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5. Sports Medicine MCQs

Practice Set 150 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 2981

Topic: Shoulder & Hip Sports

During an arthroscopic stabilization for recurrent anterior shoulder instability, the surgeon identifies an anterior labral tear that has displaced medially and healed directly to the anterior glenoid neck beneath an intact periosteum. What is the specific eponym for this lesion?

. Bankart lesion
. Perthes lesion
. ALPSA lesion
. GLAD lesion
. HAGL lesion

Correct Answer & Explanation

. ALPSA lesion

Explanation

An ALPSA (Anterior Labroligamentous Periosteal Sleeve Avulsion) lesion occurs when the anterior inferior labrum is torn and displaced medially, healing in an abnormal position on the glenoid neck with an intact periosteal sleeve. Unlike a Perthes lesion (where the periosteum is intact but the labrum is not medially displaced) or a classic Bankart (where the periosteum is torn), an ALPSA must be systematically mobilized laterally before it can be anatomically repaired.

Question 2982

Topic: 5. Sports Medicine

When performing a posterolateral corner (PLC) reconstruction of the knee using an anatomic fibular-based technique (e.g., LaPrade technique), the graft is typically routed to reconstruct which three primary stabilizing structures?

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament
. Fibular collateral ligament, lateral head of gastrocnemius, and arcuate ligament
. Popliteus tendon, arcuate ligament, and fabellofibular ligament
. Iliotibial band, popliteus tendon, and biceps femoris
. Fibular collateral ligament, arcuate ligament, and popliteofibular ligament

Correct Answer & Explanation

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

The primary static stabilizers of the posterolateral corner (PLC) of the knee are the fibular collateral ligament (FCL), the popliteus tendon (PT), and the popliteofibular ligament (PFL). Anatomic reconstructive techniques specifically aim to recreate these three crucial structures using an allograft or autograft to restore normal kinematics.

Question 2983

Topic: Knee Sports
During a reconstruction of the medial patellofemoral ligament (MPFL), the surgeon identifies Schöttle's point using intraoperative fluoroscopy to determine the anatomic femoral footprint. Anatomically, this femoral attachment is located in a saddle-shaped sulcus situated between which two bony landmarks?
. Between the adductor tubercle and the medial epicondyle
. Proximal to the adductor tubercle
. Distal to the medial epicondyle
. Anterior to the medial collateral ligament origin
. Directly on the medial joint line

Correct Answer & Explanation

. Between the adductor tubercle and the medial epicondyle

Explanation

The femoral footprint of the MPFL lies in a sulcus located between the adductor tubercle (proximal) and the medial epicondyle (distal). Schöttle's point on a lateral radiograph is 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior point of Blumensaat's line.

Question 2984

Topic: 5. Sports Medicine

A 40-year-old overhead athlete undergoes shoulder arthroscopy. A Partial Articular Supraspinatus Tendon Avulsion (PASTA lesion) is identified. According to established biomechanical and clinical guidelines, surgical repair (either completion and repair or transtendon repair) is generally indicated when the tear involves greater than what percentage of the tendon footprint thickness?

. 10%
. 25%
. 50%
. 75%
. 90%

Correct Answer & Explanation

. 50%

Explanation

For partial-thickness rotator cuff tears (both articular-sided PASTA lesions and bursal-sided tears), surgical repair is generally indicated when the tear thickness exceeds 50% of the tendon footprint (typically >3 to 6 mm depth depending on the tendon). Tears less than 50% are typically managed with debridement alone.

Question 2985

Topic: 5. Sports Medicine

A 30-year-old recreational athlete sustains an acute anterior cruciate ligament (ACL) tear. He is discussing graft options with his surgeon, specifically comparing bone-patellar tendon-bone (BPTB) autograft and hamstring autograft. Which of the following is an established long-term functional advantage of BPTB autograft over hamstring autograft?

. Lower incidence of post-operative kneeling pain
. Better preservation of deep knee flexion strength
. Decreased risk of developing osteoarthritis
. Lower incidence of contralateral ACL rupture
. Lower incidence of postoperative arthrofibrosis

Correct Answer & Explanation

. Better preservation of deep knee flexion strength

Explanation

Hamstring autografts for ACL reconstruction are associated with a persistent deficit in deep knee flexion strength and internal rotation torque compared to the uninjured leg. BPTB autografts preserve deep knee flexion strength better, although they are associated with a higher incidence of anterior knee pain and donor-site morbidity (e.g., kneeling pain). Neither graft prevents osteoarthritis.

Question 2986

Topic: Knee Sports

The posterior cruciate ligament (PCL) provides primary restraint to posterior tibial translation. During a physical examination or biomechanical testing, at which degree of knee flexion is the anterolateral (AL) bundle of the PCL most taut?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 to 120 degrees of flexion
. 10 degrees of hyperextension

Correct Answer & Explanation

. 90 to 120 degrees of flexion

Explanation

The PCL has two main bundles: the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle is most taut in deep flexion (90 to 120 degrees), whereas the PM bundle is tightest in extension and deep flexion.

Question 2987

Topic: Knee Sports

A 12-year-old active boy complains of vague knee pain and occasional catching. Radiographs reveal an osteochondritis dissecans (OCD) lesion. What is the single most common anatomic location for an OCD lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central portion of the patellar articular surface
. Lateral aspect of the lateral femoral condyle
. Weight-bearing surface of the medial tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for OCD in the knee is the lateral aspect of the medial femoral condyle, often remembered by the mnemonic LAME (Lateral Aspect Medial Epiphysis/Condyle). This accounts for approximately 70-80% of knee OCD lesions.

Question 2988

Topic: Knee Sports

A patient demonstrates increased external rotation of the tibia at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees of knee flexion. Which structure is most likely injured?

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

Correct Answer & Explanation

. Posterolateral corner (PLC) only

Explanation

The Dial test evaluates PLC and PCL injuries. Asymmetry (increased external rotation >10 degrees compared to the normal side) at 30 degrees only indicates an isolated posterolateral corner (PLC) injury. Asymmetry at both 30 and 90 degrees indicates combined PLC and PCL injury.

Question 2989

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes evaluation for recurrent anterior shoulder instability. Diagnostic arthroscopy reveals a large Hill-Sachs lesion that 'engages' the anterior glenoid rim when the arm is placed in abduction and external rotation. The glenoid bone loss is estimated at 10%. Which of the following surgical procedures is most appropriate to address the Hill-Sachs lesion in conjunction with a Bankart repair?

. Latarjet procedure
. Arthroscopic remplissage
. Humeral head osteochondral allograft
. Putti-Platt procedure
. Bristow procedure

Correct Answer & Explanation

. Arthroscopic remplissage

Explanation

Arthroscopic remplissage involves filling the Hill-Sachs defect by tenodesing the infraspinatus tendon and posterior capsule into the lesion. It is indicated for engaging Hill-Sachs lesions without critical (>20-25%) glenoid bone loss. Since the glenoid bone loss is only 10%, a Bankart repair with remplissage is an excellent choice. If glenoid bone loss was >20-25%, a Latarjet would be indicated.

Question 2990

Topic: Knee Sports

In anterior cruciate ligament (ACL) reconstruction, the addition of an anterolateral ligament (ALL) reconstruction or lateral extra-articular tenodesis (LET) is primarily indicated to control which biomechanical parameter?

. Anterior tibial translation at 90 degrees of flexion
. Posterior tibial translation at 30 degrees of flexion
. Internal rotation and the pivot-shift phenomenon
. Valgus gapping in full extension
. External rotation recurvatum

Correct Answer & Explanation

. Internal rotation and the pivot-shift phenomenon

Explanation

The anterolateral ligament (ALL) and lateral extra-articular structures act as secondary stabilizers to anterior tibial translation but are primary stabilizers against internal tibial rotation. Reconstructing these structures is indicated in high-risk patients to help control the pivot-shift phenomenon.

Question 2991

Topic: Shoulder & Hip Sports

In a patient with recurrent anterior shoulder instability, a 'remplissage' procedure is indicated for a specific type of bony defect. This procedure involves the capsulotenodesis of which structure into the humeral defect?

. The long head of the biceps into an anterior glenoid defect
. The subscapularis into a reverse Hill-Sachs lesion
. The infraspinatus and posterior capsule into an engaging Hill-Sachs lesion
. The supraspinatus into a greater tuberosity defect
. The conjoined tendon into the anterior glenoid

Correct Answer & Explanation

. The infraspinatus and posterior capsule into an engaging Hill-Sachs lesion

Explanation

Remplissage (French for 'filling in') is an adjunctive procedure to an anterior Bankart repair for an engaging (off-track) Hill-Sachs lesion. It involves the tenodesis of the posterior capsule and infraspinatus tendon into the posterolateral humeral head defect, rendering it extra-articular and preventing it from engaging the anterior glenoid rim during external rotation and abduction.

Question 2992

Topic: Knee Sports

A 45-year-old patient undergoes an MRI which reveals a complete radial tear at the posterior root insertion of the medial meniscus. If left untreated, what is the primary biomechanical consequence of this specific injury on knee joint dynamics?

. Loss of hoop stresses equivalent to a total meniscectomy
. Increased anterior tibial translation comparable to a complete ACL tear
. Paradoxical motion of the patella during deep flexion
. Decreased peak contact pressures in the medial compartment
. Increased tension on the lateral collateral ligament leading to varus thrust

Correct Answer & Explanation

. Loss of hoop stresses equivalent to a total meniscectomy

Explanation

The meniscal roots anchor the meniscus to the tibial plateau, allowing the meniscus to convert axial compressive loads into circumferential tension, known as "hoop stresses." A complete radial tear at the meniscal root functionally un-anchors the meniscus, resulting in extrusion under load. Biomechanically, a meniscal root tear leads to a complete loss of hoop stresses, drastically increasing peak articular contact pressures in a manner equivalent to a total meniscectomy. This predisposes the patient to rapid progression of osteoarthritis.

Question 2993

Topic: Knee Sports

The posterior cruciate ligament (PCL) is the primary restraint to posterior tibial translation and consists of an anterolateral (AL) bundle and a posteromedial (PM) bundle. Which of the following best describes the physiological tensioning pattern of these bundles during knee range of motion?

. The AL bundle is tightest in flexion, and the PM bundle is tightest in extension.
. Both bundles are tightest in deep flexion.
. The AL bundle is tightest in extension, and the PM bundle is tightest in flexion.
. The PM bundle is the primary restraint to posterior translation at 90 degrees of flexion.
. Both bundles exhibit isometric behavior throughout the full range of motion.

Correct Answer & Explanation

. The AL bundle is tightest in extension, and the PM bundle is tightest in flexion.

Explanation

The PCL is composed of two functional bundles named for their tibial attachments: the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. Biomechanically, the AL bundle becomes increasingly tense during knee flexion and acts as the primary restraint to posterior translation at 90 degrees of flexion. The PM bundle is tight in extension and relatively lax in flexion. Double-bundle PCL reconstructions attempt to recreate this reciprocal tensioning relationship.

Question 2994

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, identifying the exact femoral attachment site is critical to ensuring an isometric graft. Which radiographic landmarks accurately define Schöttle's point on a true lateral radiograph of the knee?
. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the Blumensaat line
. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and distal to the Blumensaat line
. 1 mm anterior to the posterior cortex line, 2.5 mm proximal to the posterior origin of the medial femoral condyle, and proximal to the Blumensaat line
. 1 mm posterior to the posterior cortex line, 2.5 mm proximal to the posterior origin of the medial femoral condyle, and proximal to the Blumensaat line
. 1 mm anterior to the posterior cortex line, 2.5 mm proximal to the posterior origin of the medial femoral condyle, and distal to the Blumensaat line

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the Blumensaat line

Explanation

Schöttle's point defines the anatomic and isometric femoral footprint of the MPFL on a true lateral radiograph. It is located 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior point of Blumensaat's line.

Question 2995

Topic: 5. Sports Medicine
During the early reparative phase of tendon healing following an acute rupture, which type of collagen is predominantly synthesized by fibroblasts to provide early bridging of the defect?
. Type I
. Type II
. Type III
. Type IV
. Type IX

Correct Answer & Explanation

. Type III

Explanation

Following an acute tendon rupture, healing proceeds through inflammatory, reparative (proliferative), and remodeling phases. During the early reparative phase, fibroblasts primarily synthesize Type III collagen, which forms a disorganized, mechanically weak bridge across the defect. During the remodeling phase, this is gradually replaced by the stronger, longitudinally oriented Type I collagen, which makes up about 95% of the collagen in normal mature tendons.

Question 2996

Topic: Knee Sports

During a transtibial posterior cruciate ligament (PCL) reconstruction, the graft is subjected to severe mechanical stress as it exits the posterior tibial tunnel, a phenomenon termed the 'killer turn.' Which surgical technique was specifically developed to completely avoid this acute angulation?

. Double-bundle transtibial technique
. Remnant-preserving technique
. Tibial inlay technique
. Anterolateral ligament (ALL) reconstruction
. Fibular collateral ligament reconstruction

Correct Answer & Explanation

. Tibial inlay technique

Explanation

In a standard transtibial PCL reconstruction, the graft must navigate a sharp, nearly 90-degree turn ('killer turn') as it exits the posterior tibial tunnel to reach its femoral origin. This acute angle causes graft abrasion and attenuation, leading to premature laxity or failure. The tibial inlay technique avoids this entirely by using a posterior approach to secure a bone block directly into a trough at the anatomic posterior tibial footprint, eliminating the tibial tunnel.

Question 2997

Topic: Knee Sports
A 28-year-old male is brought to the emergency department after sustaining a traumatic knee dislocation (KD-III). Following closed reduction, neurologic examination reveals foot drop and absent sensation over the dorsum of the foot, including the first web space. Which structure was most likely injured?
. Superficial peroneal nerve
. Saphenous nerve
. Common peroneal nerve
. Tibial nerve
. Sural nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve is uniquely tethered at the fibular head and is frequently injured in multiligamentous knee injuries, particularly those involving posterolateral corner disruption. The clinical presentation of complete foot drop (weakness of both anterior and lateral compartments) and sensory deficit over the dorsum (superficial peroneal) and first web space (deep peroneal) confirms a lesion of the common peroneal nerve proximal to its bifurcation.

Question 2998

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball attacker presents with posterior shoulder pain and isolated weakness in external rotation. Magnetic resonance imaging demonstrates a multiloculated paralabral cyst located strictly within the spinoglenoid notch. Which muscle will exhibit neurogenic atrophy on the MRI?

. Supraspinatus only
. Infraspinatus only
. Both Supraspinatus and Infraspinatus
. Teres minor
. Subscapularis

Correct Answer & Explanation

. Infraspinatus only

Explanation

The suprascapular nerve innervates the supraspinatus before it passes through the spinoglenoid notch to innervate the infraspinatus. Entrapment of the nerve at the spinoglenoid notch (commonly by a cyst associated with a posterior labral tear) results in isolated denervation and atrophy of the infraspinatus, presenting clinically as isolated weakness in external rotation.

Question 2999

Topic: Shoulder & Hip Sports

A 22-year-old rugby player has recurrent anterior shoulder instability. An MRI reveals a Bankart lesion and an engaging Hill-Sachs lesion. The glenoid bone loss is calculated at 22%. Which surgical procedure is most indicated to prevent further dislocations in this patient?

. Arthroscopic Bankart repair alone
. Open Bankart repair and inferior capsular shift
. Arthroscopic Bankart repair with Remplissage
. Latarjet procedure
. Putti-Platt procedure

Correct Answer & Explanation

. Latarjet procedure

Explanation

In collision athletes with significant glenoid bone loss (>20%) and an engaging Hill-Sachs lesion (an 'off-track' lesion), soft tissue stabilization procedures like Bankart repair have an unacceptably high failure rate. A bony augmentation procedure, most commonly the Latarjet procedure (coracoid transfer), is the standard of care to restore the anterior glenoid arc and create a 'sling' effect with the conjoint tendon.

Question 3000

Topic: Knee Sports

During an anatomic anterior cruciate ligament (ACL) reconstruction, the surgeon aims to accurately position the femoral tunnel. Relative to the lateral intercondylar ridge (resident's ridge) and the lateral bifurcate ridge, where is the native footprint of the anteromedial (AM) bundle of the ACL located?

. Anterior to the lateral intercondylar ridge
. Posterior to the lateral intercondylar ridge and superior to the lateral bifurcate ridge
. Posterior to the lateral intercondylar ridge and inferior to the lateral bifurcate ridge
. Directly on the lateral intercondylar ridge
. Distal to the lateral bifurcate ridge

Correct Answer & Explanation

. Posterior to the lateral intercondylar ridge and superior to the lateral bifurcate ridge

Explanation

The entire native ACL footprint on the femur is located posterior (deep) to the lateral intercondylar ridge (resident's ridge). The footprint is further divided into AM and PL bundles by the lateral bifurcate ridge. When the knee is viewed in 90 degrees of flexion, the AM bundle footprint is located posterior to the lateral intercondylar ridge and superior (proximal) to the lateral bifurcate ridge, whereas the PL bundle is posterior to the intercondylar ridge and inferior (distal) to the bifurcate ridge.

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