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5. Sports Medicine MCQs

Practice Set 44 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 861

Topic: 5. Sports Medicine

During which phase of ACL graft incorporation does an autograft typically exhibit its lowest mechanical strength?

. 0 to 2 weeks
. 2 to 4 weeks
. 6 to 12 weeks
. 6 to 9 months
. 12 to 18 months

Correct Answer & Explanation

. 6 to 12 weeks

Explanation

The revascularization and proliferation phase of graft healing typically occurs between 6 and 12 weeks postoperatively. During this time, the graft undergoes necrosis and subsequent revascularization, resulting in its weakest biomechanical state.

Question 862

Topic: Knee Sports

A 45-year-old female sustains a medial meniscus posterior root tear. Biomechanically, the loss of hoop stresses in this condition is most equivalent to which of the following?

. Isolated deep MCL tear
. Total medial meniscectomy
. Partial medial meniscectomy
. Anterior cruciate ligament rupture
. Medial compartment osteoarthritis without meniscal damage

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A complete meniscal root tear disrupts the circumferential hoop stresses that normally distribute axial loads. Biomechanically, this derangement results in increased contact pressures equivalent to a total meniscectomy.

Question 863

Topic: Knee Sports
During reconstruction of the medial patellofemoral ligament (MPFL), identifying the anatomic femoral attachment is critical. According to Schöttle, where is this point located radiographically?
. Posterior to the adductor tubercle
. Anterior to the posterior femoral cortex line, between the adductor tubercle and medial epicondyle
. Directly on the medial epicondyle
. Distal to the medial epicondyle
. Anterior to Blumensaat's line

Correct Answer & Explanation

. Anterior to the posterior femoral cortex line, between the adductor tubercle and medial epicondyle

Explanation

Schöttle's point is the radiographic landmark for the femoral origin of the MPFL. It is located 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the medial epicondyle.

Question 864

Topic: Knee Sports

A patient presents with a painful lack of terminal knee extension 4 months following an ACL reconstruction. MRI demonstrates a nodular mass in the anterior intercondylar notch. What is the histologic composition of this mass?

. Hyaline cartilage
. Benign giant cells
. Fibrovascular and granulation tissue
. Synovial chondromatosis
. Calcified woven bone

Correct Answer & Explanation

. Fibrovascular and granulation tissue

Explanation

The patient has a "Cyclops lesion," which is a localized form of anterior arthrofibrosis that blocks terminal extension. Histologically, it is composed of a dense nodule of fibrovascular and granulation tissue.

Question 865

Topic: Knee Sports

The classic, most common anatomic location for an osteochondritis dissecans (OCD) lesion of the knee is the:

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

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

Approximately 70% to 80% of knee OCD lesions occur on the lateral aspect of the medial femoral condyle. This classic location is often remembered by the mnemonic "LAME" (Lateral Aspect Medial Epicondyle/Condyle).

Question 866

Topic: Knee Sports

During an ACL reconstruction, placing the tibial tunnel too far anteriorly most commonly leads to which of the following complications?

. PCL impingement and loss of flexion
. Roof impingement and loss of terminal extension
. Lateral wall impingement and valgus instability
. Medial wall impingement and varus instability
. Graft laxity in full extension

Correct Answer & Explanation

. Roof impingement and loss of terminal extension

Explanation

An anteriorly placed tibial tunnel causes the graft to impinge against the roof of the intercondylar notch (Blumensaat's line) during knee extension. This results in a mechanical block to terminal extension and potential early graft failure.

Question 867

Topic: Knee Sports

If the femoral tunnel during an ACL reconstruction is placed too far anteriorly (shallow) in the intercondylar notch, what resulting kinematic mismatch will occur?

. The graft will be tight in flexion and loose in extension
. The graft will be loose in flexion and tight in extension
. The graft will be tight in both flexion and extension
. The graft will be loose in both flexion and extension
. The graft will impinge on the PCL in deep flexion

Correct Answer & Explanation

. The graft will be tight in flexion and loose in extension

Explanation

A femoral tunnel placed too far anteriorly (shallow) is non-anatomic. This positioning causes the graft to artificially tighten as the knee goes into flexion and become abnormally loose in full extension.

Question 868

Topic: 5. Sports Medicine

When counseling a 17-year-old competitive soccer player regarding ACL graft choices, what is the most accurate evidence-based information regarding the use of cadaveric allografts in her specific demographic?

. They incorporate faster than autografts.
. They carry a lower risk of postoperative infection compared to autografts.
. They have a significantly higher rupture rate in young, active patients.
. They result in greater quadriceps weakness at 1 year.
. They are biomechanically superior to autografts at time zero.

Correct Answer & Explanation

. They have a significantly higher rupture rate in young, active patients.

Explanation

Extensive literature demonstrates that the use of allografts in young (under 25), highly active patients results in a significantly higher failure rate (up to 3-4 times higher) compared to autografts. Slower biologic incorporation is the primary reason for this failure.

Question 869

Topic: 5. Sports Medicine

Current evidence-based consensus guidelines suggest that athletes should delay returning to unrestricted pivoting sports following an ACL reconstruction until their Limb Symmetry Index (LSI) on functional hop testing reaches at least what threshold?

. 70%
. 75%
. 80%
. 85%
. 90%

Correct Answer & Explanation

. 90%

Explanation

An LSI of >90% on functional hop testing (along with symmetric quadriceps strength >90%) is widely accepted as the minimal criteria before clearing an athlete to return to high-risk, pivoting sports post-ACL reconstruction.

Question 870

Topic: 5. Sports Medicine

During primary ACL reconstruction using a bone-patellar tendon-bone autograft, the surgeon inadvertently places the femoral tunnel excessively anterior. Which clinical finding is most likely to result from this technical error?

. Loss of terminal extension
. Loss of deep flexion
. Persistent pivot shift
. Patellar fracture
. Graft hypertrophy

Correct Answer & Explanation

. Loss of deep flexion

Explanation

An anteriorly placed femoral tunnel creates a graft that is relatively loose in extension but progressively tightens as the knee flexes. This typically results in a restriction or complete loss of deep knee flexion, or it may lead to graft stretching and failure if flexion is forced.

Question 871

Topic: Knee Sports

A 19-year-old female presents with persistent knee instability 1 year after ACL reconstruction. Exam demonstrates a 1A Lachman but a grade 3 pivot shift.

What is the most likely technical cause for this specific failure pattern?

. Tibial tunnel placed too posteriorly
. Tibial tunnel placed too anteriorly
. Femoral tunnel placed too vertically
. Unrecognized posterolateral corner injury
. Failure of graft incorporation

Correct Answer & Explanation

. Femoral tunnel placed too vertically

Explanation

A vertically placed femoral tunnel (e.g., high in the notch at the 12 o'clock position) may adequately restore anteroposterior translation (yielding a negative Lachman test). However, it fails to control rotational forces, clinically manifesting as a persistent, high-grade pivot shift.

Question 872

Topic: 5. Sports Medicine

When planning a revision ACL reconstruction, which of the following findings is the most universally accepted absolute indication for a two-stage approach with bone grafting prior to revision?

. Prior use of irradiated allograft
. Tibial or femoral tunnel widening > 14-15 mm
. Concurrent grade II MCL sprain
. Presence of a cyclops lesion
. Patient age less than 20 years

Correct Answer & Explanation

. Tibial or femoral tunnel widening > 14-15 mm

Explanation

A staged ACL revision is indicated when significant tunnel widening (typically >14-15 mm) or tunnel coalition compromises the structural integrity needed for new graft fixation. Bone grafting to fill the defects followed by a period of healing is required before the final reconstruction.

Question 873

Topic: 5. Sports Medicine

A 25-year-old male undergoes arthroscopy for an ACL tear. The surgeon suspects a concurrent meniscal ramp lesion. Which of the following describes the most sensitive arthroscopic method to diagnose this specific lesion?

. Standard anterolateral portal viewing with anterior probing
. Viewing from the anterolateral portal with a 70-degree arthroscope
. Viewing through a trans-notch approach or posteromedial portal
. Placing the knee in a rigid figure-of-four position
. Using a motorized shaver to clear the anterior interval

Correct Answer & Explanation

. Viewing through a trans-notch approach or posteromedial portal

Explanation

Ramp lesions are longitudinal tears of the peripheral meniscocapsular attachment of the posterior horn of the medial meniscus. They are frequently obscured from standard anterior portals and are best evaluated using a trans-notch view or a dedicated posteromedial portal.

Question 874

Topic: 5. Sports Medicine

A 16-year-old female soccer player undergoes primary ACL reconstruction with a hamstring autograft. Which of the following factors represents the most significant independent risk factor for subsequent ACL graft failure in this patient?

. Use of a hamstring autograft instead of BTB
. Patient age at the time of surgery
. Gender of the patient
. Concurrent repair of a meniscal tear
. Fixation with bioabsorbable interference screws

Correct Answer & Explanation

. Patient age at the time of surgery

Explanation

Young patient age (particularly under 20 years) and returning to high-level pivoting sports are the strongest independent predictors of ACL graft failure. While graft choice can influence outcomes, age consistently shows the highest correlation with reinjury and failure.

Question 875

Topic: Knee Sports

A 30-year-old male sustains a high-energy multiligamentous knee dislocation involving the ACL, PCL, and posterolateral corner (PLC). He presents with a complete foot drop. Which nerve is most likely injured, and what is the typical mechanism?

. Tibial nerve; stretch injury
. Common peroneal nerve; traction/stretch injury
. Saphenous nerve; direct laceration
. Deep peroneal nerve; compartment syndrome
. Sural nerve; direct contusion

Correct Answer & Explanation

. Common peroneal nerve; traction/stretch injury

Explanation

The common peroneal nerve is the most frequently injured nerve in multiligament knee injuries, particularly those with a PLC disruption. The pathomechanism is typically a stretch or traction injury (neuropraxia or axonotmesis) secondary to severe varus and hyperextension forces.

Question 876

Topic: Knee Sports

During physical examination of a patient with a suspected multiligament knee injury, the Dial test demonstrates 15 degrees of increased external rotation compared to the contralateral side at 30 degrees of knee flexion. However, there is no difference at 90 degrees of flexion. What is the diagnosis?

. Isolated PCL injury
. Isolated PLC injury
. Combined PCL and PLC injury
. Combined ACL and PLC injury
. Posteromedial corner injury

Correct Answer & Explanation

. Isolated PLC injury

Explanation

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

Question 877

Topic: Knee Sports

A patient presents with anterior knee pain and a sudden loss of terminal extension 4 months following an ACL reconstruction.

MRI reveals a localized soft-tissue nodule situated immediately anterior to the ACL graft in the notch. What is the most appropriate management?

. Manipulation under anesthesia
. Arthroscopic excision of the mass
. Revision ACL reconstruction
. Prolonged physical therapy and oral corticosteroids
. Ultrasound-guided aspiration

Correct Answer & Explanation

. Arthroscopic excision of the mass

Explanation

The clinical presentation and MRI findings describe a 'cyclops lesion', which is localized arthrofibrosis anterior to the ACL graft. Arthroscopic excision is the definitive treatment and reliably restores terminal knee extension.

Question 878

Topic: Knee Sports
In anatomic reconstruction of the medial patellofemoral ligament (MPFL), precise placement of the femoral attachment is critical to avoid anisometry. Radiographically (Schöttle's point), where is this isometric point located?
. Anterior to the posterior femoral cortical line and proximal to Blumensaat's line
. Posterior to the posterior femoral cortical line and distal to Blumensaat's line
. On the crest of the medial epicondyle
. At the apex of the adductor tubercle
. 1 cm proximal and 1 cm posterior to the lateral epicondyle

Correct Answer & Explanation

. Anterior to the posterior femoral cortical line and proximal to Blumensaat's line

Explanation

Schöttle's point is the radiographic landmark for the femoral origin of the MPFL. On a strict lateral radiograph, it is found 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line.

Question 879

Topic: Knee Sports

A 45-year-old male presents with chronic medial knee pain and varus malalignment. Radiographs confirm isolated medial compartment osteoarthritis. He is scheduled for a high tibial osteotomy (HTO). Which of the following conditions represents a relative contraindication to an opening wedge HTO?

. Age > 40 years
. Knee flexion contracture > 15 degrees
. Prior ACL reconstruction
. Medial meniscus deficiency
. Patient weight > 80 kg

Correct Answer & Explanation

. Knee flexion contracture > 15 degrees

Explanation

A knee flexion contracture greater than 15 degrees is a significant relative contraindication to a high tibial osteotomy, as the procedure cannot effectively correct sagittal plane deformity and patients do poorly. Other contraindications include tricompartmental OA and inflammatory arthritis.

Question 880

Topic: Knee Sports

What is the primary vascular supply to the anterior cruciate ligament (ACL)?

. Superior medial genicular artery
. Middle genicular artery
. Inferior lateral genicular artery
. Descending genicular artery
. Popliteal artery

Correct Answer & Explanation

. Middle genicular artery

Explanation

The primary blood supply to the ACL is the middle genicular artery, which branches directly off the popliteal artery and pierces the posterior joint capsule to supply the cruciate ligaments and synovial fold.

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