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5. Sports Medicine MCQs

Practice Set 13 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 241

Topic: 5. Sports Medicine

A 22-year-old male tennis player has dominant side shoulder pain when serving and hitting overheads. Despite a prolonged course of physiotherapy, he is unable to return to tennis because of shoulder pain. His treating physician recommend arthroscopy of his shoulder with debridement of associated lesions. What is the likelihood that he will be playing tennis at his preinjury level of competition at 1 year following surgery:

. 10%
. 30%
. 50%
. 75%
. 90%

Correct Answer & Explanation

. 50%

Explanation

This patient has internal impingement of the shoulder, presumably with associated labral and rotator cuff lesions. Sonnery-Cottet and colleagues reported results of 28 tennis players with internal impingement treated with arthroscopic debridement of associated lesions. Although 22 of the 28 tennis players were able to return to tennis following surgery, only 14 of the players were able to return to their preinjury level of competition.

Question 242

Topic: 5. Sports Medicine

A glenoid profile radiograph (Slide) of a 21-year-old male rugby player with multiple traumatic anterior shoulder dislocations is presented. Which of the following is the preferred treatment:

. Sling for a period of 6 weeks
. Physiotherapy emphasizing strengthening of dynamic shoulder stabilizers
. C apsular shift
. Bankart reconstruction
. Bony augmentation procedure(iliac crest)

Correct Answer & Explanation

. Bony augmentation procedure(iliac crest)

Explanation

The radiograph demonstrates anterior glenoid rim insufficiency, which is a risk factor for failure of soft tissue reconstructions especially in contact athletes. The arrows on the figure represent the anterior border of the glenoid rim. A coracoid transfer procedure to reconstruct the anterior bony deficiency maximizes the possibility for successful restoration of shoulder stability.

Question 243

Topic: Shoulder & Hip Sports
When performing a Latarjet coracoid transfer for anterior shoulder instability with bony anterior glenoid rim insufficiency, the glenoid surface of the coracoid transfer must be positioned:
. Flush with the glenoid rim
. 5 mm medial to the glenoid rim
. 10 mm medial to the glenoid rim
. 5 mm lateral to the glenoid rim
. 10 mm lateral to the glenoid rim

Correct Answer & Explanation

. Flush with the glenoid rim

Explanation

Allain and colleagues have clearly demonstrated that a coracoid transfer overhanging laterally to the glenoid rim is associated with the development of arthritis. One of the functions of the coracoid transfer is to increase the anteroposterior diameter of the glenoid, not to serve as a bone block.

Question 244

Topic: 5. Sports Medicine

An arthroscopic photo (Slide) during shoulder arthroscopy looking from the posterior portal is presented. The arrows point to which structure:

. Biceps tendon
. Subscapularis tendon
. Supraspinatus tendon
. Teres minor tendon
. Inferior glenohumeral ligament

Correct Answer & Explanation

. Supraspinatus tendon

Explanation

The insertion of the supraspinatus tendon is readily visible through the posterior arthroscopic portal.

Question 245

Topic: 5. Sports Medicine

An arthroscopic photo (Slide) looking from the posterior portal is presented. The arrows point to which structure:

. Biceps tendon
. Subscapularis tendon
. Supraspinatus tendon
. Middle glenohumeral ligament
. Inferior glenohumeral ligament

Correct Answer & Explanation

. Subscapularis tendon

Explanation

The identified structure is the subscapularis tendon, which is readily visible during shoulder arthroscopy. The middle glenohumeral ligament crosses the superior border of the subscapularis tendon.

Question 246

Topic: Shoulder & Hip Sports

An arthroscopic photo (Slide) looking from the posterior portal is presented. Identify the torn structure:

. Middle glenohumeral ligament
. Inferior glenohumeral ligament
. Subscapularis tendon
. Infraspinatus tendon
. Ligamentous pulley of long head biceps

Correct Answer & Explanation

. Ligamentous pulley of long head biceps

Explanation

This photo demonstrates a torn ligamentous pulley that has possibly resulted in an unstable biceps tendon. Pathology of the ligamentous pulley is often associated with rotator cuff pathology.

Question 247

Topic: Knee Sports
When comparing anterior cruciate ligament (ACL) reconstruction using autogenous hamstrings and ACL reconstruction using autogenous patellar tendon, the most consistent difference is:
. The patellar tendon group has more patellofemoral pain.
. The hamstring group has more loss of motion.
. The patellar tendon group is more likely to return to activity.
. The hamstring group has a higher incidence of graft failures.
. The hamstring group has better results with arthrometer testing.

Correct Answer & Explanation

. The patellar tendon group has more patellofemoral pain.

Explanation

Shaieb and associates recently reported a prospective randomized study comparing autogenous hamstring ACL reconstruction to autogenous patellar tendon ACL reconstruction. The only significant differences that were elicited between the groups at a minimum of 2-years' follow-up were the incidences of patellofemoral pain and loss of motion, both in favor of the hamstring group.

Question 248

Topic: Knee Sports

During reconstruction of the posterior cruciate ligament (PCL), understanding the bundle anatomy is critical for restoring normal knee kinematics. Which of the following statements regarding the anterolateral (AL) and posteromedial (PM) bundles is correct?

. The AL bundle is tight in extension and the PM bundle is tight in flexion
. The AL bundle is tight in flexion and the PM bundle is tight in extension
. Both bundles are maximally tight in deep flexion
. Both bundles are maximally tight in full extension

Correct Answer & Explanation

. The AL bundle is tight in flexion and the PM bundle is tight in extension

Explanation

The PCL consists of the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. Biomechanically, the AL bundle is tight in flexion, while the PM bundle is tight in extension.

Question 249

Topic: Knee Sports

A 24-year-old football player sustains a direct blow to the anteromedial tibia with the knee in extension. Physical examination reveals a positive dial test with 15 degrees of asymmetric external rotation at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees compared to the contralateral knee. What is the most likely injured structure?

. Isolated posterior cruciate ligament
. Isolated posterolateral corner
. Combined PCL and posterolateral corner
. Isolated anterior cruciate ligament

Correct Answer & Explanation

. Isolated posterolateral corner

Explanation

An asymmetric increase in external rotation of greater than 10 degrees at 30 degrees of flexion, but not at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. If asymmetry is present at both 30 and 90 degrees, it suggests a combined PLC and PCL injury.

Question 250

Topic: Knee Sports
In a patient with recurrent lateral patellar dislocations undergoing medial patellofemoral ligament (MPFL) reconstruction, the femoral tunnel must be placed anatomically to prevent abnormal patellofemoral contact pressures. Where is the anatomical femoral attachment of the MPFL located?
. Anterior to the adductor tubercle and proximal to the medial epicondyle
. Posterior to the adductor tubercle and distal to the medial epicondyle
. Between the adductor tubercle proximally and the medial epicondyle distally
. Directly on the medial epicondyle

Correct Answer & Explanation

. Between the adductor tubercle proximally and the medial epicondyle distally

Explanation

The anatomic femoral origin of the MPFL, clinically referred to as Schöttle's point, is located in the saddle region between the adductor tubercle proximally and the medial epicondyle distally.

Question 251

Topic: Knee Sports

A 45-year-old patient experiences a sudden 'pop' in the posterior knee while squatting. MRI reveals a posterior medial meniscus root tear. Biomechanically, this injury is equivalent to which of the following?

. A partial meniscectomy
. A total meniscectomy
. An anterior horn tear
. A radial tear of the lateral meniscus

Correct Answer & Explanation

. A total meniscectomy

Explanation

A meniscal root tear completely disrupts the hoop stresses of the meniscus, rendering it biomechanically nonfunctional. Contact pressures and joint kinematics become equivalent to a total meniscectomy, leading to rapid cartilage degeneration.

Question 252

Topic: Shoulder & Hip Sports

A 22-year-old hockey player presents with anterior groin pain exacerbated by hip flexion and internal rotation. Radiographs reveal an increased alpha angle, consistent with femoroacetabular impingement (FAI). This morphological abnormality (Cam lesion) is typically located in which quadrant of the femoral head-neck junction?

. Anterosuperior
. Anteroinferior
. Posterosuperior
. Posteroinferior

Correct Answer & Explanation

. Anterosuperior

Explanation

A Cam lesion is characterized by a loss of spherical concavity at the femoral head-neck junction, resulting in an increased alpha angle (typically >55 degrees). It is most commonly located in the anterosuperior quadrant of the proximal femur.

Question 253

Topic: 5. Sports Medicine

A 19-year-old collegiate soccer player undergoes ACL reconstruction. Which of the following autografts is associated with the lowest risk of re-rupture in highly active young athletes but the highest incidence of anterior knee pain?

. Hamstring tendon
. Bone-patellar tendon-bone
. Quadriceps tendon
. Achilles allograft
. Synthetic ligament

Correct Answer & Explanation

. Bone-patellar tendon-bone

Explanation

Bone-patellar tendon-bone (BTB) autografts historically demonstrate lower re-rupture rates compared to hamstring grafts in young, high-demand athletes. However, BTB grafts carry a significantly higher risk of donor-site morbidity, specifically anterior knee pain and pain with kneeling.

Question 254

Topic: Knee Sports

A 25-year-old rugby player sustains a direct blow to the anteromedial tibia with the knee flexed. Clinical exam reveals a positive Dial test at 30 degrees of flexion, but symmetric rotation at 90 degrees. What is the most likely injured structure?

. Isolated posterior cruciate ligament
. Isolated anterior cruciate ligament
. Isolated posterolateral corner structures
. Combined PCL and posterolateral corner
. Medial collateral ligament

Correct Answer & Explanation

. Isolated posterolateral corner structures

Explanation

A positive Dial test (increased external rotation of the tibia >10 degrees compared to the contralateral side) at 30 degrees only indicates an isolated posterolateral corner (PLC) injury. If the test is positive at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 255

Topic: Knee Sports

Which of the following zones of the meniscus is most amenable to successful surgical repair due to its robust vascular supply?

. White-white zone
. Red-white zone
. Red-red zone
. Inner avascular margin
. Central meniscal root

Correct Answer & Explanation

. Red-red zone

Explanation

The peripheral outer one-third (red-red zone) of the meniscus receives an excellent blood supply from the perimeniscal capillary plexus. Longitudinal tears in this zone have the highest healing rates following surgical repair.

Question 256

Topic: 5. Sports Medicine

The "peel-back" mechanism is a primary cause of Superior Labrum Anterior and Posterior (SLAP) tears in overhead throwing athletes. During which phase of throwing does this mechanism primarily occur?

. Wind-up
. Early cocking
. Late cocking
. Acceleration
. Deceleration

Correct Answer & Explanation

. Late cocking

Explanation

The peel-back mechanism occurs during the late cocking phase of throwing when the shoulder is positioned in maximum abduction and external rotation. This specific position places a severe torsional force on the biceps anchor, peeling the posterosuperior labrum off the glenoid.

Question 257

Topic: Shoulder & Hip Sports

A 22-year-old professional football player sustains recurrent anterior shoulder dislocations. Advanced imaging reveals a 25% bony Bankart lesion of the anterior glenoid rim. What is the most appropriate surgical intervention to prevent recurrence?

. Arthroscopic Bankart repair with suture anchors
. Latarjet procedure
. Open inferior capsular shift
. Remplissage procedure alone
. Superior capsular reconstruction

Correct Answer & Explanation

. Latarjet procedure

Explanation

For critical anterior glenoid bone loss (>20-25%), arthroscopic soft tissue stabilization has an unacceptably high failure rate. A bone-block augmentation procedure, most commonly the Latarjet (coracoid transfer), is required to restore glenoid width and stability.

Question 258

Topic: Knee Sports

What is the most common anatomic location for Osteochondritis Dissecans (OCD) lesions in the adolescent knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central articular surface of the patella
. Weight-bearing dome of the medial tibial plateau
. Trochlear groove

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most frequent location for an OCD lesion in the knee is the lateral aspect of the medial femoral condyle. The exact etiology is unknown but is highly associated with repetitive microtrauma and localized ischemia.

Question 259

Topic: 5. Sports Medicine

A 30-year-old recreational athlete suffers an acute Achilles tendon rupture. When comparing operative versus non-operative management, the patient should be counseled that surgical repair is generally associated with:

. Higher re-rupture rates
. Lower rates of wound complications
. Greater decrease in plantarflexion strength
. Lower re-rupture rates but higher surgical site complication rates
. No difference in functional outcomes or complication rates

Correct Answer & Explanation

. Lower re-rupture rates but higher surgical site complication rates

Explanation

Surgical repair of an acute Achilles tendon rupture generally yields a significantly lower re-rupture rate compared to traditional conservative management. However, it carries an inherently higher risk of soft-tissue complications, including infection and sural nerve injury.

Question 260

Topic: Knee Sports

A 16-year-old gymnast experiences an acute lateral patellar dislocation upon landing a vault. Which ligament is the primary restraint to lateral patellar translation at 0 to 30 degrees of knee flexion, and is nearly universally torn in this scenario?

. Medial patellotibial ligament
. Lateral retinaculum
. Medial patellofemoral ligament (MPFL)
. Patellar tendon
. Medial collateral ligament

Correct Answer & Explanation

. Medial patellofemoral ligament (MPFL)

Explanation

The medial patellofemoral ligament (MPFL) provides 50-60% of the stabilizing restraining force against lateral patellar displacement during early flexion. It is anatomically torn in over 90% of acute lateral patellar dislocations.

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