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5. Sports Medicine MCQs

Practice Set 127 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 2521

Topic: Shoulder & Hip Sports

An AP pelvis radiograph of a 30-year-old male with chronic groin pain demonstrates the anterior rim of the acetabulum crossing the posterior rim superiorly, but the medial aspect of the acetabulum does not cross the ilioischial line. What is this radiographic 'crossover sign' indicative of?

. Coxa profunda
. Protrusio acetabuli
. Focal cranial retroversion (Pincer impingement)
. Cam-type femoroacetabular impingement
. Developmental dysplasia of the hip

Correct Answer & Explanation

. Focal cranial retroversion (Pincer impingement)

Explanation

The crossover sign on a well-centered AP pelvis radiograph indicates focal cranial retroversion of the acetabulum, which is a common cause of Pincer-type femoroacetabular impingement (FAI). In a normal hip, the anterior rim line should lie medial to the posterior rim line. When they cross, it indicates that the superior-anterior acetabulum is over-covering the femoral head. Coxa profunda is characterized by the acetabular fossa medial to the ilioischial line, while protrusio occurs when the femoral head itself crosses medial to the ilioischial line.

Question 2522

Topic: Knee Sports

A 24-year-old football player sustains a direct blow to the anteromedial aspect of his knee while it is hyperextended. Examination reveals increased external rotation of the tibia at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees compared to the contralateral leg. What is the most likely injured structure?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Posterolateral corner
. Posteromedial corner
. Medial collateral ligament

Correct Answer & Explanation

. Posterolateral corner

Explanation

An isolated posterolateral corner (PLC) injury presents with increased external rotation at 30 degrees of flexion but not at 90 degrees on the Dial test. If external rotation is increased at both 30 and 90 degrees, a combined PLC and PCL injury should be suspected.

Question 2523

Topic: Knee Sports

A 45-year-old male laborer complains of medial-sided left knee pain. Radiographs show isolated medial compartment osteoarthritis and varus alignment. He has full range of motion and a stable knee. Which of the following is the primary biomechanical goal of a high tibial osteotomy (HTO) in this patient?

. To restore the anterior cruciate ligament tension
. To shift the mechanical axis to the lateral compartment
. To shift the mechanical axis slightly lateral to the center of the knee
. To promote regeneration of articular cartilage in the medial compartment
. To prevent the progression of patellofemoral arthritis

Correct Answer & Explanation

. To shift the mechanical axis slightly lateral to the center of the knee

Explanation

The primary goal of a valgus-producing high tibial osteotomy is to unload the arthritic medial compartment by shifting the mechanical axis slightly lateral to the midline of the knee (typically 62% of the tibial width). This relieves pain and slows the progression of medial compartment arthritis.

Question 2524

Topic: Knee Sports

A 17-year-old female dancer requires medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar instability. Which of the following radiographic landmarks correctly describes the anatomic femoral attachment of the MPFL (Schottle's point)?

. Proximal and posterior to the medial epicondyle
. Distal and anterior to the adductor tubercle
. Proximal and anterior to the adductor tubercle
. Distal and posterior to the medial epicondyle
. Directly on the medial collateral ligament insertion

Correct Answer & Explanation

. Proximal and posterior to the medial epicondyle

Explanation

Schottle's point marks the anatomic femoral origin of the MPFL on lateral fluoroscopy. It is located dynamically between the medial epicondyle and the adductor tubercle, specifically proximal and posterior to the medial epicondyle.

Question 2525

Topic: 5. Sports Medicine

A 22-year-old male athlete has a focal, symptomatic, full-thickness osteochondral defect of the medial femoral condyle measuring 2.5 cm^2. Which of the following factors makes him a better candidate for Osteochondral Autograft Transfer System (OATS) rather than microfracture?

. Defect size strictly less than 1 cm^2
. Presence of underlying subchondral bone loss or cyst
. Defect location in the patellofemoral joint
. Patient age over 50 years
. Concomitant diffuse osteoarthritic changes

Correct Answer & Explanation

. Presence of underlying subchondral bone loss or cyst

Explanation

OATS involves the transplantation of cylindrical osteochondral plugs from non-weight-bearing areas to the defect. It is particularly advantageous over microfracture when there is underlying subchondral bone loss or a cyst, because the graft replaces both the deficient articular cartilage and the compromised subchondral bone. Microfracture relies on an intact subchondral bone plate to contain the marrow elements.

Question 2526

Topic: Knee Sports

Following a microfracture procedure for a symptomatic 1.5 cm^2 focal chondral defect on the medial femoral condyle, the resultant repair tissue is histologically evaluated. Compared to native articular cartilage, this repair tissue is predominantly characterized by an increased concentration of:

. Type I collagen
. Type II collagen
. Aggrecan
. Chondroitin sulfate
. Hyaluronan

Correct Answer & Explanation

. Type I collagen

Explanation

Microfracture is a marrow-stimulating technique that allows pluripotent mesenchymal stem cells to enter the chondral defect, resulting in the formation of fibrocartilage rather than native hyaline cartilage. Fibrocartilage is primarily composed of Type I collagen, which has inferior biomechanical wear characteristics compared to the Type II collagen predominant in normal hyaline articular cartilage.

Question 2527

Topic: Shoulder & Hip Sports

A 60-year-old male presents with pseudoparalysis and intractable shoulder pain. MRI shows a massive, retracted, and irreparable tear of the supraspinatus and infraspinatus tendons. The subscapularis, teres minor, and articular cartilage are intact. Which procedure is most appropriate?

. Total shoulder arthroplasty
. Superior capsular reconstruction
. Latissimus dorsi transfer
. Reverse total shoulder arthroplasty
. Arthroscopic debridement and biceps tenotomy

Correct Answer & Explanation

. Superior capsular reconstruction

Explanation

Superior Capsular Reconstruction (SCR) is indicated for massive, irreparable posterosuperior rotator cuff tears in active patients with intact articular cartilage (no glenohumeral arthritis), a functioning deltoid, and an intact or repairable subscapularis. It helps restore the superior restraint to humeral head translation. Latissimus dorsi transfer requires an intact subscapularis but SCR more effectively prevents superior escape when the superior capsule is deficient.

Question 2528

Topic: Knee Sports

A 14-year-old male baseball pitcher complains of lateral elbow pain and catching. Radiographs show a radiolucent lesion of the capitellum. MRI demonstrates an osteochondral lesion with fluid tracking behind the fragment. What is the most appropriate management?

. Cessation of throwing for 6 months
. Arthroscopic debridement and microfracture of the lesion
. Open reduction and internal fixation or osteochondral autograft transfer (OATS)
. Radial head excision
. Corticosteroid injection and physical therapy

Correct Answer & Explanation

. Open reduction and internal fixation or osteochondral autograft transfer (OATS)

Explanation

Fluid tracking behind an osteochondral fragment on MRI signifies an unstable osteochondritis dissecans (OCD) lesion. In an adolescent with an unstable lesion, operative management is indicated. Depending on fragment viability, fixation of the fragment or an osteochondral autograft transfer (OATS) provides the best chance to restore the articular surface. Microfracture alone for a large capitellar lesion in a high-demand thrower is often structurally insufficient.

Question 2529

Topic: Knee Sports
Following arthroscopic microfracture for a 1.5 cm^2 symptomatic focal chondral defect on the medial femoral condyle, what is the predominant collagen type found in the reparative tissue at 1 year postoperatively?
. Type I collagen
. Type II collagen
. Type III collagen
. Type IX collagen
. Type X collagen

Correct Answer & Explanation

. Type I collagen

Explanation

Microfracture is a marrow-stimulating technique that leads to the formation of fibrocartilage rather than normal hyaline cartilage. Fibrocartilage is predominantly composed of Type I collagen, whereas normal hyaline articular cartilage is predominantly composed of Type II collagen. This histologic difference accounts for the poorer long-term biomechanical durability of microfracture repairs.

Question 2530

Topic: Knee Sports
Matrix-induced Autologous Chondrocyte Implantation (MACI) was developed to overcome some limitations of first-generation ACI. Which of the following best describes the primary modification introduced in MACI?
. Use of mesenchymal stem cells instead of articular chondrocytes
. Seeding cultured chondrocytes onto a Type I/III collagen membrane prior to implantation
. Utilizing a periosteal patch harvested from the proximal tibia to cover the defect
. Single-stage procedure combining cell harvest and implantation
. Injection of cultured chondrocytes in a hyaluronic acid suspension without a scaffold

Correct Answer & Explanation

. Seeding cultured chondrocytes onto a Type I/III collagen membrane prior to implantation

Explanation

First-generation ACI utilized cultured chondrocytes injected under a periosteal patch, which was associated with high rates of patch hypertrophy. MACI (Matrix-induced ACI) involves culturing the autologous chondrocytes and seeding them onto a bioabsorbable porcine-derived Type I/III collagen membrane. This membrane is then cut to size and glued or sutured into the defect, bypassing the need for a periosteal harvest.

Question 2531

Topic: Knee Sports

Autologous Chondrocyte Implantation (ACI / MACI) is an established cell-based treatment for full-thickness articular cartilage defects. Which of the following scenarios represents the most ideal indication for this procedure?

. 1.5 cm^2 defect on the medial femoral condyle in a 25-year-old
. 3.5 cm^2 unipolar defect on the lateral femoral condyle in a 30-year-old
. Bipolar 'kissing' lesions of the patellofemoral joint in a 40-year-old
. 3.0 cm^2 defect in a 65-year-old with moderate osteoarthritis
. Osteochondritis dissecans lesion with an intact cartilage cap in a 12-year-old

Correct Answer & Explanation

. 3.5 cm^2 unipolar defect on the lateral femoral condyle in a 30-year-old

Explanation

Autologous Chondrocyte Implantation (ACI/MACI) is indicated for symptomatic, large (>2.0 to 3.0 cm^2), full-thickness, unipolar articular cartilage defects in young, active patients (typically < 50 years old) without advanced osteoarthritis. Defects smaller than 2.0 cm^2 are better treated with microfracture or OATS. Bipolar kissing lesions and moderate-to-severe OA are contraindications.

Question 2532

Topic: 5. Sports Medicine

During an Osteochondral Autograft Transfer System (OATS) procedure for a focal medial femoral condyle defect, cartilage plugs are harvested from a non-weight-bearing area, such as the peripheral trochlea. What is a recognized biomechanical disadvantage of these harvested donor osteochondral plugs compared to the native weight-bearing cartilage they are replacing?

. The donor cartilage has a significantly higher proteoglycan concentration.
. The donor cartilage exhibits lower compressive stiffness.
. The donor cartilage lacks a well-defined tidemark.
. The donor cartilage relies entirely on Type I collagen for stability.
. The donor cartilage is avascular, unlike native condylar cartilage.

Correct Answer & Explanation

. The donor cartilage exhibits lower compressive stiffness.

Explanation

Cartilage thickness and biomechanical properties vary topographically within the knee based on loading. Cartilage harvested from non-weight-bearing regions (like the superolateral trochlea or intercondylar notch) is biomechanically inferior to weight-bearing cartilage. Specifically, it has lower compressive stiffness, a lower proteoglycan content, and may be of a mismatched thickness, which can affect long-term durability when transferred to a high-load zone.

Question 2533

Topic: 5. Sports Medicine

A 35-year-old athlete undergoes an arthroscopic evaluation of the knee. The health of the articular cartilage surface relies heavily on boundary lubrication to minimize friction. Which of the following glycoproteins is primarily responsible for boundary lubrication of articular cartilage?

. Hyaluronic acid
. Aggrecan
. Lubricin (PRG4)
. Type II collagen
. Chondroitin sulfate

Correct Answer & Explanation

. Lubricin (PRG4)

Explanation

Lubricin (Proteoglycan 4 or PRG4) is synthesized by superficial zone chondrocytes and synoviocytes, playing the critical role in boundary lubrication of the articular surface. Hyaluronic acid primarily contributes to fluid-film lubrication.

Question 2534

Topic: 5. Sports Medicine
A 24-year-old soccer player undergoes a knee arthroscopy for a 1.5 cm symptomatic focal chondral defect on the medial femoral condyle. The surgeon performs a marrow stimulation technique (microfracture). The primary reparative tissue that will fill this defect is predominantly composed of which of the following?
. Type I collagen
. Type II collagen
. Type III collagen
. Type IX collagen
. Type X collagen

Correct Answer & Explanation

. Type I collagen

Explanation

Microfracture stimulates bleeding from the subchondral bone, leading to the formation of a fibrocartilage clot. Fibrocartilage is primarily composed of Type I collagen, which is biomechanically inferior to native hyaline cartilage (Type II collagen).

Question 2535

Topic: 5. Sports Medicine

A 72-year-old woman sustained a patellar tendon rupture 5 years after her TKA. A primary repair failed, leaving her with an inability to actively extend the knee. She is undergoing reconstruction with a full extensor mechanism allograft. To maximize the chance of a successful outcome and prevent an extensor lag, how should the allograft be tensioned?

. In 30 degrees of flexion
. In 60 degrees of flexion
. In 90 degrees of flexion
. In full extension with maximal tension
. Loosely to permit immediate postoperative range of motion

Correct Answer & Explanation

. In full extension with maximal tension

Explanation

When reconstructing the extensor mechanism with an allograft, it must be tensioned tightly in full extension. Failure to do so uniformly leads to a significant extensor lag due to subsequent graft stretch-out during rehabilitation.

Question 2536

Topic: Knee Sports
The major blood supply to the cruciate ligaments arises from which of the following structures?
. Superior genicular artery
. Middle genicular artery
. Inferior genicular artery
. Infrapatellar fat pad
. Intramedullary vessels

Correct Answer & Explanation

. Middle genicular artery

Explanation

The major blood supply to the cruciate ligaments arises from the ligamentous branches of the middle genicular artery. Few terminal branches of the inferior genicular artery contribute to the blood supply. The synovial plexus and sheath covering the cruciate ligaments are also supplied by branches of the middle genicular artery. The blood supply to the cruciate ligaments is predominately of soft-tissue origin. There is no significant osseous vascular contribution to the ligaments.

Question 2537

Topic: Shoulder & Hip Sports

In rotator cuff tear arthropathy with pseudoparalysis, forward elevation of the humerus away from the body is prohibited because of

. deltoid atony.
. loss of the glenoid concavity.
. loss of the humeral head depression of the biceps tendon.
. loss of compressive force on the humeral head.

Correct Answer & Explanation

. loss of compressive force on the humeral head.

Explanation

The rotator cuff serves as a humeral head compressor that stabilizes the humeral head in the glenoid concavity so that the deltoid can convert a vertical force into abduction and forward elevation. The deltoid functions normally in patients with chronic rotator cuff arthropathy, so no atony is present. Glenoid concavity can be lost over time, but this is not the primary mechanism for failure of elevation. The biceps tendon does not serve as a humeral head compressor and does not prevent proximal migration of the shoulder when it is present.

Question 2538

Topic: Shoulder & Hip Sports
Figures 34a and 34b show the axial and sagittal MRI scans of a 36-year-old man who reports the insidious onset of pain in the right shoulder. What is the most appropriate description of the acromial morphology?
. Type I acromion
. Type III acromion
. Meso os acromiale
. Meta os acromiale
. Pre os acromiale

Correct Answer & Explanation

. Meso os acromiale

Explanation

The MRI scans reveal a meso os acromiale with edema at the site in a skeletally mature patient. Sher JS: Anatomy, biomechanics, and pathophysiology of rotator cuff disease, in Iannotti JP, Williams GR (eds): Disorders of the Shoulder: Diagnosis and Management. Philadelphia, PA, Lippincott Williams & Wilkins, 1999, p 23.

Question 2539

Topic: Shoulder & Hip Sports

A 51-year-old woman is seen for evaluation of chronic supraspinatus and infraspinatus tendon tears. Three years ago, in an attempted repair the surgeon was unable to repair the supraspinatus and infraspinatus tendon tears. Currently she has a marked amount of pain, reduced range of motion, and weakness. Examination reveals anterosuperior escape. Radiographs show no signs of arthritic changes. You are considering a latissimus dorsi tendon transfer. During the discussion, you mention that

. she can expect to have good pain relief following surgery.
. active forward elevation and external rotation are reliably obtained postoperatively.
. with her current anterosuperior escape, she is likely to have a poor surgical result.
. postoperatively, significant muscular atrophy in the latissimus dorsi commonly occurs.
. no advancement in glenohumeral arthritic changes should occur following surgery.

Correct Answer & Explanation

. with her current anterosuperior escape, she is likely to have a poor surgical result.

Explanation

Latissimus dorsi tendon transfer is considered a surgical option for treatment in patients with chronic supraspinatus and infraspinatus tendon tears. Preoperative subscapularis function is necessary for good clinical results. Additionally, men with active elevation to shoulder level and active external rotation to 20 degrees have predictably good results. Women with active shoulder elevation limited to below chest level have poor results from this procedure and should not be considered candidates. Postoperatively they lack pain control, active elevation, and active external rotation. Muscular atrophy in the latissimus dorsi does not occur, and glenohumeral arthritic changes frequently develop postoperatively. Gerber C, Maquieira G, Espinosa N: Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears: Factors affecting outcome. J Bone Joint Surg Am 2006;88:113-120.

Question 2540

Topic: Shoulder & Hip Sports

A 22-year-old swimmer underwent thermal capsulorrhaphy treatment for recurrent anterior subluxation. Following 3 weeks in a sling, an accelerated rehabilitation program allowed him to return to swimming in 3 1/2 months. While practicing the butterfly stroke, he sustained an anterior dislocation. He now continues to have symptoms of anterior instability and has elected to have further surgery. Surgical findings may include a

Sports Medicine 2004 Practice Questions: Set 1 (Solved) - Figure 10

. biceps subluxation.
. glenoid rim fracture.
. subscapularis detachment.
. loose body.
. deficient anterior capsule.

Correct Answer & Explanation

. deficient anterior capsule.

Explanation

Complications of thermal capsule shrinkage or accelerated rehabilitation include capsule ablation. Since the original surgery did not include labral reattachment, findings of a Bankart lesion or a glenoid fracture from a nontraumatic injury are unlikely. Subscapularis detachment or biceps subluxation is a postoperative complication of open repairs. Failure of early postoperative instability treatment should not produce loose bodies. Abrams JS: Thermal capsulorrhaphy for instability of the shoulder: Concerns and applications of the heat probe. Instr Course Lect 2001;50:29-36.

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