Sports Medicine Practice Questions

Q: A young boy presents with a swollen knee after sustaining a blow to the lateral aspect of the knee with a twist during play. Joint line tenderness is present. The Anterior Drawer test is negative. X-ray shows no fracture. Which structure is most likely damaged?

Medial Meniscus. **Explanation:** The clinical presentation of a **twisting injury** followed by **joint line tenderness** is a classic indicator of a meniscal tear. In this scenario, a blow to the lateral aspect of the knee creates a **valgus stress**, which stretches the medial compartment, making the **Medial Meniscus** the most likely structure to be damaged. * **Why Medial Meniscus is correct:** The medial meniscus is less mobile than the lateral meniscus because it is firmly attached to the deep part of the Medial Collateral Ligament (MCL). This lack of mobility makes it more prone to injury during rotational or valgus forces. Joint line tenderness is the most sensitive physical finding for meniscal tears. * **Why ACL is incorrect:** While ACL tears also occur with twisting injuries, the **Anterior Drawer test** (and Lachman test) would typically be positive. The question specifically states the Anterior Drawer test is negative. * **Why PCL is incorrect:** PCL injuries usually result from a direct blow to the proximal tibia (dashboard injury) or extreme hyperextension. They present with a positive Posterior Drawer or Sag sign. * **Why Lateral Meniscus is incorrect:** A valgus force (blow to the lateral side) stresses the medial side. The lateral meniscus is more mobile and less frequently injured than the medial meniscus in this mechanism. **Clinical Pearls for NEET-PG:** * **O’Donoghue’s Triple (Unhappy Triad):** Simultaneous injury to the ACL, MCL, and Medial Meniscus. * **McMurray’s Test:** Used to diagnose meniscal tears (External rotation for Medial Meniscus; Internal rotation for Lateral Meniscus). * **Golden Rule:** ACL tears present with rapid onset swelling (haemarthrosis), whereas meniscal tears often present with delayed swelling (traumatic synovitis) and "locking" of the joint.

Q: Which tendon is commonly used for anterior cruciate ligament (ACL) reconstruction?

Patellar tendon. **Explanation:** The **Patellar tendon** (specifically the central third Bone-Patellar Tendon-Bone or BPTB graft) is considered the "gold standard" for ACL reconstruction. 1. **Why it is correct:** The BPTB graft involves taking the middle third of the patellar tendon along with small bone plugs from the patella and the tibial tuberosity. This allows for **bone-to-bone healing** within the femoral and tibial tunnels, which is faster and stronger (occurring in about 6 weeks) compared to soft tissue-to-bone healing. It provides excellent structural stability and allows for aggressive postoperative rehabilitation. 2. **Why other options are incorrect:** * **Palmaris longus:** This is a weak, vestigial tendon in the forearm. While commonly used for hand surgery (tendon transfers) or medial collateral ligament (MCL) reconstruction of the elbow, it lacks the tensile strength required to replace the ACL. * **Plantaris tendon:** This is a small, thin tendon in the posterior leg. It is often used as a graft for small joint reconstructions or hand surgery but is insufficient for the biomechanical demands of the knee. **High-Yield Clinical Pearls for NEET-PG:** * **Common Grafts:** Apart from the Patellar tendon, the **Hamstring tendon** (Semitendinosus and Gracilis) is the other most common choice. * **Complication:** The most common complication of using a Patellar tendon graft is **anterior knee pain** and pain while kneeling. * **Lachman Test:** This is the most sensitive clinical test for diagnosing an acute ACL tear. * **Pivot Shift Test:** This is the most specific test for ACL insufficiency. * **Segond Fracture:** An avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear.

Q: What does the Anterior Cruciate Ligament (ACL) primarily prevent?

Anterior dislocation of the tibia. ### Explanation The **Anterior Cruciate Ligament (ACL)** is the primary intra-articular stabilizer of the knee. Its fundamental biomechanical role is to resist **anterior translation (dislocation) of the tibia** relative to the femur. It also acts as a secondary stabilizer against internal rotation and valgus/varus stress. #### Why the Correct Answer is Right: * **Anterior dislocation of the tibia (Option D):** The ACL originates from the medial aspect of the lateral femoral condyle and inserts onto the anterior intercondylar area of the tibia. Because of this orientation, it tightens during knee extension to prevent the tibia from sliding forward underneath the femur. #### Why Other Options are Incorrect: * **Anterior dislocation of the femur (Option A):** This is functionally equivalent to *posterior* dislocation of the tibia, which is prevented by the **Posterior Cruciate Ligament (PCL)**. * **Posterior dislocation of the tibia (Option B):** This is the primary function of the **PCL**, which prevents the tibia from sliding backward relative to the femur. * **Lateral dislocation of the tibia (Option C):** Medial and lateral stability are primarily maintained by the **Collateral Ligaments** (MCL and LCL). #### NEET-PG High-Yield Clinical Pearls: * **Mechanism of Injury:** Most commonly occurs during non-contact deceleration, "pivoting," or sudden change in direction with a planted foot. * **Clinical Tests:** The **Lachman Test** is the most sensitive clinical test for ACL deficiency. Other tests include the **Anterior Drawer Test** and the **Pivot Shift Test** (most specific). * **Segond Fracture:** An avulsion fracture of the lateral tibial plateau; it is considered pathognomonic for an ACL tear. * **Unhappy Triad (O'Donoghue):** Simultaneous injury to the ACL, Medial Collateral Ligament (MCL), and Medial Meniscus (though recent studies suggest the Lateral Meniscus is more commonly injured in acute settings).

Q: The anterior drawer test is used to assess which structure?

Anterior Cruciate Ligament (ACL). **Explanation:** The **Anterior Drawer Test** is a clinical examination used to evaluate the integrity of the **Anterior Cruciate Ligament (ACL)**. The ACL's primary function is to prevent the anterior translation of the tibia relative to the femur. During the test, the patient lies supine with the knee flexed to 90°. The examiner stabilizes the foot and pulls the proximal tibia forward. A "positive" test is indicated by excessive anterior displacement (usually >5mm) compared to the unaffected side, signifying an ACL tear. **Analysis of Options:** * **Option A (Correct):** The test specifically stresses the ACL by mimicking the force that the ligament is designed to resist. * **Option B (Incorrect):** The **Posterior Drawer Test** is used for the PCL. In this test, the tibia is pushed posteriorly; excessive backward displacement indicates a PCL injury. * **Options C & D (Incorrect):** Meniscal injuries are assessed using tests that involve joint line tenderness and rotation under compression, such as **McMurray’s Test**, **Apley’s Grind Test**, or the **Thessaly Test**. **High-Yield Clinical Pearls for NEET-PG:** * **Lachman Test:** This is the **most sensitive** clinical test for acute ACL tears. It is performed at 20–30° of flexion, which reduces the stabilizing effect of the hamstrings. * **Pivot Shift Test:** This is the **most specific** test for ACL deficiency, indicating functional instability. * **Segond Fracture:** A small avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear. * **Unhappy Triad (O'Donoghue):** Consists of injuries to the ACL, Medial Collateral Ligament (MCL), and Medial Meniscus (though recent studies suggest the Lateral Meniscus is more commonly involved in acute settings).

Q: Which of the following is NOT a feature of patellofemoral stress syndrome?

Giving way and then falling. **Explanation:** **Patellofemoral Stress Syndrome (PFSS)**, commonly known as "Runner’s Knee," is a clinical syndrome characterized by diffuse anterior knee pain caused by abnormal tracking of the patella within the femoral trochlear groove. **Why "Giving way and then falling" is the correct answer:** While "giving way" (instability) is a frequent subjective complaint in PFSS due to reflex inhibition of the quadriceps muscle triggered by pain, it **rarely leads to an actual fall**. True instability resulting in a fall is more characteristic of **patellar dislocation/subluxation** or a **ligamentous injury** (like an ACL tear). In PFSS, the "giving way" is a pseudo-instability rather than a structural failure. **Analysis of Incorrect Options:** * **Chronic anterior knee pain:** This is the hallmark symptom of PFSS. The pain is typically insidious, peripatellar or retropatellar, and exacerbated by activities that increase patellofemoral compressive forces. * **Worsening of pain with prolonged standing/sitting:** Also known as the **"Movie Theater Sign,"** pain occurs during prolonged knee flexion (sitting) or static loading (standing) as these positions maintain high pressure on the patellar articular surface. * **Worsening of pain on going upstairs:** Ascending or descending stairs significantly increases the joint reaction forces (up to 3–5 times body weight) at the patellofemoral joint, making this a classic provocative activity. **High-Yield Clinical Pearls for NEET-PG:** * **Q-Angle:** An increased Q-angle (normal: 13° in men, 18° in women) is a common predisposing factor for lateral patellar tracking. * **J-Sign:** Lateral deviation of the patella during the final stages of knee extension. * **Treatment:** Primarily conservative, focusing on **Vastus Medialis Obliquus (VMO) strengthening** and stretching of the lateral retinaculum and hamstrings.

Q: Injury to the medial meniscus is most likely when the knee joint does which of the following?

Rotates. **Explanation:** The medial meniscus is the most commonly injured fibrocartilage in the knee. The primary mechanism of injury is **rotation** (specifically internal rotation of the femur on a fixed, flexed tibia) while the knee is in a weight-bearing position. **Why Rotation is Correct:** The menisci are designed to distribute weight and act as shock absorbers. During rotation, the femoral condyles exert a "grinding" or shearing force on the menisci. Because the **medial meniscus** is less mobile than the lateral meniscus (due to its firm attachment to the Deep Medial Collateral Ligament), it cannot move out of the way of the rotating femoral condyle. This lack of mobility makes it highly susceptible to being trapped and torn during rotational stress. **Why Other Options are Incorrect:** * **Extension:** Pure extension is a stable movement for the knee. While hyperextension can lead to ACL injuries, it does not typically cause isolated meniscal tears unless accompanied by a rotational component. * **Flexion:** Simple flexion is a physiological movement. However, the meniscus is most vulnerable when the knee is **partially flexed and then rotated**. Flexion alone, without the shearing force of rotation, rarely causes a tear. **NEET-PG High-Yield Pearls:** 1. **McMurray’s Test:** The classic clinical test for meniscal tears; it utilizes rotation to elicit a "click" or pain. 2. **O’Donoghue’s Triad:** A severe injury involving the Medial Meniscus, ACL, and MCL. 3. **Shape:** The medial meniscus is **C-shaped**, while the lateral meniscus is more **circular (O-shaped)** and more mobile. 4. **Blood Supply:** Only the peripheral 1/3 (Red zone) has a good blood supply and can heal; the inner 2/3 (White zone) is avascular and usually requires excision (meniscectomy).

Q: A 67-year-old woman presents with a 3-month history of increasing right shoulder pain, resulting in an inability to lift her arm to brush her hair or retrieve items from shelves. She denies numbness, tingling, or pain radiation down her arm. Physical examination reveals weakness in abduction and external rotation of her right arm, with a normal passive range of motion. She is unable to hold her arms abducted to 90 degrees on the right side. There is no motor weakness, normal pulse, and normal sensation in her right upper extremity. Which of the following is the most likely diagnosis?

Rotator cuff tear. ### Explanation **Correct Answer: D. Rotator cuff tear** The clinical presentation is classic for a **Rotator Cuff Tear (RCT)**, likely involving the **Supraspinatus** (abduction) and **Infraspinatus** (external rotation). The hallmark of a rotator cuff tear is the **dissociation between active and passive range of motion (ROM)**. The patient has a normal passive ROM (the joint itself is not stiff), but significant weakness in active movements (the "motor" or tendon is damaged). The inability to hold the arm abducted at 90 degrees is a positive **Drop Arm Test**, a high-yield clinical sign for a full-thickness supraspinatus tear. #### Why other options are incorrect: * **A. Brachial plexus injury:** While this causes weakness, it typically presents with sensory deficits (numbness/tingling) and follows a specific dermatomal or peripheral nerve distribution, which is absent here. * **B. Glenohumeral osteoarthritis:** This would present with a **decreased passive range of motion** and "grinding" (crepitus). In OA, the joint is mechanically blocked, unlike this patient’s normal passive ROM. * **C. Proximal humerus fracture:** This is an acute traumatic event presenting with sudden severe pain, swelling, ecchymosis, and a history of a fall. A 3-month progressive history makes this unlikely. #### NEET-PG High-Yield Pearls: * **Most common muscle involved:** Supraspinatus (the "workhorse" of the rotator cuff). * **Gold Standard Investigation:** MRI Shoulder. * **Initial Investigation:** Ultrasound (highly sensitive for full-thickness tears). * **Clinical Tests:** * **Jobe’s Test (Empty Can):** Supraspinatus. * **Hornblower’s Sign:** Teres minor. * **Gerber’s Lift-off Test:** Subscapularis. * **Management:** Conservative (PT/NSAIDs) for partial tears; Surgical repair for full-thickness tears in active patients.

Question 1

Which of the following statements about ligament injuries around the knee is incorrect?

Accepted Answer

Delayed swelling after injury typically suggests an ACL injury, while immediate swelling is indicative of a meniscal injury.

Answer

The McMurray test is used to assess for meniscal tears.

Answer

The Lachman test is used for the diagnosis of ACL injury.

Answer

The Beighton score is used to assess for predisposition to ligamentous injury.

Question 2

In the "bounce home" test of the knee joint, what is the typical end feel described, EXCEPT?

Accepted Answer

Empty

Answer

Bony

Answer

Springy

Answer

Firm

Question 3

A young boy presents with a swollen knee after sustaining a blow to the lateral aspect of the knee with a twist during play. Joint line tenderness is present. The Anterior Drawer test is negative. X-ray shows no fracture. Which structure is most likely damaged?

Accepted Answer

Medial Meniscus

Answer

Anterior Cruciate Ligament (ACL)

Answer

Posterior Cruciate Ligament (PCL)

Answer

Lateral Meniscus

Question 4

Which tendon is commonly used for anterior cruciate ligament (ACL) reconstruction?

Accepted Answer

Patellar tendon

Answer

Palmaris longus tendon

Answer

Plantaris tendon

Answer

None of the above

Question 5

What does the Anterior Cruciate Ligament (ACL) primarily prevent?

Accepted Answer

Anterior dislocation of the tibia

Answer

Anterior dislocation of the femur

Answer

Posterior dislocation of the tibia

Answer

Lateral dislocation of the tibia

Question 6

The anterior drawer test is used to assess which structure?

Accepted Answer

Anterior Cruciate Ligament (ACL)

Answer

Posterior Cruciate Ligament (PCL)

Answer

Medial meniscus

Answer

Lateral meniscus

Question 7

Which of the following statements about the Anterior Cruciate Ligament (ACL) is false?

Accepted Answer

It prevents posterior motion of the femur relative to the tibia.

Answer

It prevents anterior motion of the tibia relative to the femur.

Answer

It provides some secondary varus-valgus stability.

Answer

It is taut in extension of the knee.

Question 8

Which of the following is NOT a feature of patellofemoral stress syndrome?

Accepted Answer

Giving way and then falling

Answer

Chronic anterior knee pain

Answer

Worsening of pain with prolonged standing

Answer

Worsening of pain on going upstairs

Question 9

Injury to the medial meniscus is most likely when the knee joint does which of the following?

Accepted Answer

Rotates

Answer

Extends

Answer

Flexes

Answer

None of the above

Question 10

A 67-year-old woman presents with a 3-month history of increasing right shoulder pain, resulting in an inability to lift her arm to brush her hair or retrieve items from shelves. She denies numbness, tingling, or pain radiation down her arm. Physical examination reveals weakness in abduction and external rotation of her right arm, with a normal passive range of motion. She is unable to hold her arms abducted to 90 degrees on the right side. There is no motor weakness, normal pulse, and normal sensation in her right upper extremity. Which of the following is the most likely diagnosis?

Accepted Answer

Rotator cuff tear

Answer

Brachial plexus injury

Answer

Glenohumeral osteoarthritis

Answer

Proximal humerus fracture

Sports Medicine — MCQs

Sports Medicine — MCQs

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