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5. Sports Medicine MCQs

Practice Set 122 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 2421

Topic: Shoulder & Hip Sports

A 55-year-old active laborer with an irreparable posterosuperior rotator cuff tear is evaluated for a latissimus dorsi tendon transfer. Which of the following is a strict prerequisite for a successful functional outcome?

. An intact or repairable subscapularis
. An intact supraspinatus
. Pre-existing advanced glenohumeral arthritis
. A paralyzed axillary nerve
. Patient age greater than 75 years

Correct Answer & Explanation

. An intact or repairable subscapularis

Explanation

Latissimus dorsi transfer for an irreparable posterosuperior rotator cuff tear requires an intact or repairable subscapularis to maintain an anterior force couple. Without it, the humeral head cannot be centered in the glenoid, leading to transfer failure.

Question 2422

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the femoral tunnel must be placed anatomically to avoid non-isometric graft tension. Which anatomical landmarks define Schöttle's point for the femoral origin?
. Anterior to the posterior cortical line extension and distal to Blumensaat's line
. Between the adductor tubercle and the medial epicondyle
. At the center of the medial femoral condyle articular surface
. Posterior to the adductor magnus insertion
. On the lateral femoral condyle distal to the popliteus insertion

Correct Answer & Explanation

. Between the adductor tubercle and the medial epicondyle

Explanation

The anatomic femoral origin of the MPFL (Schöttle's point) is located in the saddle-shaped depression between the adductor tubercle and the medial epicondyle. Accurate placement prevents graft overtensioning during knee flexion.

Question 2423

Topic: Knee Sports

To minimize the risk of popliteal artery injury during tibial tunnel reaming in an arthroscopic posterior cruciate ligament (PCL) reconstruction, in what position should the knee be placed and why?

. Extension, as it moves the artery anteriorly
. Flexion past 90 degrees, as it increases the distance between the posterior capsule and the artery
. Flexion past 90 degrees, as it moves the artery laterally
. Extension, to tighten the posterior capsule
. 45 degrees of flexion, to maximize capsular volume

Correct Answer & Explanation

. Flexion past 90 degrees, as it increases the distance between the posterior capsule and the artery

Explanation

Flexing the knee beyond 90 degrees allows the popliteal artery to fall posteriorly away from the joint capsule. This maximizes the safe distance between the reamer and the neurovascular bundle during PCL tibial tunnel creation.

Question 2424

Topic: Knee Sports

A 22-year-old football player sustains a complex knee injury. Physical examination reveals a positive Dial test with increased external rotation at 30 degrees of knee flexion, but symmetric external rotation at 90 degrees of flexion. Which structures are most likely injured?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

An increase in external rotation at 30 degrees of flexion that normalizes at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If external rotation is increased at both 30 and 90 degrees, a combined PLC and PCL injury is suspected.

Question 2425

Topic: Knee Sports

A 19-year-old female undergoes an anterior cruciate ligament (ACL) reconstruction. If the femoral tunnel is placed too vertically (at the 12 o'clock position) in the intercondylar notch, what is the most likely clinical outcome?

. Loss of full knee extension
. Intact rotational stability but persistent anterior-posterior laxity
. Intact anterior-posterior stability but persistent rotational laxity (positive pivot shift)
. Increased risk of graft impingement against the PCL
. Early patellofemoral arthritis

Correct Answer & Explanation

. Intact anterior-posterior stability but persistent rotational laxity (positive pivot shift)

Explanation

A vertically placed ACL graft will adequately resist anterior tibial translation but fails to control rotational kinematics. This commonly presents postoperatively as a persistent pivot shift despite a negative Lachman test.

Question 2426

Topic: Shoulder & Hip Sports
A 26-year-old professional volleyball player presents with persistent shoulder pain during overhead serving. MRI arthrogram reveals a detachment of the superior labrum and biceps anchor from the glenoid. Which classification type does this describe, and what is the primary surgical management for this young overhead athlete who failed conservative care?
. Type I SLAP tear; arthroscopic debridement
. Type II SLAP tear; arthroscopic SLAP repair
. Type III SLAP tear; biceps tenodesis
. Type IV SLAP tear; biceps tenotomy
. Type II SLAP tear; open Latarjet procedure

Correct Answer & Explanation

. Type II SLAP tear; arthroscopic SLAP repair

Explanation

A detachment of the superior labrum and biceps anchor from the glenoid is a Type II SLAP tear. In young overhead athletes who fail conservative management, arthroscopic repair of the labrum is generally preferred to restore native anatomy and function.

Question 2427

Topic: Knee Sports
A 16-year-old female presents with recurrent lateral patellar instability and is scheduled for medial patellofemoral ligament (MPFL) reconstruction. To restore normal kinematics, the femoral tunnel must be placed at the anatomic MPFL footprint (Schöttle's point). Where is this landmark located radiographically on a strict lateral view?
. 1 mm anterior to the posterior femoral cortical line and 2.5 mm distal to Blumensaat's line
. 1 mm posterior to the posterior femoral cortical line and 2.5 mm proximal to Blumensaat's line
. 5 mm anterior to the posterior femoral cortical line and 5 mm proximal to Blumensaat's line
. On the posterior femoral cortical line, at the level of the adductor tubercle
. 5 mm distal to Blumensaat's line and 5 mm anterior to the posterior femoral cortical line

Correct Answer & Explanation

. 1 mm anterior to the posterior femoral cortical line and 2.5 mm distal to Blumensaat's line

Explanation

Schöttle's point defines the radiographic femoral footprint of the MPFL on a strict lateral X-ray. It is located 1 mm anterior to the posterior femoral cortical extension line, 2.5 mm distal to the posterior border of Blumensaat's line, and proximal to the posterior aspect of the medial femoral condyle.

Question 2428

Topic: 5. Sports Medicine
A 21-year-old professional baseball player has had painful catching and stiffness in his dominant right elbow for the past year. Examination reveals a flexion contracture of 2 degrees and mild pain with full elbow flexion. Radiographs show osteochondritis dissecans of the capitellum and a loose body in the anterior compartment. The most effective management should consist of:
. Arthroscopic removal of the loose body
. Reconstruction of the medial collateral ligament
. A short period of rest followed by a gradual return to activity
. Physical therapy and dynamic extension splinting
. A corticosteroid injection

Correct Answer & Explanation

. Physical therapy and dynamic extension splinting

Explanation

The radiographs show osteochondritis dissecans of the capitellum and a loose body in the anterior compartment. Arthroscopic removal is indicated because symptoms referable to the loose body are present.

Question 2429

Topic: 5. Sports Medicine

A 35-year-old carpenter sustains a saw injury resulting in a 3.5 cm defect in the proper digital nerve of the index finger in Zone 2. Which of the following reconstructive options represents the gold standard with the most predictable sensory recovery for this specific defect?

. End-to-end repair under extreme tension
. Reconstruction using an FDA-approved collagen nerve conduit
. Autologous nerve grafting utilizing the medial antebrachial cutaneous nerve
. Decellularized nerve allograft
. Vein graft wrapping without neural tissue

Correct Answer & Explanation

. Autologous nerve grafting utilizing the medial antebrachial cutaneous nerve

Explanation

For digital nerve gaps greater than 2.5 to 3.0 cm, autologous nerve grafting remains the gold standard. While nerve conduits and decellularized allografts are often used for smaller gaps (<1.5 to 2.0 cm) to avoid donor site morbidity, their clinical outcomes drop significantly for defects larger than 3 cm. An autograft (such as the medial antebrachial cutaneous or sural nerve) provides the necessary endoneurial architecture and viable Schwann cells to support regeneration across large gaps.

Question 2430

Topic: Shoulder & Hip Sports

An 8-month-old infant presents with an unresolved Erb-Duchenne palsy (C5-C6 injury) following a difficult vertex delivery with shoulder dystocia. The affected arm rests in internal rotation and adduction at the shoulder, with the elbow extended and forearm pronated. The internal rotation contracture of the shoulder is primarily driven by the unopposed action of which of the following muscles?

. Subscapularis and Pectoralis major
. Infraspinatus and Teres minor
. Supraspinatus and Deltoid
. Latissimus dorsi and Teres major
. Biceps brachii and Coracobrachialis

Correct Answer & Explanation

. Subscapularis and Pectoralis major

Explanation

In Erb-Duchenne palsy, damage to the C5 and C6 nerve roots causes paralysis of the external rotators (infraspinatus and teres minor) and abductors (supraspinatus and deltoid) of the shoulder, as well as the elbow flexors (biceps, brachialis) and forearm supinators. The unparalyzed internal rotators—most notably the subscapularis and pectoralis major—overpower the weak external rotators, leading to a progressive internal rotation contracture of the shoulder. This positional deformity is classically referred to as the 'waiter's tip' posture.

Question 2431

Topic: 5. Sports Medicine

The sural nerve is the most common autograft utilized for bridging peripheral nerve defects. Following harvesting of the sural nerve from the posterior calf, in which specific area will the patient predictably experience a permanent sensory deficit?

. Plantar aspect of the heel
. Medial aspect of the lower leg
. Dorsal web space between the first and second toes
. Lateral aspect of the foot
. Plantar aspect of the forefoot

Correct Answer & Explanation

. Lateral aspect of the foot

Explanation

The sural nerve provides sensory innervation to the lateral aspect of the foot and the distal posterolateral lower leg, making these areas predictably insensate after graft harvest.

Question 2432

Topic: 5. Sports Medicine

During surgical exploration of a complete median nerve transection in the mid-forearm, a nerve defect of 3.5 cm is measured after debridement of non-viable tissue. The injury is 4 weeks old. What is the gold standard reconstruction for this defect?

. Primary end-to-end repair under tension
. Synthetic nerve conduit bridging
. Acellular nerve allograft
. Autologous sural nerve grafting
. Nerve transfer using the anterior interosseous nerve

Correct Answer & Explanation

. Autologous sural nerve grafting

Explanation

For critical mixed or motor nerve defects greater than 2.5 to 3 cm, autologous nerve grafting (e.g., sural nerve) remains the gold standard. Synthetic conduits and allografts have higher failure rates for defects larger than 3 cm or in major motor/mixed nerves.

Question 2433

Topic: 5. Sports Medicine

A 28-year-old carpenter presents with a 5 cm gap in the median nerve at the mid-forearm following a circular saw injury 3 months ago. Which of the following grafting techniques provides the highest likelihood of successful motor and sensory recovery?

. Acellular nerve allograft
. Silicone nerve conduit
. Polyglycolic acid tube conduit
. Reversed sural nerve autograft
. Vascularized medial antebrachial cutaneous nerve graft

Correct Answer & Explanation

. Reversed sural nerve autograft

Explanation

For critical nerve gaps greater than 3 cm, autograft (such as the reversed sural nerve) remains the gold standard. Conduits and acellular allografts have unacceptably high failure rates in gaps exceeding 3 cm.

Question 2434

Topic: Shoulder & Hip Sports

A 25-year-old pitcher experiences sudden, severe right shoulder pain, followed two weeks later by profound weakness in external rotation and elevation. EMG demonstrates denervation isolated to the supraspinatus and infraspinatus. There is no history of trauma. What is the most likely diagnosis?

. Quadrilateral space syndrome
. Suprascapular notch cyst
. Parsonage-Turner syndrome
. C5 radiculopathy
. Rotator cuff tear

Correct Answer & Explanation

. Parsonage-Turner syndrome

Explanation

Parsonage-Turner syndrome (idiopathic brachial neuritis) typically presents with acute, severe shoulder girdle pain followed by patchy weakness and amyotrophy, most commonly affecting the upper trunk distributions like the suprascapular nerve.

Question 2435

Topic: 5. Sports Medicine

A 40-year-old male requires an autologous nerve graft to bridge a 3 cm defect in the median nerve at the mid-forearm level. You choose to harvest the sural nerve. What essential biological component does this non-vascularized nerve autograft provide to facilitate axonal regeneration across the defect?

. Viable axons that directly anastomose with the proximal stump
. A rich, uninterrupted blood supply to sustain immediate endoneurial growth
. A scaffold of Schwann cell basal lamina tubes (endoneurial tubes)
. Potent osteoinductive morphogenetic proteins that inhibit scar formation
. A permanent, functioning myelin sheath that immediately restores conduction velocity

Correct Answer & Explanation

. A scaffold of Schwann cell basal lamina tubes (endoneurial tubes)

Explanation

A non-vascularized nerve autograft acts as a biological scaffold. The axons and myelin within the graft undergo Wallerian degeneration. However, the graft provides structurally intact endoneurial tubes (Schwann cell basal lamina) and viable Schwann cells (which survive via initial imbibition and later revascularization) that guide the regenerating axons from the proximal nerve stump to the distal stump.

Question 2436

Topic: 5. Sports Medicine

A surgeon is considering the use of an allograft tendon for a staged tendon reconstruction in the hand to bypass the morbidity of autograft harvest. Which of the following is an established disadvantage of using allograft tissue compared to autograft in flexor tendon reconstruction?

. Higher risk of complete rejection mediated by major histocompatibility complex (MHC) incompatibility
. Delayed cellular repopulation and slower remodeling, leading to prolonged mechanical weakness
. Inability to achieve appropriate length for tensioning due to standard allograft processing lengths
. Immediate catastrophic degradation by synovial fluid enzymes
. Absolute contraindication due to a 100% risk of pseudo-sheath collapse

Correct Answer & Explanation

. Delayed cellular repopulation and slower remodeling, leading to prolonged mechanical weakness

Explanation

Tendon allografts are primarily acellular collagen scaffolds. Because they lack living tenocytes initially, they rely entirely on cellular repopulation and creeping substitution from the host tissue. This process delays the biological remodeling phase, rendering the allograft mechanically weaker for a longer period compared to autografts, thereby increasing the risk of stretching or rupture during early active rehabilitation. Outright immunologic rejection is rare due to the relatively avascular and acellular nature of processed tendon allografts.

Question 2437

Topic: 5. Sports Medicine

A 25-year-old patient requires a sural nerve autograft to bridge a 4 cm median nerve defect in the forearm. Following the nerve grafting procedure, which of the following correctly describes a critical physiological phase that the graft must undergo to support host axonal regeneration?

. The graft provides living Schwann cells that rapidly myelinate the host axons without prior degradation.
. The graft acts strictly as an acellular osteoconductive scaffold for nerve migration.
. Wallerian degeneration must clear the donor graft's axonal debris to provide viable endoneurial tubes.
. The graft's intrinsic axons remain viable and anastomose with the host's proximal axons.
. The graft initiates central chromatolysis directly in the target end-organ muscle.

Correct Answer & Explanation

. Wallerian degeneration must clear the donor graft's axonal debris to provide viable endoneurial tubes.

Explanation

In a nerve autograft, the donor axons within the graft undergo Wallerian degeneration. The clearing of this axonal and myelin debris by macrophages is essential to create empty endoneurial tubes. The graft's viable Schwann cells then proliferate and guide the regenerating host axons from the proximal nerve stump through these endoneurial tubes toward the distal target. The graft's original axons do not survive or anastomose; they are cleared.

Question 2438

Topic: 5. Sports Medicine

A 24-year-old athlete presents 5 weeks after a 'jersey finger' injury (avulsion of the FDP tendon) of the ring finger. Surgical exploration reveals the FDP tendon is retracted into the palm with severe scarring, and primary repair is impossible. The flexor digitorum superficialis (FDS) is fully intact and functional. What is the most appropriate surgical option to restore stability to the distal finger?

. Free vascularized toe transfer
. Two-stage flexor tendon grafting using palmaris longus
. Excision of the FDS and one-stage flexor tendon grafting
. DIP joint arthrodesis
. Primary end-to-end repair using a bridging allograft

Correct Answer & Explanation

. DIP joint arthrodesis

Explanation

In a chronic Zone I FDP avulsion where the tendon cannot be primarily repaired but the FDS is completely intact and functional, attempting to pass a tendon graft through the intact FDS risks compromising the function of the FDS and causing stiffness of the PIP joint. The standard and most predictable reconstructive option is arthrodesis of the distal interphalangeal (DIP) joint (or FDP tenodesis) to provide a stable pinch.

Question 2439

Topic: Shoulder & Hip Sports

During a Latarjet procedure for recurrent anterior shoulder instability, the coracoid process is transferred to the anterior glenoid rim. The 'sling effect' provided by this procedure, which contributes significantly to stability when the arm is abducted and externally rotated, is created by which of the following?

. Coracoacromial ligament tensioning
. Conjoined tendon (biceps short head and coracobrachialis)
. Pectoralis minor dynamic pull
. Upper border of the subscapularis
. Transverse humeral ligament

Correct Answer & Explanation

. Conjoined tendon (biceps short head and coracobrachialis)

Explanation

The Latarjet procedure stabilizes the shoulder via a triple-blocking effect. The 'sling effect' is the dynamic stabilization provided by the conjoined tendon (short head of the biceps and coracobrachialis), which passes through the lower portion of the split subscapularis muscle. When the arm is placed in abduction and external rotation, the conjoined tendon acts as a sling to tension the inferior capsule and lower subscapularis, preventing anterior translation of the humeral head.

Question 2440

Topic: Shoulder & Hip Sports

During a Latarjet procedure for recurrent anterior shoulder instability, the conjoined tendon is aggressively retracted medially to facilitate exposure of the subscapularis. Over-retraction or aggressive manipulation of the conjoined tendon places which of the following nerves at greatest risk of stretch injury?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve enters the coracobrachialis (part of the conjoined tendon) approximately 5 to 8 cm distal to the tip of the coracoid process, though its course can be variable. Aggressive medial and distal retraction of the conjoined tendon during the Latarjet procedure or a deltopectoral approach puts the musculocutaneous nerve at significant risk for a neuropraxic stretch injury.

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