACL tear

Correct Answer & Explanation

. Anterior knee pain and kneeling pain

Explanation

BTB autografts are associated with a higher incidence of donor site morbidity, specifically anterior knee pain and discomfort while kneeling. Hamstring autografts are associated with decreased deep flexion strength, but they generally have equivalent rates of graft rupture and clinical stability.

Question 432

Topic: Knee Sports

In an anterior cruciate ligament (ACL) reconstruction, if the surgeon places the femoral tunnel too vertically (in the 12 o'clock position in the notch), which of the following clinical outcomes is most likely?

. Restoration of both anterior and rotatory stability
. Failure to control anterior tibial translation (positive Lachman)
. Loss of terminal knee extension
. Failure to control rotatory instability (positive pivot shift)
. Increased risk of intercondylar notch impingement

Correct Answer & Explanation

. Failure to control rotatory instability (positive pivot shift)

Explanation

A vertical femoral tunnel placement in ACL reconstruction may control straight anterior tibial translation but fails to restore the native biomechanics needed to control rotatory forces. Consequently, the patient is likely to demonstrate a persistent positive pivot shift test.

Question 433

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, anatomic placement of the femoral tunnel is critical to ensure proper graft tension throughout the range of motion. According to Schöttle's anatomical studies, where is the optimal femoral origin of the MPFL located?
. Between the medial epicondyle and adductor tubercle
. Anterior and distal to the medial epicondyle
. Proximal and posterior to the adductor tubercle
. Directly over the center of the medial epicondyle
. Distal to the medial collateral ligament origin

Correct Answer & Explanation

. Between the medial epicondyle and adductor tubercle

Explanation

Schöttle's point, identifying the anatomic femoral origin of the MPFL, is located radiographically and anatomically in the saddle between the medial epicondyle distally and the adductor tubercle proximally.

Question 434

Topic: Knee Sports

A surgeon is performing an opening wedge high tibial osteotomy (HTO) on a patient with medial compartment osteoarthritis and varus alignment. If the osteotomy gap is opened significantly more anteriorly than posteriorly, what biomechanical alteration will occur to the knee joint?

. Decreased anterior tibial translation
. Decreased posterior tibial slope
. Increased posterior tibial slope
. Decreased patellofemoral contact pressure
. Lateralization of the tibial tubercle

Correct Answer & Explanation

. Increased posterior tibial slope

Explanation

Opening an HTO anteriorly more than posteriorly increases the posterior tibial slope. Increased posterior slope can place excessive strain on the anterior cruciate ligament by increasing anterior tibial translation forces.

Question 435

Topic: Knee Sports

In the setting of chronic anterior cruciate ligament (ACL) deficiency, which of the following structures serves as the primary secondary restraint to anterior tibial translation?

. Posterior horn of the lateral meniscus
. Posterior horn of the medial meniscus
. Medial collateral ligament
. Popliteofibular ligament
. Iliotibial band

Correct Answer & Explanation

. Posterior horn of the medial meniscus

Explanation

The posterior horn of the medial meniscus acts as the primary secondary restraint to anterior translation of the tibia relative to the femur. This wedge effect is why patients with chronic ACL deficiency often go on to develop medial meniscus tears.

Question 436

Topic: 5. Sports Medicine

A 22-year-old athlete presents with recurrent instability 18 months after a primary anterior cruciate ligament (ACL) reconstruction. Imaging and clinical evaluation confirm a graft failure. What is the most common underlying cause for technical failure of an ACL reconstruction?

. Inadequate graft tensioning
. Non-anatomic femoral tunnel placement
. Missed concurrent medial collateral ligament injury
. Failure of interference screw fixation
. Premature return to sport

Correct Answer & Explanation

. Non-anatomic femoral tunnel placement

Explanation

While traumatic reinjury occurs, the most common technical error leading to ACL graft failure is non-anatomic tunnel placement. Specifically, a femoral tunnel placed too anteriorly or too vertically alters graft kinematics and tension, leading to failure.

Question 437

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction, the surgeon is preparing to drill the femoral tunnel for the fibular collateral ligament (FCL). What is the correct anatomic location of the FCL femoral footprint relative to the lateral epicondyle?

. Anterior and distal
. Anterior and proximal
. Proximal and posterior
. Distal and posterior
. Directly superimposed on the lateral epicondyle

Correct Answer & Explanation

. Proximal and posterior

Explanation

The anatomic footprint of the fibular collateral ligament (FCL) on the lateral femur is situated slightly proximal (1.4 mm) and posterior (3.1 mm) to the prominence of the lateral epicondyle.

Question 438

Topic: 5. Sports Medicine

A 25-year-old professional basketball player has an isolated, symptomatic full-thickness articular cartilage defect on the weight-bearing surface of the medial femoral condyle. The defect measures 3.5 cm2. Which of the following is the most appropriate surgical intervention?

. Arthroscopic microfracture
. Osteochondral autograft transfer (OATS)
. Autologous chondrocyte implantation (ACI) or Osteochondral allograft
. High tibial osteotomy alone
. Arthroscopic debridement and chondroplasty

Correct Answer & Explanation

. Autologous chondrocyte implantation (ACI) or Osteochondral allograft

Explanation

For large chondral defects (>2.5 to 3.0 cm2) in high-demand patients, cell-based therapies like Autologous Chondrocyte Implantation (ACI/MACI) or Osteochondral Allografts are indicated. Microfracture and OATS are typically reserved for smaller lesions (<2.0 cm2).

Question 439

Topic: Knee Sports

During the evaluation of a patient with a suspected multiligamentous knee injury, the examiner performs a 'quadriceps active test.' The knee is positioned at 90 degrees of flexion with the foot flat on the table, and the patient is asked to slide the foot forward against resistance. An anterior shift of the tibia is observed. This finding indicates a deficiency of which structure?

. Posterior cruciate ligament
. Anterior cruciate ligament
. Posterolateral corner
. Posteromedial corner
. Medial patellofemoral ligament

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

The quadriceps active test assesses for posterior cruciate ligament (PCL) deficiency. In a PCL-deficient knee flexed to 90 degrees, the tibia subluxates posteriorly; active quadriceps contraction pulls the tibia anteriorly, reducing the subluxation.

Question 440

Topic: Knee Sports
Microfracture is a marrow-stimulating technique used to treat focal chondral defects. The repair tissue that fills the defect following a successful microfracture procedure is predominantly composed of which type of collagen?
. Type II collagen
. Type III collagen
. Type IX collagen
. Type I collagen
. Type XI collagen

Correct Answer & Explanation

. Type I collagen

Explanation

Microfracture allows bone marrow elements to form a super-clot in the chondral defect. The resulting repair tissue is fibrocartilage, which is biomechanically inferior to native hyaline cartilage and is composed predominantly of Type I collagen.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page