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5. Sports Medicine MCQs

Practice Set 138 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 2741

Topic: 5. Sports Medicine

A 40-year-old right-handed professional football player reports persistent right wrist pain after falling during a game 5 days ago. A radiograph is shown in Figure 21. Management should consist of

Sports Medicine Board Review 2007: High-Yield MCQs (Set 4) - Figure 1

. immobilization in a short arm thumb spica cast.
. immobilization in a long arm thumb spica cast.
. arthroscopic repair and percutaneous pinning.
. open repair and percutaneous pinning.
. dorsal capsulodesis.

Correct Answer & Explanation

. open repair and percutaneous pinning.

Explanation

The radiograph reveals an increased distance between the scaphoid and the lunate, which is indicative of scapholunate disassociation. A ring sign is also present, which represents the distal pole of the scaphoid viewed end on in a palmarly flexed position. In the acute setting, the scapholunate can be repaired. Open repair and percutaneous pinning is the treatment of choice. Dorsal capsulodesis is performed in the chronic setting if such an injury is initially missed. Cohen MS: Ligamentous injuries of the wrist in the athlete. Clin Sports Med 1998;17:533-552.

Question 2742

Topic: 5. Sports Medicine

An 18-year-old high school football player sustains a thigh injury that results in the findings shown in Figure 1. Initial management should consist of

Sports Medicine 2001 Practice Questions: Set 1 (Solved) - Figure 1

. gentle passive stretching.
. pulsed therapeutic ultrasonography.
. interferential electrical stimulation.
. cross-fiber friction massage.
. resting the muscle group.

Correct Answer & Explanation

. resting the muscle group.

Explanation

The radiograph shows myositis ossificans within the quadriceps muscle. This condition occurs as a complication of muscle injury. Initial treatment should include rest, ice, compression, and elevation. While gentle active range of motion is encouraged in the functional recovery from this injury, passive stretching is contraindicated as it can enhance hemorrhage and accentuate the development of myositis ossificans. Ultrasound is similarly contraindicated because it can enhance the development of myositis ossificans and has no proven efficacy in this patient; electrical stimulation also has no proven benefits. Massage is contraindicated in the initial management of this injury because of its influence on increasing local blood flow. Anderson JE (ed): Grant's Atlas of Anatomy. Baltimore, MD, Williams & Wilkins, 1978, pp 4.39-4.49. Brumet ME, Hontas RB: The thigh, in DeLee JC, Drez D Jr (eds): Orthopaedic Sports Medicine. Philadelphia, PA, WB Saunders, 1994, pp 1086-1112. Antao NA: Myositis of the hip in a professional soccer player: A case report. Am J Sports Med 1988;16:82-83.

Question 2743

Topic: Knee Sports

A 55-year-old woman feels a 'pop' in the back of her knee while squatting. An MRI is shown:

A posterior horn medial meniscus root tear is identified. Biomechanically, a complete medial meniscus posterior root tear alters contact pressures to a degree equivalent to which of the following?

. Total meniscectomy
. Partial meniscectomy
. Anterior cruciate ligament tear
. Posterior cruciate ligament tear
. Medial collateral ligament tear

Correct Answer & Explanation

. Total meniscectomy

Explanation

A complete posterior root tear of the medial meniscus leads to a complete loss of hoop stresses, resulting in meniscal extrusion. Biomechanically, this alters peak tibiofemoral contact pressures and reduces contact area to a degree equivalent to a total meniscectomy, leading to rapid articular cartilage degeneration.

Question 2744

Topic: Shoulder & Hip Sports

A 21-year-old college football player experiences recurrent anterior shoulder dislocations. Imaging demonstrates a bony Bankart lesion involving 25% of the anterior glenoid width and an engaging Hill-Sachs lesion. Which procedure is most appropriate to stabilize this shoulder and prevent recurrence?

. Arthroscopic soft-tissue Bankart repair
. Arthroscopic Bankart repair with Remplissage
. Latarjet procedure
. Putti-Platt procedure
. Weaver-Dunn procedure

Correct Answer & Explanation

. Latarjet procedure

Explanation

For high-demand contact athletes with critical anterior glenoid bone loss (typically >20-25%) or bipolar bone loss with an engaging Hill-Sachs lesion, isolated arthroscopic soft-tissue repair has an unacceptably high failure rate. A bony augmentation procedure, such as the Latarjet (coracoid transfer), is indicated to restore the glenoid articular arc and provide a sling effect.

Question 2745

Topic: Knee Sports

A 19-year-old female soccer player is undergoing an arthroscopic anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. If the surgeon drills the femoral tunnel in an excessively anterior (shallow) position within the intercondylar notch relative to the native anatomic footprint, what will be the resultant kinematic behavior of the graft?

. Tight in extension and loose in flexion
. Loose in extension and tight in flexion
. Tight throughout the entire range of motion
. Loose throughout the entire range of motion
. Impingement against the posterior cruciate ligament (PCL)

Correct Answer & Explanation

. Loose in extension and tight in flexion

Explanation

Femoral tunnel positioning is critical for successful ACL reconstruction. An excessively anterior (shallow/high in the notch) femoral tunnel placement creates a graft that is non-anatomic. Because the tunnel is anterior to the isometric point, the distance between the tibial and femoral tunnels increases as the knee flexes. This results in a graft that is excessively tight in flexion (causing loss of flexion or graft failure) and loose in extension.

Question 2746

Topic: Shoulder & Hip Sports

During arthroscopic stabilization for recurrent anterior shoulder instability in a 22-year-old rugby player, the surgeon encounters an ALPSA (Anterior Labroligamentous Periosteal Sleeve Avulsion) lesion. Which of the following morphologic features distinguishes an ALPSA lesion from a classic Bankart lesion?

. Involvement of the superior labral-biceps anchor complex
. Avulsion of the anterior band of the inferior glenohumeral ligament from the humeral insertion
. Medial displacement and subsequent healing of the labrocapsular complex along the anterior glenoid neck
. Presence of an associated bony fracture of the anteroinferior glenoid rim
. Involvement and tearing of the deep fibers of the subscapularis tendon

Correct Answer & Explanation

. Medial displacement and subsequent healing of the labrocapsular complex along the anterior glenoid neck

Explanation

An ALPSA lesion is distinguished from a classic soft-tissue Bankart lesion by the intact anterior periosteal sleeve. The labrum and periosteum strip off the glenoid face and roll medially down the anterior glenoid neck, often healing in an abnormal, medially displaced position. A classic Bankart involves a discrete detachment of the labrum with a rupture of the periosteum, without the medial rolling/healing.

Question 2747

Topic: Knee Sports

A 24-year-old male sustains a severe twisting injury to his knee during a rugby match. Physical examination under anesthesia reveals 15 degrees of increased tibial external rotation compared to the contralateral knee at both 30 degrees and 90 degrees of knee flexion (Positive Dial Test). Based on this physical exam finding, which of the following structural combinations is definitively injured?

. Anterior cruciate ligament (ACL) and posterolateral corner (PLC)
. Posterior cruciate ligament (PCL) and posterolateral corner (PLC)
. Medial collateral ligament (MCL) and posterior oblique ligament (POL)
. Isolated posterolateral corner (PLC)
. Isolated posterior cruciate ligament (PCL)

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

The Dial test measures external rotation of the tibia relative to the femur. Increased external rotation (>10 degrees asymmetry) at 30 degrees of flexion, but normal at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. Increased external rotation at BOTH 30 degrees and 90 degrees of flexion indicates a combined injury to both the PLC and the posterior cruciate ligament (PCL).

Question 2748

Topic: 5. Sports Medicine

During an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, the surgeon opts to drill the femoral tunnel via an accessory anteromedial portal rather than using a transtibial technique. Compared to transtibial drilling, the anteromedial portal technique is more likely to result in a femoral tunnel that is:

. More vertical in the coronal plane
. Closer to the center of the native ACL footprint on the lateral femoral condyle
. Less likely to result in a critically short femoral tunnel length
. Positioned entirely within the footprint of the anteromedial bundle
. Associated with a lower incidence of posterior wall blowout

Correct Answer & Explanation

. Closer to the center of the native ACL footprint on the lateral femoral condyle

Explanation

Anteromedial (AM) portal drilling allows the surgeon to position the femoral tunnel independently of the tibial tunnel trajectory. This allows anatomic placement closer to the native ACL footprint. In contrast, transtibial drilling is constrained by the trajectory of the tibial tunnel, which frequently results in a femoral tunnel that is too anterior and vertical (high in the notch), missing the true anatomic footprint. AM portal drilling is actually associated with shorter femoral tunnels and a slightly higher risk of posterior wall blowout compared to transtibial drilling if not performed carefully.

Question 2749

Topic: Shoulder & Hip Sports

A 68-year-old male is evaluated for a massive, retracted rotator cuff tear involving the supraspinatus and infraspinatus. The surgeon notes significant fatty infiltration of the muscle bellies on the sagittal T1-weighted MRI. According to the Goutallier classification, which stage represents the critical prognostic threshold where there is an equal amount of fat and muscle within the muscle belly?

. Stage 1
. Stage 2
. Stage 3
. Stage 4
. Stage 5

Correct Answer & Explanation

. Stage 3

Explanation

The Goutallier classification evaluates fatty infiltration of the rotator cuff muscles, which correlates strongly with failure rates after surgical repair. Stage 0 is normal muscle. Stage 1 has occasional fatty streaks. Stage 2 has more muscle than fat. Stage 3 has an equal amount of fat and muscle. Stage 4 has more fat than muscle. Stage 3 represents the critical prognostic turning point; repairs attempted on Stage 3 and Stage 4 muscles have extremely high failure rates and poorer clinical outcomes.

Question 2750

Topic: Shoulder & Hip Sports

A 21-year-old collegiate football player sustains a recurrent anterior shoulder dislocation. A pre-operative 3D CT scan reveals a bipolar bone loss pattern, with an engaging Hill-Sachs lesion and an anterior glenoid bone defect measuring 28% of the glenoid width. What is the most appropriate surgical intervention to prevent further instability?

. Arthroscopic Bankart repair with Remplissage
. Open Bankart repair and inferior capsular shift
. Latarjet procedure (coracoid transfer to anterior glenoid)
. Arthroscopic superior labrum anterior-posterior (SLAP) repair
. Proximal humerus derotational osteotomy

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer to anterior glenoid)

Explanation

Subcritical glenoid bone loss (<15-20%) may be managed with arthroscopic stabilization (with or without remplissage). However, critical glenoid bone loss (>20-25%) in a contact athlete is a strong indication for a bony augmentation procedure. The Latarjet procedure transfers the coracoid process to the anterior glenoid, providing both a bony block and a dynamic muscular sling.

Question 2751

Topic: Knee Sports

Which bundle of the posterior cruciate ligament (PCL) is the primary restraint to posterior tibial translation at 90 degrees of knee flexion?

. Posterolateral bundle
. Anteromedial bundle
. Anterolateral bundle
. Posteromedial bundle
. Meniscofemoral ligament of Wrisberg

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The PCL has two main bundles: the anterolateral (AL) and posterolateral (PL) bundles. The AL bundle is larger, tighter in flexion, and acts as the primary restraint to posterior tibial translation at 90 degrees of knee flexion. The PL bundle is tighter in extension. Reconstructing the AL bundle is the primary goal in single-bundle PCL reconstruction.

Question 2752

Topic: Knee Sports

During a posterior-stabilized total knee arthroplasty, the surgeon assesses the flexion and extension gaps.

The extension gap is symmetric and perfectly balanced, but the flexion gap is excessively tight. Which of the following is the most appropriate surgical adjustment?

. Resect more proximal tibia
. Downsize the femoral component to decrease the anteroposterior dimension
. Release the posterior cruciate ligament (PCL)
. Release the posterior capsule
. Increase the distal femoral resection

Correct Answer & Explanation

. Downsize the femoral component to decrease the anteroposterior dimension

Explanation

When the extension gap is balanced but the flexion gap is tight, the goal is to increase the flexion gap without altering the extension gap. This can be achieved by decreasing the anteroposterior (AP) size of the femoral component, translating the femoral component anteriorly, or recessing the PCL (if retaining it, though this is a PS knee so PCL is already gone). Resecting more proximal tibia affects both gaps. Downsizing the AP femur size uniquely increases the flexion gap.

Question 2753

Topic: 5. Sports Medicine

A 25-year-old elite overhead pitcher undergoes shoulder arthroscopy for chronic shoulder pain and mechanical symptoms.

A Type II SLAP tear is identified. When evaluating the normal anatomy of the biceps-labral complex in preparation for repair, what is the typical anatomical origin of the long head of the biceps tendon?

. 100% from the superior glenoid tubercle
. 100% from the superior labrum
. Approximately 50% from the supraglenoid tubercle and 50% from the superior labrum
. Primarily from the coracoid process with expansions to the superior labrum
. Primarily from the intra-articular aspect of the greater tuberosity

Correct Answer & Explanation

. Approximately 50% from the supraglenoid tubercle and 50% from the superior labrum

Explanation

The long head of the biceps tendon originates in a bifurcated manner. Anatomical studies show that approximately 50% of the tendon fibers attach directly to the supraglenoid tubercle of the scapula, and the remaining 50% blend into the superior aspect of the glenoid labrum. This structural relationship is critical to understand when diagnosing and repairing SLAP (Superior Labrum Anterior to Posterior) lesions, as tension on the biceps directly forces the superior labrum away from the glenoid.

Question 2754

Topic: Knee Sports

During an anatomical reconstruction of the posterolateral corner (PLC) of the knee, the surgeon is carefully defining the insertions on the proximal fibula. Which of the following structures inserts slightly anterior and distal to the tip (styloid) on the lateral aspect of the fibular head?

. Biceps femoris
. Popliteofibular ligament
. Fibular collateral ligament (FCL)
. Arcuate ligament
. Fabellofibular ligament

Correct Answer & Explanation

. Fibular collateral ligament (FCL)

Explanation

The fibular collateral ligament (FCL) inserts on the lateral aspect of the fibular head, approximately 8.2 mm posterior to the anterior margin of the fibular head and 28.4 mm distal to the tip of the fibular styloid. The popliteofibular ligament (PFL) inserts on the posteromedial aspect of the fibular styloid.

Question 2755

Topic: Shoulder & Hip Sports

A 22-year-old collegiate wrestler undergoes an MRI arthrogram after sustaining a traumatic anterior shoulder dislocation. The imaging reveals that the anterior labrum is torn and displaced medially along the glenoid neck, but the anterior periosteum remains intact, forming a sleeve. What is the specific eponym for this lesion?

. Bankart lesion
. ALPSA lesion
. Perthes lesion
. GLAD lesion
. HAGL lesion

Correct Answer & Explanation

. ALPSA lesion

Explanation

An ALPSA (Anterior Labroligamentous Periosteal Sleeve Avulsion) lesion occurs when the anterior labrum is torn and rolls medially along the glenoid neck while the periosteum remains intact. A Bankart lesion is a frank detachment of both the labrum and periosteum. A Perthes lesion has an intact periosteum with a non-displaced torn labrum. GLAD is Glenolabral Articular Disruption (involving cartilage). HAGL is Humeral Avulsion of the Glenohumeral Ligament.

Question 2756

Topic: 5. Sports Medicine

A 22-year-old female collegiate soccer player requires a revision anterior cruciate ligament (ACL) reconstruction. The surgeon elects to use an irradiated allograft. What irradiation dose threshold is definitively known to significantly alter the biomechanical properties of the allograft, reducing its structural stiffness and maximal load compared to native tissue?

. 1.0 - 1.2 Mrad
. 1.5 - 1.8 Mrad
. 2.0 - 2.5 Mrad
. Greater than 3.0 Mrad
. Any dose of irradiation regardless of threshold

Correct Answer & Explanation

. Greater than 3.0 Mrad

Explanation

Irradiation is utilized by tissue banks for terminal sterilization to reduce disease transmission risk (e.g., HIV, Hepatitis). Biomechanical studies show that high-dose irradiation, specifically greater than 3.0 Mrad (megarads), significantly alters the structural and mechanical properties of the graft. Many tissue banks now use low-dose irradiation (1.0-1.5 Mrad) or targeted radioprotectants to minimize these detrimental effects while maintaining sterility.

Question 2757

Topic: Shoulder & Hip Sports

During the arthroscopic repair of a massive, retracted, U-shaped posterosuperior rotator cuff tear, the surgeon elects to perform margin convergence prior to tendon-to-bone fixation. Which of the following best explains the primary biomechanical advantage of margin convergence?

. Side-to-side suturing of the anterior and posterior leaflets reduces strain on the free margin of the tendon at the bone
. Anchoring the medial apex directly to the greater tuberosity provides the strongest single-point fixation
. It converts a U-shaped tear into an L-shaped tear, maximizing the footprint contact area for single-row repair
. It releases the coracohumeral ligament, directly addressing the posterior retraction vector
. It medializes the rotator cuff footprint beyond the articular margin, increasing the resting tension

Correct Answer & Explanation

. Side-to-side suturing of the anterior and posterior leaflets reduces strain on the free margin of the tendon at the bone

Explanation

Margin convergence is a technique popularized by Burkhart for repairing large, U-shaped rotator cuff tears. Suturing the anterior and posterior limbs of the tear side-to-side (moving laterally toward the footprint) causes the free margin of the tear to converge toward the greater tuberosity. Biomechanically, this significantly decreases the strain (tension) at the critical tendon-to-bone repair site, reducing the likelihood of repair failure.

Question 2758

Topic: Knee Sports

During a primary anterior cruciate ligament (ACL) reconstruction, the surgeon is carefully determining femoral tunnel placement.

Placing the femoral tunnel too anteriorly (shallow) relative to the anatomic footprint will result in which of the following kinematic abnormalities of the graft?

. Laxity in flexion and tightness in extension
. Tightness in flexion and laxity in extension
. Equal tension throughout the full range of motion
. Impingement against the PCL in extension
. Isolated rotatory instability with a normal Lachman test

Correct Answer & Explanation

. Tightness in flexion and laxity in extension

Explanation

Anterior placement of the femoral tunnel (too shallow in the notch) brings the femoral attachment of the ACL graft anterior to the knee's axis of rotation. During knee flexion, the distance between the tibial and femoral tunnels increases, causing the graft to become exceedingly tight in flexion, limiting motion or leading to graft failure. Conversely, the graft will be loose in extension.

Question 2759

Topic: Shoulder & Hip Sports

When evaluating a patient with recurrent anterior shoulder instability, the 'glenoid track' concept is utilized to assess the risk of recurrent dislocation.

A Hill-Sachs lesion is considered 'off-track' and at high risk of engagement if it meets which of the following criteria?

. It extends medially beyond the medial margin of the glenoid track
. It is entirely contained within the glenoid track boundaries
. It is associated with greater than 10% anterior glenoid bone loss
. It engages only in isolated external rotation without abduction
. It spares the central articular cartilage of the humeral head

Correct Answer & Explanation

. It extends medially beyond the medial margin of the glenoid track

Explanation

The glenoid track is defined as the zone of contact between the humeral head and the glenoid during arm abduction and external rotation. It is calculated based on the intact glenoid width minus anterior bone loss. If the medial margin of a Hill-Sachs defect extends further medially than the medial boundary of the glenoid track, the lesion is 'off-track.' This means it will drop over the anterior glenoid rim during functional positioning, 'engaging' and levering the humerus out of joint.

Question 2760

Topic: 5. Sports Medicine

Following a traumatic knee injury, a 24-year-old athlete undergoes an arthroscopic meniscal repair. Which zone of the meniscus has the highest healing potential, and from which vessels does it derive its primary blood supply?

. Red-red zone; middle geniculate artery
. Red-red zone; medial and lateral superior/inferior geniculate arteries
. White-white zone; popliteal artery
. Red-white zone; descending genicular artery
. White-white zone; avascular (relies on synovial fluid)

Correct Answer & Explanation

. Red-red zone; medial and lateral superior/inferior geniculate arteries

Explanation

The peripheral 10% to 30% of the meniscus (the red-red zone) is well-vascularized and thus has the highest healing potential. The blood supply to this peripheral zone is derived from the capsular and synovial branches of the medial and lateral, superior and inferior geniculate arteries. The central white-white zone is avascular and relies on diffusion from synovial fluid, lacking the intrinsic capacity to heal.

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