Menu

5. Sports Medicine MCQs

Practice Set 107 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 2121

Topic: 5. Sports Medicine

When comparing bone-patellar tendon-bone (BTB) autograft to hamstring autograft for primary anterior cruciate ligament (ACL) reconstruction, BTB autograft is associated with a statistically higher rate of which of the following postoperative complications?

. Graft rupture
. Contralateral ACL tear
. Anterior knee pain
. Deep vein thrombosis
. Arthrofibrosis

Correct Answer & Explanation

. Graft rupture

Explanation

Bone-patellar tendon-bone (BTB) autografts historically exhibit a higher incidence of anterior knee pain and kneeling pain postoperatively compared to hamstring autografts. Rates of graft rupture and DVT are comparable or slightly favor BTB depending on the study, but anterior knee pain is a well-established drawback of the BTB harvest.

Question 2122

Topic: Knee Sports

A 55-year-old female experiences a sudden 'pop' in the posterior aspect of her knee while squatting. MRI reveals a medial meniscus posterior root tear. Biomechanical studies demonstrate that this injury alters tibiofemoral contact pressures most similarly to which of the following conditions?

. Total medial meniscectomy
. 50% partial medial meniscectomy
. Anterior cruciate ligament rupture
. Medial collateral ligament sprain
. Chondral defect of the medial femoral condyle

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus disrupts the hoop stresses of the meniscus, causing it to extrude. Biomechanically, this results in peak contact pressures and contact areas that are equivalent to those seen following a total medial meniscectomy, predisposing the joint to rapid articular cartilage degeneration.

Question 2123

Topic: Shoulder & Hip Sports

A 19-year-old female gymnast presents with bilateral shoulder pain and a sensation of 'slipping.' Examination reveals a positive sulcus sign that does not decrease with external rotation, and a positive apprehension test without distinct trauma. What is the most appropriate initial management?

. Arthroscopic Bankart repair
. Open inferior capsular shift
. Arthroscopic capsular plication
. A comprehensive physical therapy program focused on periscapular and rotator cuff strengthening
. Subacromial corticosteroid injection

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

The patient's presentation (bilateral symptoms, positive sulcus sign, atraumatic) is classic for multidirectional instability (MDI). The gold standard initial management for MDI is a minimum of 6 months of physical therapy emphasizing periscapular stabilizer and rotator cuff strengthening. Surgery (e.g., capsular shift) is reserved for patients who fail an extensive course of targeted therapy.

Question 2124

Topic: Knee Sports

The primary restraint to posterior tibial translation at 90 degrees of knee flexion is the posterior cruciate ligament (PCL). Which of the following bundles of the PCL is tightest in this position?

. Anterolateral bundle
. Posteromedial bundle
. Anteromedial bundle
. Posterolateral bundle
. Meniscofemoral ligament of Wrisberg

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The PCL consists of two main bundles: the anterolateral (AL) and posteromedial (PM) bundles. The anterolateral bundle is the larger of the two and is tightest in knee flexion (particularly around 90 degrees). The posteromedial bundle is tightest in knee extension.

Question 2125

Topic: Shoulder & Hip Sports

A 60-year-old male with a massive, retracted posterosuperior rotator cuff tear complains of pronounced weakness in external rotation. MRI reveals that fatty infiltration is most severe in the infraspinatus. Entrapment of the suprascapular nerve as a result of profound tendon retraction would most likely occur at which of the following anatomic locations?

. Quadrilateral space
. Spinoglenoid notch
. Suprascapular notch
. Triangular interval
. Coracoid process

Correct Answer & Explanation

. Quadrilateral space

Explanation

Massive retraction of the supraspinatus and infraspinatus tendons can place extreme traction on the suprascapular nerve. The nerve is most vulnerable to tethering and entrapment at the spinoglenoid notch due to the direct medial pull of the retracted infraspinatus muscle belly. Entrapment here causes isolated infraspinatus denervation.

Question 2126

Topic: Shoulder & Hip Sports

A 25-year-old male hockey player presents with anterior groin pain exacerbated by hip flexion and internal rotation. Radiographs reveal a cam-type femoroacetabular impingement (FAI). This specific morphology is best described by which of the following anatomic abnormalities?

. Acetabular retroversion
. Coxa profunda
. Decreased alpha angle
. Aspherical femoral head-neck junction
. Protrusio acetabuli

Correct Answer & Explanation

. Acetabular retroversion

Explanation

Cam-type FAI is caused by an aspherical contour of the femoral head-neck junction, often described as a 'pistol grip' deformity or an osseous bump on the anterosuperior neck. This is quantified by an increased alpha angle. Pincer-type FAI is characterized by acetabular overcoverage, such as acetabular retroversion, coxa profunda, or protrusio acetabuli.

Question 2127

Topic: Shoulder & Hip Sports

A 24-year-old rugby player presents with recurrent anterior shoulder instability. An MRI arthrogram reveals an abnormal contour of the inferior glenohumeral ligament (IGHL) with a 'J-sign' and contrast extravasation into the axillary pouch, but the anterior labrum remains attached to the glenoid. What is the most likely diagnosis?

. ALPSA lesion
. GLAD lesion
. HAGL lesion
. SLAP tear
. Kim lesion

Correct Answer & Explanation

. ALPSA lesion

Explanation

A HAGL (Humeral Avulsion of the Glenohumeral Ligament) lesion occurs when the IGHL is avulsed from its humeral attachment. On coronal MRI arthrogram, the normal U-shape of the axillary recess is lost and appears as a 'J-sign' due to the dropping down of the torn ligament, allowing contrast to extravasate into the axillary tissues. It is an important cause of recurrent instability without a Bankart lesion.

Question 2128

Topic: Shoulder & Hip Sports

A 22-year-old collegiate hockey player is diagnosed with symptomatic femoroacetabular impingement (FAI), Cam type. He has an alpha angle of 75 degrees. During hip arthroscopy, which of the following intra-articular pathologies is most classically encountered as a direct biomechanical result of this specific femoral deformity?

. Chondral delamination at the anterosuperior acetabulum
. Rupture of the ligamentum teres
. Ossification of the reflected head of the rectus femoris
. Posteroinferior labral tear
. Dysplastic, shallow acetabulum with global labral hypertrophy

Correct Answer & Explanation

. Chondral delamination at the anterosuperior acetabulum

Explanation

Cam-type FAI is characterized by an aspherical femoral head-neck junction (high alpha angle) that acts like a cam, forcefully jamming into the anterosuperior acetabulum during hip flexion and internal rotation. This causes excessive shear forces across the articular cartilage, classically resulting in anterosuperior chondral delamination and separation of the labrum from the adjacent articular cartilage.

Question 2129

Topic: 5. Sports Medicine

During primary anterior cruciate ligament (ACL) reconstruction, a surgeon elects to use a bone-patellar tendon-bone (BPTB) autograft rather than a multi-strand hamstring autograft. Which of the following represents the primary biological and biomechanical advantage of the BPTB graft?

. Lower incidence of anterior knee pain and kneeling discomfort
. Higher maximum load to failure of the intact graft substance prior to implantation
. Earlier and more robust biological incorporation via bone-to-bone healing
. Decreased risk of subsequent contralateral ACL rupture
. Significantly less postoperative quadriceps and hamstring atrophy

Correct Answer & Explanation

. Lower incidence of anterior knee pain and kneeling discomfort

Explanation

The primary advantage of a bone-patellar tendon-bone (BPTB) autograft is that the bone plugs allow for rigid interference fixation and rapid bone-to-bone healing within the osseous tunnels (typically fully incorporating in about 6 weeks). In contrast, soft tissue grafts (like hamstrings) rely on Sharpey's fiber formation for tendon-to-bone healing, which is a slower biological process taking roughly 8 to 12 weeks. BPTB is known for a higher incidence of anterior knee pain.

Question 2130

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with vague dominant shoulder pain. Physical examination reveals a glenohumeral internal rotation deficit (GIRD). Which of the following examination findings defines a 'pathologic' GIRD that warrants intervention rather than an expected anatomic adaptation to overhead throwing?

. Loss of >10 degrees of internal rotation with symmetric external rotation compared to the contralateral side
. Loss of >20 degrees of internal rotation with a >5 degree loss of total arc of motion compared to the contralateral side
. Loss of >5 degrees of internal rotation with a compensatory 10 degree gain in external rotation
. A total arc of motion >180 degrees with internal rotation restricted to 45 degrees
. Symmetric internal rotation but >15 degrees greater external rotation compared to the contralateral side

Correct Answer & Explanation

. Loss of >10 degrees of internal rotation with symmetric external rotation compared to the contralateral side

Explanation

Overhead throwing athletes frequently develop an adaptive loss of internal rotation with a compensatory gain in external rotation, resulting in an unaltered total arc of motion compared to the non-dominant arm. This is a physiologic adaptation (anatomic GIRD) primarily due to osseous humeral retroversion. 'Pathologic GIRD' is defined clinically as a loss of >20 degrees of internal rotation associated with a loss of >5 degrees in the total arc of motion compared to the contralateral side. Pathologic GIRD is associated with posterior capsule contracture and an increased risk of SLAP tears and internal impingement.

Question 2131

Topic: 5. Sports Medicine

An orthopedic sports surgeon is discussing autograft options for an anterior cruciate ligament (ACL) reconstruction with a 19-year-old competitive soccer player. When comparing the initial biomechanical properties of standard autografts, which of the following possesses the highest ultimate load to failure?

. Native intact ACL
. 10-mm bone-patellar tendon-bone (BPTB) autograft
. Central third quadriceps tendon autograft without bone block
. Four-strand semitendinosus and gracilis (Hamstring) autograft
. Fascia lata autograft

Correct Answer & Explanation

. Native intact ACL

Explanation

The initial ultimate load to failure of various ACL grafts compared to the native ACL is a frequent board testable concept. The native ACL has an ultimate tensile load of approximately 2160 N. A 10-mm BPTB graft has a load of roughly 2900 N. The central third quadriceps tendon is approximately 2300 N. A quadruple-strand hamstring graft (semitendinosus and gracilis) provides the highest initial ultimate load to failure at over 4000 N. However, despite these biomechanical numbers, clinical failure rates depend more on graft incorporation, fixation methods, and biologic healing rather than pure initial tensile strength.

Question 2132

Topic: Shoulder & Hip Sports

A 26-year-old male ice hockey player is diagnosed with symptomatic cam-type femoroacetabular impingement (FAI). He elects to undergo hip arthroscopy for osteochondroplasty of the femoral head-neck junction. During diagnostic arthroscopy, the surgeon evaluates the acetabular labrum and articular cartilage. Which region of the acetabulum is most likely to exhibit articular cartilage delamination secondary to this specific impingement morphology?

. Anteroinferior
. Posterosuperior
. Posteroinferior
. Anterosuperior
. Directly at the fovea capitis

Correct Answer & Explanation

. Anteroinferior

Explanation

Cam impingement occurs due to a loss of sphericity of the femoral head (decreased head-neck offset), creating an 'aspherical' cam lesion typically on the anterosuperior aspect of the head-neck junction. During hip flexion and internal rotation, this cam lesion engages the anterosuperior acetabular rim. The outside-in shear forces generated by the cam lesion cause separation of the articular cartilage from the subchondral bone, presenting clinically and arthroscopically as chondral delamination or the 'wave sign' predominantly in the anterosuperior acetabulum.

Question 2133

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon uses intraoperative fluoroscopy to identify Schรถttle's point for the femoral tunnel. Due to a technical error, the femoral tunnel is placed 8 mm strictly proximal to the true anatomic footprint. What is the expected kinematic effect of this non-anatomic tunnel placement on the patellofemoral joint?
. The graft will be overly tight in knee flexion and loose in knee extension
. The graft will be overly tight in knee extension and loose in knee flexion
. The graft will maintain isometric tension throughout the entire range of motion
. The patella will dislocate medially during terminal extension
. The patella will experience decreased medial restraint solely between 0 and 30 degrees of flexion

Correct Answer & Explanation

. The graft will be overly tight in knee flexion and loose in knee extension

Explanation

The MPFL acts as the primary soft-tissue restraint to lateral patellar translation from 0 to 30 degrees of knee flexion. Correct femoral tunnel positioning is critical for near-isometric graft behavior. If the femoral tunnel is placed too proximal, the distance between the femoral attachment and patellar attachment increases as the knee goes into flexion. Consequently, the graft will be loose in extension (when it should be restraining the patella) and become excessively tight in flexion, causing increased medial patellofemoral cartilage contact pressures and potentially restricting flexion.

Question 2134

Topic: Shoulder & Hip Sports

A 19-year-old football player presents with recurrent anterior shoulder instability. CT imaging reveals a 28% anterior glenoid bone defect. Which of the following procedures is most appropriate to restore stability and prevent recurrence?

. Arthroscopic Bankart repair with capsular plication
. Open Bankart repair
. Coracoid process transfer (Latarjet procedure)
. Remplissage procedure alone
. Arthroscopic labral repair with bioabsorbable anchors

Correct Answer & Explanation

. Arthroscopic Bankart repair with capsular plication

Explanation

In the setting of anterior shoulder instability with critical glenoid bone loss (typically >20-25%), soft tissue stabilization alone is inadequate. A bony augmentation procedure, such as the Latarjet coracoid transfer, is required.

Question 2135

Topic: 5. Sports Medicine

A 35-year-old active female undergoes arthroscopy for a knee injury. A complete radial tear at the posterior root attachment of the medial meniscus is identified. Biomechanically, how does this specific injury alter knee joint contact pressures?

. It reduces peak contact pressures by 20%
. It shifts the contact area anteriorly without changing peak pressure
. It is biomechanically equivalent to a total medial meniscectomy
. It isolates load transmission strictly to the lateral compartment
. It maintains normal hoop stresses if the peripheral capsule is intact

Correct Answer & Explanation

. It reduces peak contact pressures by 20%

Explanation

A complete posterior root tear of the medial meniscus disrupts the meniscal hoop stresses entirely. Biomechanical studies have shown this results in decreased contact area and increased peak contact pressures equivalent to a total medial meniscectomy.

Question 2136

Topic: 5. Sports Medicine

An orthopedic surgeon is performing a posterior cruciate ligament (PCL) reconstruction and decides to use a tibial inlay technique rather than a transtibial tunnel technique. What is the primary biomechanical advantage of the tibial inlay technique?

. It allows for earlier weight-bearing
. It avoids the acute "killer turn" angle that contributes to graft abrasion
. It permits the use of bone-patellar tendon-bone autograft only
. It significantly reduces surgical time
. It eliminates the need for femoral tunnel drilling

Correct Answer & Explanation

. It allows for earlier weight-bearing

Explanation

The tibial inlay technique avoids routing the graft through a tibial tunnel and over the posterior aspect of the tibia. This eliminates the acute "killer turn," reducing repetitive graft abrasion and potential attenuation.

Question 2137

Topic: 5. Sports Medicine
A 44-year-old recreational weight lifter reports chronic deep pain in his left shoulder that is aggravated by any pressing exercises. He also notes a painful catch in the shoulder occurring with rotational movements. Physical therapy and nonsteroidal anti-inflammatory drugs for 3 months have failed to provide relief. Examination reveals pain with Oโ€™Brienโ€™s test but no signs of instability. MRI scans are shown in Figures 4a and 4b. Treatment should now consist of:
. arthroscopic repair of a superior labral tear with cyst decompression.
. open excision of the ganglion cyst.
. proximal biceps tenodesis.
. rotator cuff repair.
. anterior stabilization.

Correct Answer & Explanation

. arthroscopic repair of a superior labral tear with cyst decompression.

Explanation

DISCUSSION: The MRI scans show a large paralabral ganglion cyst in the spinoglenoid notch that communicates with an extensive tear of the glenoid labrum. Snyder and associates have classified superior labral tears into several subtypes that reflect the location and extent of the injury. Arthroscopic repair of the labral tear and aspiration of the ganglion cyst is the treatment of choice. Open excision of the cyst does not address the underlying problem of the labral tear. REFERENCE: Snyder SJ, Karzel RP, Delpizzo W: SLAP lesions of the shoulder. Arthroscopy 1990;6:274-279. Piatt BE, Hawkins RJ, Fritz RC, et al: Clinical evaluation and treatment of spinoglenoid notch cysts. J Shoulder Elbow Surg 2002;11:600-604. McFarland EG, Kim TK, Savino RM: Clinical assessment of three common tests for superior labral anterior-posterior lesions. Am J Sports Med 2002;30:810-815. Oโ€™Brien SJ, Pagnani MJ, Fealy S, et al: The active compression test: A new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med 1998;26:610-613.

Question 2138

Topic: Knee Sports

A 19-year-old running back lands directly on his anterior knee after being tackled. He has mild anterior knee pain, a trace effusion, a 2+ posterior drawer, a grade 1+ stable Lachman, no valgus laxity, and negative dial tests at 30ยฐ and 90ยฐ. What is the best treatment strategy at this time?

. Physical therapy with a focus on quadriceps strengthening
. Physical therapy and delayed posterior cruciate ligament (PCL) reconstruction
. PCL reconstruction
. PCL and posterolateral corner reconstruction

Correct Answer & Explanation

. Physical therapy with a focus on quadriceps strengthening

Explanation

This patient has likely sustained an isolated PCL injury. The examination is consistent with a grade II injury to the PCL. In this scenario, the best initial option is nonsurgical treatment and return to play as symptoms subside and strength improves. Physical therapy with a focus on quadriceps strengthening and delayed PCL reconstruction is not the answer because this patient can likely be treated without surgery. The absence of valgus laxity and negative dial testing findings suggest that an injury to the posteromedial and posterolateral corners has not occurred. Initial nonsurgical treatment is indicated for this patient. If he completes rehabilitation and experiences persistent disability with anterior and/or medial knee discomfort or senses the knee is "loose," PCL reconstruction should be considered at that time.

Question 2139

Topic: 5. Sports Medicine
Use of prophylactic knee bracing in contact sports participants results in which of the following?
. Decreased incidence of anterior cruciate ligament injuries
. Decreased incidence of posterior cruciate ligament injuries
. Decreased incidence of medial collateral ligament injuries
. Decreased incidence of meniscal tears
. Decreased incidence of ankle injuries

Correct Answer & Explanation

. Decreased incidence of medial collateral ligament injuries

Explanation

DISCUSSION: Several studies have looked at the effects of knee bracing, and it appears to be effective in prophylactically decreasing the incidence of medial collateral ligament sprains. Najibi and Albright reported that although evidence is not conclusive, bracing appears to help decrease the incidence of medial collateral ligament injuries. Albright and associates showed similar findings. Prophylactic knee braces have been associated with an increased incidence of ankle injuries. REFERENCES: Albright JP, Powell JW, Smith W, et al: Medial collateral ligament knee sprains in college football: Effectiveness of preventive braces. Am J Sports Med 1994;22:12-18. Najibi S, Albright JP: The use of knee braces: Part 1. Prophylactic knee braces in contact sports. Am J Sports Med 2005;33:602-611.

Question 2140

Topic: Shoulder & Hip Sports
The posterior circumflex humeral artery and the axillary nerve usually lie in a space bordered superiorly by the
. teres minor, medially by the long head of the triceps, laterally by the humerus, and inferiorly by the teres major.
. teres major, medially by the humerus, and inferiorly by the teres minor.
. supraspinatus, inferiorly by the infraspinatus, and posterior to the scapular body.
. supraspinatus, inferiorly by the scapular body, and covered by the superior transverse scapular ligament.
. infraspinatus, inferiorly by the teres minor, and laterally by the long head of the triceps.

Correct Answer & Explanation

. teres minor, medially by the long head of the triceps, laterally by the humerus, and inferiorly by the teres major.

Explanation

The quadrangular space is bordered superiorly by the teres minor, medially by the long head of the triceps, laterally by the humerus, and inferiorly by the teres major. The posterior circumflex humeral artery and the axillary nerve lie in this space.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page