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5. Sports Medicine MCQs

Practice Set 7 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 121

Topic: Knee Sports

The posterior cruciate ligament (PCL) consists of two main functional bundles. Which statement best describes the biomechanical properties of the anterolateral (AL) bundle?

. It is the smaller bundle and is tightest in knee extension.
. It is the smaller bundle and is tightest in knee flexion.
. It is the larger bundle and is tightest in knee extension.
. It is the larger bundle and is tightest in knee flexion.
. It acts primarily to resist varus angulation in full extension.

Correct Answer & Explanation

. It is the larger bundle and is tightest in knee flexion.

Explanation

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

Question 122

Topic: Knee Sports

Review the radiograph demonstrating a small cortical avulsion fracture from the medial aspect of the proximal tibia (Reverse Segond fracture).

This radiographic finding is virtually pathognomonic for which of the following combined injuries?

. Anterior cruciate ligament and medial meniscus tear
. Anterior cruciate ligament and lateral meniscus tear
. Posterior cruciate ligament and medial meniscus tear
. Medial collateral ligament and patellar tendon rupture
. Posterolateral corner and anterior cruciate ligament tear

Correct Answer & Explanation

. Posterior cruciate ligament and medial meniscus tear

Explanation

A reverse Segond fracture is an avulsion of the deep capsular component of the medial collateral ligament. It is highly associated with posterior cruciate ligament (PCL) tears and peripheral tears of the medial meniscus.

Question 123

Topic: Knee Sports

During surgical reconstruction of the posterolateral corner (PLC) using a fibular-based technique, a surgeon must be extremely careful to protect the common peroneal nerve. Where is this nerve most vulnerable during the approach?

. Deep to the lateral head of the gastrocnemius
. Posterior to the biceps femoris tendon at the fibular head
. Between the iliotibial band and the lateral collateral ligament
. Anterior to the anterior tibial artery at the interosseous membrane
. Superficial to the lateral collateral ligament near its femoral origin

Correct Answer & Explanation

. Posterior to the biceps femoris tendon at the fibular head

Explanation

The common peroneal nerve runs posterior to the biceps femoris tendon and wraps around the fibular neck. It must be identified and protected during a lateral approach or fibular-based PLC reconstruction to avoid iatrogenic foot drop.

Question 124

Topic: Knee Sports
According to the Schenck classification of knee dislocations, a patient with an MRI confirming complete tears of the ACL, PCL, and the posterolateral corner (PLC), with an intact medial collateral ligament (MCL), is classified as:
. KD I
. KD II
. KD III-M
. KD III-L
. KD IV

Correct Answer & Explanation

. KD III-L

Explanation

The Schenck classification describes multiligamentous knee injuries based on the involved structures. KD III-L involves the ACL, PCL, and the lateral structures (PLC/LCL), whereas KD III-M involves the ACL, PCL, and medial structures.

Question 125

Topic: Knee Sports

A 28-year-old male presents with recurrent instability 2 years after an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Clinical examination reveals an intact ACL graft on Lachman testing but significant varus thrust during gait and a positive reverse pivot shift. Failure to address which of the following at the index procedure most likely caused this outcome?

. Medial collateral ligament tear
. Posterolateral corner deficiency
. Posteromedial corner deficiency
. Ramp lesion of the medial meniscus
. Anterolateral ligament tear

Correct Answer & Explanation

. Posterolateral corner deficiency

Explanation

Unrecognized or untreated posterolateral corner (PLC) deficiency results in pathologically increased varus and external rotation forces. This abnormally increased stress on an ACL graft frequently leads to chronic graft elongation and ultimate failure.

Question 126

Topic: Knee Sports
A 22-year-old collegiate football player sustains an acute combined grade III anterior cruciate ligament (ACL) tear and grade III medial collateral ligament (MCL) tear. Assuming non-operative treatment of the MCL is chosen, what is the most widely accepted management strategy?
. Immediate single-stage reconstruction of the ACL and repair of the MCL
. Hinged knee bracing for 4 to 6 weeks followed by delayed ACL reconstruction
. Immediate ACL reconstruction with rigid immobilization in full extension for 6 weeks
. Simultaneous repair of the ACL and MCL within 3 days of injury
. Conservative treatment for both ligaments with a return to play at 3 months

Correct Answer & Explanation

. Hinged knee bracing for 4 to 6 weeks followed by delayed ACL reconstruction

Explanation

The standard management for combined ACL and MCL injuries often involves bracing the knee to allow the MCL to heal, followed by delayed ACL reconstruction once full range of motion is restored. This staged approach significantly minimizes the high risk of postoperative arthrofibrosis.

Question 127

Topic: Knee Sports
Which type of knee dislocation is most strongly associated with a stretch or complete rupture injury to the common peroneal nerve?
. Anterior dislocation
. Posterior dislocation
. Medial dislocation
. Posterolateral dislocation
. Anteromedial dislocation

Correct Answer & Explanation

. Posterolateral dislocation

Explanation

Posterolateral knee dislocations, and multiligament injuries involving the posterolateral corner (KD III-L), have the highest rate of common peroneal nerve injury. This is due to severe traction across the nerve as it wraps around the fibular neck.

Question 128

Topic: Knee Sports

An isolated rupture of the posterolateral corner (PLC) is suspected in a 25-year-old athlete. During the Dial test, what are the expected physical examination findings that differentiate an isolated PLC injury from a combined PLC and posterior cruciate ligament (PCL) injury?

. Asymmetric external rotation greater than 10 degrees at 30 degrees of flexion, with symmetric rotation at 90 degrees of flexion.
. Asymmetric external rotation greater than 10 degrees at 90 degrees of flexion, with symmetric rotation at 30 degrees of flexion.
. Asymmetric external rotation greater than 10 degrees at both 30 degrees and 90 degrees of flexion.
. Asymmetric internal rotation greater than 10 degrees at 30 degrees of flexion only.
. Symmetric external rotation at 30 degrees of flexion, but excessive posterior tibial translation at 90 degrees.

Correct Answer & Explanation

. Asymmetric external rotation greater than 10 degrees at 30 degrees of flexion, with symmetric rotation at 90 degrees of flexion.

Explanation

An isolated PLC injury exhibits excessive external rotation at 30 degrees of knee flexion but reduces to normal at 90 degrees due to an intact PCL. If external rotation is increased at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 129

Topic: Knee Sports

What is the primary anatomical and biomechanical rationale for utilizing a tibial inlay technique over a standard transtibial technique during posterior cruciate ligament (PCL) reconstruction?

. It prevents posterior capsular scarring and stiffness.
. It avoids the "killer turn" of the graft at the posterior tibial aperture.
. It allows for a significantly shorter overall graft length.
. It decreases the risk of intraoperative popliteal artery injury.
. It eliminates the need for femoral tunnel preparation.

Correct Answer & Explanation

. It avoids the "killer turn" of the graft at the posterior tibial aperture.

Explanation

The tibial inlay technique bypasses the acute angle (killer turn) at the posterior tibial tunnel opening, which can lead to graft attenuation and failure seen in transtibial PCL reconstructions.

Question 130

Topic: Knee Sports

Which of the following physical examination tests is most specific for evaluating posterolateral corner (PLC) rotatory instability?

. Anterior drawer in internal rotation
. Pivot shift test
. Reverse pivot shift test
. Posterior sag sign
. Valgus stress test at 0 degrees

Correct Answer & Explanation

. Reverse pivot shift test

Explanation

The reverse pivot shift test specifically evaluates for PLC injury. A positive test occurs when a posteriorly subluxated lateral tibial plateau reduces as the knee is flexed past 20 to 30 degrees.

Question 131

Topic: Knee Sports

A 35-year-old patient presents with a chronic posterolateral corner (PLC) deficiency and a noticeable varus thrust during gait. Radiographs show medial compartment narrowing and significant mechanical varus alignment. What is the most appropriate initial surgical management?

. Isolated PLC anatomical reconstruction
. Valgus-producing high tibial osteotomy (HTO)
. Unicompartmental knee arthroplasty
. Combined ACL and PLC reconstruction
. Fibular head advancement

Correct Answer & Explanation

. Valgus-producing high tibial osteotomy (HTO)

Explanation

In chronic PLC deficiency associated with varus malalignment, a proximal tibial valgus-producing osteotomy must be performed (either staged before or concurrently) to prevent the failure of the soft-tissue PLC reconstruction.

Question 132

Topic: Knee Sports

A 28-year-old football player presents with acute knee pain and lateral swelling after a direct blow to the anteromedial tibia. A radiograph is obtained.

Based on the classical significance of the "arcuate sign" shown, what associated structural injury is almost certainly present?

. Anterior cruciate ligament tear
. Medial collateral ligament avulsion
. Posterolateral corner injury
. Isolated popliteus tendon rupture
. Quadriceps tendon rupture

Correct Answer & Explanation

. Posterolateral corner injury

Explanation

The arcuate sign is an avulsion fracture of the fibular styloid. It is highly pathognomonic for an injury to the posterolateral corner (PLC) structures.

Question 133

Topic: Knee Sports

During a single-bundle posterior cruciate ligament (PCL) reconstruction, which specific bundle is typically reconstructed, and at what angle of knee flexion should the graft be tensioned?

. Posteromedial bundle, tensioned at 90 degrees
. Posteromedial bundle, tensioned at full extension
. Anterolateral bundle, tensioned at 90 degrees
. Anterolateral bundle, tensioned at full extension
. Anterolateral bundle, tensioned at 30 degrees

Correct Answer & Explanation

. Anterolateral bundle, tensioned at 90 degrees

Explanation

The anterolateral bundle is the larger and stronger component of the PCL. It is tightest in flexion and is standardly reconstructed and tensioned at 90 degrees of knee flexion.

Question 134

Topic: Knee Sports
A patient is diagnosed with a grade III MCL tear combined with an ACL rupture. MRI reveals the distal MCL has avulsed from its tibial insertion and retracted superficial to the pes anserinus (Stener-like lesion of the knee). What is the recommended management strategy?
. Nonoperative management in a hinged knee brace for 6 weeks, followed by ACL reconstruction.
. Immediate ACL reconstruction with nonoperative management of the MCL.
. Acute surgical repair of the MCL with concurrent or staged ACL reconstruction.
. Delayed combined reconstruction of both ligaments at 3 months.
. Isolated nonoperative management of both ligaments.

Correct Answer & Explanation

. Acute surgical repair of the MCL with concurrent or staged ACL reconstruction.

Explanation

While most combined ACL/MCL injuries are treated with bracing for the MCL and delayed ACL reconstruction, a distal MCL avulsion trapped superficial to the pes anserinus cannot heal nonoperatively and requires acute surgical repair.

Question 135

Topic: Knee Sports

Which neurological structure is at highest risk during an acute posterolateral corner injury, and what specific clinical finding dictates the poorest prognosis for conservative recovery?

. Tibial nerve; loss of plantar flexion
. Common peroneal nerve; complete palsy present immediately at the time of injury
. Saphenous nerve; medial knee numbness
. Deep peroneal nerve; isolated first web space numbness
. Sural nerve; lateral foot numbness

Correct Answer & Explanation

. Common peroneal nerve; complete palsy present immediately at the time of injury

Explanation

The common peroneal nerve is injured in up to 30% of severe PLC injuries. A complete palsy documented immediately at the time of injury has a much lower rate of spontaneous recovery compared to partial or delayed-onset lesions.

Question 136

Topic: Knee Sports

A 22-year-old female skier presents after a twisting knee injury. Radiographs reveal the finding shown.

This classical fracture (Segond fracture) represents an avulsion of which structure and strongly correlates with which associated injury?

. Biceps femoris tendon; PCL tear
. Fibular collateral ligament; PLC injury
. Anterolateral ligament; ACL tear
. Iliotibial band; Meniscal tear
. Popliteus tendon; ACL tear

Correct Answer & Explanation

. Anterolateral ligament; ACL tear

Explanation

The Segond fracture is a cortical avulsion off the lateral tibial plateau involving the anterolateral capsule and anterolateral ligament (ALL). It is highly pathognomonic for an anterior cruciate ligament (ACL) tear.

Question 137

Topic: Knee Sports

When performing an anatomical posterolateral corner (PLC) reconstruction, at what knee position should the fibular collateral ligament (FCL) graft be properly tensioned?

. 90 degrees of flexion with a varus stress
. 60 degrees of flexion in neutral rotation
. 20 degrees of flexion with a valgus stress
. Full extension with external rotation
. 90 degrees of flexion with internal rotation

Correct Answer & Explanation

. 20 degrees of flexion with a valgus stress

Explanation

During PLC reconstruction, the FCL graft is typically tensioned at 20 degrees of knee flexion while a valgus force is applied. In contrast, the popliteus graft is tensioned at 60 degrees of flexion in neutral rotation.

Question 138

Topic: Knee Sports

A 40-year-old male presents with a suspected posterior cruciate ligament (PCL) injury. On examination, a positive posterior sag sign is noted. Which radiographic view is most accurate for quantifying the exact degree of posterior tibial translation?

. AP weight-bearing view in full extension
. Merchant patellofemoral view
. Bilateral kneeling lateral radiographs
. Rosenberg view
. Lateral view at 30 degrees of flexion

Correct Answer & Explanation

. Bilateral kneeling lateral radiographs

Explanation

Bilateral kneeling lateral radiographs provide a consistent, gravity and body-weight directed posterior force to the proximal tibia. This allows for highly accurate quantification of posterior tibial translation compared to the uninjured side.

Question 139

Topic: Knee Sports

A 50-year-old patient presents with acute posteromedial knee pain after deep flexion. MRI demonstrates the lesion shown.

If left untreated, a complete posterior horn medial meniscal root tear is biomechanically equivalent to which of the following?

. Total medial meniscectomy
. Partial medial meniscectomy
. Anterior cruciate ligament deficiency
. Medial collateral ligament sprain
. Posterior cruciate ligament deficiency

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A meniscal root tear disrupts the crucial circumferential hoop stresses of the meniscus, rendering it functionally incompetent. Biomechanically, it is completely equivalent to a total meniscectomy and leads to rapid articular cartilage degeneration.

Question 140

Topic: Knee Sports

During an anatomical posterolateral corner (PLC) reconstruction, tunnels must be placed accurately in the lateral femoral condyle. What is the spatial relationship of the normal fibular collateral ligament (FCL) femoral attachment relative to the popliteus tendon attachment?

. FCL is anterior and distal to the popliteus.
. FCL is proximal and posterior to the popliteus.
. FCL is distal and posterior to the popliteus.
. FCL is anterior and proximal to the popliteus.
. They share a conjoined origin at the lateral epicondyle.

Correct Answer & Explanation

. FCL is proximal and posterior to the popliteus.

Explanation

On the lateral femoral condyle, the popliteus tendon insertion is located at the anterior end of the popliteal sulcus. The origin of the FCL is located 18.5 mm proximal and posterior to the popliteus insertion.

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