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5. Sports Medicine MCQs

Practice Set 34 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 661

Topic: 5. Sports Medicine

An 8-year-old boy (Tanner stage 1) sustains a complete mid-substance ACL tear. Conservative management fails, and he exhibits recurrent instability. What is the most appropriate surgical technique to minimize the risk of growth arrest?

. Transphyseal bone-patellar tendon-bone autograft
. Transphyseal quadrupled hamstring autograft with interference screws
. Iliotibial band extra-articular and intra-articular physeal-sparing reconstruction
. Primary repair of the ACL with suture augmentation
. Non-operative management in a hinged knee brace until skeletal maturity

Correct Answer & Explanation

. Iliotibial band extra-articular and intra-articular physeal-sparing reconstruction

Explanation

In prepubescent patients (Tanner 1) with significant remaining growth, physeal-sparing techniques, such as the Micheli-Kocher iliotibial band procedure, are recommended. Transphyseal techniques carry a high risk of growth arrest and angular deformity in this age group.

Question 662

Topic: 5. Sports Medicine

When comparing bone-patellar tendon-bone (BTB) autografts to quadrupled hamstring autografts for ACL reconstruction, which of the following is an established biological or biomechanical advantage of the BTB graft?

. Higher ultimate tensile load compared to a healthy native ACL
. Faster graft incorporation time due to bone-to-bone healing
. Decreased incidence of post-operative anterior knee pain
. Less morbidity to the extensor mechanism
. Greater cross-sectional area allowing better revascularization

Correct Answer & Explanation

. Faster graft incorporation time due to bone-to-bone healing

Explanation

BTB autografts allow for rigid bone-to-bone healing within the tunnels, typically incorporating around 6 weeks. Soft tissue grafts require Sharpey's fiber formation for bone-to-tendon healing, which generally takes 10 to 12 weeks.

Question 663

Topic: Knee Sports

The anterior cruciate ligament consists of two functionally distinct bundles. The anteromedial (AM) bundle is most responsible for resisting anterior tibial translation at which of the following degrees of knee flexion?

. 0 degrees
. 15 degrees
. 30 degrees
. 60 degrees
. 90 degrees

Correct Answer & Explanation

. 90 degrees

Explanation

The AM bundle is tensioned primarily in flexion and is the primary restraint to anterior tibial translation at 90 degrees. The posterolateral (PL) bundle is tensioned in extension and controls rotatory stability.

Question 664

Topic: Knee Sports

A 45-year-old female experiences acute posterior medial knee pain after squatting to lift a heavy box. MRI reveals a complete posterior root tear of the medial meniscus. Biomechanically, this injury most closely mimics the contact pressures of which of the following conditions?

. An intact meniscus
. A partial meniscectomy
. A total meniscectomy
. A bucket handle meniscus tear
. A radial tear of the anterior horn

Correct Answer & Explanation

. A total meniscectomy

Explanation

A complete posterior root tear disrupts the circumferential hoop stresses of the meniscus. Biomechanically, this results in a loss of load-sharing capability, increasing peak contact pressures to levels equivalent to a total meniscectomy.

Question 665

Topic: Knee Sports

The medial meniscus is injured more frequently than the lateral meniscus. This is largely attributed to its decreased mobility. Which anatomical structure firmly anchors the medial meniscus, limiting its excursion during knee motion?

. Anterior cruciate ligament
. Transverse intermeniscal ligament
. Deep medial collateral ligament
. Oblique popliteal ligament
. Popliteus tendon

Correct Answer & Explanation

. Deep medial collateral ligament

Explanation

The medial meniscus is firmly attached to the joint capsule and the deep fibers of the medial collateral ligament (MCL), known as the coronary ligament. This firm attachment severely restricts its mobility, making it more susceptible to tearing.

Question 666

Topic: 5. Sports Medicine

A 22-year-old athlete returns to the clinic 6 months following a successful ACL reconstruction. She complains of an audible "clunk" and a 10-degree block to terminal extension. MRI demonstrates a nodular mass anterior to the ACL graft in the intercondylar notch. What is the most likely diagnosis?

. Arthrofibrosis affecting the suprapatellar pouch
. Cyclops lesion
. Infrapatellar contracture syndrome
. Loose body from a meniscal root tear
. Graft hypertrophy

Correct Answer & Explanation

. Cyclops lesion

Explanation

A cyclops lesion is a localized fibrotic nodule that forms anterior to the ACL graft. It physically blocks terminal extension and can produce a palpable or audible clunk during knee motion.

Question 667

Topic: Knee Sports

During arthroscopic repair of a meniscal tear in the avascular "white-white" zone, the surgeon elects to perform an abrasion of the intercondylar notch (trephination/notch microfracture). What is the primary biological rationale for this adjunct procedure?

. Introduction of marrow elements, growth factors, and fibrin clot
. Upregulation of matrix metalloproteinases in the synovial fluid
. Decrease in synovial fluid viscosity to reduce shear stress
. Release of intra-articular pressure to prevent suture pull-out
. Denervation of the posterior capsule to reduce postoperative pain

Correct Answer & Explanation

. Introduction of marrow elements, growth factors, and fibrin clot

Explanation

Notch abrasion or microfracture releases bone marrow, mesenchymal stem cells, and a fibrin clot into the joint. This biologic augmentation enhances the healing potential of meniscal tears in the avascular zone.

Question 668

Topic: Knee Sports



During the femoral tunnel preparation for ACL reconstruction, the surgeon identifies the lateral intercondylar ridge (resident's ridge). What is the critical anatomical significance of this landmark when placing the femoral tunnel?

. It marks the anterior border of the native ACL footprint, and the tunnel must be placed posterior to it.
. It marks the posterior border of the native ACL footprint, and the tunnel must be placed anterior to it.
. It serves as the precise center for the anteromedial (AM) bundle.
. It divides the footprints of the anterior and posterior cruciate ligaments.
. It indicates the safe zone to avoid the popliteus tendon insertion.

Correct Answer & Explanation

. It marks the anterior border of the native ACL footprint, and the tunnel must be placed posterior to it.

Explanation

The lateral intercondylar ridge (resident's ridge) represents the anterior margin of the native ACL attachment on the lateral femoral condyle. The femoral tunnel must be placed posterior to this ridge to avoid anterior graft malposition.

Question 669

Topic: 5. Sports Medicine

A 16-year-old athlete undergoes an all-inside meniscal repair for a longitudinal peripheral tear in the red-red zone. Which of the following suture configurations is biomechanically strongest because it captures the primary collagen fiber orientation of the meniscus?

. Horizontal mattress
. Vertical mattress
. Figure-of-eight
. Running baseball suture
. Simple interrupted suture

Correct Answer & Explanation

. Vertical mattress

Explanation

The primary collagen fibers of the meniscus run circumferentially. A vertical mattress suture configuration passes perpendicular to these fibers, offering the greatest capture and the highest pull-out strength for repair.

Question 670

Topic: 5. Sports Medicine

A patient presents with a swollen, erythematous, and exquisitely painful knee 3 weeks after an uncomplicated ACL reconstruction with a hamstring autograft. Joint aspiration yields a white blood cell count of 85,000 cells/mcL with 90% polymorphonuclear leukocytes. What is the most appropriate initial management?

. Immediate complete removal of the ACL graft and administration of intravenous antibiotics
. Arthroscopic irrigation and debridement with retention of the graft, and intravenous antibiotics
. Oral broad-spectrum antibiotics and serial bedside aspirations
. Open complete synovectomy and placement of an antibiotic cement spacer
. Initiation of a continuous closed joint irrigation system

Correct Answer & Explanation

. Arthroscopic irrigation and debridement with retention of the graft, and intravenous antibiotics

Explanation

The standard of care for early post-operative septic arthritis following ACL reconstruction is emergent arthroscopic irrigation and debridement with retention of the graft, provided the graft is clinically intact and well-fixed. Graft removal is reserved for cases failing multiple I&Ds.

Question 671

Topic: Knee Sports

Which bundle of the anterior cruciate ligament (ACL) is primarily responsible for rotational stability and is tightest when the knee is in extension?

. Anteromedial bundle
. Posterolateral bundle
. Anterolateral ligament
. Posteromedial bundle
. Central meniscofemoral bundle

Correct Answer & Explanation

. Posterolateral bundle

Explanation

The ACL is composed of two primary bundles. The posterolateral bundle is tightest in extension and primarily controls rotational stability, whereas the anteromedial bundle is tightest in flexion and controls anterior-posterior translation.

Question 672

Topic: Knee Sports

A 50-year-old female experiences a pop in the back of her knee while squatting. MRI reveals a complete radial tear adjacent to the posterior horn medial meniscus root. Biomechanically, if left untreated, this injury is most equivalent to which of the following?

. Normal knee biomechanics due to capsular restraint
. Partial medial meniscectomy
. Total medial meniscectomy
. Isolated anterior cruciate ligament deficiency
. Isolated posterior cruciate ligament deficiency

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus completely disrupts the hoop stresses of the meniscus. Biomechanically, this failure of load distribution is equivalent to a total medial meniscectomy, leading to rapid compartmental chondrolysis.

Question 673

Topic: Knee Sports
Following an ACL reconstruction, a patient complains of recurrent knee giving way. On exam, the Lachman test is grade I with a firm endpoint, but the pivot shift is grade III. Radiographs show the femoral tunnel positioned at the 12 o'clock position in the intercondylar notch. What is the primary cause of this patient's instability?
. Inadequate graft tensioning at the time of fixation
. Femoral tunnel placed too anteriorly
. Femoral tunnel placed too vertically
. Tibial tunnel placed too medially
. Missed medial collateral ligament injury

Correct Answer & Explanation

. Femoral tunnel placed too vertically

Explanation

A vertically placed femoral tunnel (12 o'clock position) fails to reconstruct the posterolateral bundle's function. This results in restored anterior-posterior stability (negative Lachman) but persistent rotational instability (positive pivot shift).

Question 674

Topic: 5. Sports Medicine

During arthroscopy for an acute ACL tear, the surgeon evaluates the posterior horn of the medial meniscus and suspects a tear of the meniscocapsular junction. What is the most appropriate approach to optimally view and treat this 'ramp lesion'?

. Standard anterolateral portal looking medially
. Standard anteromedial portal with knee in full extension
. Posteromedial portal or a trans-notch intercondylar view
. Posterolateral portal with a 70-degree arthroscope
. Suprapatellar portal looking inferiorly

Correct Answer & Explanation

. Posteromedial portal or a trans-notch intercondylar view

Explanation

Ramp lesions are tears of the peripheral meniscocapsular attachment of the posterior horn of the medial meniscus, highly associated with ACL tears. They are notoriously missed from standard anterior viewing portals and are best evaluated via a trans-notch view or a dedicated posteromedial portal.

Question 675

Topic: 5. Sports Medicine

A 9-year-old male (Tanner stage 1) sustains a midsubstance ACL rupture. The family desires surgical intervention due to recurrent instability. Which surgical technique is most appropriate to minimize the risk of growth arrest?

. Transphyseal bone-patellar tendon-bone autograft reconstruction
. Iliotibial band physeal-sparing extra-articular reconstruction
. All-inside transphyseal hamstring reconstruction
. Primary repair with rigid suture anchors
. Tibial inlay technique with allograft

Correct Answer & Explanation

. Iliotibial band physeal-sparing extra-articular reconstruction

Explanation

In a skeletally immature patient with significant remaining growth (Tanner stage 1 or 2), physeal-sparing techniques, such as the iliotibial band over-the-top extra-articular reconstruction, are recommended to avoid damaging the distal femoral and proximal tibial physes.

Question 676

Topic: Knee Sports

The healing potential of a meniscus tear is largely dependent on its blood supply. Which of the following vascular structures are the primary source of blood supply to the peripheral aspect of the menisci?

. Descending genicular artery
. Middle genicular artery
. Medial and lateral superior and inferior genicular arteries
. Sural artery
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Medial and lateral superior and inferior genicular arteries

Explanation

The peripheral 10-30% of the meniscus (the red-red zone) is vascularized by the perimeniscal capillary plexus. This plexus is supplied predominantly by the medial and lateral branches of the superior and inferior genicular arteries.

Question 677

Topic: 5. Sports Medicine

Following a 4-strand Zone II flexor tendon repair, the patient is started on an early active motion rehabilitation protocol. Compared to static immobilization, early active motion has been shown to result in which of the following?

. Increased risk of tendon rupture by over 50%
. Decreased work of flexion and fewer peritendinous adhesions
. Delayed intrinsic tendon healing time
. Increased requirement for delayed tenolysis
. Higher rates of deep soft tissue infection

Correct Answer & Explanation

. Decreased work of flexion and fewer peritendinous adhesions

Explanation

Early active motion protocols after robust (4-strand or greater) flexor tendon repairs improve intrinsic tendon healing, decrease peritendinous adhesions, and significantly improve ultimate tendon gliding (decreased work of flexion) compared to immobilization.

Question 678

Topic: 5. Sports Medicine

A 25-year-old male is undergoing primary ACL reconstruction. He is an avid deep-squat weightlifter and sprinter. If a quadrupled hamstring autograft is chosen over a bone-patellar tendon-bone autograft, he is at the highest risk for which of the following specific post-operative deficits?

. Anterior knee pain and kneeling discomfort
. Decreased knee extension strength at terminal extension
. Decreased knee flexion strength at angles greater than 90 degrees
. Increased incidence of patella fracture
. Premature osteoarthritis of the patellofemoral joint

Correct Answer & Explanation

. Decreased knee flexion strength at angles greater than 90 degrees

Explanation

Harvesting the semitendinosus and gracilis tendons for ACL reconstruction commonly results in a permanent, measurable deficit in deep knee flexion strength (past 90 degrees) and internal rotation strength compared to bone-patellar tendon-bone grafts.

Question 679

Topic: 5. Sports Medicine

Two weeks after an uncomplicated hamstring autograft ACL reconstruction, a patient presents with an acute effusion, severe knee pain, and a fever of 101.5ยฐF. Aspiration yields purulent fluid with a WBC count of 85,000/ยตL. What is the most appropriate initial surgical management?

. Immediate open arthrotomy, graft removal, and antibiotic spacer placement
. Arthroscopic irrigation and debridement with graft retention
. Open arthrotomy with graft removal and primary closure
. Oral antibiotics and repeat joint aspiration in 48 hours
. Suppressive intravenous antibiotics until the graft completely incorporates

Correct Answer & Explanation

. Arthroscopic irrigation and debridement with graft retention

Explanation

In the setting of acute septic arthritis following ACL reconstruction, the standard of care is urgent arthroscopic irrigation and debridement with retention of the graft, provided the graft is still structurally intact and functional. Intravenous antibiotics follow.

Question 680

Topic: Knee Sports

A 28-year-old female presents with recurrent instability 2 years post-ACL reconstruction. Imaging shows a vertical femoral tunnel positioned anterior to the native footprint.

What is the most likely clinical consequence of this specific femoral tunnel malposition?

. The graft will be overly tight in extension and loose in flexion
. The graft will be overly tight in flexion, resulting in a loss of knee flexion
. The graft will cause impingement against the posterior cruciate ligament (PCL)
. The graft will lead to early isolated patellofemoral arthritis
. The graft will undergo rapid remodeling and hypertrophy

Correct Answer & Explanation

. The graft will be overly tight in flexion, resulting in a loss of knee flexion

Explanation

A femoral tunnel placed too anteriorly (high in the notch with the knee flexed) results in an ACL graft that is tight in flexion and loose in extension. Clinically, this typically presents as a significant loss of terminal knee flexion and recurrent instability.

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