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5. Sports Medicine MCQs

Practice Set 139 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 2761

Topic: Knee Sports

A 22-year-old soccer player sustains a twisting injury to the knee resulting in a rapid effusion. MRI demonstrates a complete midsubstance rupture of the anterior cruciate ligament (ACL).

Which of the following concomitant meniscal injuries is statistically most commonly associated with an acute ACL rupture?

. Medial meniscus bucket-handle tear
. Lateral meniscus posterior horn tear
. Medial meniscus root tear
. Lateral meniscus anterior horn tear
. Discoid lateral meniscus tear

Correct Answer & Explanation

. Lateral meniscus posterior horn tear

Explanation

In the setting of an acute ACL tear, tears of the lateral meniscus (particularly the posterior horn) are the most common concomitant meniscal injury, seen in roughly 50-70% of acute cases. Conversely, in the chronic ACL-deficient knee, medial meniscus tears become much more common due to the long-term altered kinematics and repeated anterior translation of the tibia, which puts the posterior horn of the medial meniscus under chronic shear stress.

Question 2762

Topic: 5. Sports Medicine

A 22-year-old female collegiate soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. During the first year postoperatively, she complains of significant anterior knee pain. Which of the following is the most likely cause of her pain associated with this specific graft choice?

. Arthrofibrosis
. Cyclops lesion
. Harvest site morbidity
. Chondromalacia patellae
. Hardware irritation

Correct Answer & Explanation

. Harvest site morbidity

Explanation

Anterior knee pain is the most common complication following ACL reconstruction with a bone-patellar tendon-bone (BTB) autograft. It is primarily related to harvest site morbidity at the patellar tendon donor site.

Question 2763

Topic: Shoulder & Hip Sports

A 21-year-old male suffers a traumatic anterior shoulder dislocation. An MRI reveals a Bankart lesion. What is the defining anatomical characteristic of a classic Bankart lesion?

. Avulsion of the anterior-inferior labrum with the anterior band of the inferior glenohumeral ligament
. Compression fracture of the posterolateral humeral head
. Superior labrum anterior to posterior tear extending to the biceps anchor
. Avulsion of the posterior-inferior labrum
. Capsular stretch without frank labral detachment

Correct Answer & Explanation

. Avulsion of the anterior-inferior labrum with the anterior band of the inferior glenohumeral ligament

Explanation

A Bankart lesion is defined as an avulsion of the anterior-inferior capsulolabral complex from the glenoid rim. This specifically involves the anterior band of the inferior glenohumeral ligament (IGHL).

Question 2764

Topic: Knee Sports

When comparing the tibial inlay technique to the transtibial tunnel technique for posterior cruciate ligament (PCL) reconstruction, the tibial inlay technique has the theoretical biomechanical advantage of decreasing what phenomenon?

. Graft stretch-out
. The "killer turn" effect
. Arthrofibrosis
. Tunnel widening
. Anterior tibial translation

Correct Answer & Explanation

. The "killer turn" effect

Explanation

The transtibial tunnel technique for PCL reconstruction forces the graft to make an acute angle at the posterior aperture of the tibial tunnel, known as the "killer turn," which can lead to graft abrasion and attenuation. The tibial inlay technique avoids this acute angle.

Question 2765

Topic: 5. Sports Medicine
A 28-year-old overhead throwing athlete undergoes arthroscopy for a suspected SLAP tear. The surgeon notes fraying of the superior labrum but the biceps anchor is intact and firmly attached to the glenoid. According to the Snyder classification, this represents:
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

Snyder classification of SLAP tears: Type I involves fraying and degeneration of the superior labrum with an intact biceps anchor. Type II involves detachment of the superior labrum and biceps anchor from the glenoid. Type III involves a bucket-handle tear of the superior labrum with an intact biceps anchor. Type IV involves a bucket-handle tear that extends into the biceps tendon.

Question 2766

Topic: Knee Sports

During normal knee flexion, the phenomenon of femoral rollback is primarily facilitated by which of the following structures?

. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Medial collateral ligament (MCL)
. Lateral collateral ligament (LCL)
. Popliteus tendon

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

Femoral rollback is the posterior translation of the femur on the tibia during knee flexion, which allows for increased flexion before impingement occurs. This is primarily guided and facilitated by the tension in the posterior cruciate ligament (PCL). In PCL-restituting or substituting TKAs, maintaining this mechanism is critical.

Question 2767

Topic: 5. Sports Medicine

During arthroscopy for an acute anterior cruciate ligament (ACL) tear, a systematic evaluation of the knee is performed. The surgeon places the arthroscope through the intercondylar notch into the posteromedial compartment. A longitudinal tear is observed at the meniscocapsular junction of the posterior horn of the medial meniscus. What is the term for this specific lesion?

. RAMP lesion
. Root tear
. Bucket-handle tear
. Wrisberg rip
. Radial tear

Correct Answer & Explanation

. RAMP lesion

Explanation

A RAMP lesion is a longitudinal tear of the peripheral attachment (meniscocapsular junction) of the posterior horn of the medial meniscus. It is highly associated with acute ACL ruptures (occurring in up to 24% of cases). Because it is located in the blind spot of the knee, it is frequently missed if the posteromedial compartment is not systematically inspected through the intercondylar notch or via a posteromedial portal.

Question 2768

Topic: Shoulder & Hip Sports

A 19-year-old collegiate swimmer presents with bilateral shoulder pain. She reports a sensation that her shoulders are constantly 'slipping out' of place, especially during the pull phase of her stroke. Physical examination demonstrates generalized ligamentous laxity, a positive sulcus sign bilaterally, and positive apprehension tests anteriorly and posteriorly. Scapular dyskinesia is prominent. What is the most appropriate initial management?

. Arthroscopic labral repair (SLAP repair)
. Physical therapy focusing on periscapular stabilization and rotator cuff strengthening
. Open inferior capsular shift
. Arthroscopic plication of the anterior capsule
. Latarjet procedure

Correct Answer & Explanation

. Physical therapy focusing on periscapular stabilization and rotator cuff strengthening

Explanation

This patient has classic symptoms of Multidirectional Instability (MDI) of the shoulder, often associated with generalized ligamentous laxity (Ehlers-Danlos, Marfan, or simply physiological hyperlaxity) and confirmed by a positive sulcus sign. The cornerstone of initial treatment for MDI is a prolonged, dedicated physical therapy program (minimum 3-6 months) focusing on strengthening the dynamic stabilizers of the shoulder (periscapular muscles and rotator cuff). Surgical stabilization (e.g., open or arthroscopic inferior capsular shift) is strictly reserved for patients who fail extensive conservative management.

Question 2769

Topic: 5. Sports Medicine

When comparing bone-patellar tendon-bone (BPTB) autografts to quadrupled hamstring autografts for primary anterior cruciate ligament (ACL) reconstruction, BPTB grafts are associated with a higher incidence of:

. Graft rupture
. Contralateral ACL tear
. Anterior knee pain
. Hamstring weakness
. Deep surgical site infection

Correct Answer & Explanation

. Anterior knee pain

Explanation

Bone-patellar tendon-bone (BPTB) autografts are historically considered the 'gold standard' for ACL reconstruction due to excellent bone-to-bone healing and stability. However, the most commonly cited morbidity specific to BPTB autografts, compared to hamstring autografts, is a higher incidence of anterior knee pain and kneeling pain at the donor site.

Question 2770

Topic: Shoulder & Hip Sports

During an arthroscopic rotator cuff repair, the 'margin convergence' technique is most biomechanically appropriate and effective for which specific tear pattern?

. Crescent-shaped tear
. U-shaped tear
. L-shaped tear
. Reverse L-shaped tear
. Partial-thickness articular-sided tear

Correct Answer & Explanation

. U-shaped tear

Explanation

Margin convergence is an arthroscopic technique popularized by Burkhart, used primarily for large U-shaped rotator cuff tears. By suturing the anterior and posterior leaves of the tear together side-to-side, the free margin of the cuff is brought closer to the greater tuberosity, significantly decreasing the strain required to fix the remaining tendon to the bone bed.

Question 2771

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with vague, deep shoulder pain and a 'dead arm' sensation. During physical examination, the O'Brien test (Active Compression Test) is performed. Which of the following findings during the O'Brien test is considered a classic positive result for a Superior Labrum Anterior Posterior (SLAP) tear?

. Pain with the arm fully internally rotated that is not relieved by external rotation
. Pain deep in the shoulder with the arm internally rotated that is relieved by external rotation
. Pain strictly localized to the acromioclavicular joint with the arm internally rotated
. Apprehension without pain when the arm is brought into external rotation and abduction
. Inability to actively elevate the arm above 90 degrees due to weakness

Correct Answer & Explanation

. Pain deep in the shoulder with the arm internally rotated that is relieved by external rotation

Explanation

The O'Brien (Active Compression) test is performed with the shoulder in 90 degrees of forward flexion and 10-15 degrees of adduction. The patient resists a downward force with the arm fully internally rotated (thumb pointing down), and then the test is repeated with the arm fully externally rotated (palm up). A positive test for a SLAP tear is pain located deep within the shoulder during internal rotation that is diminished or eliminated during external rotation. Pain localized superficially to the AC joint during the internal rotation phase suggests AC joint pathology, not a SLAP tear.

Question 2772

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, the surgeon chooses to drill the femoral tunnel independently using an anteromedial (AM) portal rather than a transtibial technique. Which of the following is an advantage of the AM portal technique?

. It decreases the risk of posterior wall blowout
. It allows for more anatomic placement of the femoral tunnel in the native footprint
. It prevents divergence of the interference screw
. It requires less knee hyperflexion during drilling
. It creates a more vertical femoral tunnel

Correct Answer & Explanation

. It allows for more anatomic placement of the femoral tunnel in the native footprint

Explanation

Independent drilling of the femoral tunnel through an anteromedial portal allows the surgeon to place the tunnel more anatomically within the native ACL footprint, independent of the tibial tunnel trajectory. Transtibial drilling often results in a more vertical, non-anatomic femoral tunnel. Disadvantages of the AM portal technique include the need for knee hyperflexion during drilling and a potentially shorter femoral tunnel.

Question 2773

Topic: 5. Sports Medicine

During knee arthroscopy for a suspected meniscal tear, the surgeon identifies a longitudinal tear 2 mm from the meniscocapsular junction. This tear is considered highly amenable to repair. Which of the following vascular structures provides the primary blood supply to this peripheral "red-red" zone of the meniscus?

. Middle geniculate artery
. Medial and lateral superior geniculate arteries
. Medial and lateral inferior geniculate arteries
. Popliteal artery branches directly
. Descending genicular artery

Correct Answer & Explanation

. Medial and lateral inferior geniculate arteries

Explanation

The blood supply to the menisci originates primarily from the medial and lateral inferior geniculate arteries, and to a lesser extent, the superior geniculate arteries. These vessels form a perimeniscal capillary plexus within the synovial and capsular tissues. The peripheral 10% to 30% of the meniscus (the "red-red" zone) is well-vascularized and has excellent healing potential following repair. The central portions rely on diffusion from synovial fluid.

Question 2774

Topic: 5. Sports Medicine

A 22-year-old female soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. During the rehabilitation phase, she is at highest risk for which of the following complications compared to a hamstring autograft?

. Deep infection
. Anterior knee pain
. Hamstring weakness
. Graft rupture
. Saphenous nerve injury

Correct Answer & Explanation

. Anterior knee pain

Explanation

BTB autograft is considered the 'gold standard' for ACL reconstruction but is associated with a higher incidence of donor-site morbidity, specifically anterior knee pain and pain with kneeling, when compared to hamstring autograft. Deep infection rates are similar or slightly higher in hamstring autografts.

Question 2775

Topic: 5. Sports Medicine

A 25-year-old male undergoes arthroscopy for a bucket-handle tear of the medial meniscus. The surgeon decides to perform an inside-out meniscus repair. Which of the following neurovascular structures is at greatest risk of injury during the posteromedial repair?

. Common peroneal nerve
. Popliteal artery
. Saphenous nerve
. Sural nerve
. Tibial nerve

Correct Answer & Explanation

. Saphenous nerve

Explanation

During an inside-out repair of the medial meniscus, the saphenous nerve (specifically its sartorial branch and the main trunk posteriorly) is at highest risk. The common peroneal nerve is at risk during a lateral meniscus repair.

Question 2776

Topic: Knee Sports

The pivot shift test is widely considered the most specific clinical examination maneuver for an anterior cruciate ligament (ACL) tear. Which of the following best describes the biomechanics of a positive pivot shift test in an ACL-deficient knee?

. The tibia subluxates anteriorly in flexion and reduces in extension
. The tibia subluxates anteriorly in extension and reduces in flexion at 20-30 degrees
. The tibia subluxates posteriorly in extension and reduces in flexion
. The tibia subluxates anteriorly at 90 degrees of flexion and reduces in full extension
. The femur subluxates anteriorly in extension and reduces in flexion

Correct Answer & Explanation

. The tibia subluxates anteriorly in extension and reduces in flexion at 20-30 degrees

Explanation

In an ACL-deficient knee, the tibia rests in an anteriorly subluxated position when the knee is in full extension. As the examiner flexes the knee with a valgus and internal rotation force, the iliotibial band (ITB) transitions from acting as a knee extensor (anterior to the axis of rotation) to a knee flexor (posterior to the axis of rotation) at approximately 20-30 degrees of flexion. This vector change creates a posterior force on the tibia, abruptly reducing the joint and producing the classic 'clunk' of the pivot shift.

Question 2777

Topic: 5. Sports Medicine

A 45-year-old male recreational athlete sustains an acute mid-substance Achilles tendon rupture.

He is discussing management options with his surgeon. Based on current high-level evidence, which of the following statements comparing nonoperative management versus surgical repair is most accurate?

. When early functional rehabilitation is employed, nonoperative management has a similar re-rupture rate to surgical repair but avoids surgical complications.
. Surgical repair has a significantly lower re-rupture rate than nonoperative management with early functional rehab.
. Plantarflexion strength is significantly better after nonoperative management compared to surgery.
. The risk of sural nerve injury is highest with open repair compared to percutaneous repair.
. Nonoperative treatment mandates strict rigid cast immobilization for 12 weeks to achieve equivalent outcomes.

Correct Answer & Explanation

. When early functional rehabilitation is employed, nonoperative management has a similar re-rupture rate to surgical repair but avoids surgical complications.

Explanation

Historically, surgical repair was thought to have a lower re-rupture rate. However, recent Level 1 evidence (RCTs and meta-analyses) has shown that when patients undergo nonoperative management combined with an early functional rehabilitation protocol (early weight-bearing in a functional brace), the re-rupture rates are not statistically different from surgical repair. Nonoperative management avoids the risks of wound healing complications and infection inherent to surgery.

Question 2778

Topic: Knee Sports

A 50-year-old woman complains of acute posterior knee pain and a 'pop' while squatting deeply. MRI reveals a complete tear of the medial meniscus posterior root.

Biomechanically, if left untreated, a complete posterior root tear of the medial meniscus acts as the equivalent to which of the following?

. A 25% partial medial meniscectomy
. A 50% partial medial meniscectomy
. A total medial meniscectomy
. An anterior cruciate ligament tear
. A medial collateral ligament tear

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

The meniscal roots anchor the meniscus to the tibial plateau, allowing it to convert axial loads into circumferential hoop stresses. A complete disruption of the posterior root disrupts these hoop stresses entirely, rendering the meniscus functionally incompetent. Biomechanical studies have proven that a medial meniscus posterior root tear alters contact pressures and kinematics equivalent to those seen in a complete (total) medial meniscectomy, predisposing the joint to rapid osteoarthritis.

Question 2779

Topic: Shoulder & Hip Sports

A 22-year-old collegiate football player presents with recurrent anterior shoulder instability. Advanced imaging reveals a 15% anterior glenoid bone loss and a large, engaging Hill-Sachs lesion. He undergoes an arthroscopic Bankart repair combined with a remplissage procedure. What structure is transferred or tenodesed into the Hill-Sachs defect during a remplissage?

. Subscapularis tendon
. Infraspinatus tendon and posterior joint capsule
. Supraspinatus tendon
. Long head of the biceps tendon
. Teres major tendon

Correct Answer & Explanation

. Infraspinatus tendon and posterior joint capsule

Explanation

The remplissage procedure (French for 'to fill') addresses a large, engaging Hill-Sachs lesion that may otherwise lever the humeral head out of the glenoid even after a Bankart repair. It involves capsulotenodesis of the posterior capsule and the infraspinatus tendon into the humeral head defect. This effectively makes the Hill-Sachs lesion extra-articular and prevents it from engaging the anterior glenoid rim during abduction and external rotation.

Question 2780

Topic: 5. Sports Medicine

A 22-year-old collegiate baseball pitcher presents with vague posterior shoulder pain and a 25-degree loss of internal rotation (GIRD) compared to the contralateral side.

An MRI reveals a type II SLAP tear. The 'peel-back' mechanism is widely considered the primary etiology of this lesion in overhead athletes. During which phase of the throwing motion does the 'peel-back' mechanism 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, where the shoulder is in maximal abduction and external rotation. In this position, the biceps vector shifts posteriorly, creating a torsional force at the base of the biceps anchor that 'peels back' the superior labrum from the glenoid rim.

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