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5. Sports Medicine MCQs

Practice Set 141 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 2801

Topic: Shoulder & Hip Sports

A 19-year-old collegiate swimmer presents with bilateral shoulder pain and a sensation of instability in multiple directions. Physical examination reveals a positive sulcus sign and generalized ligamentous laxity. If surgical intervention is ultimately indicated after exhaustive physical therapy, the procedure must address the primary patholaxity, which is characterized by:

. An avulsion of the anterior labrum from the glenoid rim
. An increased volume and redundancy of the inferior capsular pouch
. A complete tear of the superior glenohumeral ligament
. An engaging Hill-Sachs lesion
. A congenital hypoplasia of the glenoid

Correct Answer & Explanation

. An increased volume and redundancy of the inferior capsular pouch

Explanation

The patient has multidirectional instability (MDI) of the shoulder, characterized by symptomatic instability in more than one direction (anterior, posterior, inferior). The hallmark pathoanatomy of MDI is a patulous (redundant/increased volume) inferior capsule. If a prolonged course of physical therapy (focusing on rotator cuff and periscapular stabilization) fails, the surgical treatment of choice is an inferior capsular shift to reduce capsular volume.

Question 2802

Topic: Knee Sports

A 26-year-old recreational skier sustains a twisting knee injury. On physical examination, the physician notes a positive dial test (increased external rotation of the tibia relative to the femur) at 30 degrees of knee flexion, but the test normalizes and is symmetric to the contralateral uninjured side at 90 degrees of flexion. Which of the following structures is most likely injured?

. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Posterolateral corner (PLC)
. Both the PCL and the PLC
. Medial collateral ligament (MCL)

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

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

Question 2803

Topic: Knee Sports



A 22-year-old elite soccer player undergoes an anterior cruciate ligament (ACL) reconstruction. Preoperatively, she demonstrated a high-grade pivot shift test. The surgeon decides to perform an anterolateral ligament (ALL) reconstruction concurrently to improve rotational stability. Which of the following is true regarding the anatomy and biomechanics of the ALL?

. Its femoral origin is proximal and anterior to the fibular collateral ligament (FCL) attachment.
. It acts as a primary restraint to varus opening at 30 degrees of flexion.
. Its femoral origin is posterior and proximal to the lateral epicondyle.
. It inserts directly onto the fibular head.
. It is primarily responsible for preventing posterior tibial translation.

Correct Answer & Explanation

. Its femoral origin is posterior and proximal to the lateral epicondyle.

Explanation

The anterolateral ligament (ALL) originates posterior and proximal to the lateral femoral epicondyle and inserts on the proximal tibia midway between Gerdy's tubercle and the fibular head. It acts as a secondary restraint to internal tibial rotation and the pivot shift phenomenon.

Question 2804

Topic: Shoulder & Hip Sports



A 50-year-old male undergoes arthroscopic rotator cuff repair for a massive, retracted tear. To improve lateral excursion of the supraspinatus tendon, the surgeon releases the coracohumeral ligament (CHL). Which of the following is true regarding the physiological function of the intact CHL?

. It primarily originates on the acromion and inserts on the greater tuberosity.
. It acts as a primary restraint to external rotation when the arm is adducted.
. It seamlessly blends with the inferior glenohumeral ligament complex.
. It acts as a dynamic active stabilizer of the long head of the biceps tendon.
. It limits internal rotation when the arm is abducted to 90 degrees.

Correct Answer & Explanation

. It acts as a primary restraint to external rotation when the arm is adducted.

Explanation

The coracohumeral ligament (CHL) originates on the base of the coracoid process and blends into the rotator interval, inserting onto the greater and lesser tuberosities. It is a primary static restraint to inferior translation and external rotation of the humerus when the shoulder is in an adducted position.

Question 2805

Topic: 5. Sports Medicine
A 16-year-old female athlete experiences her first acute lateral patellar dislocation. Physical exam reveals a positive J-sign and severe apprehension. MRI demonstrates a complete mid-substance tear of the medial patellofemoral ligament (MPFL). If reconstruction is planned, the surgeon must identify the precise femoral attachment of the MPFL. Where is this anatomic landmark located?
. Anterior and proximal to the medial femoral epicondyle
. Posterior and proximal to the medial femoral epicondyle
. Distal to the medial femoral epicondyle, near the joint line
. Directly at the apex of the adductor tubercle
. In a saddle-shaped depression between the medial epicondyle and adductor tubercle

Correct Answer & Explanation

. In a saddle-shaped depression between the medial epicondyle and adductor tubercle

Explanation

The femoral origin of the medial patellofemoral ligament (MPFL) is a critical landmark for anatomic reconstruction (often referenced radiographically as Schöttle's point). Anatomically, it is located in a saddle-shaped depression between the medial epicondyle (distal/anterior) and the adductor tubercle (proximal/posterior).

Question 2806

Topic: Knee Sports

Which of the following best describes the functional anatomy and biomechanics of the posterior cruciate ligament (PCL)?

. The anterolateral bundle is tight in flexion and lax in extension
. The anterolateral bundle is tight in extension and lax in flexion
. The posteromedial bundle is tight in flexion and lax in extension
. The meniscofemoral ligaments are present in less than 20% of knees
. It is the primary restraint to anterior tibial translation

Correct Answer & Explanation

. The posteromedial bundle is tight in flexion and lax in extension

Explanation

The PCL consists of two main bundles: the anterolateral (AL) bundle and the posteromedial (PM) bundle. The AL bundle is the larger of the two and is tight in flexion and lax in extension. Conversely, the smaller PM bundle is tight in extension and lax in flexion.

Question 2807

Topic: Shoulder & Hip Sports

A 65-year-old male undergoes arthroscopic rotator cuff repair and is noted to have a highly degenerate long head of the biceps tendon. A biceps tenotomy is performed. Compared to biceps tenodesis, simple tenotomy is associated with a statistically higher rate of:

. Postoperative stiffness
. Cosmetic deformity (Popeye sign)
. Deep infection
. Chronic regional pain syndrome
. Need for revision surgery

Correct Answer & Explanation

. Cosmetic deformity (Popeye sign)

Explanation

While both biceps tenotomy and tenodesis yield similarly good outcomes regarding pain relief and function, simple tenotomy has a significantly higher rate of cosmetic deformity (the 'Popeye' muscle bulge) and occasional cramping, compared to tenodesis.

Question 2808

Topic: Shoulder & Hip Sports

In the surgical management of recurrent anterior shoulder instability, a 'remplissage' procedure is occasionally performed as an adjunct to arthroscopic Bankart repair. The remplissage procedure addresses a large Hill-Sachs lesion by tenodesing which of the following structures into the defect?

. Subscapularis
. Long head of the biceps brachii
. Infraspinatus
. Teres minor
. Supraspinatus

Correct Answer & Explanation

. Infraspinatus

Explanation

The term 'remplissage' translates to 'filling' in French. It is an arthroscopic procedure used to treat engaging or off-track Hill-Sachs lesions (posterosuperior humeral head impaction fractures). It involves the capsulotenodesis of the posterior capsule and the infraspinatus tendon into the humeral head defect, thereby converting an intra-articular defect into an extra-articular one and preventing it from engaging the anterior glenoid rim during abduction and external rotation.

Question 2809

Topic: 5. Sports Medicine

A 22-year-old female soccer player undergoes primary anterior cruciate ligament (ACL) reconstruction. The surgeon discusses autograft choices. Compared to a bone-patellar tendon-bone (BTB) autograft, the use of a multi-stranded hamstring autograft is statistically associated with a higher risk of which of the following postoperative outcomes?

. Anterior knee pain during kneeling
. Patellar fracture
. Postoperative extension deficit
. Increased laxity on instrumented testing
. Contralateral ACL rupture

Correct Answer & Explanation

. Increased laxity on instrumented testing

Explanation

Multiple level I studies and meta-analyses comparing BTB and hamstring autografts for ACL reconstruction have shown that hamstring grafts are associated with slightly increased laxity on instrumented testing (e.g., KT-1000) and a higher theoretical risk of graft rupture in young, high-demand female athletes. BTB autografts have higher rates of donor-site morbidity, particularly anterior knee pain, kneeling pain, and a small risk of patellar fracture. Extension deficits are also slightly more common with BTB grafts.

Question 2810

Topic: 5. Sports Medicine

A 42-year-old recreational basketball player feels a 'pop' in his calf and is diagnosed with an acute Achilles tendon rupture. He is considering non-operative management versus open surgical repair. Based on recent Level I evidence comparing non-operative management utilizing an early functional rehabilitation protocol to surgical repair, non-operative management is associated with:

. A significantly higher rerupture rate
. A significantly lower rate of return to sports
. Equivalent rerupture rates but a significantly higher risk of sural nerve injury
. Equivalent rerupture rates and a lower rate of soft-tissue and wound complications
. A 50% decrease in peak plantarflexion strength at 2-year follow-up

Correct Answer & Explanation

. Equivalent rerupture rates and a lower rate of soft-tissue and wound complications

Explanation

Historically, non-operative management of Achilles tendon ruptures with prolonged cast immobilization resulted in higher rerupture rates. However, modern Level I trials (e.g., Willits et al.) utilizing early functional rehabilitation (weight-bearing in a functional brace with early range of motion) demonstrate that non-operative management yields rerupture rates equivalent to surgical repair, while entirely avoiding surgical complications such as wound breakdown, infection, and iatrogenic nerve injury.

Question 2811

Topic: Shoulder & Hip Sports

A 22-year-old rugby player with recurrent anterior shoulder instability and 25% glenoid bone loss undergoes a Latarjet procedure. This procedure restores stability through a described 'triple-blocking' effect. Which of the following mechanisms is considered the most significant dynamic contributor to anterior stability in the Latarjet procedure?

. The static bony block extending the glenoid articular arc
. The sling effect of the conjoined tendon reinforcing the inferior capsule and subscapularis when the arm is abducted and externally rotated
. The repair of the native capsule to the coracoacromial ligament stump
. The dynamic tensioning of the long head of the biceps brachii
. The tenodesis of the subscapularis directly to the anterior labrum

Correct Answer & Explanation

. The sling effect of the conjoined tendon reinforcing the inferior capsule and subscapularis when the arm is abducted and externally rotated

Explanation

The Latarjet procedure provides a 'triple-blocking' effect for anterior shoulder instability. The three components are: 1) The dynamic 'sling' effect of the conjoined tendon across the inferior subscapularis and anterior capsule when the arm is abducted and externally rotated; 2) The static bony effect of the coracoid bone block increasing the glenoid arc; and 3) The capsular repair (capsule sutured to the CA ligament stump). Biomechanical studies have demonstrated that the dynamic sling effect of the conjoined tendon contributes most significantly to the stability provided by the construct, accounting for up to 75% of the stabilizing force.

Question 2812

Topic: Knee Sports

During a double-bundle posterior cruciate ligament (PCL) reconstruction, the surgeon aims to accurately recreate the native anatomy. Which of the following accurately describes the tensioning protocol for the two distinct bundles?

. The anterolateral bundle is tensioned in full extension, while the posteromedial bundle is tensioned in 90 degrees of flexion.
. The anterolateral bundle is tensioned in 90 degrees of flexion, while the posteromedial bundle is tensioned in full extension.
. Both bundles are tensioned simultaneously in 90 degrees of flexion.
. Both bundles are tensioned simultaneously in full extension.
. The anterolateral bundle is tensioned in 45 degrees of flexion, while the posteromedial bundle is tensioned in 90 degrees of flexion.

Correct Answer & Explanation

. The anterolateral bundle is tensioned in 90 degrees of flexion, while the posteromedial bundle is tensioned in full extension.

Explanation

The native PCL consists of two main bundles: the anterolateral (AL) bundle and the posteromedial (PM) bundle. The AL bundle is larger and provides primary restraint to posterior tibial translation in flexion; thus, it is tensioned and fixed at 90 degrees of flexion. The PM bundle is smaller and is tight in extension; therefore, it is tensioned and fixed at 0 to 30 degrees of flexion (near full extension).

Question 2813

Topic: Shoulder & Hip Sports

A 22-year-old professional baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. Physical examination reveals a loss of internal rotation of 25 degrees compared to the contralateral side. MRI demonstrates articular-sided fraying of the posterior supraspinatus and an intact anterior capsule. What is the primary pathophysiologic mechanism driving this condition?

. Subcoracoid impingement
. Subacromial abrasion
. Anterior capsular contracture
. Posteroinferior capsular contracture
. Congenital glenoid retroversion

Correct Answer & Explanation

. Posteroinferior capsular contracture

Explanation

The scenario describes internal impingement of the shoulder, common in overhead athletes. The hallmark is Glenohumeral Internal Rotation Deficit (GIRD). The primary driver is a thickened, contracted posteroinferior capsule resulting from repetitive eccentric loading during the deceleration phase of throwing. This contracture shifts the glenohumeral contact point posterosuperiorly when the arm is in maximum abduction and external rotation (late cocking phase), causing the undersurface of the rotator cuff to impinge between the greater tuberosity and the posterosuperior glenoid labrum.

Question 2814

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with insidious onset of posterior shoulder pain that is most pronounced during the late cocking phase of throwing. Physical examination reveals a glenohumeral internal rotation deficit (GIRD) of 25 degrees compared to the contralateral shoulder, but symmetric total arc of motion. Which of the following is the primary pathoanatomic alteration driving this clinical presentation?

. Contracture of the anteroinferior capsule
. Contracture of the posteroinferior capsule
. Subscapularis tendon partial tear
. Acromioclavicular joint arthrosis
. Hypertrophy of the coracoacromial ligament

Correct Answer & Explanation

. Contracture of the posteroinferior capsule

Explanation

Glenohumeral internal rotation deficit (GIRD) in overhead throwing athletes is primarily caused by contracture and thickening of the posteroinferior capsule. This contracture shifts the glenohumeral contact point posterosuperiorly during the late cocking phase (abduction and external rotation), leading to 'internal impingement' of the undersurface of the rotator cuff against the posterosuperior glenoid labrum. Treatment initially focuses on posterior capsular stretching (e.g., sleeper stretches).

Question 2815

Topic: 5. Sports Medicine

An orthopedic surgeon is evaluating the native anterior cruciate ligament (ACL) during a knee arthroscopy. The ACL is anatomically divided into two main functional bundles: the anteromedial (AM) bundle and the posterolateral (PL) bundle. Which of the following statements most accurately describes the distinct biomechanical roles of these bundles?

. The AM bundle is tightest in full extension.
. The PL bundle is primarily responsible for anterior translation control in 90 degrees of flexion.
. The PL bundle is primarily responsible for controlling rotational stability near full extension.
. The AM bundle is the primary restraint to varus stress.
. Both bundles are completely isometric throughout the entire range of motion.

Correct Answer & Explanation

. The PL bundle is primarily responsible for controlling rotational stability near full extension.

Explanation

The native ACL consists of two primary bundles named for their tibial insertion. The anteromedial (AM) bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees of knee flexion. The posterolateral (PL) bundle is tight in extension and is the primary restraint to anterior tibial translation and rotational loads (pivot shift) near full extension. Neither bundle is completely isometric.

Question 2816

Topic: 5. Sports Medicine

During an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, the surgeon inadvertently drills the femoral tunnel anterior to the isometric point. What is the most likely postoperative kinematic consequence of this technical error?

. The graft will be tight in extension and loose in flexion
. The graft will be tight in flexion and loose in extension
. The graft will be loose in both flexion and extension
. The patient will experience lateral patellar subluxation
. The posterior cruciate ligament will rupture

Correct Answer & Explanation

. The graft will be tight in flexion and loose in extension

Explanation

Proper placement of the femoral tunnel is critical for isometric graft function. If the femoral tunnel is placed too far anteriorly, the distance between the tibial and femoral tunnels increases during knee flexion. Consequently, the graft becomes excessively tight in flexion, leading to a loss of full knee flexion, while remaining relatively loose in extension.

Question 2817

Topic: Shoulder & Hip Sports

A 22-year-old elite rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability associated with 25% glenoid bone loss.

The primary biomechanical stabilizing effect of this procedure when the arm is placed in the vulnerable position of abduction and external rotation is attributed to:

. The isolated bony block effect of the coracoid
. The 'sling' effect of the conjoined tendon on the inferior subscapularis
. The direct repair of the capsulolabral complex to the anterior glenoid rim
. The tensioning of the coracoacromial ligament
. The transfer of the short head of the biceps directly to the humerus

Correct Answer & Explanation

. The 'sling' effect of the conjoined tendon on the inferior subscapularis

Explanation

The Latarjet procedure provides stability through a 'triple effect'. While the bony block restores glenoid width, the most significant dynamic stabilizing mechanism in abduction and external rotation (the typical apprehension position) is the 'sling' effect. The transferred conjoined tendon runs across the inferior aspect of the subscapularis and anterior capsule, dynamically tensioning them and preventing anterior translation of the humeral head.

Question 2818

Topic: 5. Sports Medicine
A 25-year-old overhead athlete is diagnosed with a superior labrum anterior and posterior (SLAP) tear after failing nonoperative management. During diagnostic arthroscopy, which of the following intraoperative findings specifically defines a Type II SLAP tear according to the Snyder classification?
. Degenerative fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and biceps anchor from the superior glenoid tubercle
. A bucket-handle tear of the superior labrum with an intact biceps anchor
. A bucket-handle tear of the superior labrum extending into the long head of the biceps tendon
. An anteroinferior labral tear extending contiguously to the superior labrum

Correct Answer & Explanation

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

Explanation

In the Snyder classification of SLAP tears: Type I is degenerative fraying of the labrum with an intact biceps anchor. Type II is a frank detachment of the superior labrum and the biceps anchor from the superior glenoid. Type III is a bucket-handle tear of the labrum with an intact biceps anchor. Type IV is a bucket-handle tear of the labrum that extends into the biceps tendon. Type V (an extension of the classification) involves an anteroinferior Bankart lesion extending to the superior labrum.

Question 2819

Topic: Knee Sports

The posterior cruciate ligament (PCL) is composed of two primary bundles. Which of the following accurately describes the biomechanical behavior of the anterolateral (AL) and posteromedial (PM) bundles during knee range of motion?

. AL bundle is tight in flexion; PM bundle is tight in extension
. AL bundle is tight in extension; PM bundle is tight in flexion
. Both bundles are maximally tight in flexion
. Both bundles are maximally tight in extension
. AL bundle limits external rotation; PM bundle limits internal rotation

Correct Answer & Explanation

. AL bundle is tight in flexion; 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 tightest in knee flexion and lax in extension. Conversely, the PM bundle is tightest in knee extension and lax in flexion. This reciprocal relationship is vital to understanding PCL reconstruction biomechanics.

Question 2820

Topic: Shoulder & Hip Sports

A 28-year-old male presents after an unprovoked seizure. He complains of right shoulder pain and is unable to externally rotate his arm. Imaging confirms a posterior shoulder dislocation. Further evaluation reveals an impaction fracture of the humeral head known as a reverse Hill-Sachs lesion. Where is this articular defect classically located?

. Posterolateral aspect of the humeral head
. Anteromedial aspect of the humeral head
. Posteromedial aspect of the humeral head
. Anterolateral aspect of the humeral head
. Central articular surface of the humeral head

Correct Answer & Explanation

. Anteromedial aspect of the humeral head

Explanation

A posterior shoulder dislocation commonly results in an impaction fracture of the humeral head as it is driven against the posterior glenoid rim. This defect is known as a reverse Hill-Sachs lesion and is classically located on the anteromedial aspect of the humeral head. In contrast, an anterior dislocation produces a standard Hill-Sachs lesion, which is located on the posterolateral aspect of the humeral head.

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