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5. Sports Medicine MCQs

Practice Set 92 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 1821

Topic: Shoulder & Hip Sports

Which of the following statements best describes labral tears in the hip? Review Topic

. They are unrelated to degenerative joint disease.
. They lead to increased movement of the femur relative to the acetabulum.
. They usually result from lesions of the ligamentum teres.
. They only occur with abnormal bone morphology.
. They commonly occur in the posteroinferior quadrant of the hip.

Correct Answer & Explanation

. They lead to increased movement of the femur relative to the acetabulum.

Explanation

Labral and chondral lesions are observed within the anterosuperior quadrant of the acetabulum. Tearing of the labrum markedly reduces resistance to joint motion, leading to instability. The most common associated lesions are chondral injuries. They can occur with or without abnormal bone morphology. The etiology for labral tears can be from traumatic and degenerative causes, structural abnormalities from femoroacetabular impingement, developmental abnormalities, and hip instability.

Question 1822

Topic: 5. Sports Medicine

A 24-year-old athlete undergoes ACL reconstruction using an anteromedial portal technique for femoral tunnel drilling. Compared to a transtibial technique, which of the following is true regarding the femoral tunnel position and biomechanics?

. The tunnel is placed more vertical and anterior in the notch.
. The technique provides superior rotational stability by placing the tunnel lower on the lateral wall.
. It increases the risk of posterior wall blowout if knee hyperflexion is maintained.
. The technique is associated with a longer intra-articular graft length.
. It relies on the tibial tunnel trajectory to determine femoral tunnel placement.

Correct Answer & Explanation

. The technique is associated with a longer intra-articular graft length.

Explanation

Drilling the femoral tunnel independently through an anteromedial (AM) portal allows for anatomic placement lower on the lateral wall of the intercondylar notch (closer to the native footprint). This position improves rotational stability compared to traditional transtibial drilling, which often results in a more vertical graft placement that controls sagittal translation but is less effective for rotational control.

Question 1823

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon uses fluoroscopy to identify Schöttle's point. Which of the following describes the correct anatomic landmarks for the femoral attachment of the MPFL on a lateral radiograph?
. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior notch.
. 5 mm posterior to the posterior cortex extension line, 5 mm proximal to the Blumensaat line.
. At the intersection of the Blumensaat line and the anterior cortex of the femur.
. Directly on the medial epicondyle, distal to the adductor tubercle.
. 3 mm anterior to the medial epicondyle and 3 mm distal to the adductor tubercle.

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior notch.

Explanation

Schöttle's point is a validated radiographic landmark for the anatomic femoral attachment of the MPFL. On a strictly true lateral radiograph, it is located 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior point of the Blumensaat line.

Question 1824

Topic: Knee Sports
A 22-year-old female presents with recurrent patellar dislocations. Examination reveals a positive J-sign. Imaging shows a TT-TG distance of 22 mm, normal patellar height, and grade III chondromalacia isolated to the distal/inferior patellar pole. Which of the following is the most appropriate surgical intervention?
. MPFL reconstruction alone
. Lateral release alone
. Anteromedialization (Fulkerson) osteotomy of the tibial tubercle
. Straight medialization (Elmslie-Trillat) of the tibial tubercle
. Distalization of the tibial tubercle

Correct Answer & Explanation

. Anteromedialization (Fulkerson) osteotomy of the tibial tubercle

Explanation

Anteromedialization of the tibial tubercle (Fulkerson osteotomy) is indicated for patients with patellofemoral instability, an elevated TT-TG distance (>20 mm), and associated distal/inferior or lateral patellar chondral lesions. The anterior translation component offloads the distal and lateral patella, while medialization corrects the tracking vector. Straight medialization does not offload the patellofemoral joint.

Question 1825

Topic: Knee Sports

In a single-bundle posterior cruciate ligament (PCL) reconstruction, the graft is designed to recreate the primary functional bundle of the PCL. Which bundle is being reconstructed, and in what position is it tightest?

. Posteromedial bundle; tightest in extension
. Posteromedial bundle; tightest in flexion
. Anterolateral bundle; tightest in flexion
. Anterolateral bundle; tightest in extension
. Meniscofemoral ligament; tightest in mid-flexion

Correct Answer & Explanation

. Anterolateral bundle; tightest in flexion

Explanation

The PCL consists of two main bundles: the anterolateral (AL) and posteromedial (PM). The AL bundle is the larger, stiffer bundle and is tightest in knee flexion. Single-bundle PCL reconstruction typically aims to reconstruct the AL bundle to control posterior translation at higher flexion angles.

Question 1826

Topic: Knee Sports

A 26-year-old male presents for revision ACL reconstruction after re-rupturing his graft. CT scan demonstrates significant tunnel widening with the femoral tunnel measuring 16 mm and tibial tunnel measuring 15 mm. What is the most appropriate management?

. Single-stage revision with a larger diameter bone-patellar tendon-bone graft
. Single-stage revision using a suspension cortical button on the femur and interference screw on the tibia
. Two-stage revision with initial bone grafting of the tunnels, followed by revision ACL reconstruction after graft incorporation
. Single-stage revision with extra-articular lateral extra-articular tenodesis (LET) only
. Conservative management with bracing

Correct Answer & Explanation

. Two-stage revision with initial bone grafting of the tunnels, followed by revision ACL reconstruction after graft incorporation

Explanation

In the setting of significant tunnel widening (>14 mm), a two-stage revision is indicated to ensure adequate graft fixation. The first stage involves hardware removal and bone grafting of the expanded tunnels (e.g., using iliac crest bone graft, allograft dowels, or synthetic bone substitutes). Once incorporated (usually 4-6 months later), the second stage involves the definitive revision ACL reconstruction.

Question 1827

Topic: 5. Sports Medicine

A 12-year-old boy presents with vague knee pain. Radiographs reveal a 1.5 cm osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. His physes are wide open. MRI shows no fluid behind the lesion and the overlying cartilage is intact. What is the best initial management?

. Microfracture
. Transarticular drilling
. Activity modification and non-weight-bearing
. Osteochondral autograft transfer
. Fixation with bioabsorbable screws

Correct Answer & Explanation

. Activity modification and non-weight-bearing

Explanation

This patient has a stable OCD lesion (intact cartilage, no fluid behind the lesion on MRI) and open physes (juvenile OCD). The initial management of stable juvenile OCD is non-operative, consisting of activity modification (restricting impact activities) and a period of non-weight-bearing or restricted weight-bearing, which yields a high rate of spontaneous healing. Operative intervention is reserved for patients who fail 3-6 months of conservative management or have unstable lesions.

Question 1828

Topic: Knee Sports

Which of the following structures constitutes the primary static stabilizer against external rotation of the tibia at 30 degrees of knee flexion?

. Popliteus tendon
. Lateral collateral ligament (LCL)
. Popliteofibular ligament (PFL)
. Iliotibial band
. Biceps femoris tendon

Correct Answer & Explanation

. Popliteofibular ligament (PFL)

Explanation

The posterolateral corner (PLC) of the knee consists primarily of the LCL, popliteus tendon, and popliteofibular ligament (PFL). The primary static stabilizers to external rotation at 30 degrees of knee flexion are the popliteus complex (specifically the popliteofibular ligament) and the LCL. The PFL plays a crucial role in resisting external tibial rotation.

Question 1829

Topic: 5. Sports Medicine

A 45-year-old male with end-stage renal disease on hemodialysis presents with inability to extend his knee after a stumble. Examination reveals a palpable gap superior to the patella. Which of the following histologic findings is most likely present in the torn tendon?

. Abundant acute inflammatory cells
. Amyloid deposition
. Myxoid degeneration and loss of collagen continuity
. Synovial hyperplasia
. Gouty tophi

Correct Answer & Explanation

. Myxoid degeneration and loss of collagen continuity

Explanation

Quadriceps tendon ruptures often occur in patients with systemic diseases (e.g., chronic kidney disease, diabetes, hyperparathyroidism) or fluoroquinolone use. The underlying pathophysiology involves chronic tendinopathy characterized by myxoid degeneration, loss of normal collagen architecture, and hypocellularity, rather than an acute inflammatory process.

Question 1830

Topic: Knee Sports

During an ACL reconstruction, a systematic arthroscopic evaluation is performed. A 'ramp lesion' is identified. Which of the following best describes this pathology?

. A radial tear in the anterior horn of the medial meniscus
. A tear at the meniscocapsular junction of the posterior horn of the medial meniscus
. A cleavage tear of the lateral meniscus body
. A root tear of the lateral meniscus
. An avulsion of the posterior cruciate ligament

Correct Answer & Explanation

. A tear at the meniscocapsular junction of the posterior horn of the medial meniscus

Explanation

A ramp lesion refers to a tear at the peripheral meniscocapsular attachment of the posterior horn of the medial meniscus. It is commonly associated with ACL injuries. These lesions can be easily missed if the posteromedial compartment is not thoroughly visualized (e.g., via a posteromedial portal or trans-notch view).

Question 1831

Topic: 5. Sports Medicine

A 9-year-old Tanner stage 1 female sustains a complete ACL tear. Her parents opt for surgical reconstruction. Which of the following techniques minimizes the risk of growth arrest?

. Transphyseal bone-patellar tendon-bone autograft
. Iliotibial band (ITB) extra-articular and intra-articular physeal-sparing reconstruction
. Transphyseal hamstring autograft with 10 mm tunnels
. Anteromedial portal technique using quadriceps tendon with bone block
. Wait until skeletal maturity before reconstruction

Correct Answer & Explanation

. Iliotibial band (ITB) extra-articular and intra-articular physeal-sparing reconstruction

Explanation

In a skeletally immature patient with significant growth remaining (Tanner stage 1 or 2), a physeal-sparing ACL reconstruction technique is recommended to prevent growth disturbance (leg length discrepancy or angular deformity). The Micheli-Kocher technique utilizes the IT band routed over the top of the lateral femoral condyle and under the intermeniscal ligament, completely avoiding drilling through the open physes.

Question 1832

Topic: Knee Sports

During the terminal 30 degrees of knee extension, the tibia externally rotates relative to the femur. Which of the following anatomic features is primarily responsible for this 'screw home' mechanism?

. The lateral femoral condyle is longer and projects further anteriorly than the medial condyle.
. The medial femoral condyle has a larger articular surface area than the lateral condyle.
. The tension in the anterior cruciate ligament forces the tibia into external rotation.
. The popliteus muscle actively contracts to externally rotate the tibia.
. The lateral meniscus translates more posteriorly than the medial meniscus.

Correct Answer & Explanation

. The lateral femoral condyle is longer and projects further anteriorly than the medial condyle.

Explanation

The 'screw home' mechanism refers to the obligatory external rotation of the tibia during terminal knee extension. This is primarily driven by the asymmetry of the femoral condyles; the articular surface of the medial femoral condyle is longer and curves further anteriorly than that of the lateral condyle. As the lateral side stops gliding during extension, the medial side continues, resulting in external rotation of the tibia.

Question 1833

Topic: Knee Sports

A patient presents with knee pain and instability after a hyperextension injury. The Dial test demonstrates 20 degrees of increased external rotation on the injured side compared to the normal side at 30 degrees of flexion, but equal external rotation at 90 degrees of flexion. What is the most likely injury?

. Isolated Posterior Cruciate Ligament (PCL) injury
. Combined PCL and Posterolateral Corner (PLC) injury
. Isolated Posterolateral Corner (PLC) injury
. Isolated Anterior Cruciate Ligament (ACL) injury
. Combined ACL and PCL injury

Correct Answer & Explanation

. Isolated Posterolateral Corner (PLC) injury

Explanation

The Dial test evaluates external rotation of the tibia at 30° and 90° of flexion. Increased external rotation (>10° compared to the contralateral side) only at 30° indicates an isolated posterolateral corner (PLC) injury. If increased external rotation is present at both 30° and 90°, it suggests a combined PCL and PLC injury.

Question 1834

Topic: Knee Sports
A 22-year-old female is undergoing an isolated medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. To ensure proper graft anisometry, the femoral tunnel must be placed accurately. Based on Schöttle's radiographic point on a strict lateral radiograph, where is the anatomic femoral origin of the MPFL?
. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior aspect of the Blumensaat line
. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and distal to the level of the posterior aspect of the Blumensaat line
. 1 mm posterior to the anterior cortical line, 2.5 mm proximal to the posterior origin of the medial femoral condyle
. 2 mm anterior to the posterior cortical line, proximal to the medial epicondyle
. Distal and anterior to the medial epicondyle

Correct Answer & Explanation

. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior aspect of the Blumensaat line

Explanation

Schöttle's point, which identifies the anatomic femoral origin of the MPFL on a true lateral radiograph, is located 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior aspect of the Blumensaat line. Proper placement prevents the graft from being too tight in flexion.

Question 1835

Topic: Knee Sports

In posterior cruciate ligament (PCL) reconstruction, the 'killer turn' refers to the acute angle the graft makes at the posterior aspect of the tibia. What is the primary theoretical advantage of the tibial inlay technique over the transtibial technique?

. Avoiding graft attenuation at the killer turn
. Improved visualization of the femoral footprint
. Shorter operative time
. Decreased risk of popliteal artery injury
. Greater graft isometricity

Correct Answer & Explanation

. Avoiding graft attenuation at the killer turn

Explanation

The tibial inlay technique was developed specifically to avoid the 'killer turn' associated with the transtibial tunnel technique, which can cause graft abrasion, attenuation, and ultimate failure. However, clinical outcome studies have generally demonstrated similar results between the two techniques.

Question 1836

Topic: Knee Sports

During an anatomical reconstruction of the posterolateral corner (PLC) of the knee, a surgeon intends to reconstruct the three major static stabilizing structures. Which of the following combinations represents these structures?

. Lateral collateral ligament, popliteus tendon, and iliotibial band
. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament
. Arcuate ligament, fabellofibular ligament, and popliteus tendon
. Biceps femoris tendon, lateral collateral ligament, and popliteofibular ligament
. Lateral collateral ligament, coronary ligament, and popliteus tendon

Correct Answer & Explanation

. Lateral collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

The three main static stabilizers of the posterolateral corner of the knee are the lateral collateral ligament (LCL), the popliteus tendon (PLT), and the popliteofibular ligament (PFL). Anatomical reconstruction (e.g., LaPrade technique) typically involves reconstructing these three specific structures to restore varus and external rotation stability.

Question 1837

Topic: 5. Sports Medicine
A 30-year-old male sustains a knee dislocation (KD-III) with injuries to the ACL, PCL, and MCL. Vascular workup shows an ABI of 1.0. What is the recommended surgical timing for ligamentous reconstruction to balance the risk of arthrofibrosis and optimal tissue healing?
. Immediate reconstruction (< 24 hours)
. Early reconstruction (1 to 3 weeks)
. Delayed reconstruction (3 to 6 months)
. Staged reconstruction (MCL acutely, ACL/PCL at 6 months)
. Nonoperative management

Correct Answer & Explanation

. Early reconstruction (1 to 3 weeks)

Explanation

For multiligament knee injuries without vascular compromise, early reconstruction (typically 1 to 3 weeks post-injury) is generally recommended. This allows initial capsular healing and decreases fluid extravasation risk during arthroscopy while facilitating earlier rehabilitation to prevent arthrofibrosis compared to acute or significantly delayed surgery.

Question 1838

Topic: 5. Sports Medicine

When comparing bone-patellar tendon-bone (BTB) autograft to quadriceps tendon autograft for anterior cruciate ligament (ACL) reconstruction, quadriceps tendon autografts have been shown to have:

. Higher rates of anterior knee pain
. Greater cross-sectional area and collagen density
. Higher rates of postoperative patellar fracture
. Inferior subjective knee outcome scores
. Lower ultimate tensile load

Correct Answer & Explanation

. Greater cross-sectional area and collagen density

Explanation

Quadriceps tendon autografts have a greater cross-sectional area and higher collagen density compared to patellar tendon autografts. They have lower rates of anterior knee pain and donor site morbidity compared to BTB autografts, while providing similar ultimate tensile load and clinical outcomes.

Question 1839

Topic: 5. Sports Medicine

Which of the following criteria is most commonly utilized to permit a patient to return to unrestricted cutting and pivoting sports after an ACL reconstruction?

. Limb Symmetry Index (LSI) > 70% on hop testing
. Isokinetic quadriceps strength within 10% of the contralateral limb
. Clearance at 4 months post-operation regardless of functional testing
. Isokinetic hamstring strength > 150% of the contralateral limb
. Complete resolution of the Lachman test

Correct Answer & Explanation

. Isokinetic quadriceps strength within 10% of the contralateral limb

Explanation

Return to play (RTP) criteria typically involve achieving a Limb Symmetry Index (LSI) of >90% on functional hop testing, and isokinetic quadriceps and hamstring strength within 10% of the uninjured contralateral limb (i.e., >90% symmetry). This helps reduce the risk of secondary ACL injury.

Question 1840

Topic: 5. Sports Medicine

A 12-year-old male with open physes presents with knee pain. MRI reveals an intact, stable osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. He has failed 6 months of nonoperative management (restricted weight-bearing and activity modification). What is the next best step in management?

. Continued nonoperative management for another 6 months
. Subchondral drilling
. Osteochondral autograft transfer (OATS)
. Autologous chondrocyte implantation (ACI)
. Internal fixation with bioabsorbable screws

Correct Answer & Explanation

. Subchondral drilling

Explanation

In a skeletally immature patient with a stable OCD lesion who has failed an adequate trial of nonoperative management (typically 3-6 months), subchondral drilling (retroarticular or transarticular) is indicated to promote revascularization and healing. Fixation is reserved for unstable lesions.

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