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5. Sports Medicine MCQs

Practice Set 6 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 101

Topic: Knee Sports

During the evaluation of a patient with a suspected knee ligament injury, the quadriceps active test is performed. The knee is flexed to 90 degrees, and the patient is asked to slide their foot forward against resistance. An anterior shift of the tibia is noted. This finding indicates a deficiency of the:

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

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

The quadriceps active test assesses for a PCL tear. In a PCL-deficient knee flexed to 90 degrees, the tibia sags posteriorly. Contraction of the quadriceps pulls the tibia anteriorly into its reduced anatomical position.

Question 102

Topic: Knee Sports

A 24-year-old male sustains a traumatic knee dislocation resulting in a combined ACL, PCL, and posterolateral corner (PLC) injury. He is noted to have foot drop on the affected side. Injury to which of the following nerves is most likely?

. Tibial nerve
. Femoral nerve
. Obturator nerve
. Common peroneal nerve
. Sural nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve is the most frequently injured nerve in knee dislocations, particularly those involving disruption of the posterolateral corner and lateral side structures. It typically presents as a foot drop.

Question 103

Topic: Knee Sports

A clinical examination of a knee shows increased external rotation of the tibia at 30 degrees of flexion that normalizes at 90 degrees.

To reconstruct the primary deficient structures in this specific injury pattern, grafts should be routed to replicate the functions of which anatomical structures?

. LCL, popliteus tendon, and PCL
. LCL, popliteus tendon, and popliteofibular ligament
. POL, semimembranosus, and MCL
. ACL, LCL, and popliteus tendon
. Popliteus tendon, ALL, and IT band

Correct Answer & Explanation

. LCL, popliteus tendon, and popliteofibular ligament

Explanation

The described examination indicates an isolated PLC injury. Anatomical reconstruction of the PLC aims to replicate the functions of the lateral collateral ligament, popliteus tendon, and popliteofibular ligament.

Question 104

Topic: Knee Sports
According to the Schenck classification of knee dislocations (KD), a patient who sustains tears to both the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL), with intact collateral ligaments, is classified as:
. KD I
. KD II
. KD III
. KD IV
. KD V

Correct Answer & Explanation

. KD II

Explanation

In the Schenck classification, KD II refers to tears of both the ACL and PCL, with intact collateral ligaments. KD III involves both cruciates plus one collateral, and KD IV involves all four major ligaments.

Question 105

Topic: Knee Sports
A patient presents with a knee injury. The dial test shows >10 degrees of external rotation asymmetry at 30 degrees of knee flexion, but symmetric rotation at 90 degrees. Which structure is most likely injured?
. Isolated anterior cruciate ligament
. Isolated posterior cruciate ligament
. Isolated posterolateral corner
. Combined posterior cruciate ligament and posterolateral corner
. Isolated lateral collateral ligament

Correct Answer & Explanation

. Isolated posterolateral corner

Explanation

Isolated asymmetry at 30 degrees of flexion indicates an isolated posterolateral corner (PLC) injury. If asymmetry is present at both 30 and 90 degrees, it suggests a combined PLC and PCL injury.

Question 106

Topic: Knee Sports

A 35-year-old male presents with chronic posterolateral knee instability and varus malalignment following an old injury. He is scheduled for a posterolateral corner (PLC) reconstruction. What is the most appropriate initial surgical management?

. Isolated anatomic PLC reconstruction
. High tibial osteotomy
. Distal femoral osteotomy
. ACL reconstruction followed by PLC reconstruction
. Total knee arthroplasty

Correct Answer & Explanation

. High tibial osteotomy

Explanation

In patients with chronic PLC instability and varus mechanical alignment, a high tibial osteotomy (HTO) should be performed first or concurrently. Performing a soft tissue reconstruction without correcting the bony varus alignment will predictably lead to graft stretching and failure.

Question 107

Topic: Knee Sports

Which of the following nerves is most frequently injured in the setting of a severe posterolateral corner (PLC) injury or knee dislocation?

. Tibial nerve
. Common peroneal nerve
. Saphenous nerve
. Sural nerve
. Deep peroneal nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve is uniquely tethered around the fibular neck and is highly susceptible to traction injury during a varus and hyperextension mechanism typical of PLC injuries. It occurs in up to 15-30% of knee dislocations.

Question 108

Topic: 5. Sports Medicine

A 25-year-old athlete sustains a valgus blow to the knee. MRI reveals a complete rupture of the superficial and deep medial collateral ligament (MCL) with the distal end of the superficial MCL displaced superficial to the pes anserinus. What is the recommended treatment?

. Non-operative management with a hinged knee brace locked in extension
. Non-operative management with early range of motion
. Surgical repair of the MCL
. Corticosteroid injection and immediate return to play
. Anterior cruciate ligament reconstruction

Correct Answer & Explanation

. Surgical repair of the MCL

Explanation

A Stener-like lesion of the knee occurs when the distal MCL avulses and flips superficial to the pes anserinus. Unlike typical isolated MCL tears that heal well non-operatively, this displaced lesion prevents native healing and requires surgical repair.

Question 109

Topic: Knee Sports

When reconstructing the anterior cruciate ligament (ACL), the surgeon must identify the lateral intercondylar ridge (resident's ridge). What is the anatomical relationship of the native ACL footprint to this ridge?

. The ACL footprint is completely posterior to the ridge
. The ACL footprint is completely anterior to the ridge
. The ridge bisects the anteromedial and posterolateral bundles
. The ACL footprint is completely superior to the ridge
. The ACL footprint is completely inferior to the ridge

Correct Answer & Explanation

. The ACL footprint is completely posterior to the ridge

Explanation

The lateral intercondylar ridge (resident's ridge) marks the anterior boundary of the ACL femoral footprint when the knee is in 90 degrees of flexion. No native ACL fibers attach anterior to this ridge, making it a critical landmark for femoral tunnel placement.

Question 110

Topic: Knee Sports

What is the primary restraint to posterior tibial translation at 90 degrees of knee flexion?

. Anterolateral bundle of the PCL
. Posteromedial bundle of the PCL
. Posterior oblique ligament
. Anterior cruciate ligament
. Popliteofibular ligament

Correct Answer & Explanation

. Anterolateral bundle of the PCL

Explanation

The anterolateral (AL) bundle of the Posterior Cruciate Ligament (PCL) is the primary restraint to posterior tibial translation at 90 degrees of flexion. It is the larger and stronger bundle and becomes tight in flexion.

Question 111

Topic: Knee Sports
A patient presents with a chronic grade III isolated PCL injury treated non-operatively 15 years ago. Which compartments of the knee are at the highest risk for developing secondary osteoarthritis?
. Lateral and patellofemoral compartments
. Medial and patellofemoral compartments
. Medial and lateral compartments
. Isolated lateral compartment
. Isolated medial compartment

Correct Answer & Explanation

. Medial and patellofemoral compartments

Explanation

Chronic PCL deficiency leads to altered knee kinematics, specifically increasing contact pressures in the medial compartment and the patellofemoral joint. This predictably leads to early degenerative changes in these specific areas over time.

Question 112

Topic: Knee Sports

During a physical examination for a suspected knee ligament injury, the examiner actively flexes the patient's quadriceps while the knee is held at 90 degrees of flexion. The tibia is observed to translate anteriorly. This finding is pathognomonic for an injury to which structure?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Medial collateral ligament
. Popliteus tendon
. Fibular collateral ligament

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

The quadriceps active test is highly specific for a complete posterior cruciate ligament (PCL) tear. In a PCL-deficient knee resting at 90 degrees of flexion, the tibia sags posteriorly; active quadriceps contraction pulls the tibia anteriorly into its normal reduced position.

Question 113

Topic: Knee Sports

The meniscofemoral ligaments of the knee are intimately associated with the posterior cruciate ligament (PCL). Which of the following correctly describes their anatomical relationship?

. The ligament of Wrisberg passes anterior to the PCL
. The ligament of Humphrey passes posterior to the PCL
. The ligament of Humphrey passes anterior to the PCL and Wrisberg passes posterior
. Both pass anterior to the PCL
. Both pass posterior to the PCL

Correct Answer & Explanation

. The ligament of Humphrey passes anterior to the PCL and Wrisberg passes posterior

Explanation

The ligament of Humphrey runs anterior to the PCL, whereas the ligament of Wrisberg runs posterior to the PCL. They attach the posterior horn of the lateral meniscus to the medial femoral condyle.

Question 114

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction using an anatomical technique (e.g., LaPrade), three main structures are reconstructed. Which of the following is NOT one of the three primarily reconstructed structures?

. Fibular collateral ligament
. Popliteus tendon
. Popliteofibular ligament
. Iliotibial band
. None of the above

Correct Answer & Explanation

. Iliotibial band

Explanation

Anatomic PLC reconstruction aims to recreate the three major static restraints: the fibular collateral ligament (LCL), the popliteus tendon, and the popliteofibular ligament. The iliotibial band is a dynamic stabilizer and is not routinely reconstructed in this procedure.

Question 115

Topic: Knee Sports

An isolated posterolateral corner injury is diagnosed. Which physical exam finding would most accurately differentiate an isolated PLC injury from a combined PLC and PCL injury?

. Positive posterior drawer test at 90 degrees of flexion
. Positive dial test at 30 degrees of flexion
. Positive reverse pivot shift test
. Positive varus stress test at 30 degrees
. Positive external rotation recurvatum test

Correct Answer & Explanation

. Positive posterior drawer test at 90 degrees of flexion

Explanation

The posterior drawer test at 90 degrees evaluates the integrity of the PCL. An isolated PLC injury will have a normal posterior drawer at 90 degrees, whereas a combined PLC/PCL injury will demonstrate increased posterior translation.

Question 116

Topic: Knee Sports

A patient sustains an avulsion fracture of the anterolateral proximal tibia.

This finding is considered pathognomonic for a tear of which major knee ligament?

. Medial collateral ligament
. Posterior cruciate ligament
. Anterior cruciate ligament
. Fibular collateral ligament
. Anterolateral ligament

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion of the anterolateral capsular complex from the proximal tibia. It is highly associated (pathognomonic) with an underlying Anterior Cruciate Ligament (ACL) tear.

Question 117

Topic: Knee Sports
A patient is evaluated for a knee dislocation. Which specific knee dislocation classification implies a tear of the anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament, while the posterolateral corner remains intact?
. KD-I
. KD-II
. KD-III M
. KD-III L
. KD-IV

Correct Answer & Explanation

. KD-III M

Explanation

In the Schenck classification, KD-III refers to injuries involving both cruciates and one collateral ligament. KD-III M indicates the medial collateral ligament is torn, while KD-III L indicates the lateral (PLC) structures are torn.

Question 118

Topic: Knee Sports

A 30-year-old male undergoes a single-bundle anterior cruciate ligament (ACL) reconstruction. To optimally control both anterior translation and rotational instability, where is the most appropriate location for the femoral tunnel within the native footprint?

. High and anterior (at the 12 o'clock position)
. Central within the native footprint
. In the center of the posteromedial bundle footprint
. Anterior to the lateral intercondylar ridge
. At the center of the medial femoral condyle

Correct Answer & Explanation

. Central within the native footprint

Explanation

Modern ACL reconstruction emphasizes anatomical placement central within the native footprint. Vertical placement (12 o'clock) fails to control rotational instability, and placement anterior to the resident's ridge leads to graft impingement against the PCL or notch.

Question 119

Topic: Knee Sports

Which of the following structures form the primary static stabilizing complex of the posterolateral corner (PLC) of the knee?

. Iliotibial band, popliteus tendon, and lateral collateral ligament
. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament
. Biceps femoris tendon, lateral collateral ligament, and arcuate ligament
. Popliteofibular ligament, arcuate ligament, and fabellofibular ligament
. Lateral collateral ligament, anterolateral ligament, and popliteus tendon

Correct Answer & Explanation

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

The primary static stabilizers of the PLC are the lateral collateral ligament (fibular collateral ligament), the popliteus tendon, and the popliteofibular ligament. These structures work together synergistically to resist varus, external rotation, and posterior translation of the tibia.

Question 120

Topic: Knee Sports

During physical examination of a patient with a suspected multiligamentous knee injury, the dial test reveals 15 degrees of increased external tibial rotation compared to the contralateral side at 30 degrees of knee flexion. At 90 degrees of flexion, the side-to-side difference in external rotation is 2 degrees. What is the most likely injury pattern?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

An isolated PLC injury characteristically results in increased external rotation at 30 degrees of flexion with a normal (symmetric) dial test at 90 degrees. A combined PCL and PLC injury will demonstrate increased external rotation at both 30 and 90 degrees of knee flexion.

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