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 1401
Topic: Knee Sports
An 18-year-old male soccer player sustains a knee injury during a game. Examination is notable for a positive pivot shift test. What other physical examination finding is most likely to be present? Review Topic
Correct Answer & Explanation
. Medial joint line tenderness
Explanation
The patient has sustained a tear of his anterior cruciate ligament (ACL), as demonstrated by the positive pivot shift test; therefore, he would most likely exhibit lateral joint line tenderness indicative of a lateral meniscus tear, the most common intraarticular injury associated with an ACL tear.ACL tears usually occur as a result of a non-contact pivoting injury. Abnormal anterior translation results in bone contusions of mid-lateral femoral condyle and posterolateral tibia, which can be seen on MRI. Other concomitant intraarticular injuries include meniscal tears (lateral > medial), chondral damage and other ligamentous injury (MCL, LCL, PLC) usually found in cases of higher energy trauma such as a knee dislocation.Piasecki et al prospectively analyzed intraarticular injuries associated with ACL tears in high school athletes by gender and sport. There was no significant difference in mechanism of injury between sexes. Female basketball and soccer players had fewer intraarticular injuries (medial femoral condyle lesions, medial and lateral meniscus tears) compared to male athletes. The authors hypothesized that women may therefore enjoy a better prognosis following reconstruction.Spindler et al performed a prospective cohort study investigating concomitant intraarticular injuries in patients who underwent ACL reconstruction. Eighty percent of patients had a bone bruise on MRI, 68% involving the lateral condyle. At time of arthroscopic reconstruction, meniscal tears were identified in 56% of lateral menisci and 37% of medial menisci.Incorrect Responses:
Question 1402
Topic: 5. Sports Medicine
The patient does not improve with 1 year of rehabilitation exercises. MR arthrography reveals a normal glenoid labrum and rotator cuff. Surgical treatment should consist of
Correct Answer & Explanation
. rotator interval closure.
Explanation
DISCUSSIONThis patient has multidirectional instability (MDI). Symptoms are typically of insidious onset with nonspecific sports-related pain during the second or third decade of life. The etiology of MDI involves a patulous inferior capsular complex, but, in isolation, this lesion may not produce symptoms. Patients with MDI have abnormal patterns of rotator cuff muscle activity that is not restored with nonsurgical treatment. Symptomatic patients with MDI also demonstrate increased rates of abnormal scapular kinematics. The prevalence of MDI is higher among overhead athletes. The sulcus sign is an examination finding that produces a visible dimple inferior to the lateral border of the acromion with application of inferior traction on the arm. Generalized hyperlaxity or a connective tissue disorder may be present. Physical therapy for strengthening of the rotator cuff and scapular stabilizers remains the recommended initial treatment. Rehabilitation should continue for at least 6 months (and possibly much longer). Motivated patients frequently report diminished pain and improved stability with strengthening exercises. If nonsurgical measures fail to provide adequate relief, arthroscopic capsular plication is a viable treatment option, with high rates of return to play among properly selected patients. Thermal capsulorrhaphy has a high failure rate and poses potential for serious complications, including chondrolysis and thermal injury to the axillary nerve. Closure of the rotator interval has not been definitively shown to enhance stability or improve outcomes for patients with MDI.
Question 1403
Topic: 5. Sports Medicine
A 21-year-old collegiate track athlete increased her training 4 months ago in anticipation of starting the season. Two months into her training program, she reported pain followed by a 1-month history of diffuse pain in the first metatarsophalangeal joint that was aggravated by weight bearing. A removable walker boot partially relieved the pain, and she was able to complete the season. Her pain has now returned; however, she denies any history of injury. Examination reveals tenderness over the medial sesamoid but no deformities. A radiograph and bone scan are shown in Figures 22a and 22b. What is the best treatment option at this time?
Correct Answer & Explanation
. Cast immobilization and no weight bearing for 4 to 8 weeks
Explanation
DISCUSSION: The radiograph reveals either a fractured or bipartite sesamoid. The bone scan shows asymmetrically increased uptake over the medial sesamoid. Given the history and physical examination, a stress fracture is the most likely diagnosis. Medial sesamoidectomy reliably improves pain, and athletes return to sports on an average of 7 weeks after excision. Immobilization typically requires more than 4 to 8 weeks and is not always successful; however, it would be appropriate management for a patient who is not an elite athlete.REFERENCES: Sanders R: Fractures of the midfoot and forefoot, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Mosby, 1999, pp 1601-1603.Saxena A, Krisdakumtorn T: Return to activity after sesamoidectomy in athletically active individuals. Foot Ankle Int 2003;24:415-419.
Question 1404
Topic: 5. Sports Medicine
Figure 35 shows the radiograph of a 35-year-old weightlifter who has had pain with overhead lifts for the past 7 months. Cortisone injections in the acromioclavicular joint provided only temporary relief. A bone scan reveals increased activity of the acromioclavicular joint. Treatment should now consist of
Correct Answer & Explanation
. rotator cuff interval closure.
Explanation
DISCUSSION: Osteolysis of the distal clavicle is common in weightlifters; therefore, distal clavicle excision is the treatment of choice. A subacromial decompression alone would not alleviate the acromioclavicular joint symptoms. Interval closure, biceps degeneration, and superior labrum anterior and posterior repair would limit superior migration but would not explain the abnormal bone scan. Thermal capsular shrinkage does not have a role here.REFERENCES: Flatow EL, Cordasco FA, McCluskey GM, Bigliani LU: Arthroscopic resection of the distal clavicle via a superior portal: A critical quantitative radiographic assessment of bone removal. Arthroscopy 1990;6:153-154.Lyons FR, Rockwood CA: Osteolysis of the clavicle, in DeLee JC, Drez D (eds): Orthopaedic Sports Medicine. Philadelphia, PA, WB Saunders, 1994, pp 541-546.
Question 1405
Topic: Shoulder & Hip Sports
A 40-year-old female recreational basketball player notes pain deep within her shoulder that occurs with activity. Pain began insidiously 6 months previously. She has completed a physical therapy program, and an intra-articular corticosteroid injection provided excellent temporary relief. Physical examination shows symmetric range of motion of her shoulder. She has a positive O'Brien’s active compression test. There is no pain with cross-arm adduction or tenderness to palpation over the acromioclavicular joint. Resisted abduction is nonpainful and strong. MRI shows increased signal in the substance of the superior labrum, low-grade bursal surface fraying of the supraspinatus, and mild degenerative changes within the acromioclavicular joint. What is the best treatment option?
Correct Answer & Explanation
. Biceps tenodesis
Explanation
A 50-year-old man sustained an external rotation traction injury to his right arm. He felt a pop in the anterior aspect of his shoulder associated with immediate pain and swelling. The MRI scan shows a tear of the subscapularis tendon, as shown in Figures 1 and 2. The arrow points to what anatomic structure?
Question 1406
Topic: Shoulder & Hip Sports
A 55-year-old man falls from a ladder and dislocates his nondominant shoulder. He undergoes an uncomplicated closed reduction under sedation in the emergency department. Postreduction radiographs reveal a small Hill-Sachs lesion and no other bony abnormalities. Six weeks after the dislocation, the patient has persistent pain at rest and forward elevation and external rotation weakness, but the remaining motor function in the extremity and sensation are intact. What is the best next step?
Correct Answer & Explanation
. Physical therapy with electrical stimulation and iontophoresis
Explanation
For a patient >40 years of age who has persistent pain and weakness isolated to the rotator cuff following an acute anterior shoulder dislocation, an MRI is indicated to evaluate rotator cuff integrity. EMG is not indicated in this case because this patient has no evidence of distal motor functional abnormality and their sensation is intact, thereby making a brachial plexus injury unlikely. Corticosteroid injections and physical therapymodalities do not adequately address the concern over his potential for having sustained a rotator cuff tear.
Question 1407
Topic: Shoulder & Hip Sports
A 22-year-old volleyball player reports the insidious onset of superior and posterior shoulder pain. Radiographs are normal. An MRI scan is shown in Figure 25. What is the most specific physical examination finding?
Correct Answer & Explanation
. Positive impingement sign
Explanation
DISCUSSION: Overhead athletes are prone to a number of problems involving the shoulder. Pitchers and volleyball players are susceptible to posterior superior labral tears and internal impingement. These patients will have posterior superior shoulder pain, a positive relocation sign, and a positive active compression test. Occasionally, these posterior superior labral tears are associated with a spinoglenoid cyst as seen in the MRI scan. These cysts cause compression of the suprascapular nerve which manifests primarily as weakness of the infraspinatus, resulting in weakness of external rotation.REFERENCES: Romeo AA, Rotenberg DD, Bach BR Jr: Suprascapular neuropathy. J Am Acad Orthop Surg 1999;7:358-367.Cummins CA, Messer TM, Nuber GW: Suprascapular nerve entrapment. J Bone Joint Surg Am 2000;82:415-424.
Question 1408
Topic: Shoulder & Hip Sports
What structure provides the major blood supply to the humeral head?
Correct Answer & Explanation
. Posterior circumflex humeral artery
Explanation
DISCUSSION: The ascending branch of the anterior circumflex humeral artery providesthe major blood supply to the humeral head. The posterior circumflex humeral arterysupplies a much smaller portion of the proximal humerus. The nutrient humeral artery is the main blood supply for the humeral shaft. The thoracoacromial artery is primarily a muscular branch. The rotator cuff insertions contribute some blood supply to the tuberosities but not a major contribution.REFERENCES: Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 271-286.Cushner MA, Friedman RJ: Osteonecrosis of the humeral head. J Am Acad Orthop Surg 1997;5:339-346.
Question 1409
Topic: 5. Sports Medicine
A sagittal T1-weighted MRI scan of the knee joint is shown in Figure 23. What structure is identified by the arrow?
Correct Answer & Explanation
. Popliteal tendon
Explanation
DISCUSSION: On T1-weighted images, the posterior cruciate ligament is a low-signal (black) structure that courses from the posterior aspect of the tibia to the medial femoral condyle. The posterior cruciate ligament can appear as arcuate, U-shaped, or kinked. The other structures have similar signal but different anatomic locations.REFERENCES: Gross ML, Grover JS, Bassett LW, Seeger LL, Finerman GA: Magnetic resonance imaging of the posterior cruciate ligament: Clinical use to improve diagnostic accuracy. Am J Sports Med 1992;20:732-737.Sonin AH, Fitzgerald SW, Friedman H, Hoff FL, Hendrix RW, Rogers LF: Posterior cruciate ligament injury: MR imaging diagnosis and patterns of injury. Radiology 1994;190:455-458.
Question 1410
Topic: 5. Sports Medicine
A 16-year-old right-hand dominant male pitcher has had increasing pain in his dominant shoulder for the past 6 months without treatment. A coronal T2-weighted MRI scan is shown in Figure 80. What is the most appropriate treatment plan? Review Topic
Correct Answer & Explanation
. Decreased pitch count for 4 weeks
Explanation
The coronal MRI scan shows an undersurface partial-thickness rotator cuff tear. Initial treatment for this injury should include complete cessation of throwing (or other overhead activities dependent on the athlete). Despite the duration of symptoms, he has had no treatment to date; therefore, nonsurgical management should include activity cessation, a rotator cuff and periscapular strengthening program, and then a slow and supervised return to throwing with particular attention to proper pitching mechanics. Decreasing the pitch count or continued play with observation risks progression of the problem. Surgical intervention is not indicated for initial treatment.
Question 1411
Topic: 5. Sports Medicine
A 15-year-old high school soccer player collides with an opponent and is unconscious when the trainer arrives on the field. He is conscious within 15 seconds, breathing appropriately, and denies any headache, neck pain, or nausea. It is his first head injury. Provided that the athlete is free of symptoms, when should he be allowed to return to athletic activity?
Correct Answer & Explanation
. Immediately
Explanation
DISCUSSION: The loss of consciousness indicates a grade 2 concussion, which necessitates aweek period out of sport. The last week prior to return must be symptom-free and the athlete should not have symptoms in practice.REFERENCES: Cantu RC: Return to play guidelines after a head injury. Clin Sports Med 1998;17:45-60.Stevenson KL, Adelson PD: Pediatric sports-related head injuries, in Delee JC, Drez D (eds): Orthopaedic Sports Medicine, ed 2. Philadelphia, PA, WB Saunders, 2003, vol 1, p 781.
Question 1412
Topic: 5. Sports Medicine
In the majority of patients with chronic anterior cruciate ligament (ACL)-deficient knees, analysis of the gait pattern during level walking will most likely reveal which of the following changes?
Correct Answer & Explanation
. No significant differences in gait from the contralateral knee
Explanation
DISCUSSION: Patients with chronic ACL-deficient knees typically have lower than normal net quadriceps activity during the middle portion of the stance phase; the net moment about the knee reverses from one that demands quadriceps activity to one that demands increased hamstring activity. This type of gait is termed “quadriceps avoidance.” This avoidance is believed to be a functional adaptation to reduce anterior tibial translation, and it is most prevalent as the knee moves from 45° of flexion toward full extension, the arc of motion through which the ACL is most responsible for stability.REFERENCES: Hurwitz DE, Andriacchi TP, Bush-Joseph CA, Bach BR Jr: Functional adaptations in patients with ACL-deficient knees. Exerc Sport Sci Rev 1997;25:1-20.Andriacchi TP, Birac D: Functional testing in the anterior cruciate ligament-deficient knee. Clin Orthop 1993;288:40-47.Solomonow M, Baratta R, Zhou BH, et al: The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability. Am J Sports Med 1987;15:207-213.
Question 1413
Topic: Shoulder & Hip Sports
A 27-year-old man has recurrent anterior shoulder instability following an arthroscopic Bankart repair 4 years ago. Current CT scans are shown in Figures 19a and 19b. Deficiency of what mechanism is most likely to contribute to the current joint instability? Review Topic
Correct Answer & Explanation
. Synovial fluid adhesion-cohesion
Explanation
Loss of the anterior glenoid rim can commonly occur as a result of acute fracture or progressive wear following multiple dislocations. This decreases the effective depth of the glenoid. The ability of the rotator cuff to stabilize the joint through production of a joint reactive force is markedly decreased. Synovial fluid adhesion-cohesion and negative intra-articular pressure are maintained in the closed capsular space. The Hill-Sachs lesion in this case is not large enough to be a significant factor in failed Bankart repair. Poor scapulothoracic rhythm can increase the risk of instability but is not typically the primary factor.
Question 1414
Topic: Shoulder & Hip Sports
Figures 38a & 38b show radiographs of a 40 year old man who underwent a Putti-Platt repair for recurrent dislocations at age 22. He reports increasing pain in the shoulder and limited motion for five years. Examination reveals 130 degrees of elevation and 15 degrees of external rotation. Non-surgical treatment has failed. Treatment should now consist of what?
Correct Answer & Explanation
. Manipulation Under Anesthesia
Explanation
[Radiograph: Well positioned G-H joint. Mild degenerative changes.]Late onset of pain (average 13 years) was noted following this procedure in a small number of patients. The pain is attributed to excessive G-H compressive forces due to limited external rotation. NSAIDS and PT are first line treatments. If these fail, the authors demonstrated good results with release of the anterior structures. Choices 3 & 4 would probably be reserved for patients older than 50 with more advanced signs of degenerative disease.
Question 1415
Topic: 5. Sports Medicine
A 21-year-old football player reports increasing pain and a deformity involving his chest after colliding with another player during a scrimmage. Imaging studies confirm an anterior sternoclavicular dislocation. Management should consist of
Correct Answer & Explanation
. reconstruction of the sternoclavicular capsule.
Explanation
DISCUSSION: For the patient with an anterior sternoclavicular dislocation, the most appropriate initial treatment should be symptomatic. Surgical options are usually contraindicated because the incidence of intraoperative and postoperative complications is high. A deformity from an anterior sternoclavicular dislocation is usually well tolerated. Return to play is allowed when symptoms resolve.REFERENCES: Rockwood CA Jr: Disorders of the sternoclavicular joint, in Rockwood CA Jr, Matsen FA III (eds): The Shoulder. Philadelphia, PA, WB Saunders, 1998, vol 1, pp 477-525.Rockwood CA Jr, Odor JM: Spontaneous atraumatic anterior subluxation of the sternoclavicular joint. J Bone Joint Surg Am 1989;71:1280-1288.
Question 1416
Topic: 5. Sports Medicine
The anterior portal of a hip arthroscopy places what structure at greatest risk for injury?
Correct Answer & Explanation
. Ascending branch of the lateral circumflex femoral artery
Explanation
DISCUSSION: The average location of the anterior portal is 6.3 cm distal to the anterior superior iliac spine. The lateral femoral cutaneous nerve typically has divided into three or more branches at the level of the anterior portal. The portal usually passes within several millimeters of the most medial branch. Injury to the nerve can lead to meralgia paresthetica. The femoral nerve lies an average minimum distance of 3.2 cm from the anterior portal. The ascending branch of the lateral circumflex artery lies approximately 3.7 cm inferior to the anterior portal. Neither the ascending branch of the medial circumflex artery nor the superior gluteal nerve areat risk.REFERENCES: Byrd JWT: Operative Hip Arthroscopy. New York, NY, Thieme Medical Publishers, 1998, pp 83-91.Arendt EA (ed): Orthopaedic Knowledge Update: Sports Medicine 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 281-289.
Question 1417
Topic: 5. Sports Medicine
Radiographs of a 12-year-old boy who has knee pain show a 2-cm osteochondral lesion of the lateral aspect of the medial femoral condyle. The fragments are not detached from the femur. Initial management should consist of
Correct Answer & Explanation
. casting in flexion.
Explanation
DISCUSSION: For a pediatric patient without mechanical symptoms, initial management of an osteochondral defect lesion that is not detached should consist of casting in flexion. Failure to respond to several weeks or months of nonsurgical management may warrant surgical treatment.REFERENCE: Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 505-520.
Question 1418
Topic: Shoulder & Hip Sports
A 23-year-old man reports a 6-year history of recurrent instability in the right dominant shoulder. He has not undergone surgery and has essentially stopped all of his sporting activities. On examination, he has instability and apprehension in the midrange of motion (abduction of 45 to 60 degrees with external rotation) and a palpable clunk representing a transient dislocation over the anterior glenoid rim. A three-dimensional CT scan is shown in Figure 31. What is the most appropriate surgical intervention to provide him with reliable stability postoperatively? Review Topic
Correct Answer & Explanation
. Arthroscopic Bankart surgery
Explanation
In the setting of significant anteroinferior glenoid bone deficiency (greater than 20% to 25%), both open and arthroscopic Bankart repairs have demonstrated higher rates of failure. Bony glenoid augmentation procedures such as the Bristow-Latarjet, which describe coracoid transfers to reconstruct the deficient glenoid, have led to decreased rates of recurrent shoulder instability. In this scenario, the patient has a significant loss of glenoid bone. There are also several clues in the history to suspect bone deficiency: multiple recurrences, a long history of recurrence, and instability in the midranges of motion. A bony augmentation procedure such as the Latarjet has been well-described to provide a well functioning and stable shoulder joint. A hemiarthroplasty is not indicated in the absence of arthritis. Subscapularis advancement will not address the bone loss.
Question 1419
Topic: 5. Sports Medicine
-Postsurgically, the patient recovers well and is fully rehabilitated. He demonstrates full motion with no instability or pain and is cleared to return to play 12 months after the surgery. He asks for your advice regarding use of a functional brace for playing basketball following his reconstruction. What is the most appropriate recommendation?
Correct Answer & Explanation
. The athlete must wear a functional brace for all athletic activities for 2 years following reconstruction.
Explanation
DISCUSSION FOR QUESTIONS 89 THROUGH 95The athlete most likely suffered an acute ACL rupture however the presence of a lipohemarthrosis is concerning for the possibility of an intraarticular fracture. Because of this, the patient should not be allowed full weight bearing until a fracture is ruled out with radiographs. Given the athlete’s inability to perform a straight leg raise, the extensor mechanism is not functioning and a telescoping knee brace locked in extension should be utilized. A neoprene knee sleeve does not have a role in thetreatment of this acute injury.The radiographs reveal a lateral avulsion fracture off of the proximal tibial epiphysis which is known as a Segond fracture. It is indicative of an ACL injury and the fracture fragment seen is the consequence of the lateral capsule injury sustained during the pivot-shift mechanism. There is no radiographic evidence of a medial tibial plateau fracture. A radiographic sign of a chronic MCL injury is known as a Pellegrini-Stieda lesion and this is seen as calcification of the femoral origin of the MCL. A radiographic sign of an acute LCL rupture would be an avulsion fracture of the tip of the fibula.The MRI shows kissing contusions of the posterolateral tibial plateau and the midpoint of the lateral femoral condyle. These “kissing lesions” are seen as a result of a pivot shift mechanism of injury and are diagnostic for an ACL rupture. The most common associated injury in an acute ACL rupture is a lateral meniscus tear. Medial meniscus tears are more common in chronic ACL injuries. PCL rupture and PLC injury are all associated injuries seen in acute ACL rupture; however, these are much less common than meniscal tears. The team physician has a role in encouraging, butnot demanding, the athlete to report the injury andtreatment to the scholarship school’s coaching staff. What the athlete decides to do is his decision; the physician would be violating the athlete’s HIPAA rights as well as their confidence by reporting it directly to the scholarship school. Clearly the physician should not discourage the athlete from reporting the injury. The athlete is 18 years old and, as such, the physician would need the athlete’s permission to discuss any medical issues with the family in keeping with HIPAA.The athlete’s exam demonstrates incompetence of both bundles of the ACL as demonstrated by the loss of stability with anterior translation of the tibia (Lachman test) as well as with rotation (pivot shift). The external rotation stress with the knee in 30 degrees of flexion tests the competence of the posterolateral corner while rotation at 90 degrees of flexion tests the PCL. Since the athlete’s knee is stable to posterior drawer testing demonstrating an intact PCL and the external rotation at 30 degrees is equivalent to that at 90 degrees, the posterolateral corner in intact.The ACL has two separate and distinct bundles, the AM and PL. Each bundle takes on tension at varying degrees of knee flexion and therefore each bundle is thought to have a varying contribution to the stability of the knee. The AM bundle takes on tension with the knee in flexion and the PL bundle is tight in extension. Neither bundle is isometric during knee range of motion. Both bundles have contributions to rotational stability of the knee throughout the range of motion.The success of traditional trans-tibial single-bundle ACL reconstruction has recently been called into question given the demonstration of persistent rotational instability following reconstruction. The persistence of rotational instability in trans-tibial single bundle ACL reconstruction has been attributed to the location of the graft in a vertically malpositioned femoral tunnel. The goal of double-bundle ACL reconstruction is to more accurately reproduce the native ACL and provide grafts that contribute to anteroposterior stability as well as rotational stability by placing the grafts in more anatomic locations not central in the knee axis. There is an increased cost and surgical time associated with double-bundle reconstruction.The use of functional braces following ACL reconstruction is a surgeon’s preference because there is no difference in retear rate with or without a brace. Some authors recommend brace use for one to two years following ACL reconstruction for all athletic activities, but this is not supported by the literature. No literature exists showing a higher rate of reinjury with a functional brace and off-the shelf and custom braces have been found to be equivalent leading those who advocate for braces to recommend off-theshelf braces given their significantly lower cost.
Question 1420
Topic: Knee Sports
A 24-year-old former high school wrestler had anterior cruciate ligament (ACL) reconstruction with hamstring autograft 6 years ago. He now experiences daily instability of his knee with routine activities including walking. Examination reveals a grade 3+ Lachman test with a soft endpoint, varus laxity at 30°, and a positive dial test at 30° that dissipates at 90° of knee flexion. He has mild medial joint line tenderness. When walking, there is a slight varus thrust. What treatment is most likely to lead to a successful outcome?
Correct Answer & Explanation
. Hamstring autograft
Explanation
This patient underwent an ACL reconstruction that has now failed. Based on his examination, he also has a posterolateral corner injury. Because this concomitant injury was not treated, the patient had undue strain on his graft, resulting in ultimate failure. Hamstring grafts are as effective as other graft types for ACL reconstruction. The medial meniscus provides secondary stabilization to the knee; however, this patient has a missed lateral ligamentous injury, and meniscus tears do not result in the development of a varus thrust. An unrecognized PCL tear likely results in mild-to-moderate medial and patellofemoral osteoarthritis without significant lateral laxity and thrust.
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