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5. Sports Medicine MCQs

Practice Set 23 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 441

Topic: 5. Sports Medicine

During medial patellofemoral ligament (MPFL) reconstruction, securing the graft with the knee in full extension and under excessive tension is most likely to result in which of the following complications?

. Recurrent lateral patellar instability
. Loss of knee flexion and medial patellofemoral overload
. Patella infera (baja)
. Quadriceps tendon rupture
. Increased anterior tibial translation

Correct Answer & Explanation

. Loss of knee flexion and medial patellofemoral overload

Explanation

The MPFL is tightest in full extension and becomes lax as the knee flexes. Tensioning the graft too tightly in extension restricts normal patellar tracking during flexion, leading to severe stiffness, loss of flexion, and iatrogenic medial compartment overload.

Question 442

Topic: Knee Sports

A 25-year-old football player sustains a direct blow to the anteromedial aspect of his knee. Physical examination reveals increased external rotation of the tibia at 30 degrees of knee flexion, but symmetric rotation at 90 degrees when compared to the contralateral side. Which structure is most likely injured?

. Posterior cruciate ligament
. Anterior cruciate ligament
. Posterolateral corner
. Medial collateral ligament
. Posterior oblique ligament

Correct Answer & Explanation

. Posterolateral corner

Explanation

An isolated injury to the posterolateral corner (PLC) causes increased external rotation at 30 degrees of flexion but not at 90 degrees. Combined PLC and PCL injuries typically show increased external rotation at both 30 and 90 degrees.

Question 443

Topic: 5. Sports Medicine

A 19-year-old female collegiate soccer player is undergoing anterior cruciate ligament (ACL) reconstruction. Which of the following biomechanical or anatomical factors has been most consistently shown to increase the risk of ACL injury in female athletes compared to males?

. Decreased Q-angle
. Wider femoral intercondylar notch
. Increased landing knee valgus
. Greater hamstring-to-quadriceps strength ratio
. Increased hip abduction strength

Correct Answer & Explanation

. Increased landing knee valgus

Explanation

Females have a higher rate of ACL tears primarily due to neuromuscular factors, particularly increased dynamic knee valgus during landing and pivoting. They also often exhibit a lower hamstring-to-quadriceps strength ratio and narrower intercondylar notches.

Question 444

Topic: 5. Sports Medicine

A 30-year-old male presents with persistent anterior knee pain and a block to terminal extension 6 months following an ACL reconstruction. MRI reveals a nodular fibrous mass anterior to the ACL graft. Which of the following surgical technical errors is most closely associated with this complication?

. Posterior femoral tunnel placement
. Anterior tibial tunnel placement
. Inadequate graft tensioning
. Use of an allograft
. Overtightening of the graft

Correct Answer & Explanation

. Anterior tibial tunnel placement

Explanation

Anterior tibial tunnel placement causes the ACL graft to impinge against the intercondylar notch roof in extension. This repetitive trauma leads to the formation of a localized anterior arthrofibrosis known as a Cyclops lesion.

Question 445

Topic: Knee Sports
During the surgical approach for a medial patellofemoral ligament (MPFL) reconstruction, the femoral insertion site is identified using fluoroscopy to locate Schöttle's point. Where is this radiographic point located anatomically?
. Anterior to the posterior femoral cortex line
. Distal to the posterior articular margin
. 1 mm anterior to the posterior cortex line and 2.5 mm distal to the posterior articular border
. Directly on the medial epicondyle
. Proximal to the adductor tubercle

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex line and 2.5 mm distal to the posterior articular border

Explanation

Schöttle's point is a radiographic landmark for the femoral MPFL footprint. It is defined as 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior articular margin, and proximal to Blumensaat's line.

Question 446

Topic: Knee Sports

A 16-year-old male gymnast presents with anterior knee pain, swelling, and episodic catching. Radiographs and MRI confirm osteochondritis dissecans (OCD) of the knee. What is the most common anatomical location for this lesion?

. Medial aspect of the lateral femoral condyle
. Lateral aspect of the medial femoral condyle
. Central trochlear groove
. Inferior pole of the patella
. Lateral tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most frequent location for osteochondritis dissecans in the knee is the lateral aspect of the medial femoral condyle, accounting for over 70% of cases.

Question 447

Topic: Knee Sports

In evaluating a failed ACL reconstruction, it is noted that the femoral tunnel was placed vertically (at the 12 o'clock position) in the intercondylar notch. Which of the following physical examination findings is most likely directly attributable to this specific technical error?

. Positive posterior drawer test
. Negative Lachman test with a positive pivot shift
. Positive dial test at 30 degrees
. Positive anterior drawer test in external rotation
. Negative pivot shift with a positive Lachman test

Correct Answer & Explanation

. Negative Lachman test with a positive pivot shift

Explanation

A vertical graft adequately resists anterior tibial translation (rendering a negative Lachman test) but fails to properly resist rotational forces, resulting in persistent rotational instability and a positive pivot shift test.

Question 448

Topic: Knee Sports

A 28-year-old male sustained a multiligament knee injury. Examination reveals a foot drop and decreased sensation over the dorsal aspect of his foot. Which specific ligamentous injury pattern is most highly associated with this neurological deficit?

. Anterior cruciate ligament (ACL) tear
. Posterior cruciate ligament (PCL) tear
. Posterolateral corner (PLC) injury
. Posteromedial corner (PMC) injury
. Proximal patellar tendon rupture

Correct Answer & Explanation

. Posterolateral corner (PLC) injury

Explanation

Common peroneal nerve palsies are highly associated with injuries to the posterolateral corner (PLC) and lateral collateral ligament (LCL) of the knee due to their anatomic proximity at the fibular head.

Question 449

Topic: Knee Sports

The anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) have distinct biomechanical roles. Which of the following statements is true regarding the PL bundle?

. It is tightest in full extension
. It is tightest at 90 degrees of flexion
. It primarily resists anterior translation at 90 degrees
. It is larger than the AM bundle
. It originates proximal to the AM bundle on the femoral footprint

Correct Answer & Explanation

. It is tightest in full extension

Explanation

The posterolateral (PL) bundle of the ACL is tightest in extension and serves as the primary restraint to rotatory loads. The anteromedial (AM) bundle is tightest in flexion.

Question 450

Topic: Knee Sports

Biomechanical studies have shown that a medial meniscus posterior root tear alters knee joint contact pressures most similarly to which of the following conditions?

. Normal native knee
. Anterior cruciate ligament deficient knee
. Total medial meniscectomy
. Partial medial meniscectomy
. Posterior cruciate ligament deficient knee

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior root tear disrupts the hoop stresses of the meniscus, causing it to extrude. This results in an increase in peak contact pressures and a decrease in contact area equivalent to a total medial meniscectomy.

Question 451

Topic: Knee Sports

Which of the following structures is considered the primary static restraint to lateral patellar translation at 20 degrees of knee flexion?

. Medial patellofemoral ligament (MPFL)
. Medial patellotibial ligament
. Trochlear groove geometry
. Vastus medialis obliquus (VMO)
. Lateral retinaculum

Correct Answer & Explanation

. Medial patellofemoral ligament (MPFL)

Explanation

The MPFL is the primary soft-tissue restraint to lateral patellar translation in early flexion (0 to 30 degrees). Beyond 30 degrees, the bony geometry of the trochlea becomes the primary stabilizer.

Question 452

Topic: 5. Sports Medicine

A 24-year-old athlete undergoes an anterior cruciate ligament (ACL) reconstruction. When comparing bone-patellar tendon-bone (BPTB) autograft to hamstring autograft, BPTB is historically associated with a higher incidence of:

. Graft rupture
. Contralateral ACL tear
. Anterior knee pain
. Hamstring weakness in deep flexion
. Post-operative deep infection

Correct Answer & Explanation

. Anterior knee pain

Explanation

BPTB autografts are associated with a higher rate of donor site morbidity, specifically anterior knee pain and pain with kneeling. Both graft types have comparable long-term rates of stability and graft rupture.

Question 453

Topic: Knee Sports

A patient with a suspected posterolateral corner (PLC) injury undergoes the Dial test. The test reveals greater than 10 degrees of increased external rotation compared to the contralateral knee at 30 degrees of flexion, but normal and symmetric external rotation at 90 degrees. This finding suggests:

. Isolated posterior cruciate ligament (PCL) injury
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injury
. Combined ACL and PLC injury
. Isolated popliteus tendon tear

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

Increased external rotation at 30 degrees of flexion that reduces at 90 degrees indicates an isolated PLC injury. If the external rotation remains asymmetrical at 90 degrees, it suggests a combined PLC and PCL injury.

Question 454

Topic: Knee Sports

In the evaluation of a traumatic multi-ligament knee injury, the presence of a 'dimple sign' on the medial joint line typically indicates which of the following?

. Incarceration of the medial meniscus
. Posterolateral corner avulsion
. Irreducible posterolateral knee dislocation with medial capsule invagination
. Associated tibial plateau fracture
. Complete MPFL rupture

Correct Answer & Explanation

. Irreducible posterolateral knee dislocation with medial capsule invagination

Explanation

The 'dimple sign' represents buttonholing of the medial femoral condyle through the anteromedial capsule in a posterolateral knee dislocation. This finding indicates that the dislocation is irreducible by closed means and requires open reduction.

Question 455

Topic: Knee Sports

During an arthroscopic anterior cruciate ligament (ACL) reconstruction, the surgeon evaluates the native ACL footprint. The anteromedial (AM) bundle of the ACL is primarily responsible for providing:

. Rotational stability near full extension
. Anterior translational stability in flexion
. Posterior translational stability in extension
. Varus stability at 30 degrees
. Valgus stability at 90 degrees

Correct Answer & Explanation

. Anterior translational stability in flexion

Explanation

The ACL is composed of two main bundles. The anteromedial (AM) bundle tightens in flexion to control anterior translation, while the posterolateral (PL) bundle tightens in extension to control rotational stability.

Question 456

Topic: 5. Sports Medicine

A 45-year-old high-demand patient presents with an isolated full-thickness distal femoral osteochondral defect measuring 3.5 cm^2. He has failed non-operative management. Which of the following is the most appropriate surgical treatment?

. Microfracture
. Autologous chondrocyte implantation (ACI)
. Osteochondral autograft transfer (OATS)
. Arthroscopic debridement alone
. Partial medial meniscectomy

Correct Answer & Explanation

. Autologous chondrocyte implantation (ACI)

Explanation

Autologous chondrocyte implantation (ACI) or osteochondral allograft are indicated for larger symptomatic defects (> 2 to 4 cm^2). Microfracture and OATS are typically reserved for smaller defects (< 2 cm^2).

Question 457

Topic: Knee Sports

A 19-year-old female presents with recurrent patellar dislocation. Lateral knee radiographs reveal a Caton-Deschamps index of 1.4. This radiographic finding indicates the presence of:

. Patella baja
. Patella alta
. Normal patellar height
. Trochlear dysplasia
. Increased tibial tubercle-trochlear groove (TT-TG) distance

Correct Answer & Explanation

. Patella alta

Explanation

The Caton-Deschamps index measures the ratio of the distance from the inferior pole of the patella to the anterior superior angle of the tibia over the articular length of the patella. A ratio > 1.2 indicates patella alta.

Question 458

Topic: Knee Sports

Following a direct blow to the proximal tibia with the knee flexed, a patient demonstrates a positive posterior drawer test. The posterior cruciate ligament (PCL) consists of two bundles. Which bundle is typically the tightest in knee flexion?

. Anteromedial bundle of the ACL
. Posterolateral bundle of the ACL
. Anterolateral bundle of the PCL
. Posteromedial bundle of the PCL
. Posterior oblique ligament

Correct Answer & Explanation

. Anterolateral bundle of the PCL

Explanation

The PCL has a larger anterolateral (AL) bundle and a smaller posteromedial (PM) bundle. The AL bundle is tight in knee flexion, whereas the PM bundle is tight in knee extension.

Question 459

Topic: Knee Sports

Which of the following clinical tests is considered the most specific for diagnosing an anterior cruciate ligament (ACL) tear?

. Anterior drawer test
. Lachman test
. Pivot shift test
. McMurray test
. Apley grind test

Correct Answer & Explanation

. Pivot shift test

Explanation

The pivot shift test evaluates rotational instability and is the most specific test (approx. 98%) for an ACL tear. The Lachman test is considered the most sensitive test.

Question 460

Topic: 5. Sports Medicine

A high school linebacker experiences a "stinger" resulting in transient right-sided arm weakness and burning pain after making a tackle. He is evaluated on the sidelines. According to current guidelines, when is he safely allowed to return to play?

. Immediately, provided he wears a specialized neck roll
. When his unilateral weakness resolves, even if neck stiffness persists
. Only when he has completely normal strength, no symptoms, and full painless cervical range of motion
. Only after a normal cervical MRI is obtained
. After a mandatory 4-week exclusion period

Correct Answer & Explanation

. Only when he has completely normal strength, no symptoms, and full painless cervical range of motion

Explanation

Athletes who suffer a transient brachial plexopathy (stinger) may return to play only after all neurological symptoms have resolved, strength has returned to normal, and they demonstrate full, painless cervical range of motion.

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