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5. Sports Medicine MCQs

Practice Set 5 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 81

Topic: Knee Sports

Which bundle of the anterior cruciate ligament (ACL) is responsible for primarily resisting anterior tibial translation when the knee is in near-full extension?

. Anteromedial (AM) bundle
. Posterolateral (PL) bundle
. Anterolateral (AL) bundle
. Posteromedial (PM) bundle
. Ligament of Wrisberg

Correct Answer & Explanation

. Posterolateral (PL) bundle

Explanation

The posterolateral (PL) bundle of the ACL is tightest in extension. It serves as the primary restraint to both anterior tibial translation and rotatory loads when the knee is near full extension.

Question 82

Topic: 5. Sports Medicine

During posterior cruciate ligament (PCL) reconstruction using an Achilles tendon allograft, at what degree of knee flexion should the graft typically be tensioned to restore normal knee kinematics?

. 0 degrees (full extension)
. 30 degrees
. 45 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 90 degrees

Explanation

The PCL is typically tensioned at 90 degrees of knee flexion where it normally experiences maximum tension. Tensioning in full extension can lead to over-constraint and limited functional knee flexion.

Question 83

Topic: Knee Sports

A posterior root tear of the medial meniscus in a 50-year-old patient typically results in biomechanical alterations most closely resembling which of the following scenarios?

. A partial medial meniscectomy
. A bucket-handle meniscus tear
. A total medial meniscectomy
. An anterior horn radial tear
. An intact meniscus under heavy physiological load

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A posterior root tear effectively abolishes the hoop stresses of the meniscus, leading to extrusion under load. Biomechanically, this distributes tibiofemoral contact pressures in a manner nearly identical to a total meniscectomy.

Question 84

Topic: Knee Sports
When performing a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the anatomic femoral attachment (Schöttle's point) is best described radiographically as being located:
. Anterior to the posterior femoral cortical line and distal to Blumensaat's line
. Posterior to the posterior femoral cortical line and proximal to Blumensaat's line
. Between the medial epicondyle and the adductor tubercle
. 10 mm distal to the medial epicondyle
. Directly on the medial epicondyle

Correct Answer & Explanation

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

Explanation

Anatomically, Schöttle's point is located in the saddle between the medial epicondyle and adductor tubercle. Radiographically, it is located roughly 1 mm anterior to the posterior femoral cortical line and 2.5 mm distal to the posterior origin of the medial femoral condyle.

Question 85

Topic: 5. Sports Medicine

Which of the following clinical scenarios represents an absolute indication for acute surgical repair of a proximal hamstring avulsion injury?

. A 1-tendon avulsion with 1 cm of retraction
. A 2-tendon avulsion with minimal retraction in a non-athlete
. An ischial apophyseal avulsion displaced 1 cm in a 14-year-old
. A complete 3-tendon avulsion retracted greater than 2 cm
. A partial hamstring tear failing 3 weeks of conservative management

Correct Answer & Explanation

. A complete 3-tendon avulsion retracted greater than 2 cm

Explanation

Acute surgical repair is indicated for complete 3-tendon avulsions (biceps femoris, semitendinosus, and semimembranosus) that are retracted greater than 2 cm. Most 1- or 2-tendon tears with minimal retraction can be managed conservatively.

Question 86

Topic: 5. Sports Medicine

A 40-year-old male sustains a severe acute knee injury while landing from a jump. Lateral radiographs demonstrate patella baja. Based on this finding, which of the following physical examination findings is most likely to be present?

. A palpable defect at the superior pole of the patella
. A palpable defect at the inferior pole of the patella
. A positive dial test at 30 degrees only
. A positive pivot shift test
. Significant medial joint line tenderness

Correct Answer & Explanation

. A palpable defect at the superior pole of the patella

Explanation

Patella baja, or an abnormally low-riding patella, is indicative of a quadriceps tendon rupture, which allows the intact patellar tendon to pull the patella inferiorly. This injury is characterized by a palpable gap at the superior pole of the patella.

Question 87

Topic: Knee Sports

When using the tibial external rotation test on a patient, increased external rotation at 30° and 90° of knee flexion is indicative of:

. Anterior cruciate ligament injury
. Posterior cruciate ligament injury
. Isolated posterolateral corner injury
. Posterior cruciate and posterolateral corner injury
. Anterior cruciate and posterior cruciate ligament injury

Correct Answer & Explanation

. Posterior cruciate and posterolateral corner injury

Explanation

The tibial external rotation test is performed at 30° and 90° of knee flexion. The degree of foot external rotation with regard to the femur is evaluated. Increased external rotation at 30° is consistent with an isolated posterolateral corner injury. Increased external rotation at 30° and 90° is consistent with a combined posterolateral and posterior cruciate ligament injury.

Question 88

Topic: Knee Sports

The recommended treatment for an acute combined anterior cruciate ligament and complete posterolateral corner disruption in a young athlete is:

. Anterior cruciate ligament reconstruction alone
. Nonoperative treatment emphasizing quadriceps strengthening
. Anterior cruciate ligament reconstruction and posterolateral corner repair
. Anterior cruciate ligament repair and posterolateral corner repair
. Posterolateral corner repair alone

Correct Answer & Explanation

. Anterior cruciate ligament reconstruction and posterolateral corner repair

Explanation

In cases of combined cruciate ligament and posterolateral corner injuries, most surgeons recommend addressing both injuries. In one study, the most common cause of anterior cruciate ligament failure was unrecognized and untreated concomitant posterolateral corner injuries.

Question 89

Topic: Knee Sports

The ideal timing for repair of an acute posterolateral corner knee injury is:

. In the first 3 weeks
. 4 to 6 weeks
. 8 to 12 weeks
. Acute repair is unsuccessful, and late reconstruction is recommended.
. Surgery is rarely needed for complete posterolateral corner injuries.

Correct Answer & Explanation

. In the first 3 weeks

Explanation

Surgical repair of posterolateral corner injuries is recommended within the first several weeks because dissection can be difficult and can result in the need for a reconstruction with longer delays. Results of chronic posterolateral corner injury repairs are inferior to those for acute posterolateral corner injuries.

Question 90

Topic: Knee Sports

Which of the following exercises must be delayed for up to 3 months after posterolateral corner repair or reconstruction of the knee:

. Range of motion exercises
. Isometric quadriceps exercises
. Closed chain quadriceps exercises
. Hamstring exercises
. All of the above answers should be started immediately

Correct Answer & Explanation

. Hamstring exercises

Explanation

Postoperative rehabilitation for posterolateral corner repair or reconstruction involves early protected or nonweight bearing, early range of motion exercises, and quadriceps exercises. Avoidance of hamstring exercises for up to 12 weeks is recommended to decrease external rotational torque and posterior subluxation forces at the knee joint.

Question 91

Topic: General Sports & Tendon

The following figure is the magnetic resonance image (MRI) of a 40-year- old avid female water-skier who felt a pop in her left hip as she was pulled over the front of her ski. Recommended treatment includes:

. Percutaneous pinning
. Nonweight bearing crutch ambulation
. Physical therapy
. Operative repair of the injured structures
. Reassurance and symptomatic treatment

Correct Answer & Explanation

. Operative repair of the injured structures

Explanation

The MRI shows a complete avulsion of the hamstring tendons off the ischial tuberosity. In active individuals, operative repair is recommended for complete avulsions. Nonoperative treatment of complete hamstring avulsion injury yields a low rate of return to sport at preinjury activity level.

Question 92

Topic: 5. Sports Medicine

Which of the following is a risk factor for anterior cruciate ligament (AC L) injury in noncontact athletes:

. Smaller than average cross sectional size of the AC L
. High shoe-surface coefficient of friction
. Smaller than average diameter of the femoral notch
. Failure to use a knee brace
. Failure to modify activity of female athletes during certain phases of the menstrual cycle

Correct Answer & Explanation

. High shoe-surface coefficient of friction

Explanation

A high coefficient of friction at the shoe-surface interface is a risk factor for AC L injury in noncontact athletes. Insufficient evidence exists to definitively implicate the other possible answers as risk factors.

Question 93

Topic: Knee Sports

Which of the following structures constitute the primary static stabilizers of the posterolateral corner (PLC) of the knee?

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament
. Biceps femoris, lateral collateral ligament, and iliotibial band
. Popliteus tendon, arcuate ligament, and fabellofibular ligament
. Lateral collateral ligament, anterolateral ligament, and popliteus tendon
. Coronary ligament, lateral collateral ligament, and popliteofibular ligament

Correct Answer & Explanation

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

The primary static stabilizers of the PLC are the lateral collateral ligament (LCL), the popliteus tendon, and the popliteofibular ligament (PFL). These structures primarily resist varus stress and external rotation of the tibia.

Question 94

Topic: Knee Sports

During the tibial external rotation (dial) test, a patient exhibits 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side, but normal external rotation at 90 degrees. This finding is most indicative of an isolated injury to which of the following?

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

Correct Answer & Explanation

. Posterolateral corner

Explanation

Increased external rotation at 30 degrees of flexion only indicates an isolated posterolateral corner (PLC) injury. If increased rotation is present at both 30 and 90 degrees, a combined PLC and PCL injury is suspected.

Question 95

Topic: 5. Sports Medicine

A 22-year-old athlete undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Which of the following is the most frequently reported complication associated with this specific graft choice?

. Patellar fracture
. Patellar tendon rupture
. Anterior knee pain
. Loss of knee flexion
. Graft tunnel mismatch

Correct Answer & Explanation

. Anterior knee pain

Explanation

Anterior knee pain (or donor site morbidity) is the most common complication following BPTB autograft ACL reconstruction. Patellar fracture and tendon rupture are severe but rare complications.

Question 96

Topic: Knee Sports

Which of the following clinical tests is most specific for diagnosing a posterolateral corner (PLC) deficiency in the knee?

. Pivot shift test
. Reverse pivot shift test
. Lachman test
. Anterior drawer test
. Quadriceps active test

Correct Answer & Explanation

. Reverse pivot shift test

Explanation

The reverse pivot shift test evaluates PLC instability. The knee is brought from flexion to extension with a valgus and external rotation force; a palpable clunk occurs as the posteriorly subluxated lateral tibial plateau reduces.

Question 97

Topic: Knee Sports

The posterior cruciate ligament (PCL) consists of two main functional bundles. Which of the following statements regarding the anterolateral (AL) bundle is correct?

. It is the smaller of the two bundles.
. It is tightest in knee extension.
. It is tightest in knee flexion.
. It primarily resists valgus stress.
. It originates on the lateral femoral condyle.

Correct Answer & Explanation

. It is tightest in knee flexion.

Explanation

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

Question 98

Topic: Knee Sports
A 25-year-old soccer player sustains an acute combined Grade III femoral-sided medial collateral ligament (MCL) tear and an anterior cruciate ligament (ACL) rupture. What is the most widely accepted treatment strategy for this injury pattern?
. Acute repair of both ACL and MCL
. Acute repair of MCL followed by delayed ACL reconstruction
. ACL reconstruction with nonoperative management of the MCL using a hinged brace
. Nonoperative management of both ligaments
. Acute ACL reconstruction with staged MCL reconstruction

Correct Answer & Explanation

. ACL reconstruction with nonoperative management of the MCL using a hinged brace

Explanation

The standard treatment for a combined ACL tear and a femoral-sided Grade III MCL tear is ACL reconstruction with conservative management of the MCL in a hinged brace, as the MCL has excellent healing potential.

Question 99

Topic: 5. Sports Medicine
A 10-year-old boy falls from his bicycle and sustains a Meyers and McKeever Type III tibial eminence fracture. What is the most appropriate definitive management?
. Cylinder cast in 20 degrees of flexion
. Long leg cast in full extension
. Open or arthroscopic reduction and internal fixation
. Non-weight bearing with early physical therapy
. Primary ACL reconstruction with hamstring autograft

Correct Answer & Explanation

. Open or arthroscopic reduction and internal fixation

Explanation

Type III tibial eminence (spine) fractures are completely displaced. The standard of care is anatomic reduction and internal fixation (using sutures or screws) via an arthroscopic or open approach to restore ACL tension and joint congruity.

Question 100

Topic: Knee Sports

Which of the following arteries provides the primary blood supply to the anterior cruciate ligament (ACL)?

. Lateral inferior genicular artery
. Medial inferior genicular artery
. Middle genicular artery
. Descending genicular artery
. Superior medial genicular artery

Correct Answer & Explanation

. Middle genicular artery

Explanation

The middle genicular artery, a branch of the popliteal artery, pierces the posterior capsule to provide the primary blood supply to the cruciate ligaments and the synovial fold.

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