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5. Sports Medicine MCQs

Practice Set 53 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 1041

Topic: 5. Sports Medicine

A 26-year-old rugby player presents after an awkward fall onto his left knee during a tackle. Clinical examination reveals a posterior sag and a positive posterior drawer test. Radiographs and MRI are obtained, as shown in the image below. Based on the findings, what is the most appropriate initial management for this patient's primary knee injury?

. Non-operative management with bracing and physical therapy
. Arthroscopic PCL reconstruction with allograft
. Open reattachment of the PCL avulsion fragment
. Posterior capsular repair with augmentation
. Acute arthroscopic debridement and observation

Correct Answer & Explanation

. Open reattachment of the PCL avulsion fragment

Explanation

Correct Answer: CThe case describes a 26-year-old rugby player with a PCL injury, and the images show a cortical disruption at the PCL insertion with a displaced avulsed fragment. The candidate in the viva correctly identifies this as a large, displaced avulsion fragment. For a displaced PCL avulsion fracture, especially in a young, active athlete, open reattachment of the fragment is the preferred treatment to restore PCL integrity and knee stability. The candidate in the case specifically states, 'I would offer this patient reattachment of the PCL avulsion through open procedure.'Option A (Non-operative management with bracing and physical therapy):While non-operative management can be considered for isolated, non-displaced PCL tears or mid-substance tears in less active individuals, it is generally not appropriate for a significantly displaced bony avulsion in an active athlete, as it would likely lead to persistent instability and poor functional outcomes.Option B (Arthroscopic PCL reconstruction with allograft):PCL reconstruction (arthroscopic or open) is typically reserved for mid-substance PCL tears or chronic PCL instability. In this case, there is a bony avulsion, which is amenable to direct reattachment, offering superior bone-to-bone healing and often better outcomes than a reconstruction with an allograft for this specific injury pattern.Option D (Posterior capsular repair with augmentation):A posterior capsular repair might be part of a broader reconstruction or repair strategy if there's significant capsular injury, but it does not address the primary issue of the displaced bony PCL avulsion.Option E (Acute arthroscopic debridement and observation):Debridement alone would not stabilize the displaced fragment and would lead to persistent instability. Observation is not appropriate for a displaced bony avulsion in an active individual.

Question 1042

Topic: Knee Sports

During the viva, the candidate describes the posterior approach to the knee. Which of the following is NOT a commonly accepted indication for utilizing a posterior approach to the knee?

. Open reduction and internal fixation of posterior tibial plateau shear fractures
. Fixation of bone avulsions associated with a posterior cruciate ligament (PCL) injury
. Repair of posterior vascular injuries
. Arthroscopic meniscal repair of a posterior horn tear
. Removal of popliteal cysts and neoplasms

Correct Answer & Explanation

. Arthroscopic meniscal repair of a posterior horn tear

Explanation

Correct Answer: DThe candidate explicitly lists the indications for a posterior approach to the knee: 'The indications include removal of popliteal cysts and neoplasms, posterior synovectomy, open reduction and internal fixation of posterior tibial plateau shear fractures, fixation of bone avulsions associated with a posterior cruciate ligament (PCL) injury, repair of posterior vascular injuries, and more recently, posterior inlay PCL reconstructions.'Option A (Open reduction and internal fixation of posterior tibial plateau shear fractures):This is a direct indication mentioned in the text.Option B (Fixation of bone avulsions associated with a posterior cruciate ligament (PCL) injury):This is the specific injury discussed in the case and is a direct indication mentioned.Option C (Repair of posterior vascular injuries):This is a direct indication mentioned in the text.Option E (Removal of popliteal cysts and neoplasms):This is a direct indication mentioned in the text.Option D (Arthroscopic meniscal repair of a posterior horn tear):While posterior horn meniscal tears are common, their repair is almost universally performed arthroscopically through standard anterior portals, sometimes with an accessory posteromedial or posterolateral portal, but not via a formal open posterior approach as described. The posterior approach is for deeper, more extensive posterior pathology or direct access to the PCL and vessels.

Question 1043

Topic: Knee Sports

A 30-year-old professional soccer player undergoes single-bundle ACL reconstruction for a right knee injury. To achieve optimal anatomical and isometric tunnel placement, where should the femoral tunnel ideally be positioned?

. At 12 o'clock, anterior to the resident's ridge
. At 3 o'clock, in the intercondylar notch
. At 10 to 10:30 o'clock, targeting the posterolateral bundle footprint
. At 1:30 to 2 o'clock, targeting the anteromedial bundle footprint
. Posterior to the resident's ridge, at 7 o'clock

Correct Answer & Explanation

. At 10 to 10:30 o'clock, targeting the posterolateral bundle footprint

Explanation

Correct Answer: CThe candidate states: 'For the femoral tunnel the isometric point lies at about 10 to 10.30 o’clock for right knee and 1.30 to 2 for left knee. The anteromedial bundle is thought to be the most isometric but most surgeons feel that it’s important to replace the posterolateral bundle.' The question specifies a right knee and single-bundle reconstruction aiming for anatomical and isometric placement.Option A (At 12 o'clock, anterior to the resident's ridge):Placing the tunnel too anterior (e.g., 12 o'clock or anterior to the resident's ridge) is described as a common mistake that restricts knee flexion and may result in graft elongation.Option B (At 3 o'clock, in the intercondylar notch):This position is not described as optimal for a right knee ACL femoral tunnel.Option C (At 10 to 10:30 o'clock, targeting the posterolateral bundle footprint):This is the exact optimal position described for a right knee, with the aim of replacing the posterolateral bundle.Option D (At 1:30 to 2 o'clock, targeting the anteromedial bundle footprint):This position is described for a left knee, not a right knee. While the anteromedial bundle is isometric, the text states most surgeons aim to replace the posterolateral bundle.Option E (Posterior to the resident's ridge, at 7 o'clock):While avoiding the resident's ridge is important, placing the tunnel too posterior (e.g., 7 o'clock) results in excessive tightening of the graft when the knee is extended.

Question 1044

Topic: Knee Sports

A 28-year-old patient undergoes an arthroscopic single-bundle ACL reconstruction. Post-operatively, the patient complains of significant restriction in knee flexion, particularly beyond 90 degrees. Based on the principles discussed in the case, which of the following is the most likely technical error during the procedure?

. Femoral tunnel placed too posterior
. Tibial tunnel placed too posterior
. Graft tensioned excessively in extension
. Femoral tunnel placed too anterior ('resident's ridge')
. Inadequate notchplasty leading to impingement in extension

Correct Answer & Explanation

. Femoral tunnel placed too anterior ('resident's ridge')

Explanation

Correct Answer: DThe candidate explicitly states: 'The most common mistake is to place femoral tunnel too anterior or ‘resident’s ridge’. This restricts flexion of the knee and may result in elongation of graft.'Option A (Femoral tunnel placed too posterior):A femoral tunnel placed too posterior would result in excessive tightening of the graft when the knee is extended, not restricted flexion.Option B (Tibial tunnel placed too posterior):While tibial tunnel malpositioning can cause issues, the text specifically links restricted flexion to an anterior femoral tunnel. A too-posterior tibial tunnel might lead to impingement in flexion or extension, but the primary cause of restricted flexion is often an anterior femoral tunnel.Option C (Graft tensioned excessively in extension):While excessive tensioning can cause stiffness, the specific pattern of restricted flexion is most directly linked to an anterior femoral tunnel.Option E (Inadequate notchplasty leading to impingement in extension):Impingement from an inadequate notchplasty is mentioned, but the text links it to impingement on the lateral femoral condyle, and the specific complication of restricted flexion is attributed to an anterior femoral tunnel. Impingement in extension would typically be due to a too-anterior tibial tunnel or an inadequate notchplasty.

Question 1045

Topic: 5. Sports Medicine

A 35-year-old recreational athlete is considering ACL reconstruction. The surgeon discusses graft options, including bone-patella tendon-bone (BPTB) autograft. According to the case discussion, which of the following is a recognized disadvantage or donor site morbidity specifically associated with BPTB autografts?

. Slow healing due to tendon-to-bone incorporation
. Increased risk of saphenous nerve injury
. Higher incidence of hamstring weakness
. Anterior knee pain in 30-50% of patients
. Radiographic femoral tunnel widening

Correct Answer & Explanation

. Anterior knee pain in 30-50% of patients

Explanation

Correct Answer: DThe candidate discusses the disadvantages of BPTB grafts: 'However, it has donor site morbidity which includes anterior knee pain in 30–50%, patellar tendonitis 3–5%, patellar fracture and patella baja.'Option A (Slow healing due to tendon-to-bone incorporation):This is a disadvantage specifically associated with hamstring grafts, not BPTB grafts, which benefit from bone-to-bone healing.Option B (Increased risk of saphenous nerve injury):This is a potential complication associated with hamstring graft harvest, not BPTB.Option C (Higher incidence of hamstring weakness):This is a potential complication associated with hamstring graft harvest, not BPTB.Option E (Radiographic femoral tunnel widening):The text mentions 'increased knee laxity with radiographic femoral tunnel wide in hamstring graft,' indicating this is more associated with hamstring grafts.

Question 1046

Topic: 5. Sports Medicine

A 22-year-old patient undergoes ACL reconstruction using a four-strand hamstring autograft. Post-operatively, the patient reports numbness and altered sensation along the medial aspect of the leg, distal to the knee. Which nerve is most likely to have been injured during graft harvest?

. Common peroneal nerve
. Tibial nerve
. Sural nerve
. Saphenous nerve
. Posterior femoral cutaneous nerve

Correct Answer & Explanation

. Saphenous nerve

Explanation

Correct Answer: DThe candidate states that a disadvantage of hamstring grafts is that 'It can also result in hamstring weakness and saphenous nerve injury.' The saphenous nerve provides sensory innervation to the medial aspect of the leg distal to the knee, making its injury consistent with the described symptoms.Option A (Common peroneal nerve):Injury to the common peroneal nerve would typically result in foot drop (weakness in dorsiflexion and eversion) and sensory loss over the dorsum of the foot and lateral leg, not the medial aspect of the leg.Option B (Tibial nerve):Injury to the tibial nerve would affect plantarflexion and toe flexion, with sensory loss over the sole of the foot.Option C (Sural nerve):The sural nerve provides sensation to the posterolateral aspect of the leg and lateral foot.Option E (Posterior femoral cutaneous nerve):This nerve provides sensation to the posterior thigh and upper calf, not the medial aspect of the distal leg.

Question 1047

Topic: Knee Sports

During an arthroscopic ACL reconstruction, after drilling the femoral tunnel in the anatomically correct position (10-10:30 o'clock for a right knee), the surgeon observes that the graft impinges against the anterior portion of the lateral femoral condyle when the knee is flexed. What is the most appropriate next step to address this issue?

. Redrill the femoral tunnel in a more posterior position
. Perform a notchplasty of the anterior portion of the lateral femoral condyle
. Tension the graft less aggressively to avoid impingement
. Redrill the tibial tunnel in a more anterior position
. Proceed with graft fixation, as minor impingement is expected

Correct Answer & Explanation

. Perform a notchplasty of the anterior portion of the lateral femoral condyle

Explanation

Correct Answer: BThe candidate discusses this exact scenario: 'Careful assessment of notch should be done prior to graft insertion using a pin to ensure no impingement on lateral femoral condyle. The presence of impingement with correct placement of tunnels necessitates notchplasty of the anterior portion of lateral femoral condyle.'Option A (Redrill the femoral tunnel in a more posterior position):The text explicitly states that the tunnel is already in the 'correct placement.' Redrilling it more posteriorly would lead to excessive tightening of the graft in extension, as mentioned in the case.Option C (Tension the graft less aggressively to avoid impingement):Graft tensioning is crucial for stability. Reducing tension to avoid impingement would compromise the stability of the reconstruction. The issue is mechanical impingement, not tension.Option D (Redrill the tibial tunnel in a more anterior position):This would likely exacerbate impingement or lead to other issues, as the problem is identified at the femoral side with the lateral femoral condyle.Option E (Proceed with graft fixation, as minor impingement is expected):Impingement, even if minor, can lead to graft wear, failure, and restricted range of motion. It should be addressed.

Question 1048

Topic: 5. Sports Medicine

A 20-year-old collegiate basketball player requires ACL reconstruction. The surgeon is comparing the use of a bone-patella tendon-bone (BPTB) autograft versus a four-strand hamstring autograft. According to the provided case discussion, which statement accurately reflects a key difference or outcome between these two graft types?

. BPTB grafts have slower integration due to tendon-to-bone healing compared to hamstring grafts.
. Hamstring grafts are associated with a higher incidence of anterior knee pain compared to BPTB grafts.
. Most studies show BPTB grafts result in similar functional outcomes but increased donor site morbidity compared to hamstring grafts.
. Hamstring grafts provide more rigid fixation and faster integration due to bone-to-bone healing.
. BPTB grafts are associated with a higher risk of saphenous nerve injury during harvest.

Correct Answer & Explanation

. Most studies show BPTB grafts result in similar functional outcomes but increased donor site morbidity compared to hamstring grafts.

Explanation

Correct Answer: CThe candidate summarizes the comparison: 'Most studies show arthroscopic reconstruction with either graft results in similar functional outcome but increased morbidity in BPTB in form of early OA and increased knee laxity with radiographic femoral tunnel wide in hamstring graft.'Option A (BPTB grafts have slower integration due to tendon-to-bone healing compared to hamstring grafts):This is incorrect. BPTB grafts have faster integration due to bone-to-bone healing, while hamstring grafts have slower tendon-to-bone incorporation.Option B (Hamstring grafts are associated with a higher incidence of anterior knee pain compared to BPTB grafts):This is incorrect. Anterior knee pain (30-50%) is a significant donor site morbidity associated with BPTB grafts, not hamstring grafts.Option C (Most studies show BPTB grafts result in similar functional outcomes but increased donor site morbidity compared to hamstring grafts):This accurately reflects the summary provided by the candidate, noting similar functional outcomes but increased morbidity (e.g., anterior knee pain, patellar tendonitis) with BPTB.Option D (Hamstring grafts provide more rigid fixation and faster integration due to bone-to-bone healing):This is incorrect. BPTB grafts provide rigid fixation and faster integration due to bone-to-bone healing.Option E (BPTB grafts are associated with a higher risk of saphenous nerve injury during harvest):This is incorrect. Saphenous nerve injury is a risk associated with hamstring graft harvest.

Question 1049

Topic: 5. Sports Medicine

The case describes a 26-year-old rugby player with a displaced PCL avulsion fracture. The candidate proposes open reattachment. Considering the patient's age and activity level, what is the primary biomechanical advantage of open reattachment of a displaced bony PCL avulsion compared to a mid-substance PCL reconstruction?

. Reduced risk of infection due to smaller incision
. Faster return to sport due to less invasive procedure
. Superior bone-to-bone healing potential, restoring the native PCL footprint
. Lower incidence of post-operative knee stiffness
. Elimination of donor site morbidity

Correct Answer & Explanation

. Superior bone-to-bone healing potential, restoring the native PCL footprint

Explanation

Correct Answer: CWhile not explicitly stated as a direct comparison in the text, the underlying principle for choosing reattachment for an avulsion is the ability to restore the native anatomy and leverage bone-to-bone healing. The text implies this by stating the candidate would offer 'reattachment of the PCL avulsion through open procedure,' which is the standard of care for displaced bony avulsions in active patients. Bone-to-bone healing is generally more robust and faster than tendon-to-bone healing required for mid-substance reconstructions.Option A (Reduced risk of infection due to smaller incision):An open reattachment typically involves a larger incision than an arthroscopic reconstruction, so this is incorrect.Option B (Faster return to sport due to less invasive procedure):Open reattachment is generally more invasive than arthroscopic reconstruction, and recovery times can be similar or longer depending on the specific reconstruction technique.Option C (Superior bone-to-bone healing potential, restoring the native PCL footprint):This is the key advantage. Reattaching a bony fragment allows for bone-to-bone healing, which is biologically more favorable and provides a stronger initial fixation and faster healing compared to the tendon-to-bone healing required for a graft in a mid-substance reconstruction. It also directly restores the original PCL insertion site.Option D (Lower incidence of post-operative knee stiffness):Post-operative stiffness can occur with any knee surgery, and there's no inherent guarantee that reattachment leads to less stiffness than reconstruction.Option E (Elimination of donor site morbidity):While reattachment avoids the donor site morbidity associated with autografts used in reconstruction, it is not the primary biomechanical advantage. Furthermore, if an allograft is used for reconstruction, donor site morbidity is also avoided.

Question 1050

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with a history of recurrent anterior shoulder instability. CT scan evaluation of the glenoid demonstrates a 25% anterior glenoid bone defect. Which of the following is the most appropriate definitive surgical management?

. Arthroscopic Bankart repair with Remplissage
. Arthroscopic capsular plication
. Open Latarjet procedure
. Open Bankart repair
. Arthroscopic superior capsular reconstruction

Correct Answer & Explanation

. Open Latarjet procedure

Explanation

The open Latarjet procedure (coracoid transfer) is indicated for anterior shoulder instability with critical glenoid bone loss, typically defined as greater than 20-25%. Arthroscopic or open Bankart repairs alone in this setting have an unacceptably high failure rate. The Latarjet provides a triple-blocking effect: bone block, sling effect of the conjoint tendon, and capsule repair.

Question 1051

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar dislocation, identifying the correct femoral attachment site is critical to prevent abnormal joint kinematics. According to Schöttle's point, where is the anatomic femoral origin of the MPFL located?
. Anterior to the medial epicondyle and distal to the adductor tubercle
. Posterior to the medial epicondyle and proximal to the adductor tubercle
. Between the medial epicondyle and the adductor tubercle
. Directly on the adductor tubercle
. At the insertion of the medial collateral ligament

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle

Explanation

The anatomic femoral origin of the MPFL (Schöttle's point) is located radiographically between the medial epicondyle and the adductor tubercle. Non-anatomic placement, particularly too proximal, results in excessive graft tension during knee flexion, leading to medial patellar overload and loss of flexion. Accurate placement is essential for restoring native kinematics.

Question 1052

Topic: 5. Sports Medicine

A 50-year-old patient undergoes knee arthroscopy for a suspected medial meniscus injury. Intraoperatively, a complete radial tear at the posterior root of the medial meniscus is identified. Biomechanically, this injury is most equivalent to which of the following?

. Anterior cruciate ligament (ACL) rupture
. Total medial meniscectomy
. Isolated medial collateral ligament (MCL) tear
. Partial medial meniscectomy
. Normal intact knee biomechanics

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A complete tear of the medial meniscus posterior root eliminates the hoop stresses necessary for the meniscus to dissipate axial loads. Biomechanical studies have demonstrated that a root tear is functionally and biomechanically equivalent to a total medial meniscectomy. This leads to a significant increase in peak contact pressures and rapid articular cartilage degeneration.

Question 1053

Topic: Knee Sports

A patient presents with lateral knee pain and a sensation of giving way following a hyperextension injury. Physical examination reveals a positive dial test with 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of knee flexion, the external rotation is equal bilaterally. What is the most likely diagnosis?

. Isolated anterior cruciate ligament (ACL) tear
. Isolated posterior cruciate ligament (PCL) tear
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injury
. Medial collateral ligament (MCL) tear

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

The dial test evaluates for posterolateral corner (PLC) and posterior cruciate ligament (PCL) injuries. Asymmetry of more than 10 degrees at 30 degrees of flexion, but symmetric rotation at 90 degrees, indicates an isolated PLC injury. If the asymmetry persists at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 1054

Topic: Knee Sports

During a posterior cruciate ligament (PCL) reconstruction, the surgeon must address the distinct functional bundles of the native PCL. Which of the following statements accurately describes the biomechanics of the PCL bundles?

. The anterolateral bundle is tight in flexion, and the posteromedial bundle is tight in extension.
. The anterolateral bundle is tight in extension, and the posteromedial bundle is tight in flexion.
. Both bundles maintain constant, equal tension throughout the entire range of motion.
. The anteromedial bundle is tight in flexion, and the posterolateral bundle is tight in extension.
. The posteromedial bundle is the primary restraint to posterior tibial translation at 90 degrees of flexion.

Correct Answer & Explanation

. The anterolateral bundle is tight in flexion, and the posteromedial bundle is tight in extension.

Explanation

The PCL consists of two main bundles: the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle is tight in knee flexion and is the primary restraint to posterior translation at 90 degrees. The PM bundle is tight in extension and deep flexion.

Question 1055

Topic: 5. Sports Medicine

A 22-year-old male presents with persistent knee pain 1 year after an injury. MRI and subsequent arthroscopy reveal a 3 cm x 3 cm isolated, full-thickness chondral defect (Outerbridge Grade IV) on the weight-bearing portion of the medial femoral condyle. The surrounding cartilage and menisci are normal. What is the most appropriate surgical treatment for a defect of this size?

. Arthroscopic microfracture
. Arthroscopic debridement and lavage
. Autologous chondrocyte implantation (ACI) or Osteochondral allograft (OCA)
. Osteochondral autograft transfer (OATS)
. Unicompartmental knee arthroplasty

Correct Answer & Explanation

. Autologous chondrocyte implantation (ACI) or Osteochondral allograft (OCA)

Explanation

For large full-thickness chondral defects (>2-3 cm^2) in young, active patients, cartilage restoration procedures like Osteochondral Allograft (OCA) or Autologous Chondrocyte Implantation (ACI) are indicated. Microfracture and OATS (autograft) are generally reserved for smaller defects (<2 cm^2) due to donor site morbidity and the production of mechanically inferior fibrocartilage in microfracture.

Question 1056

Topic: Knee Sports

A 22-year-old female soccer player sustains a non-contact twisting injury to her knee, feeling a "pop" and developing a rapid effusion. MRI confirms an acute anterior cruciate ligament (ACL) rupture. Which concomitant intra-articular injury is most commonly associated with this acute presentation?

. Medial meniscus tear
. Lateral meniscus tear
. Posterior cruciate ligament tear
. Medial collateral ligament tear
. Osteochondral defect of the medial femoral condyle

Correct Answer & Explanation

. Lateral meniscus tear

Explanation

In the acute setting, lateral meniscus tears are the most common concomitant injury with an ACL rupture. Medial meniscus tears become more common in chronic ACL-deficient knees due to repetitive anterior tibial translation.

Question 1057

Topic: Knee Sports

A 30-year-old male is evaluated for knee instability following a motor vehicle accident. On physical examination, the dial test reveals 15 degrees of increased external rotation of the tibia at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of flexion, the external rotation is equal bilaterally. What is the most likely diagnosis?

. Isolated posterior cruciate ligament (PCL) injury
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injury
. Isolated medial collateral ligament (MCL) injury
. Combined ACL and MCL injury

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

Increased external rotation at 30 degrees of flexion that reduces to normal at 90 degrees indicates an isolated posterolateral corner (PLC) injury. Combined PCL and PLC injuries show increased external rotation at both 30 and 90 degrees.

Question 1058

Topic: Shoulder & Hip Sports

A 20-year-old collegiate rugby player presents with recurrent anterior shoulder instability. A pre-operative 3D CT scan demonstrates 27% anterior glenoid bone loss. Which of the following is the most appropriate definitive management?

. Arthroscopic Bankart repair with suture anchors
. Open Bankart repair with capsular shift
. Coracoid transfer (Latarjet procedure)
. Arthroscopic remplissage alone
. Non-operative management with a physical therapy stabilization program

Correct Answer & Explanation

. Coracoid transfer (Latarjet procedure)

Explanation

In a high-demand collision athlete with greater than 20-25% anterior glenoid bone loss, a bony augmentation procedure such as the Latarjet procedure is indicated. Soft tissue procedures alone carry unacceptably high failure rates in this setting.

Question 1059

Topic: Knee Sports

A 16-year-old female presents with recurrent lateral patellar dislocations. You decide to surgically reconstruct the primary restraint to lateral patellar translation. Where is the normal anatomic femoral origin of this ligament located?

. The lateral epicondyle
. The saddle region between the medial epicondyle and the adductor tubercle
. Directly on the medial collateral ligament (MCL) bursa
. Gerdy's tubercle
. The fibular head

Correct Answer & Explanation

. The saddle region between the medial epicondyle and the adductor tubercle

Explanation

The medial patellofemoral ligament (MPFL) is the primary restraint to lateral translation from 0 to 30 degrees of flexion. Its femoral attachment (Schottle's point) is situated between the medial epicondyle and the adductor tubercle.

Question 1060

Topic: 5. Sports Medicine
A 28-year-old recreational skier catches an edge and forcefully abducts his tibia. Clinical exam and MRI confirm an isolated, complete (Grade III) midsubstance tear of the medial collateral ligament (MCL). What is the standard of care for this injury?
. Immediate open primary repair
. Hinged knee brace and early functional rehabilitation
. Casting in full extension for 6 weeks
. Arthroscopic debridement and strict non-weight-bearing
. Allograft reconstruction of the superficial MCL

Correct Answer & Explanation

. Hinged knee brace and early functional rehabilitation

Explanation

Isolated Grade III MCL tears, particularly midsubstance injuries, heal predictably well with non-operative management. A hinged knee brace allowing early range of motion is the standard of care.

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