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5. Sports Medicine MCQs

Practice Set 354 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 7061

Topic: Shoulder & Hip Sports

On an anteroposterior radiograph of the pelvis, the 'cross-over sign' is indicative of which acetabular morphology?

. Acetabular anteversion
. Acetabular retroversion
. Coxa profunda
. Protrusio acetabuli
. Acetabular dysplasia

Correct Answer & Explanation

. Acetabular retroversion

Explanation

The cross-over sign occurs when the anterior wall of the acetabulum crosses over the posterior wall on a well-centered AP pelvic radiograph. It is a hallmark sign of focal or global acetabular retroversion, often contributing to pincer-type FAI.

Question 7062

Topic: Knee Sports

A neonate presents with an anteromedial bowing of the tibia, a shortened leg, and an absent lateral ray of the foot. Radiographs confirm fibular hemimelia. Which associated ligamentous deficiency is most commonly seen in the knee of this patient?

. Anterior cruciate ligament (ACL) deficiency
. Posterior cruciate ligament (PCL) deficiency
. Medial collateral ligament (MCL) deficiency
. Lateral collateral ligament (LCL) deficiency
. Posterolateral corner (PLC) deficiency

Correct Answer & Explanation

. Anterior cruciate ligament (ACL) deficiency

Explanation

Fibular hemimelia is frequently associated with congenital anterior cruciate ligament (ACL) deficiency, leading to anteroposterior knee instability. Ball-and-socket ankle joint and tarsal coalitions are also common associations.

Question 7063

Topic: 5. Sports Medicine

A 28-year-old male athlete presents with anterior groin pain. Imaging reveals a CAM-type femoroacetabular impingement. At which clock-face location on the femoral head-neck junction is the maximum CAM deformity most commonly located?

. 12:00 to 1:00
. 1:00 to 3:00
. 3:00 to 5:00
. 6:00 to 8:00
. 9:00 to 11:00

Correct Answer & Explanation

. 1:00 to 3:00

Explanation

CAM deformities represent an abnormal femoral head-neck offset. They are most frequently located in the anterosuperior quadrant of the femoral head-neck junction, which corresponds to the 1:00 to 3:00 position on the clock face.

Question 7064

Topic: Shoulder & Hip Sports

A 45-year-old female undergoes an MRI of her shoulder for suspected rotator cuff pathology. An incidental lesion is found in the proximal humerus, corresponding to punctate calcifications seen on plain radiographs. MRI shows a lobulated high T2 signal lesion with no endosteal scalloping or cortical breakthrough.

What is the most appropriate management for this bone lesion?

. Extended curettage and bone grafting
. Marginal excision
. Wide resection and endoprosthetic reconstruction
. Observation with serial radiographs
. Neoadjuvant chemotherapy followed by wide resection

Correct Answer & Explanation

. Observation with serial radiographs

Explanation

This is an incidental enchondroma, characterized by punctate calcifications and lack of aggressive features like endosteal scalloping or pain. Asymptomatic enchondromas in the appendicular skeleton are safely managed with observation. Surgical intervention is reserved for symptomatic lesions or those showing signs of malignant transformation.

Question 7065

Topic: Knee Sports

The posterolateral corner of the knee is a complex arrangement of static and dynamic stabilizers. Biomechanical studies have shown that the primary function of the popliteofibular ligament is to resist which of the following motions?

. Anterior translation of the tibia on the femur
. Posterior translation of the tibia at 90 degrees of flexion
. Varus angulation at 0 degrees of flexion
. Posterolateral rotation of the tibia on the femur
. Anteromedial rotation of the tibia on the femur

Correct Answer & Explanation

. Posterolateral rotation of the tibia on the femur

Explanation

Correct Answer: DThe primary function of the popliteofibular ligament is to resist posterolateral rotation of the tibia on the femur. It also acts as a secondary restraint to varus angulation and posterior displacement of the tibia. The posterior cruciate ligament is the primary restraint to posterior tibial displacement, and the lateral collateral ligament is the primary restraint to varus displacement at 30 degrees of flexion.

Question 7066

Topic: Knee Sports

The popliteofibular ligament is a critical stabilizer of the posterolateral corner of the knee. What is its primary biomechanical function?

. Resisting varus displacement at 30 degrees of knee flexion
. Resisting posterior tibial displacement at 90 degrees of knee flexion
. Resisting anterolateral rotation of the tibia on the femur
. Resisting posterolateral rotation of the tibia on the femur
. Resisting valgus displacement at 0 degrees of knee flexion

Correct Answer & Explanation

. Resisting posterolateral rotation of the tibia on the femur

Explanation

Correct Answer: DThe primary function of the popliteofibular ligament is to resist posterolateral rotation of the tibia on the femur. While it provides secondary restraint to varus angulation and posterior displacement, the lateral collateral ligament is the primary restraint to varus at 30 degrees, and the posterior cruciate ligament is the primary restraint to posterior translation at 90 degrees.

Question 7067

Topic: 5. Sports Medicine

A 24-year-old collegiate soccer player undergoes primary anterior cruciate ligament (ACL) reconstruction. Which of the following graft choices is associated with the highest incidence of postoperative anterior knee pain?

. Quadrupled hamstring tendon autograft
. Bone-patellar tendon-bone (BTB) autograft
. Quadriceps tendon autograft
. Achilles tendon allograft
. Tibialis anterior allograft

Correct Answer & Explanation

. Bone-patellar tendon-bone (BTB) autograft

Explanation

Bone-patellar tendon-bone (BTB) autografts are historically associated with a higher incidence of donor site morbidity, specifically anterior knee pain and kneeling pain, compared to hamstring or allograft options. However, they demonstrate excellent graft incorporation and high stability.

Question 7068

Topic: Shoulder & Hip Sports

A 19-year-old athlete undergoes evaluation for recurrent anterior shoulder instability. Advanced imaging reveals an anterior glenoid bone loss of 28%. What is the most appropriate surgical intervention?

. Arthroscopic Bankart repair with suture anchors
. Arthroscopic Bankart repair with Remplissage
. Coracoid process transfer (Latarjet procedure)
. Open capsular shift
. Arthroscopic thermal capsulorrhaphy

Correct Answer & Explanation

. Coracoid process transfer (Latarjet procedure)

Explanation

Critical glenoid bone loss (>20-25%) in the setting of anterior shoulder instability is an indication for a bony augmentation procedure, most commonly the Latarjet procedure (coracoid transfer). Soft tissue stabilization alone (Bankart repair) carries an unacceptably high failure rate in this scenario.

Question 7069

Topic: Knee Sports
A 40-year-old man sustains a traumatic high-energy knee dislocation (KD III) resulting in multiligamentous injury. During the initial neurological assessment, he exhibits a foot drop and decreased sensation over the dorsum of the foot. Which nerve is injured?
. Tibial nerve
. Saphenous nerve
. Common peroneal nerve
. Deep femoral nerve
. Sural nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve is the most frequently injured nerve in high-energy knee dislocations, particularly those involving disruption of the posterolateral corner. Injury results in foot drop (loss of dorsiflexion) and numbness over the dorsum of the foot.

Question 7070

Topic: 5. Sports Medicine

When comparing a quadrupled hamstring autograft to a bone-patellar tendon-bone (BPTB) autograft for primary anterior cruciate ligament (ACL) reconstruction, the hamstring autograft is most likely to demonstrate which of the following characteristics?

. A higher incidence of postoperative anterior knee pain
. A lower ultimate tensile load to failure at time zero
. A decreased incidence of postoperative kneeling pain
. Faster graft incorporation at the bone-tunnel interface
. A higher risk of a contralateral ACL rupture

Correct Answer & Explanation

. A decreased incidence of postoperative kneeling pain

Explanation

Quadrupled hamstring autografts are associated with less donor-site morbidity, specifically a lower incidence of anterior knee pain and kneeling pain, compared to BPTB autografts. They have equivalent or higher tensile strength at time zero but slower biological incorporation into the bone tunnels.

Question 7071

Topic: Knee Sports

An 18-year-old football player sustains a knee injury with immediate hemarthrosis after decelerating and pivoting. Examination reveals a positive Lachman test. The injured structure consists of two distinct bundles. Which of the following statements regarding the biomechanics of these bundles is correct?

. The anteromedial bundle is tight in extension and controls rotatory stability.
. The posterolateral bundle is tight in flexion and controls anterior translation.
. The anteromedial bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees of flexion.
. The posterolateral bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees of flexion.
. Both bundles are equally tight throughout the entire range of motion.

Correct Answer & Explanation

. The anteromedial bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees of flexion.

Explanation

Correct Answer: The anteromedial bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees of flexion.The anterior cruciate ligament (ACL) consists of two main bundles: the anteromedial (AM) bundle and the posterolateral (PL) bundle. The AM bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees of flexion (tested via the anterior drawer test). The PL bundle is tight in extension and is the primary restraint to rotatory loads and anterior translation in near-extension (tested via the Lachman and pivot shift tests). Understanding this anatomy is crucial for anatomic ACL reconstruction.

Question 7072

Topic: 5. Sports Medicine

A 19-year-old athlete undergoes evaluation for a suspected anterior cruciate ligament (ACL) tear. Magnetic resonance imaging (MRI) confirms a complete midsubstance ACL rupture. Which of the following associated meniscal injuries is most commonly seen in the acute setting of an ACL tear?

. Medial meniscus bucket-handle tear
. Lateral meniscus posterior horn tear
. Medial meniscus anterior horn tear
. Lateral meniscus anterior horn tear
. Medial meniscus root tear

Correct Answer & Explanation

. Lateral meniscus posterior horn tear

Explanation

Correct Answer: Lateral meniscus posterior horn tearIn the acute setting of an ACL tear, lateral meniscus tears are more common than medial meniscus tears. The mechanism of injury often involves a valgus and internal rotation force, leading to a bone bruise on the lateral femoral condyle and the posterior aspect of the lateral tibial plateau. This mechanism frequently traps and tears the posterior horn of the lateral meniscus. Conversely, in chronic ACL deficiency, the medial meniscus becomes the primary secondary restraint to anterior tibial translation, making it more susceptible to tearing over time due to repetitive microtrauma.

Question 7073

Topic: Knee Sports

An 18-year-old football player sustains an acute anterior cruciate ligament (ACL) tear with a large hemarthrosis. He currently has a knee range of motion from 15 degrees of extension to 90 degrees of flexion. What is the most significant risk of performing an immediate ACL reconstruction before he regains full range of motion?

. Graft rupture
. Arthrofibrosis
. Deep vein thrombosis
. Infection
. Patellar tendon rupture

Correct Answer & Explanation

. Arthrofibrosis

Explanation

Correct Answer: BPerforming an ACL reconstruction in the acute phase when the knee is swollen, inflamed, and lacks full range of motion significantly increases the risk of postoperative arthrofibrosis (stiffness). Current standard of care involves a period of "prehabilitation" to allow the acute hemarthrosis to resolve, restore normal gait mechanics, and achieve full range of motion (especially full extension) prior to surgical reconstruction. This approach drastically reduces the incidence of postoperative motion complications.

Question 7074

Topic: 5. Sports Medicine

During an ACL reconstruction on an 18-year-old athlete, the surgeon is identifying the native footprints of the ACL. The anteromedial (AM) bundle of the ACL is tightest in which position, and what is its primary biomechanical function?

. Tightest in extension; primary restraint to anterior tibial translation
. Tightest in flexion; primary restraint to anterior tibial translation
. Tightest in extension; primary restraint to rotatory loads
. Tightest in flexion; primary restraint to rotatory loads
. Tightest in mid-flexion; primary restraint to valgus loads

Correct Answer & Explanation

. Tightest in flexion; primary restraint to anterior tibial translation

Explanation

Correct Answer: BThe native ACL consists of two primary bundles: the anteromedial (AM) bundle and the posterolateral (PL) bundle. The AM bundle is tightest in flexion and serves as the primary restraint to anterior tibial translation. The PL bundle is tightest in extension and serves as the primary restraint to rotatory loads (evaluated clinically by the pivot shift test). Understanding this anatomy is critical for anatomic ACL reconstruction.

Question 7075

Topic: 5. Sports Medicine

An 18-year-old high school football player sustains a non-contact deceleration and pivoting injury to his knee, resulting in an immediate, tense hemarthrosis. Examination reveals a large effusion, range of motion from 15 to 90 degrees, a 2+ Lachman test, and no joint line tenderness. What is the most appropriate initial management before considering surgical reconstruction?

. Immediate anterior cruciate ligament reconstruction within 48 hours
. Aspiration of the hemarthrosis and immediate return to play
. Physical therapy to achieve full symmetric range of motion
. Diagnostic knee arthroscopy and meniscal repair
. Immobilization in a cylinder cast for 4 weeks

Correct Answer & Explanation

. Physical therapy to achieve full symmetric range of motion

Explanation

Correct Answer: CThis patient has sustained an acute anterior cruciate ligament (ACL) tear, evidenced by the mechanism of injury, immediate hemarthrosis, and positive Lachman test. He currently has restricted range of motion (15 to 90 degrees). Performing an ACL reconstruction in an acutely inflamed knee with restricted range of motion significantly increases the risk of postoperative arthrofibrosis. The standard of care is to delay surgery until the acute inflammatory phase has subsided, the effusion has resolved, and the patient has regained full, symmetric range of motion (especially full extension) through a "prehab" physical therapy program. Immediate surgery is generally avoided unless there is a locked knee (e.g., bucket-handle meniscus tear) or a multi-ligamentous knee injury requiring acute repair.

Question 7076

Topic: Knee Sports

An 18-year-old football player develops an immediate, tense hemarthrosis following a pivoting injury to his knee. Aspiration yields 60 mL of frank blood. He is subsequently diagnosed with an anterior cruciate ligament (ACL) tear. The primary blood supply to the ruptured ligament, which is responsible for the rapid hemarthrosis, is derived from which of the following arteries?

. Lateral inferior genicular artery
. Medial inferior genicular artery
. Middle genicular artery
. Descending genicular artery
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Middle genicular artery

Explanation

Correct Answer: CThe primary blood supply to the anterior and posterior cruciate ligaments is the middle genicular artery. This artery originates from the popliteal artery, pierces the posterior joint capsule, and supplies the synovial fold that envelops the cruciate ligaments. Rupture of the ACL tears these vascular structures, leading to the rapid accumulation of blood in the joint (immediate hemarthrosis). The medial and lateral inferior genicular arteries primarily supply the menisci and peripheral joint capsule.

Question 7077

Topic: Knee Sports

An 18-year-old high school football player sustains a non-contact deceleration and pivoting injury to his knee. He develops an immediate, tense hemarthrosis. Examination reveals a 2+ Lachman test, no joint line tenderness, and a range of motion from 15 to 90 degrees. Radiographs are negative for fracture. What is the most appropriate initial management to optimize his outcome prior to definitive surgical reconstruction?

. Immediate anterior cruciate ligament (ACL) reconstruction
. Aspiration of the hemarthrosis followed by immediate ACL reconstruction
. Immobilization in full extension for 4 weeks followed by ACL reconstruction
. Physical therapy to restore full range of motion and resolve the effusion prior to ACL reconstruction
. Diagnostic arthroscopy and meniscal repair

Correct Answer & Explanation

. Physical therapy to restore full range of motion and resolve the effusion prior to ACL reconstruction

Explanation

Correct Answer: DThe patient has sustained an acute anterior cruciate ligament (ACL) tear, evidenced by the mechanism of injury, immediate hemarthrosis, and positive Lachman test. Performing an ACL reconstruction in an acutely inflamed knee with limited range of motion significantly increases the risk of postoperative arthrofibrosis (stiffness). The standard of care is to delay surgical reconstruction until the acute inflammatory phase has passed, the effusion has resolved, normal gait is restored, and full range of motion (especially full extension) is achieved. This process typically takes 3 to 6 weeks and is facilitated by "prehabilitation" physical therapy. Immediate reconstruction or prolonged immobilization would both unacceptably increase the risk of permanent knee stiffness.

Question 7078

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, the surgeon must accurately identify the native femoral footprint to ensure proper graft placement. The ACL consists of two main bundles: the anteromedial (AM) and posterolateral (PL) bundles, named according to their tibial insertions. Where does the AM bundle originate on the femur?

. 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
. Central portion of the intercondylar notch roof

Correct Answer & Explanation

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

Explanation

Correct Answer: AThe anterior cruciate ligament (ACL) originates on the medial wall of the lateral femoral condyle and inserts on the anterior intercondylar area of the tibia. The two functional bundles, the anteromedial (AM) and posterolateral (PL), are named for their tibial insertion sites. On the femoral side (with the knee in extension), the AM bundle originates high and deep (proximal and posterior) on the medial wall of the lateral femoral condyle. The PL bundle originates lower and more shallow (distal and anterior). The AM bundle is tight in flexion and controls anterior translation, while the PL bundle is tight in extension and primarily controls rotatory stability.

Question 7079

Topic: Knee Sports

An 18-year-old football player sustains a twisting knee injury resulting in an immediate hemarthrosis. Examination reveals a 2+ Lachman test and a range of motion from 15 to 90 degrees. If an anterior cruciate ligament (ACL) reconstruction is performed immediately, the patient is at the highest risk for developing which of the following postoperative complications?

. Patellar tendon rupture
. Arthrofibrosis
. Recurrent instability
. Deep vein thrombosis
. Complex regional pain syndrome

Correct Answer & Explanation

. Arthrofibrosis

Explanation

Correct Answer: BPerforming an anterior cruciate ligament (ACL) reconstruction in the acute setting, when the knee is swollen, inflamed, and lacks full range of motion, significantly increases the risk of postoperative arthrofibrosis. Arthrofibrosis is characterized by the proliferation of scar tissue within the joint, leading to a painful restriction of motion. To minimize this risk, the standard of care is to delay ACL reconstruction until the acute inflammatory phase has resolved, the effusion has subsided, and the patient has regained full extension and at least 120 degrees of flexion. This typically takes 2 to 4 weeks of preoperative physical therapy ("prehab").

Question 7080

Topic: Knee Sports

An 18-year-old athlete undergoes evaluation for an acute anterior cruciate ligament (ACL) tear after a non-contact pivoting injury. He has a large effusion and a positive Lachman test. Which of the following meniscal tear patterns is most commonly associated with this specific acute injury?

. Medial meniscus bucket-handle tear
. Lateral meniscus posterior horn root tear
. Medial meniscus horizontal cleavage tear
. Lateral meniscus posterior horn tear
. Medial meniscus radial tear

Correct Answer & Explanation

. Lateral meniscus posterior horn tear

Explanation

Correct Answer: DMeniscal tears are highly associated with ACL injuries. In the setting of an acute ACL tear, lateral meniscus tears are more common than medial meniscus tears, occurring in up to 60-70% of cases. The most frequent location is the posterior horn of the lateral meniscus. This occurs due to the mechanism of injury, where the lateral femoral condyle subluxates posteriorly and impacts the posterior aspect of the lateral tibial plateau, trapping the lateral meniscus. Conversely, in chronic ACL deficiency, medial meniscus tears become more common. This is because the medial meniscus acts as a secondary stabilizer to anterior tibial translation; over time, the repetitive anterior shear forces lead to failure of the posterior horn of the medial meniscus.

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