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5. Sports Medicine MCQs

Practice Set 148 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 2941

Topic: Knee Sports
Following a knee dislocation (KD-III), a patient undergoes multiligament knee reconstruction including the posterolateral corner (PLC). Which of the following anatomical structures forms the primary static stabilizer to external tibial rotation at 30 degrees of knee flexion?
. Fibular collateral ligament (FCL)
. Popliteus tendon
. Popliteofibular ligament (PFL)
. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)

Correct Answer & Explanation

. Fibular collateral ligament (FCL)

Explanation

The Fibular Collateral Ligament (FCL) is the primary static stabilizer to varus stress and external tibial rotation at 30 degrees of flexion. The popliteus and PFL are secondary stabilizers for these forces.

Question 2942

Topic: 5. Sports Medicine

A 24-year-old athlete presents 4 months following an anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone autograft. He complains of a painful clunk and an inability to achieve terminal extension. MRI reveals a focal, nodular mass situated anterior to the tibial tunnel. Histologically, this lesion is primarily composed of:

. Multinucleated synovial giant cells
. Fibrovascular scar tissue
. Chondroid metaplasia
. Granulomatous inflammation
. Avascular necrosis of bone

Correct Answer & Explanation

. Fibrovascular scar tissue

Explanation

The clinical scenario describes a 'cyclops lesion' (localized anterior arthrofibrosis), which is a common cause of loss of terminal extension after ACL reconstruction. The nodule impinges in the intercondylar notch during extension. Histologically, a cyclops lesion consists of fibrovascular scar tissue with central areas of granulation tissue.

Question 2943

Topic: Knee Sports

During an isolated Posterior Cruciate Ligament (PCL) reconstruction using an anterolateral tibial tunnel technique, the 'killer turn' is associated with which of the following complications?

. Injury to the popliteal artery during reaming
. Attenuation, stretching, and early failure of the graft
. Iatrogenic chondral damage to the medial femoral condyle
. Post-operative arthrofibrosis
. Nonunion of the tibial tunnel

Correct Answer & Explanation

. Attenuation, stretching, and early failure of the graft

Explanation

The 'killer turn' in a transtibial PCL reconstruction refers to the acute angle the PCL graft must navigate as it exits the posterior tibial tunnel to pass anteriorly to the femur. This sharp angle causes repetitive abrasion, leading to attenuation, elongation, and potential early failure of the graft. The tibial inlay technique was developed to avoid this phenomenon.

Question 2944

Topic: 5. Sports Medicine

A 40-year-old male undergoes non-operative management with an early functional rehabilitation protocol for an acute Achilles tendon rupture. Based on high-level evidence, which of the following outcomes is most accurate when comparing this approach to traditional open surgical repair?

. Significantly higher rerupture rate in the non-operative group
. Higher rate of sural nerve injury in the non-operative group
. Similar rerupture rate with a significantly lower soft-tissue complication rate
. Decreased plantarflexion strength at 2 years in the non-operative group
. Faster return to competitive sports in the non-operative group

Correct Answer & Explanation

. Similar rerupture rate with a significantly lower soft-tissue complication rate

Explanation

Multiple Level I randomized controlled trials (e.g., Willits et al.) have demonstrated that when acute Achilles tendon ruptures are treated non-operatively with an aggressive early functional rehabilitation protocol (early weight-bearing in a boot and active ROM), the rerupture rates are statistically similar to surgical repair. Furthermore, non-operative management completely avoids surgical complications such as infection, wound breakdown, and sural nerve injury.

Question 2945

Topic: 5. Sports Medicine

A 25-year-old elite baseball pitcher presents with deep shoulder pain and decreased throwing velocity. Physical exam reveals a positive O'Brien's test and a 'peel-back' sign. MR arthrogram confirms a Type II SLAP tear. After 3 months of failed physical therapy focusing on periscapular stabilizers, what is the most appropriate surgical treatment?

. Arthroscopic SLAP debridement only
. Arthroscopic SLAP repair with suture anchors
. Subpectoral biceps tenodesis
. Arthroscopic biceps tenotomy
. Superior capsule reconstruction

Correct Answer & Explanation

. Arthroscopic SLAP repair with suture anchors

Explanation

In a young, high-demand overhead-throwing athlete (like an elite pitcher) with a symptomatic Type II SLAP tear that has failed rigorous conservative management, arthroscopic SLAP repair is the preferred treatment. The goal is to restore the native labral-biceps complex biomechanics essential for high-level throwing. Older patients (>35-40 years) or non-throwers often have better functional outcomes and lower stiffness rates with biceps tenodesis.

Question 2946

Topic: Knee Sports

A patient sustains a posterolateral corner (PLC) knee injury and develops a complete foot drop. Exploration of the common peroneal nerve is planned. The nerve is most vulnerable to tethering and injury at which anatomical site?

. Biceps femoris short head origin
. Fibular tunnel beneath the peroneus longus origin
. Popliteal fossa superior to the medial gastrocnemius
. Arcuate ligament complex
. Anterior intermuscular septum

Correct Answer & Explanation

. Fibular tunnel beneath the peroneus longus origin

Explanation

The common peroneal nerve is firmly tethered as it wraps around the fibular neck and passes beneath the fibrous edge of the peroneus longus muscle (the fibular tunnel). This rigid tethering point makes it highly vulnerable to severe stretch or traction injuries during varus and hyperextension trauma to the knee.

Question 2947

Topic: Shoulder & Hip Sports
A 22-year-old baseball pitcher presents with vague, deep shoulder pain and a 'dead arm' feeling. An MRI arthrogram reveals a Type II SLAP (Superior Labrum Anterior and Posterior) tear. What is the defining anatomical characteristic of a Type II SLAP tear?
. Fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and biceps anchor from the glenoid
. Bucket-handle tear of the superior labrum with an intact biceps anchor
. Bucket-handle tear of the superior labrum extending into the biceps tendon
. Anterior-inferior labral detachment with capsular stripping

Correct Answer & Explanation

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

Explanation

According to the Snyder classification of SLAP lesions: Type I is fraying of the superior labrum; Type II is detachment of the superior labrum and the long head of the biceps anchor from the superior glenoid tubercle; 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.

Question 2948

Topic: 5. Sports Medicine
A 24-year-old elite baseball pitcher complains of deep shoulder pain that worsens during the late cocking phase of throwing. Magnetic resonance arthrography (MRA) demonstrates a superior labral tear with detachment of the biceps anchor. During arthroscopy, an extreme external rotation maneuver reveals the superior labrum dropping medially over the glenoid edge (peel-back sign). What is the specific classification of this injury?
. Type I SLAP tear
. Type II SLAP tear
. Type III SLAP tear
. Type IV SLAP tear
. Reverse Bankart lesion

Correct Answer & Explanation

. Type II SLAP tear

Explanation

A Type II Superior Labrum Anterior to Posterior (SLAP) tear is characterized by detachment of the superior labrum and the origin of the long head of the biceps tendon from the glenoid. In overhead throwing athletes, this often occurs via a 'peel-back' mechanism during the late cocking phase of throwing (maximum abduction and external rotation). Type I is fraying; Type III is a bucket-handle tear with intact biceps; Type IV is a bucket-handle tear extending into the biceps tendon.

Question 2949

Topic: Knee Sports

A 28-year-old rugby player sustains a knee injury. The dial test demonstrates 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the uninjured side, but symmetric external rotation at 90 degrees. Which of the following structures is most likely injured?

. Posterior cruciate ligament
. Posterolateral corner
. Medial collateral ligament
. Anterior cruciate ligament
. Posteromedial corner

Correct Answer & Explanation

. Posterolateral corner

Explanation

The dial test evaluates external rotation asymmetry. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion, but not at 90 degrees, indicates an isolated injury to the posterolateral corner (PLC). Increased external rotation at both 30 and 90 degrees indicates a combined injury to the PLC and the posterior cruciate ligament (PCL).

Question 2950

Topic: 5. Sports Medicine

A 25-year-old overhead athlete is diagnosed with a Type II SLAP lesion. He also demonstrates a 'peel-back' sign during arthroscopy. This pathology is most commonly associated with which of the following physical examination findings?

. Positive belly-press test
. Glenohumeral internal rotation deficit (GIRD)
. Positive hornblower's sign
. Multidirectional instability
. Positive empty can test

Correct Answer & Explanation

. Glenohumeral internal rotation deficit (GIRD)

Explanation

Type II SLAP tears in overhead athletes are strongly associated with Glenohumeral Internal Rotation Deficit (GIRD) and a tight posterior capsule. The tight posterior capsule causes a posterosuperior shift of the humeral head during the late cocking phase of throwing, leading to the 'peel-back' mechanism that exacerbates the superior labral tear.

Question 2951

Topic: Knee Sports

During reconstruction of the posterior cruciate ligament (PCL), the tibial inlay technique is theoretically designed to prevent which of the following mechanical complications associated with the traditional transtibial technique?

. Arthrofibrosis of the knee from over-constraining the joint
. Graft abrasion and attenuation at the posterior tibial aperture
. Popliteal artery injury during drilling of the tibial tunnel
. Posterior capsular contracture leading to extension deficit
. Hardware prominence and soft tissue irritation over the anterior tibia

Correct Answer & Explanation

. Graft abrasion and attenuation at the posterior tibial aperture

Explanation

The traditional transtibial PCL reconstruction technique requires the graft to bend sharply (often > 90 degrees) as it exits the posterior tibial tunnel to reach the femoral footprint. This acute angle is known as the 'killer turn' and is a site of significant mechanical stress, leading to graft abrasion, elongation, and potential failure. The tibial inlay technique secures the bone block directly to the posterior tibia, avoiding this turn.

Question 2952

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. He has a positive apprehension test but no relief with the relocation test. MRI reveals articular-sided, partial-thickness tears of the supraspinatus and a superior labrum anterior-posterior (SLAP) lesion. What is the underlying pathophysiology of this condition?

. Subcoracoid impingement
. Anterosuperior capsular tightness
. Glenohumeral internal rotation deficit (GIRD) with posterior capsular contracture
. Congenital glenoid hypoplasia
. Scapular dyskinesia causing primary external impingement

Correct Answer & Explanation

. Glenohumeral internal rotation deficit (GIRD) with posterior capsular contracture

Explanation

This presentation describes 'internal impingement' (posterosuperior impingement), classically seen in overhead throwing athletes. The underlying pathophysiology is driven by posterior capsular contracture, leading to a glenohumeral internal rotation deficit (GIRD). The tight posterior capsule causes an obligate posterosuperior shift of the humeral head in extreme abduction and external rotation (late cocking phase), pinching the undersurface of the rotator cuff and superior labrum between the greater tuberosity and the posterosuperior glenoid rim.

Question 2953

Topic: 5. Sports Medicine

During an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, an overly vertical femoral tunnel is drilled in the intercondylar notch. Which of the following complications is most likely to result from this specific technical error?

. Anterior knee pain
. Loss of knee extension
. Loss of knee flexion
. Residual rotational instability
. Patellar fracture

Correct Answer & Explanation

. Residual rotational instability

Explanation

An overly vertical femoral tunnel (often resulting from a transtibial drilling technique that does not reach low enough on the lateral wall of the notch) typically restores anteroposterior stability (Lachman test) but fails to restore the native anatomy of the ACL, leaving the knee with residual rotational instability (positive pivot shift test).

Question 2954

Topic: 5. Sports Medicine

A 19-year-old collegiate soccer player is undergoing primary anterior cruciate ligament (ACL) reconstruction. The surgeon discusses graft choices. Compared to bone-patellar tendon-bone (BPTB) autograft, the use of a non-irradiated BPTB allograft in this specific patient demographic is associated with which of the following?

. A significantly higher clinical failure rate
. Decreased risk of disease transmission
. Faster graft incorporation and remodeling
. Lower rates of contralateral ACL rupture
. Superior return to play rates at 6 months

Correct Answer & Explanation

. A significantly higher clinical failure rate

Explanation

Multiple studies (such as those by the MOON group) have demonstrated that the use of allograft tissue for ACL reconstruction in young, active patients (typically defined as under 25 years of age) is associated with a significantly higher clinical failure and re-rupture rate compared to autograft. Allografts undergo a slower incorporation and remodeling process (ligamentization) and are not recommended for young, high-demand athletes.

Question 2955

Topic: Knee Sports

Biomechanical studies of the knee demonstrate that a complete radial tear adjacent to the posterior root of the medial meniscus results in contact pressures that are most similar to which of the following conditions?

. An intact normal meniscus
. A total medial meniscectomy
. A bucket-handle meniscal tear
. A partial meniscectomy resecting 10% of the posterior horn
. An isolated anterior cruciate ligament deficiency

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A complete radial tear near the posterior root of the medial meniscus completely disrupts the circumferential continuity of the meniscus. Biomechanically, this results in a complete loss of 'hoop stresses', leading to meniscal extrusion under load. Studies have shown that this creates peak contact pressures and altered kinematics in the medial compartment equivalent to those of a total meniscectomy.

Question 2956

Topic: Knee Sports

In a patient with an isolated complete rupture of the posterior cruciate ligament (PCL), the most significant increase in posterior tibial translation on examination occurs at what degree of knee flexion?

. 0 degrees
. 30 degrees
. 60 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 90 degrees

Explanation

The anterolateral (AL) bundle of the PCL is the primary restraint to posterior tibial translation at 90 degrees of knee flexion. Therefore, a complete PCL rupture yields the maximum abnormal posterior translation at 90 degrees of flexion, which is the basis for the posterior drawer test.

Question 2957

Topic: 5. Sports Medicine
A 24-year-old overhead throwing athlete presents with deep shoulder pain and clicking. MR arthrogram reveals a SLAP tear. Arthroscopy demonstrates detachment of the superior labrum and biceps anchor from the superior glenoid, but the biceps tendon itself is intact. Which SLAP tear classification does this represent?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

This describes a Type II SLAP tear, the most common type. Type I involves fraying of the superior labrum with an intact biceps anchor. 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.

Question 2958

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. Which of the following statements accurately describes the biomechanical function of the posterolateral (PL) bundle?

. It is the primary restraint to anterior tibial translation in 90 degrees of flexion
. It is tightest in full extension and is the primary restraint to rotatory loads
. It originates on the posteromedial aspect of the lateral femoral condyle and inserts on the anteromedial tibia
. It is larger and stronger than the anteromedial (AM) bundle
. It primarily resists valgus opening of the knee joint

Correct Answer & Explanation

. It is tightest in full extension and is the primary restraint to rotatory loads

Explanation

The ACL consists of the anteromedial (AM) and posterolateral (PL) bundles. The PL bundle is tightest in full extension and serves as the primary restraint to rotatory loads (e.g., resisting the pivot shift). The AM bundle is tightest in flexion (e.g., 90 degrees) and is the primary restraint to anterior tibial translation at that angle.

Question 2959

Topic: Knee Sports

A 25-year-old athlete undergoes a physical examination after a knee injury. The dial test demonstrates 15 degrees of increased external rotation of the tibia compared to the contralateral side when tested at 30 degrees of knee flexion. However, at 90 degrees of knee flexion, the external rotation is symmetric bilaterally. What is the most likely diagnosis?

. Isolated ACL tear
. Isolated PCL tear
. Isolated posterolateral corner (PLC) tear
. Combined PCL and PLC tear
. Combined ACL and PLC tear

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) tear

Explanation

The dial test assesses tibial external rotation. Asymmetry of greater than 10 degrees at 30 degrees of flexion, which reduces to symmetry at 90 degrees of flexion, indicates an isolated posterolateral corner (PLC) injury. If the asymmetry persists or worsens at 90 degrees, it indicates a combined PLC and posterior cruciate ligament (PCL) injury.

Question 2960

Topic: Knee Sports

The anterior cruciate ligament (ACL) consists of two distinct bundles. Which of the following statements accurately describes the biomechanical behavior of these bundles during knee range of motion?

. The anteromedial (AM) bundle is tight in extension and the posterolateral (PL) bundle is tight in flexion
. The anteromedial (AM) bundle is tight in flexion and the posterolateral (PL) bundle is tight in extension
. Both bundles are equally tight in deep flexion
. Both bundles are equally tight in terminal extension
. The PL bundle controls anteroposterior translation in deep flexion

Correct Answer & Explanation

. The anteromedial (AM) bundle is tight in flexion and the posterolateral (PL) bundle is tight in extension

Explanation

The ACL is composed of the anteromedial (AM) and posterolateral (PL) bundles. Biomechanically, the AM bundle is tightest in flexion and primarily resists anterior tibial translation in this position. The PL bundle is tightest in extension and plays a primary role in resisting rotatory loads near full extension.

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