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5. Sports Medicine MCQs

Practice Set 119 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 2361

Topic: Shoulder & Hip Sports

In a Latarjet procedure for recurrent anterior shoulder instability, the crucial 'sling effect' that dynamically stabilizes the anterior shoulder is primarily provided by:

. The transferred coracoacromial ligament
. The transferred short head of the biceps
. The conjoined tendon acting on the inferior third of the subscapularis
. The bony block of the coracoid process
. The capsular repair to the native glenoid

Correct Answer & Explanation

. The conjoined tendon acting on the inferior third of the subscapularis

Explanation

The Latarjet procedure provides stability via three mechanisms: the bony block, the capsulolabral repair, and the dynamic 'sling effect.' The sling effect is generated by the conjoined tendon passing through the split lower subscapularis, tensioning it in abduction and external rotation.

Question 2362

Topic: Knee Sports

Which MRI finding is most classically associated with a posterior medial meniscus root tear, functionally representing a loss of meniscal hoop stresses?

. Medial meniscus extrusion greater than 3 mm on coronal MRI
. Parameniscal cyst formation in the anterior horn
. Double PCL sign on sagittal MRI
. Subchondral edema isolated to the lateral femoral condyle
. Focal articular cartilage defect in the trochlea

Correct Answer & Explanation

. Medial meniscus extrusion greater than 3 mm on coronal MRI

Explanation

A posterior root tear disrupts the circumferential hoop stresses of the meniscus, causing it to functionally behave like a total meniscectomy. This loss of tension leads to meniscal extrusion of > 3 mm beyond the tibial margin on a coronal MRI.

Question 2363

Topic: Knee Sports

Physical examination of a knee injury reveals increased external tibial rotation at 30 degrees of flexion compared to the contralateral side, but symmetric external rotation at 90 degrees. This finding indicates an isolated injury to the:

. Anterior cruciate ligament
. Posterior cruciate ligament
. Posterolateral corner
. Superficial medial collateral ligament
. Posterior oblique ligament

Correct Answer & Explanation

. Posterolateral corner

Explanation

A positive dial test at 30 degrees but normal at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If external rotation is increased at both 30 and 90 degrees, it suggests a combined PLC and posterior cruciate ligament (PCL) injury.

Question 2364

Topic: Shoulder & Hip Sports

In cases of recurrent anterior shoulder instability, a Hill-Sachs lesion is a common bony defect resulting from an impaction fracture on the:

. Anteromedial aspect of the humeral head
. Posterosuperior aspect of the humeral head
. Anterolateral aspect of the humeral head
. Posteroinferior aspect of the humeral head
. Superior aspect of the greater tuberosity

Correct Answer & Explanation

. Posterosuperior aspect of the humeral head

Explanation

A Hill-Sachs lesion is a cortical depression in the posterosuperior lateral aspect of the humeral head. It occurs when the humeral head dislocates anteriorly and impacts against the firm anterior glenoid rim.

Question 2365

Topic: 5. Sports Medicine

During an anatomical single-bundle anterior cruciate ligament (ACL) reconstruction using a soft tissue autograft, the graft is typically tensioned and secured at what knee angle to avoid a capture deficit?

. 90 degrees of flexion
. 0 to 20 degrees of flexion
. 45 degrees of flexion
. 120 degrees of flexion
. Full hyperextension

Correct Answer & Explanation

. 0 to 20 degrees of flexion

Explanation

Soft tissue (hamstring) ACL grafts are typically tensioned and fixed near extension (0 to 20 degrees of flexion) to ensure stability throughout the arc of motion and to prevent a loss of extension (capture deficit).

Question 2366

Topic: Knee Sports

Osteochondritis dissecans (OCD) lesions of the knee most frequently occur in which of the following anatomical locations?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central weight-bearing portion of the medial femoral condyle
. Trochlear groove
. Inferior pole of the patella

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for osteochondritis dissecans in the knee is the lateral aspect of the medial femoral condyle (LAME - Lateral Aspect Medial Epicondyle/Condyle), accounting for roughly 70% of cases.

Question 2367

Topic: General Sports & Tendon

When performing a surgical repair of a complete proximal hamstring rupture, understanding the anatomy of the ischial tuberosity origin is essential. Which muscle's tendon originates most laterally and anteriorly on the tuberosity?

. Long head of the biceps femoris
. Short head of the biceps femoris
. Semimembranosus
. Semitendinosus
. Adductor magnus

Correct Answer & Explanation

. Semimembranosus

Explanation

At the ischial tuberosity footprint, the semimembranosus tendon has a distinct lateral and anterior origin. The long head of the biceps femoris and semitendinosus form a conjoined tendon that originates more medially and posteriorly.

Question 2368

Topic: Knee Sports

A 25-year-old football player presents with a knee injury. On physical examination, the dial test shows 15 degrees of increased external rotation at 30 degrees of flexion compared to the contralateral knee, but equal external rotation at 90 degrees of flexion. Which structure is most likely injured?

. Posterior cruciate ligament (PCL) only
. Posterolateral corner (PLC) only
. Both PCL and PLC
. Anterior cruciate ligament (ACL)
. Medial collateral ligament (MCL)

Correct Answer & Explanation

. Posterolateral corner (PLC) only

Explanation

Increased external rotation on the dial test at 30 degrees of flexion, but not at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. If asymmetry persists at both 30 and 90 degrees, a combined PLC and PCL injury is present.

Question 2369

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, femoral tunnel placement proximal to Schöttle's point will result in which of the following graft kinematics?
. The graft will be tightest in full extension and lax in deep flexion.
. The graft will be tightest in deep flexion and lax in extension.
. The graft will maintain perfect isometric tension throughout the entire range of motion.
. The graft will cause increased lateral patellar tracking.
. The graft will primarily limit internal rotation of the tibia.

Correct Answer & Explanation

. The graft will be tightest in deep flexion and lax in extension.

Explanation

Placing the MPFL femoral attachment too proximal results in the graft being overly tight in flexion and loose in extension, risking loss of knee flexion and medial patellar overload. Correct placement is slightly anterior to the posterior femoral cortex extension line.

Question 2370

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. MRI arthrogram reveals a SLAP tear and partial articular-sided supraspinatus tendon avulsion (PASTA). What is the primary pathomechanical etiology of this injury?

. Subcoracoid impingement
. Glenohumeral internal rotation deficit (GIRD) leading to peel-back
. Primary external impingement against the coracoacromial arch
. Anterior capsular laxity causing excessive external rotation
. Posterior capsular redundancy leading to obligate anterior translation

Correct Answer & Explanation

. Glenohumeral internal rotation deficit (GIRD) leading to peel-back

Explanation

Internal impingement in overhead throwers is driven by repetitive late-cocking motions causing a tight posterior capsule (GIRD). This leads to a posterosuperior shift of the humeral head, pinching the rotator cuff and peeling back the superior labrum.

Question 2371

Topic: Knee Sports

What is the most common anatomic location for an osteochondritis dissecans (OCD) lesion in the knee?

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

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The lateral aspect of the medial femoral condyle is the classic and most common location for osteochondritis dissecans (OCD) lesions of the knee. This is often remembered by the mnemonic 'LAME' (Lateral Aspect Medial Epicondyle/condyle).

Question 2372

Topic: Shoulder & Hip Sports

A 65-year-old patient with a massive, chronic, retracted rotator cuff tear involving the supraspinatus and infraspinatus develops fatty infiltration and marked atrophy. EMG studies show denervation changes in the infraspinatus only. Where is the most likely site of nerve compression?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Spiral groove

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus. Isolated denervation of the infraspinatus indicates compression at the spinoglenoid notch, often by a paralabral cyst.

Question 2373

Topic: Knee Sports

When performing a single-bundle posterior cruciate ligament (PCL) reconstruction, recreating the anterolateral (AL) bundle is prioritized. During which phase of knee range of motion is the native AL bundle most taut?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 degrees of flexion
. 120 degrees of flexion

Correct Answer & Explanation

. 90 degrees of flexion

Explanation

The anterolateral (AL) bundle of the PCL is the larger, stiffer bundle and is most taut at 90 degrees of knee flexion. The posteromedial (PM) bundle is tight in extension and deep flexion.

Question 2374

Topic: 5. Sports Medicine

According to the Instability Severity Index Score (ISIS), which of the following preoperative factors significantly increases the risk of recurrence after an isolated arthroscopic Bankart repair?

. Age older than 30 years at surgery
. First dislocation occurring after age 20
. Absence of a Hill-Sachs lesion on AP external rotation radiographs
. Participation in competitive contact sports
. Lack of hyperlaxity on physical examination

Correct Answer & Explanation

. Participation in competitive contact sports

Explanation

The ISIS score helps predict failure of arthroscopic Bankart repair. Risk factors for recurrence include age under 20 at surgery, competitive/contact sports participation, anterior hyperlaxity, visible Hill-Sachs on AP view, and loss of sclerotic contour on the glenoid.

Question 2375

Topic: Shoulder & Hip Sports

Which of the following radiographic parameters is considered an established indication for operative intervention in the management of a displaced extra-articular scapular body/neck fracture?

. Glenopolar angle greater than 45 degrees
. Glenopolar angle less than 22 degrees
. Medial displacement of the glenoid of 5 mm
. Angulation of the scapular body of 15 degrees
. Inferior displacement of the glenoid of 2 mm

Correct Answer & Explanation

. Glenopolar angle less than 22 degrees

Explanation

Surgical indications for extra-articular scapular neck and body fractures include a glenopolar angle (GPA) of < 22 degrees (normal is 30-45 degrees), medial-lateral displacement > 20 mm, and angulation > 45 degrees. A severely decreased GPA alters the resting length and vectors of the rotator cuff, leading to poor functional outcomes if treated nonoperatively.

Question 2376

Topic: 5. Sports Medicine

A professional football player sustains a hyperdorsiflexion injury to his great toe. Examination reveals profound ecchymosis, loss of plantarflexion strength at the MTP joint, and a positive dorsal drawer test. Radiographs show proximal migration of the sesamoids compared to the uninjured side. What is the most appropriate management?

. Stiff-soled shoe with carbon fiber insert and return to play in 2 weeks
. Taping of the great toe in slight plantarflexion for 6 weeks
. Corticosteroid injection into the MTP joint
. Primary surgical repair of the plantar plate
. Excision of the proximal sesamoids

Correct Answer & Explanation

. Primary surgical repair of the plantar plate

Explanation

This is a Grade 3 turf toe injury, characterized by complete disruption of the plantar plate-sesamoid complex with proximal sesamoid migration. Surgical repair is indicated in high-level athletes to restore push-off strength and prevent progressive deformity.

Question 2377

Topic: 5. Sports Medicine

Which of the following is the most significant potential advantage of non-operative management compared to operative repair for an acute Achilles tendon rupture?

. Decreased risk of re-rupture
. Increased plantarflexion strength
. Decreased risk of soft-tissue complications
. Faster return to competitive sports
. Decreased tendon elongation

Correct Answer & Explanation

. Decreased risk of soft-tissue complications

Explanation

Non-operative management of acute Achilles tendon ruptures with early functional rehabilitation has re-rupture rates comparable to surgery. However, operative management carries a significantly higher risk of soft-tissue complications, such as infection and wound breakdown.

Question 2378

Topic: 5. Sports Medicine

A 22-year-old collegiate basketball player sustains an acute fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal. He wishes to return to play as soon as safely possible. What is the most appropriate management?

. Short leg walking boot for 6 weeks
. Non-weight bearing cast for 6 weeks
. Percutaneous intramedullary screw fixation
. Open reduction and dual mini-fragment plate fixation
. Excision of the proximal fragment and peroneus brevis advancement

Correct Answer & Explanation

. Percutaneous intramedullary screw fixation

Explanation

This is a Zone 2 (Jones) fracture, which has a high risk of delayed union or nonunion due to a watershed blood supply. In high-level athletes, intramedullary screw fixation is recommended to ensure healing and expedite return to play.

Question 2379

Topic: 5. Sports Medicine

A 30-year-old professional athlete suffers a forced hyperextension injury to the first MTP joint. Clinical examination and MRI confirm a Grade 3 "turf toe" injury with complete rupture of the plantar plate complex and proximal retraction of the sesamoids. What is the most appropriate management?

. Taping of the hallux into plantarflexion and immediate return to play
. Immobilization in a walking boot for 6 weeks followed by physical therapy
. Primary surgical repair of the plantar plate and capsuloligamentous complex
. Corticosteroid injection and use of a carbon fiber rigid shoe insert
. First MTP joint arthrodesis

Correct Answer & Explanation

. Primary surgical repair of the plantar plate and capsuloligamentous complex

Explanation

A Grade 3 turf toe injury involves complete tearing of the plantar plate with sesamoid retraction and clinical instability. In high-level athletes, this necessitates primary surgical repair to restore push-off strength and joint stability.

Question 2380

Topic: Shoulder & Hip Sports

A 22-year-old professional baseball catcher has posterior shoulder pain and severe external rotation weakness with the arm in adduction. Radiographs are normal. MRI scans are shown in Figures 15a through 15c. Management should consist of Review Topic

. aspiration and steroid injection.
. rest.
. acromioplasty.
. arthroscopic repair and decompression.
. rehabilitation.

Correct Answer & Explanation

. arthroscopic repair and decompression.

Explanation

The MRI scans reveal a large posterior paralabral cyst associated with a posterior-superior labral tear. The cyst appears as a well-defined, smoothly marginated mass with low signal intensity on T1-weighted MRI scans and with high signal intensity on T2-weighted MRI scans. MRI also reveals changes in the supraspinatus and infraspinatus muscles secondary to denervation, including decreased muscle bulk and fatty infiltration. MRI has the added advantage, compared with other imaging modalities, of detecting intra-articular lesions, such as labral tears, which are frequently associated with ganglion cysts of the shoulder. In this case of a professional baseball player with a space-occupying lesion causing nerve compression with an associated labral tear, the treatment of choice is arthroscopic decompression of the cyst and repair of the tear. Acromioplasty would not address the primary pathology in this patient.

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