Menu

5. Sports Medicine MCQs

Practice Set 109 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 2161

Topic: 5. Sports Medicine

In the context of anterior cruciate ligament (ACL) reconstruction, which of the following patients has the strongest indication for a concomitant lateral extra-articular tenodesis (LET) or anterolateral ligament (ALL) reconstruction?

. A 35-year-old male recreational skier with an isolated ACL tear
. A 20-year-old female soccer player with generalized hyperlaxity and a high-grade pivot shift
. A 25-year-old male with a concomitant grade I medial collateral ligament (MCL) sprain
. A 40-year-old female with an ACL tear and mild medial compartment osteoarthritis
. A 19-year-old male with a partial ACL tear demonstrating a negative pivot shift

Correct Answer & Explanation

. A 35-year-old male recreational skier with an isolated ACL tear

Explanation

Indications for an added LET or ALL reconstruction include young age (<25), pivoting sports, generalized hyperlaxity, high-grade pivot shift, and revision ACL reconstruction. It helps control anterolateral rotatory instability.

Question 2162

Topic: Shoulder & Hip Sports

Which of the following best describes the pathomechanics of pincer-type femoroacetabular impingement (FAI)?

. An aspherical femoral head engaging the anterosuperior acetabulum in flexion
. Decreased femoral head-neck offset causing shear forces on the labrum
. Acetabular overcoverage causing linear impact and crushing of the labrum against the femoral neck
. Slipped capital femoral epiphysis leading to posterior impingement
. Chondral delamination occurring before labral pathology

Correct Answer & Explanation

. An aspherical femoral head engaging the anterosuperior acetabulum in flexion

Explanation

Pincer FAI is caused by local or global acetabular overcoverage. The femoral neck abuts the overhanging acetabular rim, causing linear contact that crushes the labrum and can lead to secondary contrecoup cartilage lesions.

Question 2163

Topic: Knee Sports
A 24-year-old male sustains a multiligament knee injury resulting in a KD-III L classification (ACL, PCL, and posterolateral corner disruption). He is at highest risk for injury to which of the following neurovascular structures?
. Femoral nerve
. Popliteal artery
. Common peroneal nerve
. Tibial nerve
. Saphenous nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

KD-III L injuries involve the posterolateral corner (PLC). The common peroneal nerve anatomically courses around the fibular neck and is highly susceptible to traction injury during varus-hyperextension mechanisms that disrupt the PLC.

Question 2164

Topic: Knee Sports

When evaluating an osteochondritis dissecans (OCD) lesion of the medial femoral condyle, which of the following factors is the most reliable predictor of successful healing with non-operative management?

. Lesion size greater than 400 mm squared
. Location on the weight-bearing aspect of the lateral femoral condyle
. Open distal femoral physes
. Presence of a high signal rim behind the lesion on T2-weighted MRI
. Patient age over 18 years

Correct Answer & Explanation

. Lesion size greater than 400 mm squared

Explanation

Juvenile OCD (patients with open physes) has a significantly higher rate of spontaneous healing with non-operative management compared to adult OCD. Open physes are the strongest predictor of non-operative success.

Question 2165

Topic: Knee Sports

Compared to traditional first-generation Autologous Chondrocyte Implantation (ACI), what is the primary technical advantage of Matrix-induced Autologous Chondrocyte Implantation (MACI)?

. It can be performed as a single-stage procedure
. It eliminates the need for a sutured periosteal patch by using a seeded collagen scaffold
. It does not require prior cartilage biopsy and cell expansion
. It utilizes mesenchymal stem cells directly harvested from the iliac crest
. It is primarily indicated for diffuse, severe osteoarthritis rather than focal defects

Correct Answer & Explanation

. It can be performed as a single-stage procedure

Explanation

MACI uses cultured chondrocytes seeded onto a porcine collagen membrane, which is then secured into the defect with fibrin glue. This avoids the technical morbidity of harvesting and suturing a periosteal patch used in first-generation ACI.

Question 2166

Topic: General Sports & Tendon

During open surgical repair of a chronic proximal hamstring avulsion, careful retractor placement is required to protect the sciatic nerve. Anatomically, what is the normal relationship of the sciatic nerve to the ischial tuberosity?

. Medial and deep to the ischial tuberosity
. Approximately 1.2 cm lateral to the ischial tuberosity
. Directly posterior and superficial to the hamstring origin
. Anterior to the adductor magnus origin
. Inferior to the lesser trochanter

Correct Answer & Explanation

. Medial and deep to the ischial tuberosity

Explanation

The sciatic nerve typically exits the greater sciatic foramen and descends approximately 1.2 cm lateral to the lateral border of the ischial tuberosity. Retractors must be placed carefully on the lateral aspect of the tuberosity to avoid injury.

Question 2167

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. Which of the following statements correctly describes their biomechanical behavior during knee range of motion?

. The anteromedial (AM) bundle is tightest in extension and controls rotatory stability
. The posterolateral (PL) bundle is tightest in deep flexion
. The anteromedial (AM) bundle is tightest in flexion and is the primary restraint to anterior tibial translation at 90 degrees
. The posterolateral (PL) bundle is the primary restraint to anterior translation at 90 degrees of flexion
. Both bundles maintain isometric tension throughout the full arc of motion

Correct Answer & Explanation

. The anteromedial (AM) bundle is tightest in extension and controls rotatory stability

Explanation

The ACL's anteromedial (AM) bundle is tightest in flexion and primarily restricts anterior tibial translation at 90 degrees. The posterolateral (PL) bundle is tightest in extension and provides critical rotatory stability.

Question 2168

Topic: 5. Sports Medicine

In anterior cruciate ligament (ACL) reconstruction, which of the following autografts possesses the highest ultimate tensile load?

. 10-mm bone-patellar tendon-bone
. 10-mm quadriceps tendon
. Quadrupled semitendinosus-gracilis
. Native anterior cruciate ligament
. Doubled semitendinosus

Correct Answer & Explanation

. 10-mm bone-patellar tendon-bone

Explanation

A quadrupled hamstring (semitendinosus and gracilis) autograft has an ultimate tensile load exceeding 4000 N, which is the highest among common autografts. The native ACL has an ultimate tensile load of approximately 2160 N.

Question 2169

Topic: Shoulder & Hip Sports
A 39-year-old man has anterior shoulder pain after landing on his abducted left shoulder while playing softball. Examination reveals a stable glenohumeral joint, pain on passive external rotation of greater than 25 degrees, and pain and weakness on belly press (Napoleon’s) test. An MRI scan is shown. To provide maximum pain relief and return of function, management should include
. physical therapy to restore range of motion and rotator cuff strength.
. repair of the supraspinatus and biceps tenotomy.
. repair of the supraspinatus and biceps tenodesis.
. repair of the subscapularis and biceps tenotomy.
. repair of the subscapularis and biceps tenodesis.

Correct Answer & Explanation

. repair of the subscapularis and biceps tenodesis.

Explanation

The examination and MRI scan confirm a subscapularis rupture and dislocation of the long head of the biceps tendon. The greatest return of function will result from repair of the subscapularis and tenodesis of the biceps tendon. Physical therapy alone will result in inadequate healing of the subscapularis and will not address the biceps tendon. While biceps tenotomy is an option, it will not provide the same level of pain relief and return of function as a tenodesis in a young, active man. There is no evidence for a supraspinatus tear.

Question 2170

Topic: 5. Sports Medicine
A 21-year-old football player had severe pain and immediate swelling in the left anteromedial chest wall while bench pressing near maximal weights several days ago. Examination at the time of injury revealed a mass on the anteromedial chest wall. Follow-up examination now reveals decreased swelling, and axillary webbing is observed. The patient has weakness to adduction and forward flexion. The injured muscle originates from the
. proximal clavicle and sternocostal margin.
. proximal humerus.
. coracoid process.
. distal clavicle and acromion.
. anterior scapula.

Correct Answer & Explanation

. proximal clavicle and sternocostal margin.

Explanation

The patient has a pectoralis major rupture, an injury that occurs most commonly during weight lifting. Grade III injuries represent complete tears of either the musculotendinous junction or an avulsion of the tendon from the humerus, the most common injury site. Examination will most likely reveal ecchymoses and swelling in the proximal arm and axilla, and strength testing will show weakness with internal rotation and in adduction and forward flexion. Axillary webbing, caused by a more defined inferior margin of the anterior deltoid as the result of rupture of the pectoralis, can be seen as the swelling diminishes. Surgical repair is the treatment of choice for complete ruptures. The pectoralis major originates from the proximal clavicle and the border of the sternum, including ribs two through six.

Question 2171

Topic: 5. Sports Medicine

Which of the following is more likely to occur with use of a bone patellar bone allograft instead of a bone patellar bone autograft for anterior cruciate ligament (ACL) reconstruction in an 18-year-old high school or collegiate athlete? Review Topic

. Septic arthritis
. Early onset osteoarthritis
. ACL graft re-rupture
. Cyclops lesion formation
. Femoral and tibial tunnel osteolysis

Correct Answer & Explanation

. Septic arthritis

Explanation

The best reason to use an autograft (rather than an allograft) for anterior cruciate ligament (ACL) reconstruction in a young athlete is lower graft rupture rate.Many factors can potentially contribute to the failure of ACL reconstructions, including the surgical technique, the selection of graft material, the integrity of the secondary restraints, the condition of the articular and meniscal cartilage, and postoperative rehabilitation. Early failure, usually within the first 6 months, most often is the result of technical errors, incorrect or overly aggressive rehabilitation,premature return to sports, or failure of graft incorporation. Later failure, usually after one year, is more typically the result of recurrent injury.Kaeding et al. report data from the MOON multicenter research consortium. They present Level 2 evidence that the odds of graft rupture with an allograft reconstruction are 4 times higher than those of autograft reconstruction in athletes aged 10-19 years old. For each age, the number of autograft ACL reconstructions (ACLRs) performed to prevent one failure is as follows: 14 years, 7 ACLRs; 18 years, 8 ACLRs; 22 years,11 ACLRs; 30 years, 25 ACLRs; 40 years, 50 ACLRs.Krych et al. present a systematic review of prospective trials using BTB autograft and BTB allograft tissue for ACL reconstruction with a minimum 2-year follow-up. They found that BTB allograft patients were more likely to rupture their graft than BTB autograft patients (OR, 5.03; P = .01), however once irradiated and chemically processed allografts were excluded there was no statistical difference in graft re-rupture between the groups.Greenberg et al. conducted a study of nearly 1300 patients and found no increased clinical risk of infection with the use of allograft tissue compared with autologous tissue for primary anterior cruciate ligament reconstruction.Incorrect Answers:1: There is no proven increased clinical risk of postoperative superficial or deep bacterial infection with the use of allograft tissue compared with autologous tissue for primary anterior cruciate ligament reconstruction. 2: There is no definitive data suggesting different arthritis progression rates based on autograft versus allograft. 4: Cyclops lesion formation is not related to graft choice. 5: There is some literature that tunnel osteolysis and enlargement is more common and greater with hamstring soft tissue grafts, however it does not appear to affect the clinical outcome in the first 2 postoperative years. There is no definitive data comparing BTB auto vs allograft in regards to tunnel osteolysis.

Question 2172

Topic: 5. Sports Medicine
Thirty minutes later the gymnast is experiencing headache and difficulty concentrating. If her symptoms persist 1 week later, the next treatment step should be
. a functional MRI scan.
. serial neurocognitive testing.
. no return to play that season.
. cognitive, cranial nerve, and balance testing after a period of moderate-to-intense exercise.

Correct Answer & Explanation

. cognitive, cranial nerve, and balance testing after a period of moderate-to-intense exercise.

Explanation

The National Collegiate Athletic Association’s (NCAA) 2011 revised health and safety guidelines regarding concussion management recommend no return to play on the same day of an injury. Before resuming exercise, athletes must be asymptomatic or returned to baseline symptoms at rest and have no symptoms with cognitive effort. The athlete’s clinical neurological examination findings (cognitive, cranial nerve, and balance testing) must return to baseline before resuming exercise.

Question 2173

Topic: 5. Sports Medicine
Based on the appearance of the imaging studies shown in Figures 11a through 11c, what structure has most likely been injured?
. Quadriceps tendon
. Medial collateral ligament
. Medial patellofemoral ligament
. Anterior cruciate ligament
. Lateral retinaculum

Correct Answer & Explanation

. Medial patellofemoral ligament

Explanation

The radiographs reveal marked lateral subluxation of the patella in a patient who has recurrent patellar instability. The medial patellofemoral ligament is the main restraint to lateral subluxation of the patella.

Question 2174

Topic: 5. Sports Medicine

A 20-year-old collegiate basketball player complains of acute lateral foot pain after cutting during a game. Radiographs demonstrate a non-displaced transverse fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal, extending into the fourth-fifth intermetatarsal facet. What is the most appropriate management for this elite athlete to ensure the fastest reliable return to play?

. Non-weight-bearing in a short leg cast for 6 weeks
. Immediate weight-bearing in a stiff-soled shoe
. Intramedullary screw fixation
. Primary partial metatarsectomy
. Corticosteroid injection and immediate return to play

Correct Answer & Explanation

. Non-weight-bearing in a short leg cast for 6 weeks

Explanation

The patient has a Zone II fracture of the proximal fifth metatarsal, commonly known as a Jones fracture. Due to the watershed blood supply in this area, these fractures have a high rate of delayed union or nonunion. In elite athletes, early intramedullary screw fixation is the standard of care to achieve a reliable union and allow a faster return to sport compared to prolonged conservative management.

Question 2175

Topic: 5. Sports Medicine

A 45-year-old male sustains an acute, closed, midsubstance Achilles tendon rupture. He is active but not a professional athlete. He is considering non-operative management with an early functional rehabilitation protocol versus surgical repair. Based on recent high-quality randomized controlled trials, what is the most accurate information regarding re-rupture rates?

. Operative repair has a significantly higher re-rupture rate
. Non-operative management with functional rehab has a re-rupture rate nearly equivalent to operative repair
. Non-operative management with rigid cast immobilization has the lowest re-rupture rate
. Re-rupture rates are exclusively dependent on the patient's age and not the treatment modality
. Operative repair eliminates the risk of re-rupture entirely

Correct Answer & Explanation

. Non-operative management with functional rehab has a re-rupture rate nearly equivalent to operative repair

Explanation

Historically, non-operative treatment of Achilles tendon ruptures (involving prolonged rigid casting) had higher re-rupture rates than surgical repair. However, recent landmark studies (such as the WILL trial and studies by Willits et al.) have demonstrated that when non-operative treatment is paired with an early functional rehabilitation protocol (early weight-bearing in a functional brace), the re-rupture rates are statistically similar to operative repair, while completely avoiding surgical complications like wound breakdown and infection.

Question 2176

Topic: 5. Sports Medicine

A 28-year-old female presents with chronic ankle pain and catching after a severe inversion ankle sprain 1 year ago. MRI demonstrates a 1.2 cm x 1.0 cm osteochondral lesion on the posteromedial talar dome with intact overlying cartilage. After failure of conservative management, what is the most appropriate next step in treatment?

. Ankle arthrodesis
. Osteochondral autograft transfer (OATS)
. Arthroscopic bone marrow stimulation (microfracture)
. Matrix-induced autologous chondrocyte implantation (MACI)
. Total ankle arthroplasty

Correct Answer & Explanation

. Ankle arthrodesis

Explanation

For primary osteochondral lesions of the talus that are small (< 1.5 cm^2) and have failed conservative management, arthroscopic bone marrow stimulation (microfracture or drilling) is the gold standard initial surgical treatment. OATS or structural allografts are reserved for larger lesions or revisions.

Question 2177

Topic: 5. Sports Medicine

A 21-year-old collegiate wide receiver hyperextends his great toe during a game on artificial turf. He has significant pain, swelling, and ecchymosis at the first MTP joint, and is unable to push off. MRI reveals a complete tear of the plantar plate and capsuloligamentous complex with proximal retraction of the sesamoids. What is the most appropriate management?

. Taping to the adjacent toe and immediate return to play
. Stiff-soled shoe and protected weight-bearing for 2 weeks
. Corticosteroid injection into the first MTP joint
. Surgical repair of the plantar plate
. First MTP arthrodesis

Correct Answer & Explanation

. Surgical repair of the plantar plate

Explanation

This describes a Grade 3 turf toe injury. In a high-level athlete, a complete tear of the plantar plate with visible proximal retraction of the sesamoids severely compromises push-off strength and first MTP joint stability. Surgical repair of the plantar plate is indicated to restore anatomy and function.

Question 2178

Topic: 5. Sports Medicine

A 28-year-old male presents with persistent anterolateral ankle pain 1 year after an ankle sprain. MRI demonstrates an osteochondral lesion of the talus (OCL) measuring 1.8 cm x 1.6 cm without massive subchondral cyst formation. He has failed non-operative management. What is the most appropriate surgical treatment?

. Arthroscopic bone marrow stimulation (microfracture)
. Osteochondral autograft transfer system (OATS)
. Retrograde drilling of the talar dome
. Arthroscopic debridement and synovectomy alone
. Total ankle arthroplasty

Correct Answer & Explanation

. Osteochondral autograft transfer system (OATS)

Explanation

For primary talar OCLs larger than 1.5 cm squared (or >15 mm in diameter), structural restoration using an osteochondral autograft transfer (OATS) or allograft is recommended. Microfracture has a significantly higher failure rate in lesions of this size.

Question 2179

Topic: 5. Sports Medicine

A 21-year-old collegiate football player sustains a severe hyperextension injury to his first metatarsophalangeal (MTP) joint. MRI confirms a complete disruption of the plantar plate complex with proximal retraction of the sesamoids. What is the most appropriate management?

. Carbon fiber Morton extension orthotic and early return to play
. Buddy taping and immediate weight-bearing in a stiff shoe
. Surgical repair of the plantar plate and capsuloligamentous structures
. Excision of the medial sesamoid
. First MTP arthrodesis

Correct Answer & Explanation

. Surgical repair of the plantar plate and capsuloligamentous structures

Explanation

This is a Grade 3 turf toe injury involving complete disruption of the plantar plate and sesamoid retraction. High-level athletes typically require surgical repair to restore push-off mechanics and prevent chronic MTP joint instability.

Question 2180

Topic: Shoulder & Hip Sports

A 45-year-old man sustains a comminuted fracture of the scapular body that extends into the spinoglenoid notch.

If the nerve passing through this specific notch is entrapped by fracture callus, which of the following physical examination findings would be exclusively expected?

. Weakness of both shoulder abduction and external rotation.
. Isolated weakness of external rotation with completely preserved shoulder abduction.
. Loss of sensation over the lateral aspect of the deltoid.
. Scapular winging prominent with forward elevation of the arm.
. Weakness of internal rotation of the shoulder.

Correct Answer & Explanation

. Isolated weakness of external rotation with completely preserved shoulder abduction.

Explanation

The suprascapular nerve innervates both the supraspinatus and infraspinatus muscles. It passes first through the suprascapular notch (giving motor branches to the supraspinatus) and then continues through the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch results in isolated infraspinatus weakness (weak external rotation), while supraspinatus function (initiation of abduction) remains intact.

Test Yourself

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

On this Page