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5. Sports Medicine MCQs

Practice Set 108 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 2141

Topic: 5. Sports Medicine
A 42-year-old man has increasing pain and, to a lesser extent, some occasional left knee instability. Several years earlier he sustained a noncontact twisting injury to his knee. He had some initial soreness and pain but was able to resume his normal activities while avoiding sports. On examination, the patient has medial joint line pain, a grade 2+ Lachman, and a slight varus thrust. His radiographs reveal mild-to-moderate medial compartment osteoarthritis with varus alignment. What surgical treatment strategy likely will alleviate his pain?
. Distal femoral osteotomy
. Unicompartmental knee replacement
. High tibial osteotomy (HTO), lateral closing wedge
. HTO, medial opening wedge with decreased tibial slope

Correct Answer & Explanation

. HTO, medial opening wedge with decreased tibial slope

Explanation

This patient had a previous anterior cruciate ligament (ACL) and posterolateral complex injury. With chronic instability and osteoarthritis, the best option is HTO with a decrease in the tibial slope to reduce anterior laxity. Distal femoral osteotomy is better suited to address valgus malalignment. The lateral closing-wedge osteotomy would not allow for adequate correction of the tibial slope. Unicompartmental knee replacement is not indicated when there is ligament instability. If the patient continues to experience instability following correction of the varus malalignment, reconstruction of the ACL and posterolateral corner would be appropriate at that time.

Question 2142

Topic: 5. Sports Medicine

In comparing operative versus non-operative management of acute Achilles tendon ruptures utilizing modern functional rehabilitation protocols, which of the following statements is true?

. Operative management has a significantly higher rerupture rate.
. Non-operative management has a significantly higher rate of deep infection.
. Rerupture rates are similar when early functional rehabilitation is utilized.
. Operative management results in permanently decreased plantarflexion strength compared to non-operative.
. Non-operative management ensures a faster return to play in professional athletes.

Correct Answer & Explanation

. Operative management has a significantly higher rerupture rate.

Explanation

Recent high-quality randomized controlled trials (such as the study by Willits et al.) have demonstrated that when early functional rehabilitation (early weight-bearing and ROM) is utilized, the rerupture rates between operative and non-operative management of acute Achilles tendon ruptures are statistically similar. However, operative management still carries a higher risk of soft-tissue complications and infection.

Question 2143

Topic: Shoulder & Hip Sports
A 58-year-old man has persistent pain and weakness of his right shoulder after undergoing primary rotator cuff repair 1 year ago. A clinical photograph is shown in Figure 11. Which of the following factors might make functional improvement problematic with revision rotator cuff surgery?
. Patient’s age
. Patient’s gender
. Number of prior surgical procedures
. Detachment of the deltoid
. Duration of the rotator cuff tear

Correct Answer & Explanation

. Detachment of the deltoid

Explanation

Functional improvement after revision rotator cuff surgery is most likely to occur in patients with an intact deltoid, good-quality rotator cuff tissue, preoperative active elevation alone to 90 degrees, and only one prior rotator cuff repair. In this patient, the compromised deltoid origin might make functional improvement less likely.

Question 2144

Topic: Shoulder & Hip Sports
A 25-year-old carpenter falls on his outstretched arm. What physical finding best correlates with the lesion seen on the MRI scan shown in Figure 3?
. Weakness in external rotation
. Weakness in abduction
. Positive lift-off test
. Loss of biceps contour
. Deltoid atrophy

Correct Answer & Explanation

. Positive lift-off test

Explanation

The MRI scan shows disruption of the subscapularis muscle. Subscapularis rupture is associated with weakness in internal rotation as shown with a positive lift-off test as described by Gerber and Krushell. The belly press test also has been shown to be a useful clinical test for this problem. Weakness in external rotation and abduction is more consistent with supraspinatus and infraspinatus tears. Deltoid atrophy is associated with an axillary nerve injury. Loss of biceps contour is associated with rupture of the long head of the biceps.

Question 2145

Topic: 5. Sports Medicine
During preparation for the NCAA wrestling championships, a participant reports the development of vesicular lesions on his right chest wall that are mildly painful; however, they have not affected his ability to wrestle. How should this athlete be managed?
. He may wrestle if his lesions are covered.
. He may wrestle if he is on oral antiviral agents for 48 hours.
. He may wrestle immediately with no other treatment.
. He cannot wrestle until the lesions are scabbed over and there are no new lesions for at least 72 hours.
. He cannot wrestle for 2 weeks.

Correct Answer & Explanation

. He cannot wrestle until the lesions are scabbed over and there are no new lesions for at least 72 hours.

Explanation

Herpes simplex virus (HSV) is highly contagious. For wrestlers, the NCAA states that the athlete must be free from systemic symptoms and any new blisters for 72 hours before being allowed to participate. Also, all lesions must be dry and crusted and at least 120 hours of antiviral therapy should have been instituted.

Question 2146

Topic: 5. Sports Medicine
A 20-year-old collegiate baseball pitcher has persistent deep shoulder pain. Examination reveals normal strength, 130 degrees of external rotation in abduction, 10 degrees of internal rotation in abduction, mild dynamic scapular winging, and equivocal findings on provocative tests for labral tears. Management should consist of
. shoulder arthroscopy and repair of a possible labral tear.
. anterior capsulorrhaphy for subtle anterior instability.
. diagnostic arthroscopy of the glenohumeral joint and arthroscopic subacromial decompression.
. rest from pitching, initiation of a rehabilitation program to restore internal rotation, and scapular stabilization.
. rest from pitching and a corticosteroid injection into the subacromial space.

Correct Answer & Explanation

. rest from pitching, initiation of a rehabilitation program to restore internal rotation, and scapular stabilization.

Explanation

Initial management generally includes rest from throwing, restoring normal joint function, specifically motion and strength as well as eliminating pain. Treatment should first focus on restoring a 180-degree arc with posterior scapular stretching, as well as pain control and muscle rehabilitation. Injections and surgery are generally reserved for patients who fail to respond to rest and rehabilitation.

Question 2147

Topic: Shoulder & Hip Sports
Figures 49a and 49b show MRI scans of the shoulder. What is the most likely diagnosis?
. Rotator cuff tear
. Normal anatomic variant
. Stage II impingement
. Bankart lesion
. Acromioclavicular grade II sprain

Correct Answer & Explanation

. Rotator cuff tear

Explanation

The supraspinatus tendon shows clear detachment and retraction from its greater tuberosity attachment by the absence of the normal dark subacromial signal extending to the attachment on the greater tuberosity. There is no anterior inferior glenoid labral detachment that usually is seen in a Bankart lesion. The acromioclavicular joint shows no evidence of separation. The humeral head is migrated cranially, indicating a chronic rotator cuff tear.

Question 2148

Topic: Shoulder & Hip Sports

A 25-year-old professional hockey player presents with chronic, deep groin pain exacerbated by hip flexion and internal rotation.

Imaging demonstrates a classic pistol-grip deformity. Which of the following represents the primary mechanism of articular cartilage damage in this condition?

. Chondral delamination of the anterosuperior acetabulum from the subchondral bone.
. Linear wear of the posteroinferior acetabular cartilage.
. Global thinning of the femoral head articular cartilage.
. Crushing injury to the base of the labrum without cartilage involvement.
. Hypertrophy of the ligamentum teres causing foveal wear.

Correct Answer & Explanation

. Chondral delamination of the anterosuperior acetabulum from the subchondral bone.

Explanation

The scenario describes Cam-type femoroacetabular impingement (FAI), characterized by a non-spherical femoral head-neck junction (pistol-grip deformity). As the hip goes into flexion and internal rotation, this aspherical head engages the anterosuperior acetabular rim. The shear forces generated cause an outside-in separation (delamination) of the acetabular cartilage from the subchondral bone, often leaving the labrum partially intact initially, unlike Pincer impingement where the primary failure is a crushing of the labrum.

Question 2149

Topic: Knee Sports
A 16-year-old female basketball player suffers recurrent lateral patellar dislocations. An MRI reveals an avulsion of the medial patellofemoral ligament (MPFL) at its femoral origin. In an MPFL reconstruction, correct femoral tunnel placement is critical. Where is the anatomical femoral attachment of the MPFL (Schöttle's point) located radiographically on a true lateral view?
. Distal to Blumensaat's line and anterior to the posterior femoral cortex line.
. Proximal to the adductor tubercle and posterior to the medial epicondyle.
. 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 Blumensaat's line.
. Directly over the center of the medial epicondyle.
. At the junction of the medial collateral ligament and the posterior oblique ligament.

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 Blumensaat's line.

Explanation

Schöttle's point defines the optimal radiographic and anatomic femoral attachment for MPFL reconstruction. On a strictly true lateral radiograph of the knee, Schöttle's point is found 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 posterior point of Blumensaat's line. Anatomically, it is situated between the adductor tubercle (proximal) and the medial epicondyle (distal and anterior).

Question 2150

Topic: Knee Sports

A 12-year-old male baseball player presents with vague, activity-related right knee pain. Radiographs demonstrate a classic Osteochondritis Dissecans (OCD) lesion. Assuming the most common anatomic location for this lesion, which of the following best describes its position?

. Medial aspect of the lateral femoral condyle
. Lateral aspect of the medial femoral condyle
. Central weight-bearing dome of the medial femoral condyle
. Anterior aspect of the lateral femoral condyle
. Inferior pole of the patella

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for an Osteochondritis Dissecans (OCD) lesion in the knee is the lateral aspect of the medial femoral condyle (often remembered by the mnemonic LAME: Lateral Aspect Medial Epicondyle/condyle, though technically it's the condyle). It accounts for roughly 70-80% of all knee OCD lesions. These lesions are thought to result from repetitive microtrauma and vascular insufficiency to the subchondral bone.

Question 2151

Topic: 5. Sports Medicine

During a primary anterior cruciate ligament (ACL) reconstruction, the surgeon must decide on graft choice. From a purely biomechanical standpoint, which of the following common graft choices possesses the highest ultimate tensile load at the time of time zero testing?

. Bone-patellar tendon-bone (BPTB) autograft (10 mm)
. Quadrupled hamstring autograft
. Quadriceps tendon autograft (10 mm)
. Native intact anterior cruciate ligament
. Achilles tendon allograft

Correct Answer & Explanation

. Quadrupled hamstring autograft

Explanation

A quadrupled hamstring (semitendinosus and gracilis) autograft has the highest ultimate tensile load to failure among the standard graft choices at time zero, approximating 4000 N. For comparison, the native ACL is approximately 2160 N, a 10 mm BPTB is around 2977 N, and a 10 mm quadriceps tendon is around 2352 N. However, despite the higher time-zero strength of the quadrupled hamstring graft, clinical outcomes and stability rates are generally comparable among these graft choices, with BPTB traditionally having lower rerupture rates in high-demand young athletes due to bone-to-bone healing.

Question 2152

Topic: Knee Sports
A 19-year-old football player sustains a complex knee injury involving an acute grade III medial collateral ligament (MCL) tear and a complete ACL rupture. Based on current literature and sports medicine guidelines, what is the most broadly accepted initial treatment strategy for this combined injury?
. Immediate surgical repair of both the ACL and MCL.
. Conservative management with a hinged knee brace for the MCL for 4-6 weeks, followed by ACL reconstruction.
. Primary ACL reconstruction within 48 hours, leaving the MCL to heal.
. Immediate MCL repair followed by delayed ACL reconstruction after 3 months.
. Non-operative management of both ligaments with a 12-week intensive physical therapy protocol.

Correct Answer & Explanation

. Conservative management with a hinged knee brace for the MCL for 4-6 weeks, followed by ACL reconstruction.

Explanation

The standard of care for a combined ACL and grade III MCL tear is to allow the MCL to heal non-operatively in a hinged knee brace for approximately 4 to 6 weeks, followed by delayed reconstruction of the ACL. Operating on the ACL immediately or repairing the MCL routinely increases the risk of severe post-operative arthrofibrosis. The MCL has an excellent intrinsic healing capacity due to its robust blood supply. If valgus instability persists after 6 weeks of conservative management, an MCL reconstruction or repair can be performed concurrently with the ACL reconstruction.

Question 2153

Topic: Knee Sports

When performing a medial patellofemoral ligament (MPFL) reconstruction, identifying the correct anatomic femoral attachment is critical to ensure anisometry is minimized. Radiographically, Schottle's point represents the ideal femoral origin. Which of the following best describes the radiographic location of Schottle's point on a true lateral radiograph of the knee?

. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line
. 3 mm posterior to the posterior cortical line, 5 mm proximal to the posterior articular border, and distal to Blumensaat's line
. On the anterior cortical line, 2.5 mm proximal to the posterior articular border, and proximal to Blumensaat's line
. 5 mm anterior to the posterior cortical line, 5 mm distal to the posterior articular border, and intersecting Blumensaat's line
. 1 mm posterior to the posterior cortical line, 2.5 mm proximal to the posterior articular border, and distal to Blumensaat's line

Correct Answer & Explanation

. 1 mm posterior to the posterior cortical line, 2.5 mm proximal to the posterior articular border, and distal to Blumensaat's line

Explanation

Schottle's point is a radiographic landmark for the femoral origin of the MPFL on a strict lateral radiograph. It is located 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to a line parallel to the posterior articular border of the medial femoral condyle, and proximal to a line extending from Blumensaat's line.

Question 2154

Topic: Knee Sports

A 25-year-old male presents with a chief complaint of profound loss of knee flexion 8 months following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. He states the knee feels 'locked' whenever he tries to bend it past 80 degrees.

Based on the radiographic principles of ACL graft placement, what is the most likely technical error leading to this specific complication?

. The femoral tunnel was placed too far posterior
. The tibial tunnel was placed too far posterior
. The femoral tunnel was placed too far anterior
. The tibial tunnel was placed too far anterior
. The graft was tensioned in 90 degrees of flexion

Correct Answer & Explanation

. The femoral tunnel was placed too far anterior

Explanation

Placement of the femoral tunnel too far anteriorly is a classic error in ACL reconstruction that results in the graft becoming excessively tight as the knee goes into flexion. This leads to restricted knee flexion and a feeling of 'locking' or extreme tightness when attempting to bend the knee. Conversely, if the femoral tunnel is placed too far posterior, the graft will be tight in extension, resulting in an extension deficit. Tibial tunnel malpositioning typically leads to roof impingement (if too anterior) or PCL impingement (if too posterior).

Question 2155

Topic: Knee Sports
A 28-year-old male sustains a high-energy multi-ligament knee injury following a motorcycle collision. Clinical and MRI evaluation reveals a Schenck KD III-L injury (disruption of the ACL, PCL, and the posterolateral corner/LCL). He has intact pulses with normal ABIs. Which associated neurologic injury is most frequently seen with this specific ligamentous injury pattern?
. Saphenous nerve palsy
. Sural nerve palsy
. Tibial nerve palsy
. Common peroneal nerve palsy
. Femoral nerve palsy

Correct Answer & Explanation

. Common peroneal nerve palsy

Explanation

The Schenck KD III-L classification denotes a multi-ligament knee injury involving the anterior cruciate ligament, posterior cruciate ligament, and the lateral/posterolateral structures. Due to the severe varus and internal rotation forces required to disrupt the posterolateral corner, traction on the common peroneal nerve is highly likely. Common peroneal nerve palsy occurs in approximately 15-25% of KD III-L and KD IV knee dislocations, representing the most common neurologic deficit in this setting.

Question 2156

Topic: Shoulder & Hip Sports

A 22-year-old collegiate hockey player presents with chronic, insidious onset groin pain exacerbated by hip flexion and internal rotation.

Radiographs demonstrate an aspherical femoral head-neck junction with an alpha angle of 65 degrees. He is diagnosed with Cam-type femoroacetabular impingement (FAI). During hip arthroscopy, which pattern of intra-articular damage is most characteristically observed in isolated Cam FAI?

. Posteroinferior acetabular cartilage delamination with an intact anterior labrum
. Global full-thickness acetabular cartilage loss resembling inflammatory arthritis
. Anterosuperior acetabular cartilage delamination (often with a relatively intact overlying labrum initially)
. Fraying and tearing of the ligamentum teres with a normal chondrolabral junction
. Linear, full-thickness fissuring strictly on the femoral head articular cartilage

Correct Answer & Explanation

. Posteroinferior acetabular cartilage delamination with an intact anterior labrum

Explanation

Cam-type FAI is caused by a loss of sphericity at the anterolateral femoral head-neck junction (decreased offset). During hip flexion and internal rotation, this prominent cam lesion engages the anterosuperior acetabulum. The shear forces generated typically cause the articular cartilage to delaminate from the subchondral bone at the anterosuperior chondrolabral junction. Often, in early stages, the overlying labrum remains relatively intact or detaches from the articular cartilage (the 'carpet delamination' sign), unlike Pincer impingement where the labrum itself is crushed first.

Question 2157

Topic: Knee Sports

A 19-year-old female presents with recurrent episodes of lateral patellar dislocation. Conservative management with physical therapy and bracing has failed. Advanced imaging is obtained to assess risk factors for patellofemoral instability. Which of the following anatomic parameters is a primary indication for adding a tibial tubercle medialization osteotomy (e.g., Fulkerson osteotomy) to a medial patellofemoral ligament (MPFL) reconstruction?

. Caton-Deschamps index of 0.8
. Tibial Tubercle-Trochlear Groove (TT-TG) distance of 22 mm
. Trochlear dysplasia Type A according to the Dejour classification
. Q angle of 12 degrees
. Patellar tilt angle of 5 degrees

Correct Answer & Explanation

. Caton-Deschamps index of 0.8

Explanation

A Tibial Tubercle-Trochlear Groove (TT-TG) distance greater than 20 mm is pathologically elevated and represents significant lateralization of the tibial tubercle. This abnormal extensor mechanism vector strongly pulls the patella laterally. In the setting of recurrent patellar instability with a TT-TG > 20 mm, an MPFL reconstruction alone is at high risk of failure due to excessive tension on the graft. Therefore, a tibial tubercle medialization osteotomy (anterior-medialization or AMZ) is indicated to correct the underlying bony malalignment.

Question 2158

Topic: 5. Sports Medicine

An 18-year-old female collegiate soccer player sustains an anterior cruciate ligament (ACL) tear. She wishes to undergo reconstruction that offers the lowest rate of re-rupture to ensure she can return to high-demand sports. Which of the following graft choices is most statistically supported to minimize her risk of graft failure?

. Autologous bone-patellar tendon-bone (BPTB)
. Autologous hamstring tendon
. Irradiated allograft
. Non-irradiated allograft
. Synthetic graft

Correct Answer & Explanation

. Autologous bone-patellar tendon-bone (BPTB)

Explanation

Autologous bone-patellar tendon-bone (BPTB) grafts have consistently demonstrated the lowest re-rupture rates in young, high-demand athletes. Allografts carry a significantly higher failure rate in this specific demographic.

Question 2159

Topic: 5. Sports Medicine

A 45-year-old male undergoes arthroscopy for a medial meniscus posterior root tear. Which of the following best describes the biomechanical consequence of this specific pathology if left untreated?

. Increased hoop stresses within the residual meniscus
. Decreased peak contact pressure in the medial compartment
. Biomechanical equivalence to a total medial meniscectomy
. Isolated increased internal rotational laxity
. Shift of contact forces primarily to the patellofemoral joint

Correct Answer & Explanation

. Increased hoop stresses within the residual meniscus

Explanation

A posterior root tear disrupts the meniscal ring, resulting in a loss of hoop stresses and meniscal extrusion. Biomechanically, this effectively mimics the altered contact pressures and areas seen in a total meniscectomy.

Question 2160

Topic: Knee Sports
When performing a medial patellofemoral ligament (MPFL) reconstruction, anatomic femoral tunnel placement is critical to prevent graft anisometry. According to Schöttle, where is the ideal radiographic femoral attachment point?
. Anterior to the posterior femoral cortical line and distal to Blumensaat's line
. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line
. Distal to the adductor tubercle and anterior to the medial epicondyle
. Posterior to the posterior cortical line and distal to Blumensaat's line
. At the center of the medial femoral condyle articular surface

Correct Answer & Explanation

. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line

Explanation

Schöttle's point is radiographically defined on a true lateral knee radiograph as 1 mm anterior to the posterior cortical line extension, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line. Proper placement prevents graft overtensioning in flexion.

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