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5. Sports Medicine MCQs

Practice Set 145 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 2881

Topic: 5. Sports Medicine

A 40-year-old recreational athlete sustains an acute complete Achilles tendon rupture. Based on high-quality randomized controlled trials (e.g., Willits et al.), which of the following statements is true regarding non-operative management utilizing an early functional rehabilitation protocol compared to traditional open surgical repair?

. Non-operative management has a significantly higher re-rupture rate regardless of the rehabilitation protocol.
. Non-operative management with early functional rehab has a similar re-rupture rate but a significantly lower rate of soft-tissue complications.
. Open surgical repair has a higher rate of sural nerve injury than percutaneous repair, but lower than non-operative management.
. Non-operative management leads to significantly decreased plantar flexion strength and endurance at 2-year follow-up.
. Early weight-bearing in equinus during non-operative treatment drastically increases the risk of DVT compared to casting.

Correct Answer & Explanation

. Non-operative management with early functional rehab has a similar re-rupture rate but a significantly lower rate of soft-tissue complications.

Explanation

Modern studies incorporating early functional rehabilitation (early weight bearing in a functional brace/boot) for acute Achilles tendon ruptures have demonstrated that the re-rupture rates are equivalent to open surgical repair. However, surgical repair continues to have a significantly higher rate of minor and major soft-tissue complications (e.g., infection, wound breakdown). Thus, functional non-operative protocols are increasingly favored.

Question 2882

Topic: Knee Sports
A 16-year-old female undergoes medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar instability. To ensure proper graft isometry during knee flexion, where must the femoral attachment of the graft be placed anatomically?
. Anterior to the medial epicondyle and proximal to the adductor tubercle.
. Posterior to the medial epicondyle and distal to the adductor tubercle.
. In the saddle region, proximal and posterior to the medial epicondyle, and distal to the adductor tubercle.
. Directly atop the adductor tubercle.
. Distal to the superficial MCL femoral attachment.

Correct Answer & Explanation

. In the saddle region, proximal and posterior to the medial epicondyle, and distal to the adductor tubercle.

Explanation

The anatomic femoral footprint of the MPFL (often radiographically localized by Schöttle's point) is situated in a "saddle" region between the adductor tubercle and the medial epicondyle. Specifically, it lies proximal and posterior to the medial epicondyle, and just distal and anterior to the adductor tubercle. Accurate placement is essential to ensure the graft remains appropriately tensioned (isometric) throughout the knee arc of motion.

Question 2883

Topic: Knee Sports

A 28-year-old male sustains a knee injury during a soccer tackle. Physical examination reveals a positive dial test at 30 degrees of knee flexion with 15 degrees of increased external rotation compared to the contralateral side. At 90 degrees of knee flexion, the external rotation is symmetric bilaterally. Which of the following structures is most likely injured?

. Posterior cruciate ligament (PCL) only
. Anterior cruciate ligament (ACL) and PCL
. Posterolateral corner (PLC) and PCL
. Posterolateral corner (PLC) isolated
. Medial collateral ligament (MCL) and posterior oblique ligament

Correct Answer & Explanation

. Posterolateral corner (PLC) and PCL

Explanation

An isolated injury to the posterolateral corner (PLC) results in a positive dial test at 30 degrees but not at 90 degrees. If both the PLC and PCL are torn, the dial test will be positive at both 30 and 90 degrees.

Question 2884

Topic: Shoulder & Hip Sports

During an open Latarjet procedure for recurrent anterior shoulder instability, the coracoid process is osteotomized and transferred. Which of the following neural structures must be meticulously protected as it enters the conjoint tendon approximately 3-5 cm distal to the coracoid tip?

. Axillary nerve
. Median nerve
. Musculocutaneous nerve
. Suprascapular nerve
. Radial nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve routinely enters the deep surface of the coracobrachialis (part of the conjoint tendon) 3 to 8 cm distal to the coracoid process. It is at highest risk during the dissection and retraction of the conjoint tendon in a Latarjet procedure.

Question 2885

Topic: 5. Sports Medicine

An athlete undergoes anterior cruciate ligament (ACL) reconstruction. Post-operatively, he complains of anterior knee pain and a lack of terminal extension. MRI demonstrates the graft impinging against the intercondylar roof in extension. Which technical error is the most likely cause of this complication?

. The femoral tunnel was placed too anteriorly.
. The tibial tunnel was placed too anteriorly.
. The femoral tunnel was placed too posteriorly.
. The tibial tunnel was placed too posteriorly.
. The graft was over-tensioned during fixation.

Correct Answer & Explanation

. The tibial tunnel was placed too anteriorly.

Explanation

Placement of the tibial tunnel too anteriorly results in roof impingement of the ACL graft, leading to a loss of extension. In contrast, placing the femoral tunnel too anteriorly generally leads to a graft that is tight in flexion and loose in extension.

Question 2886

Topic: 5. Sports Medicine

A 25-year-old professional baseball pitcher presents with vague, deep shoulder pain and clicking during the late cocking phase of throwing. He is diagnosed with a Type II Superior Labrum Anterior and Posterior (SLAP) tear. What is the primary biomechanical mechanism causing this pathology in this patient population?

. Direct axial load on an adducted and internally rotated arm
. Traction injury to the long head of the biceps during early acceleration
. The "peel-back" mechanism during maximum abduction and external rotation
. Impingement of the greater tuberosity against the coracoacromial arch
. Subcoracoid impingement causing attrition of the superior labrum

Correct Answer & Explanation

. The "peel-back" mechanism during maximum abduction and external rotation

Explanation

In overhead throwing athletes, Type II SLAP tears typically occur due to the "peel-back" mechanism. During the late cocking phase (maximum abduction and external rotation), the biceps vector shifts posteriorly, transmitting torsional force that peels the superior labrum off the glenoid.

Question 2887

Topic: 5. Sports Medicine

A 19-year-old female collegiate soccer player undergoes ACL reconstruction using a bone-patellar tendon-bone (BTB) autograft. Compared to hamstring autograft, which of the following is an expected long-term outcome associated with BTB autograft?

. Increased rate of graft rupture.
. Decreased rate of return to pre-injury level of sport.
. Increased incidence of anterior knee pain and kneeling pain.
. Increased incidence of deep infection.
. Decreased incidence of contralateral ACL rupture.

Correct Answer & Explanation

. Increased incidence of anterior knee pain and kneeling pain.

Explanation

Bone-patellar tendon-bone (BTB) autograft is associated with a significantly higher incidence of anterior knee pain and kneeling pain compared to hamstring autografts. BTB grafts typically have a lower or equivalent rate of graft rupture compared to hamstrings in young athletes and do not alter the risk of contralateral ACL rupture.

Question 2888

Topic: 5. Sports Medicine

A 22-year-old male collegiate baseball pitcher complains of anterior shoulder pain during the late cocking phase of throwing. An MRI arthrogram reveals a SLAP tear. He undergoes arthroscopic SLAP repair. Which of the following is the most likely postoperative complication that could end his pitching career?

. Recurrent SLAP tear.
. Postoperative stiffness (loss of external rotation).
. Axillary nerve injury.
. Suprascapular nerve injury.
. Anchor pull-out.

Correct Answer & Explanation

. Postoperative stiffness (loss of external rotation).

Explanation

In elite overhead throwing athletes (such as pitchers), arthroscopic SLAP repair has a low rate of return to pre-injury level of play. Postoperative stiffness, specifically a loss of maximum external rotation, is the most common reason for failure to return to pitching. Due to this high failure rate, many surgeons now prefer nonoperative management focusing on posterior capsular stretching or biceps tenodesis in this specific athletic population.

Question 2889

Topic: Shoulder & Hip Sports

A 65-year-old male undergoes arthroscopic repair of a massive rotator cuff tear. Preoperative MRI demonstrated significant tendon retraction. Which of the following preoperative imaging findings is the strongest independent predictor of structural failure following repair?

. Acromiohumeral interval of 8 mm
. Type II SLAP tear
. Goutallier stage 3 or 4 fatty infiltration of the rotator cuff muscles
. Os acromiale
. Subacromial spurring

Correct Answer & Explanation

. Goutallier stage 3 or 4 fatty infiltration of the rotator cuff muscles

Explanation

High grades of fatty infiltration (Goutallier stage 3 or 4) are irreversible and highly predictive of poor clinical outcomes and structural failure of the repaired rotator cuff tendon.

Question 2890

Topic: Knee Sports

A 22-year-old collegiate soccer player undergoes primary ACL reconstruction using a bone-patellar tendon-bone (BTB) autograft. Six months postoperatively, she complains of anterior knee pain and a palpable click when extending the knee from 30 degrees to full extension. What is the most likely etiology?

. Cyclops lesion
. Patellar clunk syndrome
. Graft impingement due to an anteriorly placed tibial tunnel
. Symptomatic hardware at the tibial tubercle
. Arthrofibrosis

Correct Answer & Explanation

. Cyclops lesion

Explanation

A Cyclops lesion (localized anterior arthrofibrosis) typically presents with an extension deficit and a terminal extension click or clunk after ACL reconstruction. Patellar clunk syndrome is classically associated with posterior stabilized total knee arthroplasty, not ACL reconstruction.

Question 2891

Topic: Shoulder & Hip Sports

A 19-year-old competitive swimmer presents with bilateral shoulder pain and a sensation of "slipping" in all directions. Examination reveals a positive sulcus sign bilaterally that does not decrease with external rotation. What is the first-line treatment?

. Arthroscopic anterior labral repair
. Arthroscopic posterior labral repair
. Open inferior capsular shift
. Prolonged physical therapy emphasizing periscapular and rotator cuff strengthening
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Prolonged physical therapy emphasizing periscapular and rotator cuff strengthening

Explanation

The patient has multidirectional instability (MDI), classically presenting with generalized laxity and a sulcus sign. First-line management is conservative, utilizing a rigorous physical therapy program focused on dynamic stabilizers (rotator cuff and periscapular muscles).

Question 2892

Topic: 5. Sports Medicine

A 9-year-old male sustains a mid-substance ACL tear. He is Tanner Stage 1 with wide-open physes. Conservative management fails, and he experiences recurrent instability. Which surgical technique minimizes the risk of growth arrest and angular deformity?

. Transphyseal reconstruction with bone-patellar tendon-bone autograft
. Iliotibial band extra-articular tenodesis alone
. Physeal-sparing all-epiphyseal reconstruction
. Transphyseal reconstruction with quadrupled hamstring autograft
. Partial physeal-sparing with diaphyseal femoral tunnel

Correct Answer & Explanation

. Physeal-sparing all-epiphyseal reconstruction

Explanation

In Tanner Stage 1 or 2 patients with wide-open physes, physeal-sparing techniques like all-epiphyseal constructs are recommended to avoid crossing the growth plates. Transphyseal techniques are typically reserved for older patients nearing skeletal maturity.

Question 2893

Topic: 5. Sports Medicine

A 28-year-old professional athlete presents with a symptomatic 2.5 cm full-thickness chondral defect on the femoral condyle following an acute twisting injury. Previous microfracture surgery 6 months ago failed to provide lasting relief. MRI confirms the defect. The patient is keen on returning to high-level sports. Considering advanced biologic augmentation techniques, which option represents the MOST evidence-supported next-step treatment approach for superior hyaline-like cartilage repair in a young, active patient?

. Repeat microfracture with platelet-rich plasma (PRP) augmentation
. Autologous Chondrocyte Implantation (ACI)
. Osteochondral Autograft Transfer System (OATS)
. Particulated juvenile articular cartilage allograft transplantation
. Mesenchymal Stem Cell (MSC) injection alone

Correct Answer & Explanation

. Autologous Chondrocyte Implantation (ACI)

Explanation

For a symptomatic, large (2.5 cm) full-thickness chondral defect, especially after failed microfracture in a young, active patient desiring return to high-level sports, Autologous Chondrocyte Implantation (ACI) is a well-established and evidence-supported option. ACI aims to regenerate hyaline-like cartilage and has demonstrated good long-term outcomes for larger defects. OATS (osteochondral autograft) is typically better suited for smaller defects (<2.5 cm) due to donor site morbidity. Particulated juvenile articular cartilage allograft is a newer technique with promising early results but less long-term data compared to ACI. Repeat microfracture, even with PRP, is unlikely to succeed where primary microfracture failed for a defect of this size. MSC injection alone lacks robust evidence for stand-alone treatment of full-thickness defects.

Question 2894

Topic: Knee Sports

A 21-year-old female soccer player undergoes primary anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Six months postoperatively, she complains of anterior knee pain and a hard block to terminal knee extension at 10 degrees of flexion. What is the most likely surgical etiology of this complication?

. Anterior placement of the tibial tunnel
. Posterior placement of the femoral tunnel
. Inadequate tensioning of the graft
. Failure to repair a concomitant medial meniscal tear
. Anterior placement of the femoral tunnel

Correct Answer & Explanation

. Anterior placement of the tibial tunnel

Explanation

A hard block to terminal knee extension following ACL reconstruction is a classic presentation for intercondylar roof impingement. This is most commonly caused by placing the tibial tunnel too anteriorly, causing the graft to impinge against the notch in extension.

Question 2895

Topic: Knee Sports

A 25-year-old athlete sustains a multi-ligament knee injury. Physical examination reveals a negative posterior drawer test but a dial test that shows 20 degrees of increased external rotation at 30 degrees of flexion, which reduces to symmetric rotation at 90 degrees of flexion compared to the uninjured side. Which structure or combination of structures is most likely injured?

. Posterior Cruciate Ligament (PCL) and Posterolateral Corner (PLC)
. Isolated Posterior Cruciate Ligament (PCL)
. Isolated Posterolateral Corner (PLC)
. Anterior Cruciate Ligament (ACL) and Medial Collateral Ligament (MCL)
. Posterior Cruciate Ligament (PCL), Anterior Cruciate Ligament (ACL), and PLC

Correct Answer & Explanation

. Posterior Cruciate Ligament (PCL) and Posterolateral Corner (PLC)

Explanation

An isolated posterolateral corner (PLC) injury presents with increased external rotation at 30 degrees of flexion but symmetric rotation at 90 degrees on the dial test. If external rotation is increased at both 30 and 90 degrees, a combined PCL and PLC injury should be suspected.

Question 2896

Topic: Shoulder & Hip Sports

A 55-year-old right-hand dominant male presents with acute onset severe right shoulder pain after attempting to lift a heavy box. He describes an audible 'pop' and now has weakness in abduction and external rotation. On examination, he has significant tenderness over the greater tuberosity and a positive painful arc sign. Active abduction is limited to 70 degrees, but passive range of motion is full. Which of the following is the MOST appropriate initial investigation to confirm the diagnosis and guide management?

. Plain radiographs (AP, lateral, axillary views)
. MRI scan of the shoulder
. CT scan of the shoulder with contrast
. Diagnostic ultrasound of the shoulder
. EMG/NCS studies

Correct Answer & Explanation

. Diagnostic ultrasound of the shoulder

Explanation

The patient's presentation with an acute 'pop', pain, and weakness in abduction and external rotation strongly suggests an acute rotator cuff tear. While MRI is the gold standard for detailed assessment of rotator cuff integrity, a diagnostic ultrasound is an excellent, cost-effective, and readily available initial investigation to confirm the presence and often the size of a full-thickness rotator cuff tear in the acute setting. It can be performed dynamically and is superior to radiographs for soft tissue assessment. Radiographs rule out fractures or dislocations but provide no information on the rotator cuff. CT scans are primarily for bony pathology. EMG/NCS studies are for nerve entrapment or injury, which is less likely to be the primary acute issue here.

Question 2897

Topic: Shoulder & Hip Sports

A 30-year-old male presents with recurrent anterior shoulder dislocations. He has undergone two previous arthroscopic Bankart repairs, but continues to experience instability, particularly with overhead activities. On examination, he has hyperlaxity and a positive apprehension test in abduction and external rotation. Radiographs show a bony Bankart lesion and a significant Hill-Sachs lesion. Which of the following surgical procedures is MOST appropriate to address his recurrent instability?

. Repeat arthroscopic Bankart repair
. Open Bankart repair with capsular shift
. Latarjet procedure
. Remplissage procedure alone
. Arthroscopic capsular plication

Correct Answer & Explanation

. Latarjet procedure

Explanation

This patient has failed previous arthroscopic Bankart repairs, indicating persistent instability likely due to significant bone loss (bony Bankart and Hill-Sachs lesions) or generalized hyperlaxity. The Latarjet procedure is highly effective in cases of significant glenoid bone loss (>20-25%) or failed previous stabilization attempts, as it transfers the coracoid process with the attached conjoint tendon to the anterior glenoid, providing both a bone block effect and a sling effect. A repeat arthroscopic Bankart repair is unlikely to succeed given the previous failures and bone loss. Open Bankart with capsular shift is an option for capsular laxity but doesn't directly address significant bone loss. Remplissage alone is for engaging Hill-Sachs lesions without significant glenoid bone loss. Arthroscopic capsular plication addresses generalized laxity but not the underlying bony deficiency.

Question 2898

Topic: Shoulder & Hip Sports

A 40-year-old construction worker presents with chronic, diffuse shoulder pain, weakness, and night pain. He denies any acute trauma. On examination, he has a positive Neer and Hawkins impingement sign, and a painful arc of motion. Resisted external rotation is weak but painless. MRI reveals a large, full-thickness supraspinatus tear and severe tendinopathy of the infraspinatus. What is the MOST appropriate surgical intervention?

. Subacromial decompression alone
. Arthroscopic debridement of the tear
. Rotator cuff repair with acromioplasty
. Superior capsular reconstruction
. Reverse total shoulder arthroplasty

Correct Answer & Explanation

. Rotator cuff repair with acromioplasty

Explanation

The patient has symptoms of impingement and a large, full-thickness supraspinatus tear. The most appropriate surgical intervention for a reparable full-thickness rotator cuff tear is rotator cuff repair, often combined with subacromial decompression (acromioplasty) to address impingement and facilitate healing. Subacromial decompression alone will not heal the tear and is insufficient. Arthroscopic debridement is generally reserved for very small, partial tears or irreparable tears where the goal is symptom management, not repair. Superior capsular reconstruction is for irreparable massive cuff tears. Reverse total shoulder arthroplasty is for rotator cuff tear arthropathy where the cuff is irreparable and severe arthritis exists, which is not described here.

Question 2899

Topic: Shoulder & Hip Sports

A 22-year-old female presents with chronic shoulder pain and a sensation of the shoulder 'slipping out' during overhead activities. She has generalized ligamentous laxity and a positive sulcus sign bilaterally. Examination reveals positive apprehension and relocation tests, and generalized hypermobility. What is the MOST likely diagnosis?

. Anterior labral tear (Bankart lesion)
. Posterior instability
. Multidirectional instability (MDI)
. SLAP tear
. Rotator cuff tendinopathy

Correct Answer & Explanation

. Multidirectional instability (MDI)

Explanation

The presence of chronic instability, a sensation of 'slipping out', generalized ligamentous laxity, a positive sulcus sign, and positive apprehension/relocation tests strongly points towards Multidirectional Instability (MDI). MDI is often non-traumatic in origin and associated with generalized ligamentous laxity, affecting anterior, posterior, and inferior directions. Bankart lesions are typically associated with traumatic anterior dislocations. Posterior instability can occur, but MDI encompasses multiple directions. SLAP tears are often associated with overhead activities but typically present with pain and mechanical symptoms rather than global instability. Rotator cuff tendinopathy causes pain and weakness but not instability.

Question 2900

Topic: Shoulder & Hip Sports

A 28-year-old male presents with sudden-onset, excruciating right shoulder pain that woke him from sleep. He denies trauma. On examination, the shoulder is exquisitely tender globally, and all active and passive movements are severely restricted and painful. Radiographs reveal a large, well-defined calcific deposit within the supraspinatus tendon. What is the MOST appropriate initial treatment?

. Physical therapy with rotator cuff strengthening
. Oral corticosteroids and NSAIDs, with consideration for subacromial corticosteroid injection
. Arthroscopic debridement of the calcific deposit
. Extracorporeal shockwave therapy (ESWT)
. Needle lavage and aspiration of calcific deposit

Correct Answer & Explanation

. Oral corticosteroids and NSAIDs, with consideration for subacromial corticosteroid injection

Explanation

This is a classic presentation of acute calcific tendinitis, typically characterized by sudden onset, severe pain, and profound restriction of motion due to the inflammatory response to calcium crystal deposition. The initial management is focused on pain control and reducing inflammation. High-dose oral NSAIDs and potentially a short course of oral corticosteroids are often very effective. A subacromial corticosteroid injection can also provide significant pain relief by reducing inflammation. Physical therapy is not indicated during the acute painful phase. Arthroscopic debridement or needle lavage are options for chronic, refractory cases, but not typically the first-line for acute pain. ESWT is for chronic tendinitis.

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