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5. Sports Medicine MCQs

Practice Set 151 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 3001

Topic: 5. Sports Medicine

When evaluating graft choices for Anterior Cruciate Ligament (ACL) reconstruction, which of the following grafts exhibits the highest initial ultimate tensile load?

. 10mm Bone-Patellar Tendon-Bone (BPTB) autograft
. Quadrupled hamstring (semitendinosus/gracilis) autograft
. Native, uninjured ACL
. 10mm Quadriceps tendon autograft with bone block
. Double-bundle anterior tibialis allograft

Correct Answer & Explanation

. Quadrupled hamstring (semitendinosus/gracilis) autograft

Explanation

A quadrupled hamstring autograft demonstrates an initial ultimate tensile load of approximately 4000 to 4100 N, which is significantly higher than that of a 10mm BPTB graft (~2900 N), quadriceps tendon (~2100-2300 N), and the native ACL (~2100 N). Despite the higher ultimate load, clinical outcomes depend heavily on graft healing, fixation, and stiffness.

Question 3002

Topic: Shoulder & Hip Sports

A 19-year-old collegiate gymnast presents with bilateral shoulder pain. Examination reveals a 2+ sulcus sign in neutral rotation, 3+ anterior load-and-shift, and 3+ posterior load-and-shift bilaterally. She denies any specific traumatic event. What is the most appropriate initial management?

. Arthroscopic 270-degree capsulolabral plication
. Open inferior capsular shift
. Physical therapy focusing on periscapular and rotator cuff strengthening
. Thermal capsulorrhaphy
. Latarjet procedure

Correct Answer & Explanation

. Physical therapy focusing on periscapular and rotator cuff strengthening

Explanation

This patient presents with atraumatic Multidirectional Instability (MDI), classically seen in hyperlax individuals (AMBRI: Atraumatic, Multidirectional, Bilateral, Rehabilitation, Inferior capsular shift). The initial, and often definitive, treatment is an extensive course of physical therapy (usually 6-12 months) focused on strengthening the dynamic stabilizers (rotator cuff and periscapular musculature). Surgery is reserved for patients who fail prolonged rehabilitation.

Question 3003

Topic: Shoulder & Hip Sports

In evaluating a patient with recurrent anterior shoulder instability, you assess the 'glenoid track' on advanced imaging. A Hill-Sachs lesion is deemed 'off-track'. Which of the following anatomic scenarios correctly defines an off-track Hill-Sachs lesion?

. The medial margin of the Hill-Sachs lesion lies medial to the medial margin of the glenoid track
. The medial margin of the Hill-Sachs lesion lies lateral to the medial margin of the glenoid track
. The width of the Hill-Sachs lesion is less than the width of the intact glenoid minus any anterior bone loss
. The glenoid bone loss is less than 15% of the total glenoid width
. The lesion exclusively engages in external rotation at 0 degrees of abduction

Correct Answer & Explanation

. The medial margin of the Hill-Sachs lesion lies medial to the medial margin of the glenoid track

Explanation

The glenoid track is defined as the contact zone of the glenoid on the humeral head during shoulder abduction and external rotation. It is calculated as 83% of the normal glenoid width minus the width of any anterior glenoid bone defect. A Hill-Sachs lesion is 'off-track' (meaning it will engage the anterior glenoid rim) if its medial margin extends further medially than the medial margin of the glenoid track. This typically requires an operation that addresses the humeral head defect (e.g., remplissage) or restores the glenoid track (e.g., Latarjet).

Question 3004

Topic: 5. Sports Medicine

A 22-year-old female is 16 weeks status-post an uncomplicated primary anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. She complains of anterior knee pain and a painful clunk at terminal extension. On examination, her knee flexion is symmetric to the contralateral side, but she lacks the final 15 degrees of terminal extension. What is the most likely cause of this complication?

. Graft placement that is too anterior on the femoral footprint
. Arthrofibrosis secondary to complex regional pain syndrome
. Formation of a localized fibrovascular nodule anterior to the graft
. Graft rupture due to premature return to sports
. Patella baja due to patellar tendon shortening

Correct Answer & Explanation

. Formation of a localized fibrovascular nodule anterior to the graft

Explanation

The patient is presenting with a classic 'Cyclops lesion' (localized anterior arthrofibrosis), which is a fibrovascular nodule that forms anterior to the ACL graft in the intercondylar notch. It typically presents with a mechanical block to terminal extension, an audible or palpable 'clunk' at terminal extension, and anterior knee pain. It does not severely restrict flexion. Treatment is arthroscopic excision of the nodule. Anterior placement of the tibial (not femoral) tunnel can impinge the graft and lead to a Cyclops lesion, but the direct cause of the block is the fibrovascular nodule itself.

Question 3005

Topic: 5. Sports Medicine

A 20-year-old soccer player undergoes an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. What is the most common complication specifically associated with this graft choice compared to hamstring autograft?

. Graft rupture
. Anterior knee pain
. Deep vein thrombosis
. Infection
. Hamstring weakness

Correct Answer & Explanation

. Anterior knee pain

Explanation

Bone-patellar tendon-bone (BTB) autograft is highly associated with donor site morbidity, most notably anterior knee pain and pain with kneeling, compared to hamstring autografts.

Question 3006

Topic: 5. Sports Medicine

During an ACL reconstruction using a bone-patellar tendon-bone autograft, the surgeon chooses to drill the femoral tunnel via an accessory anteromedial portal rather than a transtibial approach. Which of the following is a recognized risk of this technique?

. Creation of an excessively vertical graft placement
. Posterior wall blowout of the femoral tunnel
. Iatrogenic injury to the anterior horn of the medial meniscus
. Increased incidence of graft impingement in the intercondylar notch
. Inability to reach the native femoral footprint

Correct Answer & Explanation

. Posterior wall blowout of the femoral tunnel

Explanation

Drilling the femoral tunnel independently through an anteromedial portal allows for more anatomic (lower and more horizontal) placement of the ACL graft. However, it carries a higher risk of posterior wall blowout (a short, compromised tunnel) and requires the knee to be hyperflexed (at least 110-120 degrees) during drilling to avoid articular cartilage damage and ensure adequate tunnel length.

Question 3007

Topic: Shoulder & Hip Sports

A 22-year-old professional rugby player presents with recurrent anterior shoulder instability. A 3D CT scan of the shoulder reveals an anterior glenoid bone loss of 28%. Which surgical procedure is most highly indicated for this patient to prevent further dislocations?

. Arthroscopic Bankart repair with suture anchors
. Arthroscopic Remplissage procedure
. Latarjet procedure (coracoid transfer)
. Inferior capsular shift
. Osteochondral allograft of the humeral head

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

In the presence of critical anterior glenoid bone loss (>20-25%), soft-tissue repairs (Bankart) have an unacceptably high failure rate. The Latarjet procedure (transfer of the coracoid process to the anterior glenoid) is the gold standard. It restores the bony arc and provides a dynamic 'sling effect' from the attached conjoined tendon.

Question 3008

Topic: 5. Sports Medicine

When comparing the structural properties of a standard 10-mm central third bone-patellar tendon-bone (BTB) autograft to the native intact anterior cruciate ligament (ACL) at time zero, which of the following statements is most accurate?

. The graft has lower ultimate tensile load and lower stiffness
. The graft has equal ultimate tensile load and lower stiffness
. The graft has lower ultimate tensile load and higher stiffness
. The graft has higher ultimate tensile load and higher stiffness
. The graft has equal ultimate tensile load and equal stiffness

Correct Answer & Explanation

. The graft has higher ultimate tensile load and higher stiffness

Explanation

A 10-mm BTB graft has an ultimate failure load of approximately 2,900 N and a stiffness of 685 N/mm. The native ACL has an ultimate failure load of approximately 2,160 N and a stiffness of 242 N/mm. Thus, the 10-mm BTB autograft is both stronger (higher ultimate load) and stiffer than the native ACL at time zero.

Question 3009

Topic: Knee Sports

A patient is evaluated for a knee injury using the dial test in the prone position. At 30 degrees of knee flexion, the injured leg shows 15 degrees of increased external rotation compared to the normal leg. At 90 degrees of knee flexion, the external rotation is symmetric between both legs. What is the most likely diagnosis?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

The dial test assesses the integrity of the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). An increase in external rotation of >10 degrees compared to the contralateral side is considered positive. If the test is positive at 30 degrees of flexion but normal at 90 degrees, it indicates an isolated PLC injury (the intact PCL limits external rotation at 90 degrees). If the test is positive at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 3010

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles, the anteromedial (AM) and posterolateral (PL) bundles. During physiologic knee range of motion, how do the tension patterns of these distinct bundles behave?

. The AM bundle becomes tight in flexion, while the PL bundle is tight in extension
. Both bundles become equally tight in flexion
. The PL bundle becomes tight in flexion, while the AM bundle is tight in extension
. Both bundles are lax in flexion and tight in extension
. The tension of both bundles remains constant throughout the range of motion

Correct Answer & Explanation

. The AM bundle becomes tight in flexion, while the PL bundle is tight in extension

Explanation

The anteromedial (AM) bundle of the ACL is primarily tight in flexion and is the main restraint to anterior tibial translation at 90 degrees of flexion. The posterolateral (PL) bundle is tightest in extension and is the primary restraint against rotatory instability.

Question 3011

Topic: 5. Sports Medicine
A 24-year-old professional baseball pitcher undergoes shoulder arthroscopy. A Type II SLAP (Superior Labrum Anterior to Posterior) lesion is identified. Which of the following best describes the pathomechanics of a Type II SLAP lesion?
. Fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and the origin of the long head of the biceps 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 that extends into the biceps tendon
. An anteroinferior labral detachment with an associated Hill-Sachs lesion

Correct Answer & Explanation

. Detachment of the superior labrum and the origin of the long head of the biceps from the superior glenoid tubercle

Explanation

A Type II SLAP lesion involves the detachment of the superior labrum and the origin of the long head of the biceps tendon from the superior glenoid tubercle. Type I is fraying; Type III is a bucket-handle tear with an intact anchor; Type IV is a bucket-handle tear extending into the biceps tendon.

Question 3012

Topic: 5. Sports Medicine

When evaluating graft choices for primary Anterior Cruciate Ligament (ACL) reconstruction, biomechanical studies demonstrate varying properties of ultimate tensile load. Which of the following graft constructs possesses the highest ultimate tensile load (strength) compared to the native ACL (~2160 N)?

. 10-mm Bone-Patellar Tendon-Bone (BPTB) autograft
. Quadrupled hamstring autograft
. 10-mm Quadriceps tendon autograft
. Achilles tendon allograft
. Native hamstring tendon (semitendinosus only)

Correct Answer & Explanation

. Quadrupled hamstring autograft

Explanation

A quadrupled hamstring graft has an ultimate tensile load of roughly 4090 N, which is nearly twice that of the native ACL (~2160 N). By comparison, a 10-mm BPTB graft has an ultimate tensile load of approximately 2977 N, and a quadriceps tendon graft is about 2352 N. Therefore, the quadrupled hamstring graft is biomechanically the strongest of the standard autograft choices.

Question 3013

Topic: Knee Sports
A 28-year-old football player is evaluated for acute knee instability. The tibial dial test is performed in the supine position. The examiner notes >10 degrees of increased external rotation on the injured side compared to the normal side when the knee is flexed at 30 degrees. However, when the knee is flexed to 90 degrees, the external rotation is symmetric bilaterally. This specific pattern confirms injury to which structure(s)?
. Isolated Posterolateral Corner (PLC)
. Combined Posterolateral Corner (PLC) and Posterior Cruciate Ligament (PCL)
. Isolated Posterior Cruciate Ligament (PCL)
. Anterolateral Ligament (ALL) and Anterior Cruciate Ligament (ACL)
. Medial Collateral Ligament (MCL) and Posterior Oblique Ligament (POL)

Correct Answer & Explanation

. Isolated Posterolateral Corner (PLC)

Explanation

The dial test assesses external rotation of the tibia. Increased external rotation (>10 degrees compared to the contralateral side) at 30 degrees of flexion indicates an injury to the Posterolateral Corner (PLC). If the external rotation reduces and becomes symmetric at 90 degrees, the PCL is intact (isolated PLC injury). If external rotation is increased at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 3014

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, accurate femoral tunnel placement is critical to avoid graft mal-tensioning. Radiographically, 'Schöttle's point' is used to identify the anatomic femoral footprint. Anatomically, where is this point located?
. 1 cm distal to the medial epicondyle
. In the saddle region between the adductor tubercle and the medial epicondyle
. Directly on the prominence of the adductor tubercle
. 2 cm anterior to the medial epicondyle
. At the insertion of the superficial medial collateral ligament

Correct Answer & Explanation

. In the saddle region between the adductor tubercle and the medial epicondyle

Explanation

The anatomic femoral origin of the MPFL is located in the saddle-shaped depression between the adductor tubercle (proximal) and the medial epicondyle (distal). Radiographically, Schöttle's point is 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line.

Question 3015

Topic: 5. Sports Medicine
A 23-year-old elite collegiate gymnast presents with vague anterior shoulder pain and a catching sensation. MRI arthrogram demonstrates a detachment of the superior labrum and the origin of the long head of the biceps tendon from the glenoid, without extension into the anterior or posterior labrum. What is the classification of this injury and the historically accepted gold standard surgical treatment for a young athletic patient?
. Type I SLAP; simple debridement
. Type II SLAP; superior labral repair with suture anchors
. Type III SLAP; biceps tenodesis
. Type IV SLAP; biceps tenotomy
. Type II SLAP; open subpectoral biceps tenodesis

Correct Answer & Explanation

. Type II SLAP; superior labral repair with suture anchors

Explanation

This describes a Type II SLAP tear (detachment of the superior labrum and biceps anchor). In young, high-demand athletes (like a 23-year-old gymnast), the traditional gold standard treatment is an arthroscopic superior labral repair using suture anchors. Tenodesis is increasingly favored in older patients (>35-40) or workers with heavy lifting requirements, but labral repair remains the standard for young athletes.

Question 3016

Topic: Knee Sports

When performing an anterior cruciate ligament (ACL) reconstruction, drilling the femoral tunnel via an anteromedial (AM) portal instead of a transtibial technique is advantageous primarily because it allows for:

. A more vertical femoral tunnel, reducing rotational instability
. Independent placement of the femoral tunnel closer to the native ACL footprint
. Decreased risk of posterior wall blowout
. Longer femoral tunnel length for better graft incorporation
. Avoidance of the need to hyperflex the knee during drilling

Correct Answer & Explanation

. Independent placement of the femoral tunnel closer to the native ACL footprint

Explanation

The primary advantage of the anteromedial (AM) portal technique over the traditional transtibial technique is that it uncouples the femoral tunnel from the tibial tunnel trajectory. This allows for independent, anatomic placement of the femoral tunnel at the native ACL footprint, which creates a more oblique graft that better restores rotational stability.

Question 3017

Topic: Shoulder & Hip Sports

Superior capsular reconstruction (SCR) is a surgical option for massive, irreparable rotator cuff tears. The primary biomechanical goal of the graft in SCR is to:

. Reconstruct the anterior restraint to prevent anterior subluxation
. Restore active abduction through a dynamic tenodesis effect
. Depress the humeral head and prevent superior migration during shoulder elevation
. Act as a spacer to widen the subacromial space without attaching to the humerus
. Replace the subscapularis footprint to balance transverse force couples

Correct Answer & Explanation

. Depress the humeral head and prevent superior migration during shoulder elevation

Explanation

In massive, irreparable posterosuperior rotator cuff tears, the loss of the supraspinatus and infraspinatus leads to superior migration of the humeral head due to unopposed deltoid pull. Superior capsular reconstruction (SCR) utilizes a graft (typically fascia lata or human dermal allograft) attached medially to the superior glenoid and laterally to the greater tuberosity. Its primary biomechanical role is to function as a static restraint to prevent superior migration of the humeral head, restoring the glenohumeral fulcrum to improve deltoid efficiency.

Question 3018

Topic: Knee Sports
A 28-year-old male sustains a high-energy multiligamentous knee injury with complete ruptures of the ACL, PCL, and MCL (Schenck KD-III M). Upon closed reduction in the emergency department, his pedal pulses are palpable, but his ankle-brachial index (ABI) is 0.85. What is the most appropriate next step in management?
. Observation and repeat the ABI in 4 hours
. Perform a CT angiogram of the lower extremity
. Immediate surgical exploration of the popliteal artery
. Apply a hinged knee brace and perform duplex ultrasound
. Initiate intravenous heparin infusion

Correct Answer & Explanation

. Perform a CT angiogram of the lower extremity

Explanation

An ABI < 0.9 in the setting of a multiligament knee injury (knee dislocation) is highly suspicious for a popliteal artery injury, even if pedal pulses are palpable. A CT angiogram is the gold standard next step to evaluate the arterial tree before proceeding with possible vascular repair.

Question 3019

Topic: 5. Sports Medicine

A 42-year-old recreational overhead athlete presents with persistent anterior shoulder pain and deep clicking. An MRI arthrogram demonstrates an isolated Type II SLAP tear. After 6 months of dedicated physical therapy, symptoms remain debilitating. Which of the following surgical interventions is most strongly supported by current literature for a patient of this age?

. Arthroscopic debridement of the superior labrum only
. Anatomic SLAP repair utilizing suture anchors
. Biceps tenodesis
. Biceps tenotomy without tenodesis
. Coracoid process transfer (Latarjet procedure)

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In older patients (typically > 35-40 years old), SLAP repairs have a higher rate of stiffness, continued pain, and clinical failure compared to younger patients. Current evidence strongly favors primary biceps tenodesis over SLAP repair for Type II SLAP lesions in patients over 40.

Question 3020

Topic: Knee Sports

Compared to a traditional transtibial drilling technique, utilizing an independent anteromedial (AM) portal drilling technique for the femoral tunnel in an anterior cruciate ligament (ACL) reconstruction increases the risk of which of the following intraoperative complications?

. Vertical graft placement in the coronal plane
. Posterior cruciate ligament impingement
. Posterior wall blowout of the lateral femoral condyle
. Anterior placement of the femoral tunnel
. Inability to adequately tension the graft

Correct Answer & Explanation

. Posterior wall blowout of the lateral femoral condyle

Explanation

The anteromedial (AM) portal technique allows for more anatomic placement of the femoral tunnel footprint compared to the transtibial technique, which often results in a more vertical and non-anatomic graft. However, drilling through the AM portal is associated with specific risks, particularly a shorter femoral tunnel length and a higher risk of posterior wall blowout of the lateral femoral condyle due to the acute angle of the drill trajectory relative to the intercondylar notch.

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