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5. Sports Medicine MCQs

Practice Set 121 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 2401

Topic: 5. Sports Medicine

A 70-year-old male presents with an inability to perform a straight leg raise 4 years after a primary TKA. Ultrasound confirms a massive distal patellar tendon rupture with poor tissue quality. An extensor mechanism allograft reconstruction is planned. Which of the following technical principles is considered critical for optimizing the success of this procedure?

. Utilizing a fresh-frozen Achilles tendon allograft without bone blocks to allow soft-tissue ingrowth
. Tensioning the allograft tightly in full, absolute knee extension
. Tensioning the allograft in 30 degrees of knee flexion to prevent late stiffness
. Preserving the native patella to augment the allograft repair
. Revising the polyethylene to a highly constrained condylar knee (CCK) insert

Correct Answer & Explanation

. Tensioning the allograft tightly in full, absolute knee extension

Explanation

When performing an extensor mechanism reconstruction with a complete allograft (e.g., extensor mechanism allograft including the tibial tubercle, patellar tendon, patella, and quadriceps tendon), the graft must be tensioned under maximal tension in full, absolute extension (or even slight hyperextension). Over time, the allograft will inevitably stretch; if it is tensioned in any amount of flexion, it will stretch out and result in a debilitating permanent extensor lag.

Question 2402

Topic: 5. Sports Medicine

A 72-year-old male undergoes a full extensor mechanism allograft reconstruction for a chronic patellar tendon rupture following a total knee arthroplasty. To minimize the risk of postoperative extensor lag and ensure a successful outcome, what is the most critical intraoperative technical step?

. Tensioning the allograft tightly in full extension
. Tensioning the allograft tightly at 30 degrees of flexion
. Using an Achilles tendon allograft instead of a whole extensor mechanism
. Releasing the lateral retinaculum of the host tissue
. Allowing immediate active range of motion postoperatively

Correct Answer & Explanation

. Tensioning the allograft tightly in full extension

Explanation

Extensor mechanism allografts inevitably stretch over time. To prevent a debilitating postoperative extensor lag, the graft must be tensioned 'bar-string' tight with the knee in full, absolute extension during fixation.

Question 2403

Topic: 5. Sports Medicine
A 24-year-old professional athlete undergoes microfracture for a 1.5 cm^2 symptomatic full-thickness chondral defect on the medial femoral condyle. The reparative tissue that fills the defect over the next several months is primarily composed of which type of collagen?
. Type I collagen
. Type II collagen
. Type III collagen
. Type IV collagen
. Type X collagen

Correct Answer & Explanation

. Type I collagen

Explanation

Microfracture stimulates the release of mesenchymal stem cells from the underlying bone marrow. These cells differentiate and produce fibrocartilage, which is biomechanically inferior and primarily composed of Type I collagen, as opposed to normal hyaline articular cartilage, which is predominantly Type II collagen.

Question 2404

Topic: Knee Sports

During a primary posterior cruciate ligament (PCL)-retaining total knee arthroplasty, the surgeon notes that the trial components result in a knee that is well-balanced in extension but exhibits a significantly tight flexion gap with restricted femoral rollback. Which of the following is the most likely cause of this kinematic abnormality?

. The polyethylene insert is too thick
. The femoral component is undersized
. The tibial component was cut in excessive varus
. The posterior cruciate ligament (PCL) is too tight
. Excessive distal femoral bone was resected

Correct Answer & Explanation

. The posterior cruciate ligament (PCL) is too tight

Explanation

In a PCL-retaining TKA, a tight flexion gap with restricted rollback and anterior lift-off of the tibial tray indicates a tight PCL. Management includes sequential release of the PCL or increasing the posterior slope of the tibial cut to open the flexion gap.

Question 2405

Topic: Knee Sports

A 50-year-old female suffers an acute tear of the posterior root of the medial meniscus. If left untreated, what is the primary biomechanical consequence of this specific injury on the knee joint?

. Loss of circumferential hoop stresses leading to contact pressures equivalent to a total meniscectomy
. Increased anterior tibial translation during the Lachman test
. Decreased contact pressures in the medial compartment
. Immediate patellofemoral cartilage degradation due to altered tracking
. Lateral compartment overload leading to valgus deformity

Correct Answer & Explanation

. Loss of circumferential hoop stresses leading to contact pressures equivalent to a total meniscectomy

Explanation

A medial meniscal root tear completely unanchors the meniscus, leading to radial extrusion and a complete loss of circumferential hoop stresses. Biomechanically, this failure of load distribution results in articular contact pressures that are essentially equivalent to those seen after a complete total meniscectomy, rapidly accelerating medial compartment osteoarthritis.

Question 2406

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he has weakness with elbow flexion and supination, and numbness over the lateral forearm. Which nerve is most likely injured?

. Axillary nerve
. Musculocutaneous nerve
. Suprascapular nerve
. Radial nerve
. Median nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is at significant risk during the Latarjet procedure, particularly when retracting the conjoined tendon (coracobrachialis and short head of the biceps). The nerve typically enters the coracobrachialis 3-8 cm distal to the coracoid tip. Injury causes weakness in elbow flexion and supination, and sensory deficits in the lateral antebrachial cutaneous nerve distribution.

Question 2407

Topic: Knee Sports

A patient sustains a knee dislocation. Physical exam reveals a positive dial test at 30 degrees of flexion that normalizes to symmetry at 90 degrees of flexion. Which structures are most likely injured?

. Posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL)
. Isolated posterolateral corner (PLC)
. Combined PLC and PCL
. Medial collateral ligament (MCL) and ACL
. Isolated posteromedial corner (PMC)

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

The dial test assesses external rotation of the tibia relative to the femur. A positive test is defined as >10 degrees of external rotation compared to the contralateral side. Increased external rotation at 30 degrees that normalizes at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If it is increased at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 2408

Topic: Shoulder & Hip Sports

A 25-year-old hockey player is diagnosed with symptomatic cam-type femoroacetabular impingement (FAI). During arthroscopic osteochondroplasty, excessive resection of the femoral neck can lead to a femoral neck fracture. What is the recommended maximum depth of resection to minimize this risk?

. 5% of the femoral neck diameter
. 10% of the femoral neck diameter
. 30% of the femoral neck diameter
. 50% of the femoral neck diameter
. 70% of the femoral neck diameter

Correct Answer & Explanation

. 30% of the femoral neck diameter

Explanation

Biomechanical studies have demonstrated that resecting more than 30% of the anterolateral femoral neck diameter during osteochondroplasty for cam impingement significantly alters the load-bearing capacity of the proximal femur, exponentially increasing the risk of an iatrogenic postoperative femoral neck fracture.

Question 2409

Topic: 5. Sports Medicine

A 62-year-old laborer undergoes a superior capsular reconstruction (SCR) using a dermal allograft for a massive, irreparable posterosuperior rotator cuff tear. Which two anatomical structures serve as the primary medial and lateral attachment sites for the graft?

. Medial: Superior glenoid; Lateral: Greater tuberosity
. Medial: Base of coracoid; Lateral: Lesser tuberosity
. Medial: Acromion; Lateral: Greater tuberosity
. Medial: Supraspinatus fossa; Lateral: Humeral head articular margin
. Medial: Superior labrum; Lateral: Lesser tuberosity

Correct Answer & Explanation

. Medial: Superior glenoid; Lateral: Greater tuberosity

Explanation

In Superior Capsular Reconstruction (SCR), the allograft or autograft is attached medially to the superior glenoid (often incorporating the superior labrum) and laterally to the greater tuberosity footprint. This reconstructs the superior restraint of the shoulder, helping to depress the humeral head and allowing the deltoid to effectively elevate the arm.

Question 2410

Topic: Knee Sports
A 32-year-old male sustains an isolated Grade III posterior cruciate ligament (PCL) injury. Non-operative management is chosen. Which of the following rehabilitation protocols is most appropriate during the first 2-4 weeks to optimize ligament healing?
. Immobilization in full extension
. Immobilization in 90 degrees of flexion
. Immediate active knee flexion exercises
. Weight-bearing as tolerated in a hinged brace locked at 45 degrees
. Immediate open kinetic chain hamstring strengthening

Correct Answer & Explanation

. Immobilization in full extension

Explanation

For acute isolated PCL injuries, conservative management emphasizes immobilization in full extension (or slight hyperextension) for 2 to 4 weeks. This position minimizes posterior tibial sag, keeping the PCL in a shortened, reduced position to promote healing. Active hamstring exercises pull the tibia posteriorly and must be avoided in the early phases.

Question 2411

Topic: Knee Sports
A 17-year-old female requires medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar instability. According to Schöttle's point, where is the optimal anatomic femoral origin of the MPFL located radiographically on a true lateral view?
. Anterior to a line extending the posterior femoral cortex and distal to Blumensaat's line
. Anterior to a line extending the posterior femoral cortex and proximal to Blumensaat's line
. Posterior to a line extending the posterior femoral cortex and proximal to Blumensaat's line
. Posterior to a line extending the posterior femoral cortex and distal to Blumensaat's line
. Centered on the adductor tubercle

Correct Answer & Explanation

. Anterior to a line extending the posterior femoral cortex and proximal to Blumensaat's line

Explanation

Schöttle's point is the radiographic landmark for the femoral origin of the MPFL. On a true lateral radiograph, it 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 Blumensaat's line. Placing the graft here ensures proper isometry, avoiding over-tensioning in flexion.

Question 2412

Topic: Knee Sports

A 25-year-old football player sustains a lateral blow to his knee. On examination, he has a positive dial test at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees compared to the uninjured side. Which structure is most likely injured?

. Isolated anterior cruciate ligament (ACL)
. Isolated posterior cruciate ligament (PCL)
. Isolated posterolateral corner (PLC)
. Combined posterolateral corner (PLC) and posterior cruciate ligament (PCL)
. Combined anterior cruciate ligament (ACL) and posterolateral corner (PLC)

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

The dial test assesses for posterolateral knee instability. Asymmetry at 30 degrees of flexion with symmetry at 90 degrees indicates an isolated posterolateral corner (PLC) injury, whereas asymmetry at both 30 and 90 degrees suggests combined PLC and PCL injury.

Question 2413

Topic: Knee Sports
An 18-year-old female is undergoing medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. To ensure proper graft isometry, the femoral tunnel is placed at Schöttle's point. Where is this point located anatomically and radiographically on a true lateral view?
. Anterior to the posterior cortical line and distal to Blumensaat's line
. Anterior to the posterior cortical line and proximal to Blumensaat's line
. Posterior to the posterior cortical line and proximal to Blumensaat's line
. Anterior to the posterior cortical line and directly crossing Blumensaat's line
. Directly on the medial epicondyle prominence

Correct Answer & Explanation

. Anterior to the posterior cortical line and proximal to Blumensaat's line

Explanation

Schöttle's point is the radiographic anatomical origin of the MPFL. It is located 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the posterior extension of Blumensaat's line.

Question 2414

Topic: 5. Sports Medicine

A 40-year-old recreational tennis player presents with persistent shoulder pain and a confirmed type II SLAP tear. After failing non-operative management, surgery is planned. Compared to a SLAP repair, what is the primary advantage of a primary biceps tenodesis in this specific patient demographic?

. Higher rate of return to pre-injury overhead sports
. Decreased risk of postoperative shoulder stiffness
. Improved superior glenohumeral ligament stability
. Significantly shorter surgical time
. Lower incidence of musculocutaneous nerve injury

Correct Answer & Explanation

. Decreased risk of postoperative shoulder stiffness

Explanation

In patients over the age of 35-40 with type II SLAP tears, primary biceps tenodesis has been shown to result in greater patient satisfaction and a significantly decreased risk of postoperative stiffness compared to SLAP repair.

Question 2415

Topic: Knee Sports

A 55-year-old female presents with sudden medial knee pain. MRI shows a medial meniscus posterior root tear with 4 mm of meniscal extrusion. What is the primary biomechanical consequence of this specific injury pattern?

. Increased anterior tibial translation during terminal extension
. Complete loss of hoop stresses leading to increased peak contact pressures
. Decreased peak contact pressures across the medial compartment
. Increased internal rotation of the tibia at 90 degrees of flexion
. Loss of secondary valgus restraint

Correct Answer & Explanation

. Complete loss of hoop stresses leading to increased peak contact pressures

Explanation

A meniscal root tear results in complete loss of circumferential hoop stresses, making it biomechanically equivalent to a total meniscectomy. This leads to increased peak contact pressures and rapid progression of osteoarthritis.

Question 2416

Topic: 5. Sports Medicine

A patient undergoes primary ACL reconstruction with a bone-patellar tendon-bone autograft. Postoperatively, he achieves full terminal extension but has significantly limited flexion, describing a tight block at 90 degrees. What technical error in femoral tunnel placement most likely caused this specific complication?

. Placed too far anteriorly
. Placed too far posteriorly
. Placed too far superiorly (high on the wall)
. Placed too far inferiorly (low on the wall)
. Placed at the exact anatomical footprint

Correct Answer & Explanation

. Placed too far anteriorly

Explanation

A femoral tunnel placed too far anteriorly (non-isometric) creates a graft that is relatively lax in extension but becomes increasingly taut as the knee flexes. This excessive tension causes a mechanical block to flexion.

Question 2417

Topic: Shoulder & Hip Sports

A 24-year-old male presents with recurrent anterior shoulder instability. Imaging reveals a 15% anterior glenoid bone loss and an engaging Hill-Sachs lesion that is determined to be 'off-track'. What is the most appropriate surgical management?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with remplissage
. Latarjet procedure
. Open Bankart repair
. Putti-Platt procedure

Correct Answer & Explanation

. Arthroscopic Bankart repair with remplissage

Explanation

Although 15% glenoid bone loss is considered subcritical, an engaging Hill-Sachs lesion makes it 'off-track'. Arthroscopic Bankart repair combined with remplissage is indicated for off-track lesions with subcritical glenoid bone loss to prevent engagement.

Question 2418

Topic: 5. Sports Medicine

A 9-year-old boy (Tanner stage 1) sustains a mid-substance anterior cruciate ligament (ACL) tear. He and his family elect for surgical reconstruction. Which of the following techniques minimizes the risk of physeal arrest?

. Transphyseal reconstruction with a bone-patellar tendon-bone autograft
. Iliotibial band extra-articular physeal-sparing reconstruction
. Standard transphyseal adult reconstruction techniques
. Primary repair of the ACL with suture anchors
. Partial transphyseal reconstruction with rigid suspensory fixation

Correct Answer & Explanation

. Iliotibial band extra-articular physeal-sparing reconstruction

Explanation

In a Tanner stage 1 patient with significant remaining growth, physeal-sparing techniques such as an all-epiphyseal or an iliotibial band extra-articular (over-the-top) reconstruction are indicated. Placing bone plugs or drilling large tunnels across open physes carries a high risk of growth arrest.

Question 2419

Topic: Shoulder & Hip Sports

A 25-year-old hockey player is diagnosed with Femoroacetabular Impingement (FAI). Radiographs demonstrate an alpha angle of 65 degrees. Where is the cam lesion most commonly located on the femoral head-neck junction?

. Anteroinferior
. Anterosuperior
. Posterosuperior
. Posteroinferior
. Direct medial

Correct Answer & Explanation

. Anterosuperior

Explanation

Cam lesions in FAI represent an osseous bump at the femoral head-neck junction that decreases the normal concavity. They are most commonly located in the anterosuperior quadrant, leading to labral impingement during hip flexion and internal rotation.

Question 2420

Topic: Knee Sports

A 50-year-old female experiences a sudden pop in the back of her knee while squatting. MRI reveals a medial meniscus posterior root tear with meniscal extrusion. Biomechanically, what is the primary consequence if this injury is left untreated?

. Increased hoop stresses on the remaining meniscus
. Conversion of hoop stresses to destructive shear stresses
. Decreased contact pressures in the medial compartment
. Prevention of further meniscal extrusion
. Reversal of the screw-home mechanism

Correct Answer & Explanation

. Conversion of hoop stresses to destructive shear stresses

Explanation

A meniscal root tear disrupts the circumferential continuity of the meniscus, preventing the proper generation of hoop stresses. This converts normal compressive loads into shear stresses, functioning biomechanically like a total meniscectomy and leading to rapid cartilage wear.

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