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5. Sports Medicine MCQs

Practice Set 93 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 1841

Topic: 5. Sports Medicine

Quadriceps tendon ruptures often occur in a known hypovascular zone. Where is this critical hypovascular zone of the quadriceps tendon located?

. 1 to 2 cm superior to the superior pole of the patella
. 3 to 4 cm superior to the superior pole of the patella
. At the myotendinous junction
. Directly at the bony insertion
. 1 to 2 cm inferior to the inferior pole of the patella

Correct Answer & Explanation

. 1 to 2 cm superior to the superior pole of the patella

Explanation

The quadriceps tendon has a hypovascular zone located approximately 1 to 2 cm superior to its insertion on the superior pole of the patella. This 'watershed' area is structurally weaker and is the most common site for spontaneous quadriceps tendon ruptures in older adults or those with systemic risk factors.

Question 1842

Topic: Knee Sports

A 19-year-old female soccer player undergoes revision ACL reconstruction. The surgeon decides to perform a lateral extra-articular tenodesis (LET) using a modified Lemaire technique. Where is the graft typically routed in relation to the lateral collateral ligament (LCL) to provide optimal rotational stability?

. Deep to the LCL
. Supericial to the LCL
. Through a split in the LCL
. Anterior to the LCL and deep to the popliteus
. Posterior to the LCL and superficial to the biceps femoris

Correct Answer & Explanation

. Deep to the LCL

Explanation

In a modified Lemaire lateral extra-articular tenodesis (LET), a strip of the iliotibial band is harvested, left attached at Gerdy's tubercle, routed deep to the lateral collateral ligament (LCL), and fixed to the anterolateral distal femur. This biomechanically mimics the native anterolateral complex and provides a strong check against internal tibial rotation.

Question 1843

Topic: Knee Sports

A 28-year-old active male presents with a symptomatic 4 cm^2 focal full-thickness chondral defect on the weight-bearing surface of the medial femoral condyle with minimal subchondral bone involvement. He previously underwent a microfracture procedure 2 years ago that failed. Which of the following cartilage restoration procedures is most appropriate?

. Repeat microfracture
. Matrix-induced autologous chondrocyte implantation (MACI)
. Osteochondral autograft transfer (OATS)
. Fresh osteochondral allograft transplantation
. Unicompartmental knee arthroplasty

Correct Answer & Explanation

. Matrix-induced autologous chondrocyte implantation (MACI)

Explanation

For larger chondral defects (typically > 2 to 3 cm^2) that have failed primary bone marrow stimulation techniques like microfracture, MACI is highly indicated, provided the subchondral bone is largely intact. OATS is generally reserved for smaller defects due to donor site morbidity.

Question 1844

Topic: Knee Sports

A 30-year-old male is evaluated for knee instability. On physical examination, the dial test shows 15 degrees of increased external rotation at 30 degrees of flexion compared to the contralateral side, but symmetric rotation at 90 degrees of flexion. Which structure(s) is/are most likely injured?

. Posterior cruciate ligament only
. Posterolateral corner only
. Both posterolateral corner and posterior cruciate ligament
. Anterior cruciate ligament and posterolateral corner
. Medial collateral ligament and posterior oblique ligament

Correct Answer & Explanation

. Posterolateral corner only

Explanation

An isolated injury to the posterolateral corner (PLC) presents with increased external rotation at 30 degrees of flexion but not at 90 degrees. If both the PLC and PCL are injured, there is increased external rotation at both 30 and 90 degrees.

Question 1845

Topic: Knee Sports

During reconstruction of the posterior cruciate ligament (PCL), the surgeon aims to recreate its primary biomechanical bundles. Which of the following best describes the tensioning pattern of the normal PCL bundles during knee range of motion?

. Anterolateral bundle is tight in flexion; posteromedial bundle is tight in extension
. Anteromedial bundle is tight in flexion; posterolateral bundle is tight in extension
. Anterolateral bundle is tight in extension; posteromedial bundle is tight in flexion
. Both bundles are equally tight throughout the entire range of motion
. Both bundles are tightest at 45 degrees of flexion

Correct Answer & Explanation

. Anterolateral bundle is tight in extension; posteromedial bundle is tight in flexion

Explanation

The PCL consists of two main bundles: the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. Biomechanically, the AL bundle is tight in flexion, while the PM bundle is tight in extension.

Question 1846

Topic: Knee Sports

A 45-year-old active male with medial compartment osteoarthritis and varus alignment undergoes a medial opening wedge high tibial osteotomy (HTO). If the osteotomy gap is opened disproportionately more anteriorly than posteriorly, what biomechanical effect will this have on the knee?

. Increases posterior tibial slope and increases strain on the ACL
. Decreases posterior tibial slope and increases strain on the PCL
. Increases posterior tibial slope and increases strain on the PCL
. Decreases posterior tibial slope and increases strain on the ACL
. No change in tibial slope but increases patellofemoral contact pressures

Correct Answer & Explanation

. Increases posterior tibial slope and increases strain on the PCL

Explanation

Opening a medial HTO gap more anteriorly than posteriorly increases the posterior tibial slope. An increased posterior tibial slope translates the tibia anteriorly, which correspondingly increases the resting strain on the anterior cruciate ligament (ACL).

Question 1847

Topic: 5. Sports Medicine

A 22-year-old female presents with an isolated 4.5 cm2 full-thickness chondral defect on the weight-bearing surface of her medial femoral condyle. She has failed conservative management. Which of the following is the most appropriate surgical intervention for this lesion?

. Arthroscopic microfracture
. Osteochondral autograft transfer (OATS)
. Matrix-induced autologous chondrocyte implantation (MACI)
. High tibial osteotomy without cartilage restoration
. Unicompartmental knee arthroplasty

Correct Answer & Explanation

. Matrix-induced autologous chondrocyte implantation (MACI)

Explanation

For large full-thickness chondral defects (>2-4 cm2) in young active patients, cell-based therapies like MACI or osteochondral allografts are indicated. Microfracture and OATS (autograft) are generally reserved for smaller defects (<2 cm2).

Question 1848

Topic: Knee Sports

A 7-year-old boy presents with a painless clunking sensation in his lateral knee during extension. MRI confirms a complete Wrisberg variant discoid lateral meniscus. What anatomical feature defines the Wrisberg variant of a discoid meniscus?

. Lack of an anterior horn attachment to the tibia
. Absence of the posterior meniscofemoral ligament
. Lack of posterior coronary ligament attachments to the tibia
. Direct attachment to the anterior cruciate ligament
. Presence of a parameniscal cyst extending into the popliteal fossa

Correct Answer & Explanation

. Lack of an anterior horn attachment to the tibia

Explanation

The Wrisberg variant of a discoid lateral meniscus lacks the normal posterior meniscotibial (coronary) attachments. Its only posterior attachment is the meniscofemoral ligament of Wrisberg, leading to hypermobility and a snapping sensation during extension.

Question 1849

Topic: Knee Sports

The predominant vascular supply to the anterior cruciate ligament (ACL) is derived from which of the following arteries?

. Inferior medial geniculate artery
. Superior lateral geniculate artery
. Middle geniculate artery
. Descending genicular artery
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Middle geniculate artery

Explanation

The middle geniculate artery pierces the posterior capsule to supply the synovial sheath of the ACL and PCL. The intrinsic blood supply of the cruciate ligaments is predominantly from this vessel, with minor distal contributions from the inferior genicular arteries.

Question 1850

Topic: Knee Sports

A 28-year-old male sustains a multiligament knee injury. Physical examination reveals a +3 posterior drawer test and a positive dial test at both 30 and 90 degrees of flexion. Which combination of injured structures is most likely responsible for these findings?

. Isolated posterior cruciate ligament (PCL)
. Isolated posterolateral corner (PLC)
. Posterior cruciate ligament (PCL) and posterolateral corner (PLC)
. Posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL)
. Anterior cruciate ligament (ACL) and posterolateral corner (PLC)

Correct Answer & Explanation

. Posterior cruciate ligament (PCL) and posterolateral corner (PLC)

Explanation

An isolated PLC injury results in increased external rotation asymmetry (>10 degrees) only at 30 degrees of knee flexion. A combined PCL and PLC injury results in increased external rotation at both 30 and 90 degrees, along with a positive posterior drawer.

Question 1851

Topic: Knee Sports

A 22-year-old soccer player undergoes arthroscopic repair of a bucket-handle medial meniscus tear. Which of the following factors most significantly increases the biological healing rate of the meniscal repair?

. Concomitant anterior cruciate ligament (ACL) reconstruction
. Repair with all-inside devices compared to inside-out sutures
. Use of non-absorbable instead of absorbable sutures
. Delaying surgery for >6 weeks post-injury to allow acute inflammation to subside
. Strict non-weight bearing for 8 weeks postoperatively

Correct Answer & Explanation

. Concomitant anterior cruciate ligament (ACL) reconstruction

Explanation

Concomitant ACL reconstruction enhances meniscal healing due to the release of pluripotent marrow cells and growth factors from tunnel drilling into the joint. Studies consistently show higher healing rates for meniscal repairs performed with concurrent ACL reconstruction compared to isolated repairs.

Question 1852

Topic: Knee Sports

A 12-year-old male presents with chronic anterior knee pain. Radiographs and an MRI

demonstrate a stable osteochondritis dissecans (OCD) lesion. What is the most common anatomical location for an OCD lesion of the knee?

. Central aspect of the lateral femoral condyle
. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Trochlear groove
. Inferior pole of the patella

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The lateral aspect of the medial femoral condyle is the classic and most common site for OCD lesions of the knee, accounting for roughly 70% of cases. Nonoperative management is the first-line treatment for stable lesions in patients with open physes.

Question 1853

Topic: 5. Sports Medicine

In comparing a 10-mm bone-patellar tendon-bone (BPTB) autograft to the native anterior cruciate ligament (ACL), which of the following biomechanical statements is most accurate regarding the graft's initial properties at the time of implantation?

. It has a lower ultimate load and higher stiffness
. It has a higher ultimate load and lower stiffness
. It has a higher ultimate load and higher stiffness
. It has a lower ultimate load and lower stiffness
. It exactly matches the ultimate load and stiffness of the native ACL

Correct Answer & Explanation

. It has a higher ultimate load and higher stiffness

Explanation

A 10-mm BPTB graft has an initial ultimate load (~2977 N) and stiffness (~620 N/mm) that exceed those of the native ACL (ultimate load ~2160 N, stiffness ~242 N/mm). Over time, the graft undergoes ligamentization and its mechanical properties decrease.

Question 1854

Topic: Knee Sports

A 6-year-old girl presents with a painless clicking and "snapping" sensation in her lateral knee with extension. MRI confirms a discoid lateral meniscus. The Wrisberg variant of a discoid meniscus causes this hypermobility due to the absence of which of the following normal anatomical structures?

. Coronary (meniscotibial) ligaments posteriorly
. Ligament of Wrisberg
. Anterior horn meniscal root attachment
. Ligament of Humphrey
. Popliteofibular ligament

Correct Answer & Explanation

. Coronary (meniscotibial) ligaments posteriorly

Explanation

The Wrisberg variant of a discoid lateral meniscus is uniquely characterized by the lack of normal posterior meniscotibial (coronary) attachments. It is solely anchored posteriorly by the meniscofemoral ligament of Wrisberg, leading to meniscal subluxation and a snapping knee.

Question 1855

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, identifying the correct femoral footprint is critical to ensure proper graft isometry. According to Schöttle's point on a true lateral radiograph, where should the femoral attachment be positioned?
. 1 mm anterior to the posterior femoral cortical line and just proximal to the posterior extension of Blumensaat's line
. 5 mm posterior to the posterior femoral cortical line and distal to Blumensaat's line
. 10 mm proximal to the adductor tubercle along the medial epicondylar ridge
. Directly centered on the medial epicondyle
. 5 mm anterior to the posterior femoral cortical line and 10 mm distal to the medial epicondyle

Correct Answer & Explanation

. 1 mm anterior to the posterior femoral cortical line and just proximal to the posterior extension of Blumensaat's line

Explanation

Schöttle's point for the MPFL femoral origin is radiographically defined as 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior border of the medial femoral condyle articular surface, and proximal to the posterior extension of Blumensaat's line. Positioning the graft too proximal results in pathologic tightness during knee flexion.

Question 1856

Topic: Knee Sports

A 28-year-old male sustains a varus-hyperextension injury to his knee. Examination reveals a positive dial test at 30 degrees of knee flexion, but symmetric external rotation at 90 degrees compared to the contralateral knee. Which of the following structures is most likely injured?

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

Correct Answer & Explanation

. Posterolateral corner

Explanation

A positive dial test (increased external rotation >10 degrees) at 30 degrees of flexion with a normal test at 90 degrees isolates an injury to the posterolateral corner (PLC). Combined PLC and PCL injuries show increased external rotation at both 30 and 90 degrees.

Question 1857

Topic: 5. Sports Medicine

A 22-year-old collegiate soccer player presents with a symptomatic 3.5 cm^2 full-thickness osteochondral defect on the weight-bearing surface of the medial femoral condyle. He has failed nonoperative management. Which of the following is the most appropriate surgical intervention?

. Microfracture
. Matrix-induced autologous chondrocyte implantation (MACI)
. Osteochondral autograft transfer (OATS)
. Arthroscopic debridement
. High tibial osteotomy

Correct Answer & Explanation

. Microfracture

Explanation

MACI or osteochondral allograft transplantation are indicated for large (>2-3 cm^2) symptomatic full-thickness cartilage defects. Microfracture and OATS (autograft) are typically reserved for smaller lesions (<2 cm^2) due to donor site morbidity.

Question 1858

Topic: 5. Sports Medicine

An 11-year-old female soccer player (Tanner stage 2) sustains a midsubstance ACL rupture. She has wide open physes. The surgeon plans an epiphyseal-sparing ACL reconstruction. Which of the following grafts and techniques avoids the femoral and tibial physes entirely?

. Bone-patellar tendon-bone autograft via transtibial technique
. Iliotibial band extra-articular tenodesis (MacIntosh technique)
. Hamstring autograft with transphyseal drilling
. Quadriceps tendon with bone block
. All-inside hamstring technique with independent drilling

Correct Answer & Explanation

. Bone-patellar tendon-bone autograft via transtibial technique

Explanation

The modified MacIntosh (iliotibial band over-the-top) procedure is a purely extra-articular, physeal-sparing technique used in prepubescent patients to avoid growth arrest. Transphyseal drilling risks physeal injury, and bone blocks are contraindicated across open physes.

Question 1859

Topic: Knee Sports

A 24-year-old male undergoes arthroscopy for an acute ACL rupture. The surgeon evaluates the posterior horn of the medial meniscus through the intercondylar notch and identifies a ramp lesion. Biomechanically, untreated ramp lesions in the setting of ACL reconstruction primarily increase which of the following?

. Varus laxity
. Valgus laxity
. Posterior tibial translation
. Anterior tibial translation
. Internal tibial rotation

Correct Answer & Explanation

. Varus laxity

Explanation

Untreated meniscal ramp lesions significantly increase anterior tibial translation and external rotation forces on an ACL graft. Repair of the ramp lesion restores native knee kinematics and protects the ACL reconstruction.

Question 1860

Topic: Knee Sports

A 30-year-old male sustains a posterior dashboard injury to his knee. Physical examination reveals a 12-mm posterior step-off of the tibia relative to the femoral condyles at 90 degrees of flexion. The dial test shows 20 degrees of increased external rotation at both 30 and 90 degrees of knee flexion compared to the contralateral side. Which structures are injured?

. Isolated PCL
. Isolated PLC
. PCL and PLC
. PCL and MCL
. ACL and PCL

Correct Answer & Explanation

. Isolated PCL

Explanation

Increased external rotation at both 30 and 90 degrees of flexion on the dial test indicates a combined injury to the posterior cruciate ligament (PCL) and posterolateral corner (PLC). An isolated PLC injury increases ER at 30 degrees only.

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