100+ Free ABOS Orthopaedic Sports Medicine Practice Questions

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Question 1

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A 22-year-old male collegiate soccer player sustains a noncontact ACL rupture. You are planning ACL reconstruction and considering graft choice. Which graft has historically demonstrated HIGHER re-tear rates in young, high-demand athletes compared to other autograft options?

Bone-patellar tendon-bone (BTB) autograft

Hamstring autograft — multiple meta-analyses (e.g., MOON cohort, Samuelsen meta-analysis of 47,613 patients) demonstrate slightly higher re-tear rates for hamstring vs BTB autograft in young athletes <25, though clinical outcomes often equivalent

Quadriceps tendon autograft

Contralateral BTB autograft

to track

2026 Statistics

Key Facts: ABOS Orthopaedic Sports Medicine Exam

175

Multiple-Choice Items

Single session, computer-based

4.5 hrs

Test Center Duration

Includes testing, break, tutorial

$2,450

Total 2026 Fee

$1,225 application + $1,225 exam

41%

Lower Extremity Weight

Largest domain on blueprint

75 / 115

Arthroscopic Cases Required

Of 115 operative cases on case list

~2,800

Current Diplomates

Holding the Sports Med subspecialty certificate

The ABOS Orthopaedic Sports Medicine exam is a 4.5-hour, 175-question computer-based subspecialty certification examination at Pearson VUE test centers. The blueprint allocates Lower Extremities 41%, Upper Extremities 32%, Multiple Sites/Systemic/Other 17%, General Principles 7%, and Spine 3%. Emphasis is surgical — arthroscopy dominates the case list (75 of 115 required operative cases). Fees are $1,225 application + $1,225 exam = $2,450. Applications and case lists are due February 1 of the exam year. Approximately 2,800 ABOS diplomates currently hold this subspecialty certificate.

Sample ABOS Orthopaedic Sports Medicine Practice Questions

Try these sample questions to test your ABOS Orthopaedic Sports Medicine exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 22-year-old male collegiate soccer player sustains a noncontact ACL rupture. You are planning ACL reconstruction and considering graft choice. Which graft has historically demonstrated HIGHER re-tear rates in young, high-demand athletes compared to other autograft options?

A.Bone-patellar tendon-bone (BTB) autograft

B.Hamstring autograft — multiple meta-analyses (e.g., MOON cohort, Samuelsen meta-analysis of 47,613 patients) demonstrate slightly higher re-tear rates for hamstring vs BTB autograft in young athletes <25, though clinical outcomes often equivalent

C.Quadriceps tendon autograft

D.Contralateral BTB autograft

Explanation: In young, high-demand athletes, hamstring autograft has slightly higher re-tear rates (roughly 1.5-2x) than BTB autograft per the MOON cohort and Samuelsen meta-analysis of 47,613 patients. BTB has lower re-tear but higher anterior knee pain and kneeling discomfort. Quadriceps tendon has emerged as a competitive autograft option with favorable biomechanics and lower donor-site morbidity than BTB. Allografts have 3-4x higher re-tear rates than autografts in patients <25 and are generally avoided in young athletes.

2During anatomic single-bundle ACL reconstruction, where should the femoral tunnel be placed for optimal biomechanical restoration?

A.Over-the-top (12 o'clock transtibial position)

B.Anatomic footprint — at the center of the native ACL femoral footprint, typically via anteromedial portal or outside-in technique (anatomic placement ~2 o'clock right knee / 10 o'clock left knee, low and deep on lateral wall)

C.High on the lateral wall at 1 o'clock

D.At the roof of the notch

Explanation: Anatomic ACL reconstruction places the femoral tunnel at the center of the native ACL footprint — low and deep on the lateral wall of the intercondylar notch (approximately 2 o'clock in right knee / 10 o'clock in left knee when viewed through the anteromedial portal). Anteromedial portal drilling or outside-in (retrograde) techniques enable independent femoral tunnel positioning. Transtibial drilling often produces a vertical, nonanatomic tunnel (12 o'clock) associated with persistent rotational instability and higher re-tear rates in contemporary series.

3A 17-year-old female soccer player with open physes sustains an ACL tear. She has 2 years of growth remaining. Which reconstruction technique minimizes physeal injury?

A.Standard adult-style transphyseal hamstring reconstruction

B.All-epiphyseal reconstruction or physeal-sparing techniques (e.g., Anderson, MicheliiT band technique) using soft-tissue graft, avoiding hardware or bone blocks crossing the physis

C.Transphyseal BTB graft with bone blocks at each physis

D.Delayed reconstruction until skeletal maturity is always preferred

Explanation: In skeletally immature athletes (>2 years growth remaining), physeal-sparing techniques are preferred: all-epiphyseal reconstruction (drilling within the epiphysis only), IT band (Micheli) physeal-sparing, or over-the-top technique avoid hardware and bone blocks crossing the physis, minimizing growth arrest risk. Transphyseal reconstruction with soft-tissue graft (no bone blocks across physis) is appropriate for Tanner III+ adolescents with <2 y growth remaining. Delayed reconstruction to maturity is associated with worsening meniscal and chondral pathology (per Hickie Am J Sports Med 2025, 2,740 adolescents) — early reconstruction is favored.

4In high-risk adolescent ACL reconstruction patients (young age, pivoting sport, hyperlaxity), which adjunct procedure has evidence for reducing graft re-tear rates?

A.Lateral extra-articular tenodesis (LET) or modified Lemaire procedure — RCT evidence (e.g., STABILITY trial) shows LET reduces re-tear rates in high-risk patients

B.Medial meniscectomy

C.Posterior capsular plication

D.Fibular osteotomy

Explanation: Lateral extra-articular tenodesis (LET) — typically a modified Lemaire procedure using IT band graft tensioned between the lateral epicondyle and Gerdy's tubercle — adds rotational stability to anatomic ACL reconstruction. The STABILITY trial (2020) and subsequent multicenter studies demonstrate LET reduces re-tear rates (~4% vs ~11%) in high-risk adolescent and young adult patients undergoing ACL reconstruction. Indications include young age (<25), high-grade pivot shift, generalized laxity, revision ACLR, and pivoting/contact sports. Anterolateral ligament (ALL) reconstruction is an alternative extra-articular augmentation with similar rationale.

5What is a 'ramp lesion' in the context of ACL injury?

A.A longitudinal vertical tear of the medial meniscus at the meniscocapsular junction of the posterior horn — high association with ACL injury and often missed on standard arthroscopy without specific posteromedial portal or probing

B.A chondral defect of the lateral femoral condyle

C.A ligamentous injury of the PCL

D.A bone bruise on the posterior tibia

Explanation: Ramp lesion is a tear of the medial meniscus at the meniscocapsular attachment of the posterior horn (peripheral 'red-red' zone, ~5 mm from the meniscocapsular junction). Prevalence is 10-25% with ACL tears and often missed during standard anterior arthroscopy; detection requires specific posteromedial (Gillquist) viewing via the intercondylar notch or dedicated posteromedial portal with probing. Repair is typically performed with all-inside devices via posteromedial portal to restore rotational stability. Unrepaired ramp lesions correlate with higher ACL graft re-tear and functional instability.

6A patient develops posterior knee pain and limp 6 weeks after ACL reconstruction with BTB autograft. Patellar tendon tenderness is present; passive knee extension is painful. What is the MOST likely diagnosis?

A.Graft failure

B.Donor-site patellar tendinopathy or ('cyclops' lesion causing arthrofibrosis) — common BTB-related complication treated with PT, sometimes arthroscopic cyclops excision

C.DVT

D.Infection

Explanation: After BTB autograft ACL reconstruction, patellar tendon donor-site pain is a known complication (~10-40% report anterior knee pain). Loss of extension with palpable anterior notch fullness suggests a 'cyclops' lesion — a nodule of fibrous tissue at the ACL graft anterior to the tibial tunnel that blocks extension and is pathognomonic for causing loss of terminal extension post-ACLR. Treatment: aggressive PT for extension, sometimes arthroscopic excision of the cyclops lesion. Hamstring harvest can cause hamstring weakness/pain; quadriceps tendon harvest can cause quadriceps weakness.

7Which functional testing criteria are recommended before return-to-sport clearance after ACL reconstruction?

A.Time-based criteria alone (6 months post-op)

B.Combined time- and function-based criteria: minimum 9+ months post-op, quadriceps LSI (limb symmetry index) ≥90%, hop test battery LSI ≥90%, psychological readiness (ACL-RSI), and neuromuscular control

C.Pain resolution alone

D.Surgeon preference without objective testing

Explanation: Modern ACL return-to-sport criteria emphasize both time and function. Recommended: minimum 9+ months post-op (data show ~50% reduction in re-tear risk per month delay to 9+ months), quadriceps strength LSI ≥90% (isokinetic testing), hop test battery LSI ≥90% (single, triple, crossover, 6-meter timed), dynamic neuromuscular control (Y-balance, landing biomechanics), and psychological readiness (ACL-RSI scale). Early return-to-sport (<9 months) and persistent quadriceps asymmetry (LSI <90%) are strong predictors of re-tear.

8A 16-year-old recreational basketball player has a medial meniscus root tear. What is the optimal management in this young athletic patient?

A.Nonoperative observation

B.Meniscal root repair (transtibial pullout or suture anchor) to restore hoop stress protection — unrepaired posterior root tears biomechanically equivalent to total meniscectomy and accelerate cartilage loss

C.Total medial meniscectomy

D.Partial medial meniscectomy

Explanation: Meniscal root tears (complete radial tears or avulsions at the meniscal root insertion on the tibial plateau) are biomechanically equivalent to total meniscectomy — they lose the meniscus's hoop stress protection, leading to rapid cartilage degeneration. In young active patients, root repair (transtibial pullout suture technique with two sutures through the root tied over a button on the anterior tibial cortex) is indicated to restore meniscal function. Outcomes: ~70-90% good results at 2-5 years. Chronicity, cartilage damage, and malalignment reduce success. Meniscal allograft transplant may be considered in post-meniscectomy young patients with symptomatic joint line pain.

9A 20-year-old has a peripheral vertical longitudinal tear of the medial meniscus 2 cm long in the red-red zone. What is the BEST management?

A.Total meniscectomy

B.Meniscus repair (inside-out, all-inside, or outside-in) — peripheral vertical tears in the vascular zone have excellent healing potential, especially with concomitant ACLR

C.Observation

D.Partial meniscectomy

Explanation: Peripheral vertical longitudinal tears (2-4 cm) in the red-red (vascular) zone have the best healing potential with meniscal repair. Techniques: inside-out (gold standard, greatest number of sutures, uses posteromedial/posterolateral open incision to protect neurovascular structures), all-inside (all-arthroscopic, fast, risk of device prominence), outside-in (anterior horn tears). Concomitant ACL reconstruction significantly improves meniscal healing rates (synovial environment with hemarthrosis). Prioritize repair over meniscectomy in young patients — long-term outcomes are superior despite a 20-25% revision rate for unhealed/re-tear.

10Which finding is most consistent with osteochondritis dissecans (OCD) of the lateral femoral condyle in an adolescent?

A.Loose body always present

B.Focal subchondral bone and cartilage lesion most commonly on the lateral aspect of the medial femoral condyle; adolescent age; MRI shows fluid tracking behind the fragment suggests instability

C.Generalized cartilage loss

D.Synovial chondromatosis

Explanation: OCD (osteochondritis dissecans) is a focal subchondral bone lesion with overlying cartilage, most commonly on the LATERAL aspect of the MEDIAL femoral condyle (70% of knee OCD); can also occur on lateral condyle, talus, and capitellum (Panner's being the younger child equivalent). Adolescents with open physes have better prognosis than adults. MRI findings of fluid around the fragment, cystic changes, and fragment displacement suggest instability. Stable juvenile lesions may heal with activity modification and protected weight-bearing. Unstable lesions or those in adults often require arthroscopic drilling (transarticular or retroarticular), internal fixation, or chondral restoration (OATS, osteochondral allograft) depending on stability and cartilage quality.

About the ABOS Orthopaedic Sports Medicine Exam

The ABOS Orthopaedic Sports Medicine Subspecialty Examination is the surgical sports medicine Certificate of Added Qualification (CAQ) for ABOS-certified orthopaedic surgeons. Unlike the non-operative sports medicine CAQ offered jointly by ABEM/ABFM/ABIM/ABP/ABPMR, the ABOS version emphasizes surgical decision-making — ACL reconstruction graft choice and tunnel placement, rotator cuff repair techniques (single- vs double-row), Bankart/Latarjet/Remplissage for shoulder instability, cartilage restoration (OATS/MACI), multi-ligament knee reconstruction, hip arthroscopy for FAI, and arthroscopic/open surgical management. Candidates must hold ABOS Board Certification, complete a one-year ACGME-accredited orthopaedic sports medicine fellowship, and submit a one-year case list of at least 115 operative cases (75 arthroscopic) plus 10 non-operative cases.

Questions

175 scored questions

Time Limit

4.5 hours at test center (includes testing, break, and tutorial)

Passing Score

Criterion-referenced scaled passing standard set by the ABOS Sports Medicine Written Examination Committee

Exam Fee

$1,225 application + $1,225 exam = $2,450 (ABOS 2026) (American Board of Orthopaedic Surgery (ABOS) — administered at Pearson VUE test centers)

ABOS Orthopaedic Sports Medicine Exam Content Outline

41%

Lower Extremities

Largest domain — pelvis, hip (dislocation/instability, femoroacetabular impingement — cam/pincer, labral repair vs reconstruction, 3%+3%), tibiofemoral joint: dislocation/instability/ligament 11% (ACL — BTB vs hamstring vs quad tendon, anatomic single vs double bundle, LET/Lemaire augmentation, ramp lesion, pediatric all-epiphyseal; PCL tibial inlay; multi-ligament knee), tibiofemoral cartilage/meniscus 5% (root tear repair, meniscus allograft transplant, OATS, MACI, osteochondral allograft), patellofemoral instability 3% (MPFL reconstruction, TTO, trochleoplasty), ankle (Broström-Gould), foot (Jones fracture IM screw).

32%

Upper Extremities

Shoulder-dominant — clavicle 3% (midshaft ORIF vs nonop, distal clavicle), scapula 1%, glenohumeral instability/labral 7% (Bankart repair, Latarjet for >20% glenoid bone loss, Remplissage for off-track Hill-Sachs with <20% glenoid bone loss, HAGL), rotator cuff 6% (single- vs double-row repair, superior capsular reconstruction, reverse TSA for cuff tear arthropathy), nerve injury/proximal humerus/proximal biceps 5% (tenotomy vs tenodesis, quadrilateral space), elbow instability 2% (UCL reconstruction — Tommy John docking/modified Jobe, PLRI), elbow cartilage/arthritis/nerve/fx 1%, elbow tendon/muscle tears 2% (distal biceps, distal triceps, lateral/medial epicondylitis), wrist 2%, hand 3%.

17%

Multiple Sites / Systemic / Other

Surgical complications (DVT/PE prophylaxis, infection — periprosthetic joint infection, anesthesia/blocks — interscalene for shoulder, mechanical failure), medical aspects of sports medicine (concussion return-to-play, cardiac screening — HCM, exertional heat stroke), rehabilitation protocols (ACL RTS 9+ months and LSI ≥90%), biologics (PRP, BMAC, stem cells), overuse and stress fractures.

General Principles

Biostatistics/epidemiology (odds ratio, effect size, RCT interpretation), legal/ethical (team physician role, conflicts of interest, fitness-for-duty), basic science (graft biology and ligamentization, tendon-to-bone healing, cartilage biology — hyaline vs fibrocartilage, biomaterials, suture anchors).

Spine

Cervical 2% (stingers/burners, cervical stenosis, transient quadriplegia, Torg-Pavlov ratio, return-to-play after cervical cord neuropraxia), thoracic/lumbar 1% (spondylolysis in athletes, disc herniation).

How to Pass the ABOS Orthopaedic Sports Medicine Exam

What You Need to Know

Passing score: Criterion-referenced scaled passing standard set by the ABOS Sports Medicine Written Examination Committee
Exam length: 175 questions
Time limit: 4.5 hours at test center (includes testing, break, and tutorial)
Exam fee: $1,225 application + $1,225 exam = $2,450 (ABOS 2026)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABOS Orthopaedic Sports Medicine Study Tips from Top Performers

1Know ACL graft choice indications — BTB autograft: lower re-tear but more anterior knee pain and kneeling discomfort; hamstring: better kneeling but ~1.5-2x re-tear risk in young high-demand athletes; quadriceps tendon: growing adoption with favorable outcomes; allograft: higher re-tear rates in patients <25 and generally avoided in young athletes

2Memorize surgical indications for shoulder instability — first-time dislocators with <20% glenoid bone loss and on-track Hill-Sachs → arthroscopic Bankart; off-track Hill-Sachs or subcritical glenoid bone loss → Bankart + Remplissage; >20-25% glenoid bone loss → Latarjet coracoid transfer (dynamic sling + bone block + capsular repair)

3Master rotator cuff repair: double-row (transosseous equivalent/SpeedBridge) improves structural healing at MRI over single-row, though clinical outcomes are often comparable; factors predicting poor healing include age >65, tear size >3 cm, fatty infiltration Goutallier grade ≥3, and smoking; irreparable cuff with arthropathy → reverse TSA

4Review patellofemoral instability — after 2+ dislocations consider MPFL reconstruction (gracilis/semitendinosus); add tibial tubercle osteotomy if TT-TG distance >20 mm; add trochleoplasty for Dejour type B/C/D severe trochlear dysplasia; isolated soft-tissue procedures in high-risk patients have recurrence rates up to 30-40%

5Understand UCL reconstruction for overhead throwers (Tommy John) — docking technique and modified Jobe are most common; palmaris longus or gracilis autograft; return-to-throw typically 12-15 months with long-tosses starting at ~4-5 months; biologic augmentation (UCL repair with internal brace) is emerging for select partial tears in athletes

Frequently Asked Questions

What is the ABOS Orthopaedic Sports Medicine subspecialty exam?

The ABOS Orthopaedic Sports Medicine Subspecialty Examination is a surgical sports medicine Certificate of Added Qualification for ABOS-certified orthopaedic surgeons. Established in 2007, it is developed and administered by the American Board of Orthopaedic Surgery and is distinct from the non-operative Sports Medicine CAQ administered jointly by ABEM, ABFM, ABIM, ABP, and ABPMR. The ABOS version emphasizes surgical decision-making, operative technique, and arthroscopy — reflecting the practice of fellowship-trained orthopaedic sports surgeons.

How is this exam different from the ABEM/ABFM Sports Medicine CAQ?

The ABOS Orthopaedic Sports Medicine exam is SURGICAL — it emphasizes ACL reconstruction technique, rotator cuff repair, Bankart/Latarjet, cartilage restoration, and arthroscopy. The non-operative Sports Medicine CAQ (ABEM/ABFM/ABIM/ABP/ABPMR) emphasizes concussion, cardiac screening, MSK diagnosis, and return-to-play decisions from a non-surgical perspective. The two subspecialties address complementary but separate practice domains. The ABOS exam case list requires 115 operative cases (75 arthroscopic), while the non-operative CAQ does not require operative case logs.

How many questions are on the exam and how long is it?

The ABOS Orthopaedic Sports Medicine exam consists of 175 multiple-choice items administered at Pearson VUE test centers. Candidates spend approximately 4.5 hours at the test center including testing, break time, and tutorial. The blueprint allocates Lower Extremities 41% (with tibiofemoral ligament reconstruction alone comprising 11%), Upper Extremities 32% (shoulder dominant), Multiple Sites/Systemic/Other 17%, General Principles 7%, and Spine 3%.

What are the eligibility requirements?

Candidates must (1) hold ABOS Board Certification in Orthopaedic Surgery (having passed both Part I and Part II); (2) complete a one-year ACGME-accredited Orthopaedic Sports Medicine fellowship; and (3) submit a one-year case list of at least 115 operative cases — 75 of which must involve arthroscopy as a component of the surgical procedure — plus 10 non-operative cases. Applications and case lists are due by February 1 for that year's examination. Approximately 2,800 ABOS diplomates currently hold the Orthopaedic Sports Medicine subspecialty certificate.

How much does the exam cost?

The 2026 ABOS Orthopaedic Sports Medicine fee structure is $1,225 application fee plus $1,225 examination fee for a total of $2,450. A $750 late fee applies to applications submitted after the initial deadline but before the late deadline. The application fee is non-refundable but is transferable for one year. The examination fee is refundable if the candidate withdraws in writing at least 5 days prior to the exam date. Note: the 'combined' (dual-purpose) recertification exam for diplomates who hold both the subspecialty and general certificate is $1,400 in 2026 (rising to $1,700 in 2028).

What are the highest-yield topics on the exam?

Lower extremities (41%) dominate — master ACL reconstruction (graft choice: BTB vs hamstring vs quad tendon; hamstring has slightly higher re-tear in young athletes per meta-analyses; anatomic anteromedial portal femoral tunnel; modified Lemaire LET in high-risk adolescents), meniscus repair (ramp lesion, root repair), cartilage (OATS for small defects, MACI for large, osteochondral allograft), MPFL reconstruction for patellofemoral instability, and hip arthroscopy for FAI. Upper extremities (32%) — Bankart repair, Latarjet for >20% glenoid bone loss, Remplissage for off-track Hill-Sachs, rotator cuff repair single- vs double-row (double-row improves structural healing; clinical outcomes often equivalent), SLAP tenodesis >35 years, UCL Tommy John reconstruction.

How should I prepare for this exam?

Work through a structured 6-9 month plan during or immediately after fellowship. Recommended resources: DeLee/Drez's Orthopaedic Sports Medicine, Miller's Review of Sports Medicine, AAOS Comprehensive Orthopaedic Review, recent ABOS WLA (Web-Based Longitudinal Assessment) Knowledge Sources lists, and thousands of practice questions. Focus on surgical indications and technique (graft tension, tunnel placement, suture anchor choice), key RCTs (BEAR trial for bridge-enhanced ACL repair, FACTS for adolescent clavicle, SANTI ramp lesion data), and operative videos. Review the 2025 ABOS Sports Medicine Blueprint to ensure proportional coverage.

How does recertification work?

The subspecialty certificate expires when the diplomate's primary ABOS General Certificate expires. For recertification going forward, diplomates take a Combined Orthopaedic Sports Medicine Examination that covers both general orthopaedics and sports medicine subspecialty content in a single examination. The 2026 fee for the combined computer-based recertification exam is $1,400 (rising to $1,700 effective January 1, 2028). Diplomates with a subspecialty certificate pay a higher annual ABOS Web-based Longitudinal Assessment (WLA) fee ($300/year, rising to $380 in April 2027).