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5. Sports Medicine MCQs

Practice Set 140 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 2781

Topic: Knee Sports
A 28-year-old male sustains an isolated, grade III posterior cruciate ligament (PCL) injury during a rugby match. He opts for non-operative management. Long-term follow-up studies of isolated, non-operatively treated PCL tears indicate that altered knee kinematics most commonly lead to the premature development of osteoarthritis in which compartments?
. Medial and patellofemoral compartments
. Lateral and patellofemoral compartments
. Medial and lateral compartments
. Lateral compartment only
. Patellofemoral compartment only

Correct Answer & Explanation

. Medial and patellofemoral compartments

Explanation

A deficient PCL leads to posterior tibial sag. This altered biomechanics increases contact pressures significantly in both the medial compartment and the patellofemoral joint. Long-term natural history studies of non-operatively treated PCL tears consistently show a high incidence of degenerative changes in the medial and patellofemoral compartments.

Question 2782

Topic: Shoulder & Hip Sports

A 55-year-old carpenter presents with right shoulder pain and weakness after attempting to lift a heavy tool box. On physical examination, he demonstrates a positive drop-arm test and profound weakness with active abduction in the scapular plane. An MRI confirms a massive, retracted tear of the supraspinatus and infraspinatus tendons. Fatty infiltration of these muscles is graded. Which classification system is most commonly used to grade fatty infiltration of the rotator cuff muscles on imaging?

. Patte classification
. Goutallier classification
. Snyder classification
. Hamada classification
. Seebauer classification

Correct Answer & Explanation

. Goutallier classification

Explanation

The Goutallier classification is used to quantify the amount of fatty infiltration of the rotator cuff muscles, originally described on CT but now widely adapted for MRI. High grades of fatty infiltration (Goutallier 3 and 4) are associated with poor functional outcomes and higher re-tear rates following surgical repair.

Question 2783

Topic: Knee Sports

During reconstruction of the posterolateral corner (PLC) of the knee, identifying the insertion of the popliteofibular ligament (PFL) is crucial. Where does the PFL anatomically insert?

. Anterior aspect of the fibular head
. Posteromedial aspect of the fibular styloid
. Anterolateral aspect of the fibular head
. Posterolateral aspect of the lateral tibial plateau
. Gerdy's tubercle

Correct Answer & Explanation

. Posteromedial aspect of the fibular styloid

Explanation

The posterolateral corner (PLC) includes the lateral collateral ligament (LCL), popliteus tendon, and popliteofibular ligament (PFL). The PFL originates from the popliteus musculotendinous junction and inserts on the posteromedial aspect of the fibular styloid (tip of the fibular head). This ligament is a primary restraint to external rotation of the tibia.

Question 2784

Topic: Shoulder & Hip Sports
A 24-year-old professional baseball pitcher presents with vague anterior shoulder pain and a 'dead arm' sensation. MR arthrogram reveals a bucket-handle tear of the superior labrum that extends into the long head of the biceps tendon, resulting in an unstable biceps anchor. According to the Snyder classification, what type of SLAP tear is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

The Snyder classification of SLAP (Superior Labrum Anterior to Posterior) tears: Type I is fraying of the superior labrum with an intact biceps anchor. Type II is a detachment of the superior labrum and biceps anchor from the superior glenoid. Type III is a bucket-handle tear of the superior labrum with an intact biceps anchor. Type IV is a bucket-handle tear of the superior labrum that extends into the biceps tendon, resulting in instability of the biceps anchor.

Question 2785

Topic: Shoulder & Hip Sports

A 65-year-old male undergoes MRI of the shoulder for chronic weakness and pain. The radiologist notes a positive 'tangent sign' on the sagittal oblique T1-weighted images.

What does this radiographic finding specifically indicate regarding the supraspinatus muscle?

. Intramuscular fatty infiltration of Goutallier Stage 1
. Retraction of the tendon medial to the glenoid rim
. Complete tearing of the anterior cable of the rotator cuff
. Severe muscle atrophy signifying a likely irreparable tear
. Concomitant injury to the suprascapular nerve

Correct Answer & Explanation

. Severe muscle atrophy signifying a likely irreparable tear

Explanation

The 'tangent sign' is assessed on a sagittal oblique MRI slice (Y-view). A line is drawn connecting the superior border of the coracoid process to the superior border of the scapular spine. If the supraspinatus muscle belly falls below this line, the tangent sign is positive. This indicates severe muscle atrophy and is strongly predictive of an irreparable rotator cuff tear and poor functional outcomes following attempted repair.

Question 2786

Topic: 5. Sports Medicine

A 17-year-old female high school soccer player sustains an isolated anterior cruciate ligament (ACL) tear. She undergoes primary ACL reconstruction. Which of the following graft choices is associated with the highest rate of re-rupture in this specific demographic?

. Bone-patellar tendon-bone (BPTB) autograft
. Quadrupled hamstring autograft
. Quadriceps tendon autograft
. Bone-patellar tendon-bone (BPTB) allograft
. Hamstring allograft augmented with suture tape

Correct Answer & Explanation

. Bone-patellar tendon-bone (BPTB) allograft

Explanation

In young, active patients (particularly those under 25 years of age returning to high-impact pivoting sports like soccer), allografts (such as BPTB allograft) have a significantly higher clinical failure and re-rupture rate compared to autografts. Autografts (BPTB, hamstring, or quadriceps) are the gold standard for this patient demographic.

Question 2787

Topic: Shoulder & Hip Sports

A newborn delivered via forceps-assisted vaginal delivery presents with the right upper extremity held in adduction, internal rotation, and extension at the elbow, with the wrist flexed ('waiter's tip' posture). Which nerve roots are predominantly injured in this condition?

. C8 and T1
. C7, C8, and T1
. C5 and C6
. C5, C6, and C7
. Isolated C7

Correct Answer & Explanation

. C5 and C6

Explanation

The 'waiter's tip' posture is characteristic of Erb's palsy, which is an upper trunk brachial plexus injury involving the C5 and C6 nerve roots. This causes paralysis of the deltoid and supraspinatus (loss of abduction), infraspinatus and teres minor (loss of external rotation), and biceps and brachialis (loss of elbow flexion). Injury to C8 and T1 results in Klumpke's palsy, affecting the intrinsic muscles of the hand (claw hand).

Question 2788

Topic: Knee Sports

A 50-year-old female presents with sudden onset medial knee pain without mechanical locking. MRI demonstrates a medial meniscus posterior root tear with 4 mm of meniscal extrusion. Biomechanically, untreated meniscal root tears have been shown to be equivalent to which of the following?

. Total meniscectomy
. Partial meniscectomy
. Anterior cruciate ligament deficiency
. Medial collateral ligament sprain
. Posterior cruciate ligament deficiency

Correct Answer & Explanation

. Total meniscectomy

Explanation

Meniscal root tears completely disrupt the circumferential hoop stresses of the meniscus. Without these intact roots anchoring the meniscus to the tibial plateau, axial loading simply pushes the meniscus out of the joint (extrusion). Biomechanical studies have demonstrated that an untreated meniscal root tear leads to peak contact pressures identical to a total meniscectomy, resulting in rapid joint degeneration.

Question 2789

Topic: 5. Sports Medicine

A 16-year-old female athlete undergoes primary anterior cruciate ligament (ACL) reconstruction using a soft-tissue hamstring autograft. Which of the following factors has been shown to be most strongly associated with an increased risk of early graft failure in this population?

. Use of suspensory fixation on the femur
. Graft diameter less than 8 mm
. Concomitant partial medial meniscectomy
. Use of interference screw fixation on the tibia
. Timing of surgery within 3 weeks of injury

Correct Answer & Explanation

. Graft diameter less than 8 mm

Explanation

In adolescent and young adult patients, utilizing a hamstring autograft with a diameter of less than 8 mm has been significantly associated with higher rates of graft failure. Surgeons often consider augmenting the graft or choosing an alternative graft source (like bone-patellar tendon-bone) if the intraoperative hamstring size is inadequate.

Question 2790

Topic: Knee Sports

A posterior medial meniscal root tear severely compromises normal knee biomechanics. Which of the following statements regarding the biomechanical consequence of a complete posterior medial root tear is most accurate?

. It results in increased tension on the anterior cruciate ligament but does not alter contact pressures.
. Peak contact pressures in the medial compartment are equivalent to those seen after a total medial meniscectomy.
. The tear increases hoop stresses but maintains normal tibiofemoral kinematics.
. It primarily increases lateral compartment contact pressures due to a varus shift.
. Biomechanical forces remain unchanged if the meniscofemoral ligament of Wrisberg is intact.

Correct Answer & Explanation

. Peak contact pressures in the medial compartment are equivalent to those seen after a total medial meniscectomy.

Explanation

A complete tear of the posterior medial meniscal root disrupts the meniscal ring, abolishing its ability to convert axial loads into hoop stresses. Biomechanical studies have shown that this effectively renders the meniscus non-functional, resulting in peak contact pressures in the medial compartment that are equivalent to those measured after a total medial meniscectomy.

Question 2791

Topic: Shoulder & Hip Sports

A 22-year-old rugby player has a history of recurrent anterior shoulder instability. A 3D reconstructed pre-operative CT scan is shown.

The imaging demonstrates an inverted pear-shaped glenoid with a calculated anterior-inferior bone loss of 27%. What is the most appropriate surgical management to minimize his recurrence risk?

. Arthroscopic Bankart repair with capsular plication
. Arthroscopic remplissage alone
. Open inferior capsular shift
. Latarjet procedure (coracoid transfer)
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

In patients with anterior shoulder instability and significant glenoid bone loss (>20-25%, often creating an 'inverted pear' appearance), soft tissue procedures alone (like an arthroscopic Bankart repair) have unacceptably high recurrence rates. A bony augmentation procedure, most commonly the Latarjet procedure (transfer of the coracoid process with the attached conjoint tendon to the anterior glenoid neck), is the gold standard treatment.

Question 2792

Topic: Knee Sports

A 22-year-old collegiate football player sustains a twisting injury to his knee during a tackle. Radiographs reveal an avulsion fracture of the lateral aspect of the proximal tibia, just distal to the articular surface (a Segond fracture). Which ligamentous injury is most strongly associated with this pathognomonic finding?

. Posterior cruciate ligament (PCL) tear
. Medial collateral ligament (MCL) tear
. Lateral collateral ligament (LCL) tear
. Anterior cruciate ligament (ACL) tear
. Medial patellofemoral ligament (MPFL) tear

Correct Answer & Explanation

. Anterior cruciate ligament (ACL) tear

Explanation

A Segond fracture is an avulsion fracture of the anterolateral capsule and the anterolateral ligament (ALL) complex from the lateral tibial plateau. It is considered pathognomonic for an anterior cruciate ligament (ACL) tear. It typically occurs via an internal rotation and varus stress mechanism.

Question 2793

Topic: Shoulder & Hip Sports

A 20-year-old collegiate swimmer presents with bilateral shoulder pain. On physical examination, she demonstrates a positive sulcus sign and apprehension in abduction/external rotation, but she is able to voluntarily dislocate and reduce her shoulders without pain. She has no history of an acute traumatic dislocation. Which of the following is the most appropriate initial management?

. Arthroscopic Bankart repair
. Open inferior capsular shift
. Latarjet procedure (coracoid transfer)
. Physical therapy emphasizing periscapular and rotator cuff strengthening
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Physical therapy emphasizing periscapular and rotator cuff strengthening

Explanation

This patient exhibits classic signs of atraumatic, multidirectional instability (MDI), often characterized by the AMBRI acronym (Atraumatic, Multidirectional, Bilateral, Rehabilitation, Inferior capsular shift). The hallmark of treatment for MDI is a prolonged, dedicated physical therapy program focusing on strengthening the dynamic stabilizers of the shoulder (rotator cuff and periscapular muscles). Surgery (inferior capsular shift) is reserved for patients who fail extensive conservative management.

Question 2794

Topic: 5. Sports Medicine

A 22-year-old collegiate soccer player requires ACL reconstruction. The surgeon opts for a bone-patellar tendon-bone (BTB) autograft.

Compared to a 4-strand hamstring autograft, the BTB autograft has a higher incidence of which postoperative complication?

. Deep surgical site infection
. Graft rupture within 2 years
. Anterior knee pain and kneeling pain
. Hardware failure
. Hamstring weakness in deep flexion

Correct Answer & Explanation

. Anterior knee pain and kneeling pain

Explanation

Both bone-patellar tendon-bone (BTB) and hamstring autografts provide excellent stability for ACL reconstruction. However, BTB autografts are historically and consistently associated with a higher incidence of donor site morbidity, specifically anterior knee pain and pain with kneeling. Hamstring grafts may result in a minor deficit in deep flexion strength but avoid extensor mechanism morbidity.

Question 2795

Topic: 5. Sports Medicine

A 40-year-old recreational athlete sustains an acute Achilles tendon rupture.

When comparing non-operative management utilizing an early functional rehabilitation protocol against operative repair, recent high-level literature (e.g., Willits et al.) demonstrates which of the following?

. A significantly higher re-rupture rate in the non-operative group
. Similar re-rupture rates between both groups
. A significantly higher deep infection rate in the non-operative group
. Superior long-term functional outcomes favoring operative management
. A higher incidence of sural nerve injury in the non-operative group

Correct Answer & Explanation

. Similar re-rupture rates between both groups

Explanation

Historically, non-operative management of Achilles tendon ruptures was associated with higher re-rupture rates. However, modern level I studies (e.g., Willits et al.) have demonstrated that when non-operative management is paired with an early functional rehabilitation protocol (early weight-bearing in an orthosis), the re-rupture rates and functional outcomes are statistically similar to those of operative repair, while completely avoiding surgical complications like infection or nerve injury.

Question 2796

Topic: Shoulder & Hip Sports

A 24-year-old rugby player has recurrent anterior shoulder instability with 25% anterior glenoid bone loss on a 3D CT scan.

A Latarjet procedure is performed. What is the primary biomechanical stabilizing mechanism of this procedure when the shoulder is in the apprehension position (abduction/external rotation)?

. Bony augmentation of the glenoid arc by the coracoid graft
. Sling effect of the conjoined tendon against the inferior subscapularis and capsule
. Anatomic repair of the torn coracoacromial ligament
. Tensioning of the middle glenohumeral ligament (MGHL)
. Rerouting the long head of the biceps brachii

Correct Answer & Explanation

. Sling effect of the conjoined tendon against the inferior subscapularis and capsule

Explanation

The Latarjet procedure involves transferring the coracoid process with the attached conjoined tendon to the anterior glenoid. While the bony block restores the glenoid arc (the 'bony effect'), biomechanical studies have demonstrated that the primary stabilizing mechanism in abduction and external rotation is the dynamic 'sling effect.' The conjoined tendon acts as a hammock against the inferior capsule and lower subscapularis, preventing anterior translation of the humeral head.

Question 2797

Topic: Shoulder & Hip Sports
During arthroscopic evaluation of a 22-year-old baseball pitcher's shoulder, a superior labral anterior to posterior (SLAP) tear is identified. The labrum is visibly frayed, but the biceps anchor is completely intact and firmly attached to the superior glenoid tubercle without any detachment. What type of SLAP lesion is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type I

Explanation

Type I SLAP tears are characterized by 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 is a bucket-handle tear of the labrum with an intact biceps anchor. Type IV is a bucket-handle tear that extends into the biceps tendon.

Question 2798

Topic: 5. Sports Medicine

In Anterior Cruciate Ligament (ACL) reconstruction, graft choice depends on multiple factors including initial graft strength. Which of the following commonly utilized autografts possesses the highest initial ultimate tensile load?

. Bone-patellar tendon-bone (10 mm)
. Quadrupled hamstring (semitendinosus and gracilis)
. Quadriceps tendon (10 mm without bone block)
. Single-strand semitendinosus
. Patellar tendon (8 mm)

Correct Answer & Explanation

. Quadrupled hamstring (semitendinosus and gracilis)

Explanation

A quadrupled hamstring autograft (semitendinosus and gracilis) has the highest initial ultimate tensile load of the common grafts, averaging approximately 4000-4100 N. This is stronger than a standard 10 mm bone-patellar tendon-bone (BPTB) graft (~2900 N) and significantly stronger than the native ACL, which has an ultimate tensile load of approximately 2160 N.

Question 2799

Topic: Knee Sports

Biomechanically, a complete radial tear of the posterior horn of the medial meniscus root alters knee kinematics most similarly to which of the following conditions?

. Total meniscectomy
. 50% partial meniscectomy
. ACL deficiency
. PCL deficiency
. Isolated MCL tear

Correct Answer & Explanation

. Total meniscectomy

Explanation

Complete meniscal root tears or complete radial tears disrupt the circumferential hoop stresses of the meniscus. This results in functional meniscal extrusion under axial load, biomechanically mimicking a total meniscectomy and dramatically increasing peak tibiofemoral contact pressures.

Question 2800

Topic: Shoulder & Hip Sports
A 22-year-old collegiate baseball pitcher presents with deep shoulder pain, decreased velocity, and a positive O'Brien's test. MRI arthrogram reveals a Type II SLAP lesion. What anatomic feature specifically distinguishes a Type II SLAP tear from a Type I tear?
. Fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and biceps anchor from the superior glenoid
. A bucket-handle tear of the labrum with an intact biceps anchor
. A bucket-handle tear of the labrum extending into the biceps tendon
. A labral tear extending into the middle glenohumeral ligament

Correct Answer & Explanation

. Detachment of the superior labrum and biceps anchor from the superior glenoid

Explanation

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

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