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5. Sports Medicine MCQs

Practice Set 147 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 2921

Topic: 5. Sports Medicine

A 60-year-old female presents with a painful shoulder after a fall. Radiographs show a posterior dislocation of the glenohumeral joint with a large reverse Hill-Sachs lesion (impaction fracture of the anteromedial humeral head). What is the most appropriate management for this specific injury pattern?

. Closed reduction and immobilization in internal rotation.
. Closed reduction and immobilization in external rotation.
. Open reduction and internal fixation (ORIF) of the reverse Hill-Sachs lesion and stabilization of the joint.
. Hemiarthroplasty.
. Diagnostic arthroscopy.

Correct Answer & Explanation

. Open reduction and internal fixation (ORIF) of the reverse Hill-Sachs lesion and stabilization of the joint.

Explanation

A posterior shoulder dislocation with a large reverse Hill-Sachs lesion (often referred to as a 'locked posterior dislocation') indicates significant bone loss from the humeral head, which can prevent successful closed reduction or lead to recurrent dislocation if left unaddressed. Open reduction and internal fixation (ORIF) of the reverse Hill-Sachs lesion (e.g., using an allograft, autograft, or filling with a bone paste) combined with capsular repair or subscapularis tenodesis is often required to restore articular congruity and stability. Immobilization in external rotation (rather than internal) may be usedafterreduction for anterior dislocations, but for posterior dislocations, immobilization in internal rotation is typically used. However, for alockeddislocation with a large bony defect, simple immobilization won't suffice. Hemiarthroplasty is for severely comminuted fractures or significant humeral head destruction. Diagnostic arthroscopy may be part of the workup but not the definitive treatment for a large bony lesion.

Question 2922

Topic: Knee Sports

The primary blood supply to the anterior cruciate ligament (ACL) is derived from which artery?

. Descending genicular artery
. Inferior medial genicular artery
. Superior lateral genicular artery
. Middle genicular artery
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Middle genicular artery

Explanation

The middle genicular artery, a branch of the popliteal artery, provides the primary vascular supply to the ACL. It pierces the posterior capsule to supply the cruciate ligaments.

Question 2923

Topic: Knee Sports

During deep flexion of the normal knee joint, femoral rollback on the tibial plateau is primarily driven by the tension in which structure?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Medial collateral ligament
. Lateral collateral ligament
. Popliteus tendon

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

The PCL is responsible for the posterior translation of the femur on the tibia (femoral rollback) during deep knee flexion. This mechanism optimizes the extensor mechanism's moment arm and prevents posterior impingement.

Question 2924

Topic: 5. Sports Medicine

A 28-year-old athlete sustains an acute mid-substance Achilles tendon rupture. Compared to functional bracing and early mobilization (non-operative management), surgical repair is associated with a higher incidence of which complication?

. Tendon re-rupture
. Decreased plantarflexion strength
. Sural nerve injury
. Deep vein thrombosis
. Excessive tendon elongation

Correct Answer & Explanation

. Sural nerve injury

Explanation

While operative repair historically lowered the re-rupture rate slightly, it carries a significantly higher risk of iatrogenic complications. These include wound breakdown, deep infection, and sural nerve injury.

Question 2925

Topic: 5. Sports Medicine

In flexor tendon repairs within Zone II of the hand, the preservation of the A2 and A4 pulleys is considered biomechanically critical. What is the primary functional consequence of completely resecting these specific pulleys?

. Decreased total excursion of the flexor tendon
. Tendon bowstringing with a decreased work of flexion
. Tendon bowstringing with an increased work of flexion
. Spontaneous tendon rupture at the repair site
. Development of a lumbrical plus deformity

Correct Answer & Explanation

. Tendon bowstringing with an increased work of flexion

Explanation

The A2 and A4 pulleys keep the flexor tendons closely apposed to the phalanges. Their loss results in bowstringing, which increases the moment arm but significantly reduces tendon excursion efficiency, leading to an increased work of flexion and loss of terminal active flexion.

Question 2926

Topic: 5. Sports Medicine

When reconstructing the anterior cruciate ligament (ACL) with a bone-patellar tendon-bone autograft, placing the femoral tunnel too anteriorly (shallow) will result in which of the following postoperative clinical findings?

. Graft laxity in extension and tightness in flexion
. Graft tightness in extension and laxity in flexion
. Uniform graft tightness throughout the arc of motion
. Uniform graft laxity throughout the arc of motion
. Early failure due to roof impingement

Correct Answer & Explanation

. Graft laxity in extension and tightness in flexion

Explanation

A femoral tunnel placed too anteriorly creates a non-isometric graft where the distance between the tibial and femoral tunnels increases during knee flexion. This results in the graft becoming excessively tight in flexion and loose in extension, restricting normal knee flexion.

Question 2927

Topic: 5. Sports Medicine

A young surgeon is preparing to perform a complex wrist arthroscopy. The patient is a professional musician. Beyond obtaining standard informed consent, what additional ethical principle is paramount in this specific scenario?

. Justice, ensuring equitable access to care.
. Non-maleficence, 'do no harm'.
. Beneficence, acting in the patient's best interest.
. Autonomy, respecting the patient's right to make choices.
. Confidentiality, protecting patient information.

Correct Answer & Explanation

. Beneficence, acting in the patient's best interest.

Explanation

While all listed ethical principles are important, the question implies a scenario beyond basic consent, focusing on the patient's specific circumstances (professional musician). In this context, beneficence becomes paramount. It means not only acting in the patient's best medical interest but also considering their specific life circumstances and aspirations. This might involve discussing risks and benefits in the context of their career, exploring all reasonable treatment options (surgical vs. non-surgical), and involving multidisciplinary teams to optimize functional outcomes critical for their profession. Autonomy relates to consent itself, non-maleficence is about avoiding harm, justice about fair allocation, and confidentiality about privacy. Beneficence here encapsulates the comprehensive 'doing good' for this specific patient.

Question 2928

Topic: Knee Sports

Which of the following describes the anatomical structure primarily responsible for resisting valgus stress at the knee joint?

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

Correct Answer & Explanation

. Medial collateral ligament (MCL).

Explanation

The Medial Collateral Ligament (MCL) is the primary static stabilizer that resists valgus stress (forces pushing the knee inward) at the knee joint. The LCL resists varus stress. The ACL resists anterior translation of the tibia, and the PCL resists posterior translation. The popliteus tendon has a role in posterolateral stability and external rotation but is not the primary valgus restraint.

Question 2929

Topic: 5. Sports Medicine

You are discussing anterior cruciate ligament (ACL) reconstruction. When comparing Bone-Patellar Tendon-Bone (BPTB) autografts to Hamstring autografts, which of the following is a recognized disadvantage specific to the BPTB graft?

. Higher risk of graft elongation over time
. Increased incidence of anterior knee pain and kneeling pain
. Lower ultimate tensile strength at time zero
. Slower incorporation into the bone tunnels
. Higher rate of postoperative deep vein thrombosis

Correct Answer & Explanation

. Increased incidence of anterior knee pain and kneeling pain

Explanation

BPTB autografts are associated with a higher incidence of donor site morbidity, specifically anterior knee pain and discomfort while kneeling. However, they offer rigid bone-to-bone healing and excellent initial stability.

Question 2930

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction of the knee, accurate anatomical placement of the fibular collateral ligament (FCL) femoral tunnel is critical. What is the correct relationship of the FCL femoral origin relative to the lateral epicondyle?

. Proximal and posterior
. Distal and anterior
. Directly over the lateral epicondyle
. Proximal and anterior
. Distal and posterior

Correct Answer & Explanation

. Proximal and posterior

Explanation

The femoral origin of the Fibular Collateral Ligament (FCL) is located slightly proximal (1.4 mm) and posterior (3.1 mm) to the lateral epicondyle. The origin of the popliteus tendon is located anterior and distal to the FCL origin. Recreating this anatomic footprint is vital for restoring normal knee kinematics during posterolateral corner reconstruction.

Question 2931

Topic: Knee Sports

A 45-year-old male sustains a complete radial tear at the posterior horn root attachment of the medial meniscus. Biomechanical studies have demonstrated that this specific injury alters knee joint contact pressures in a manner most similar to which of the following?

. A partial medial meniscectomy
. A bucket-handle medial meniscus tear
. An anterior cruciate ligament rupture
. A total medial meniscectomy
. A normal, intact knee due to secondary restraints

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

The meniscal roots are essential for converting axial loads into hoop stresses within the meniscus. A complete tear of the posterior root of the medial meniscus completely disrupts this ability to generate hoop stresses, allowing the meniscus to extrude radially. Biomechanical studies have consistently shown that a medial meniscus posterior root tear results in a significant increase in peak contact pressures and a decrease in contact area, which are biomechanically equivalent to the derangements seen in a total medial meniscectomy.

Question 2932

Topic: Knee Sports

A 28-year-old football player sustains a twisting injury to his knee. On physical examination, the dial test is performed. The examiner notes 15 degrees of increased external rotation of the tibia compared to the contralateral normal knee at 30 degrees of knee flexion. However, at 90 degrees of knee flexion, the external rotation is equal bilaterally. Which of the following structures is most likely injured?

. Anterior cruciate ligament and posterolateral corner
. Isolated posterior cruciate ligament
. Isolated posterolateral corner
. Posterior cruciate ligament and posterolateral corner
. Medial collateral ligament and posterior oblique ligament

Correct Answer & Explanation

. Isolated posterolateral corner

Explanation

The dial test evaluates for posterolateral instability. An increase of >10 degrees of external rotation at 30 degrees of flexion, but not at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. Increased external rotation at both 30 and 90 degrees suggests a combined PCL and PLC injury.

Question 2933

Topic: 5. Sports Medicine

A 22-year-old collegiate baseball pitcher presents with deep shoulder pain and decreased throwing velocity. MR arthrogram demonstrates detachment of the superior labrum and the origin of the long head of the biceps tendon from the glenoid, with an intact labral margin elsewhere. This corresponds to a Snyder Type II SLAP tear. After failed conservative management, what is the most appropriate surgical treatment for this young overhead athlete?

. Debridement of the superior labrum with intact biceps anchor
. Biceps tenodesis and labral debridement
. Biceps tenotomy
. Arthroscopic repair of the superior labrum to the glenoid
. Open Latarjet procedure

Correct Answer & Explanation

. Arthroscopic repair of the superior labrum to the glenoid

Explanation

A Snyder Type II SLAP tear involves detachment of the superior labrum and biceps anchor from the superior glenoid. In young, active patients, especially overhead athletes (like pitchers), arthroscopic repair of the superior labrum back to the glenoid is the standard of care to restore normal anatomy and shoulder mechanics. In older patients (>40-45 years), biceps tenodesis is generally preferred due to higher stiffness and failure rates associated with SLAP repairs in that age group.

Question 2934

Topic: Knee Sports

During a posterior cruciate ligament (PCL) reconstruction, understanding the biomechanics of the native bundles is essential to reproduce normal knee kinematics. Which of the following best describes the tensioning pattern of the anterolateral (AL) and posteromedial (PM) bundles of the native PCL?

. AL bundle is tight in extension; PM bundle is tight in flexion
. AL bundle is tight in flexion; PM bundle is tight in extension
. Both bundles are equally tight in deep flexion
. Both bundles are equally tight in full extension
. AL bundle is tight in internal rotation; PM bundle is tight in external rotation

Correct Answer & Explanation

. AL bundle is tight in flexion; PM bundle is tight in extension

Explanation

The PCL is composed of two main bundles: the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle is tight in flexion and lax in extension, while the PM bundle is tight in extension and lax in flexion. This reciprocal relationship is crucial when tensioning grafts during PCL reconstruction.

Question 2935

Topic: 5. Sports Medicine

During an arthroscopic anterior cruciate ligament (ACL) reconstruction using a hamstring autograft, the surgeon elects to drill the femoral tunnel independently through an accessory anteromedial portal rather than using a transtibial technique. Which of the following is the most recognized anatomical risk or complication specifically associated with anteromedial portal femoral drilling?

. Anterior placement of the femoral tunnel
. Vertical orientation of the femoral tunnel
. Blowout of the posterior wall of the lateral femoral condyle
. Injury to the popliteal artery during guidewire insertion
. Premature amputation of the hamstring graft during passage

Correct Answer & Explanation

. Blowout of the posterior wall of the lateral femoral condyle

Explanation

Drilling the femoral tunnel through an accessory anteromedial portal allows for more anatomic, independent placement of the tunnel compared to the transtibial technique. However, it requires acute knee flexion (hyperflexion to at least 120 degrees) to properly orient the drill. A major risk with this technique is drilling too posterior or shallow, leading to a critically short femoral tunnel or a posterior wall blowout of the lateral femoral condyle. Transtibial drilling is historically associated with tunnels that are placed too vertical and high in the notch.

Question 2936

Topic: 5. Sports Medicine

A 19-year-old collegiate soccer player undergoes an MRI of the knee after a twisting injury, which demonstrates a 'ghost sign' on successive sagittal images through the mid-body of the lateral meniscus. This radiographic sign is pathognomonic for which type of meniscal tear?

. Longitudinal vertical tear
. Bucket-handle tear
. Horizontal cleavage tear
. Radial tear
. Root avulsion tear

Correct Answer & Explanation

. Radial tear

Explanation

The 'ghost sign' (or empty meniscus sign) on a sagittal MRI is a characteristic finding of a complete radial tear of the meniscus. Because a radial tear runs perpendicular to the long axis of the meniscus, consecutive sagittal slices through the tear will show an absence of the normal low-signal meniscal tissue (the 'bow-tie' is missing), leaving a blank space or 'ghost'. This is crucial to identify as radial tears severely disrupt the hoop stresses of the meniscus, often requiring surgical repair in young athletes.

Question 2937

Topic: Knee Sports

A 45-year-old female sustains a completely detached posterior root tear of the medial meniscus. From a biomechanical perspective, what is the direct consequence of this injury on the knee joint?

. It alters knee kinematics to a degree equivalent to a totally meniscectomized knee
. It predominantly causes isolated lateral compartment osteoarthritis over time
. It does not significantly alter peak tibiofemoral contact pressures
. It increases the mechanical efficiency of the intact anterior cruciate ligament
. It causes an immediate mechanical axis shift from varus to valgus

Correct Answer & Explanation

. It alters knee kinematics to a degree equivalent to a totally meniscectomized knee

Explanation

A complete tear of the medial meniscal root disrupts the transmission of circumferential hoop stresses. Biomechanical studies have shown that this results in a loss of meniscal function and an increase in peak contact pressures equivalent to that of a total meniscectomy, predisposing the knee to rapid medial compartment osteoarthritis.

Question 2938

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, a surgeon places the femoral tunnel very high in the intercondylar notch, corresponding to the "12 o'clock" position in the coronal plane. What is the most likely biomechanical consequence of this vertically oriented graft placement?

. Over-constrained in extension and loose in flexion
. Effective at controlling rotational loads but poor at controlling anterior translation
. Highly isometric but fails to control rotational instability (pivot shift)
. Over-tensioned in flexion leading to capture of the knee
. Prone to early impingement on the posterior cruciate ligament (PCL)

Correct Answer & Explanation

. Highly isometric but fails to control rotational instability (pivot shift)

Explanation

A vertical femoral tunnel (e.g., 12 o'clock position) produces a highly isometric graft that effectively limits anterior-posterior translation (Lachman) but biomechanically fails to reproduce the native ACL's oblique orientation, resulting in an inability to control rotational instability (evidenced by a persistent positive pivot-shift test).

Question 2939

Topic: Shoulder & Hip Sports

A 25-year-old professional baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. He is diagnosed with internal impingement. Which of the following physical exam findings is most characteristically associated with this condition?

. Glenohumeral internal rotation deficit (GIRD)
. Positive Hornblower's sign
. Positive belly press test
. Scapular winging with wall push-ups
. Profound weakness in external rotation at 0 degrees of abduction

Correct Answer & Explanation

. Glenohumeral internal rotation deficit (GIRD)

Explanation

Internal impingement (posterosuperior impingement) occurs when the greater tuberosity abuts the posterosuperior glenoid during extreme abduction and external rotation. It is highly associated with Glenohumeral Internal Rotation Deficit (GIRD) in overhead athletes, driven by repetitive microtrauma leading to contracture of the posterior capsule and posterior band of the inferior glenohumeral ligament.

Question 2940

Topic: 5. Sports Medicine

A 25-year-old athlete undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. If the surgeon inadvertently places the femoral tunnel too far anteriorly (away from the isometric footprint), what is the most likely biomechanical consequence during postoperative range of motion?

. 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 fail early due to PCL impingement
. The patient will lack terminal extension but have normal flexion
. The knee will be globally lax throughout the entire arc of motion

Correct Answer & Explanation

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

Explanation

Placement of the femoral tunnel too anteriorly (shallow) in ACL reconstruction causes the graft to tension excessively as the knee flexes. This leads to a graft that is tight in flexion (often restricting flexion or stretching out the graft) and loose in extension. A tunnel placed too far posteriorly will result in a graft that is tight in extension.

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