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5. Sports Medicine MCQs

Practice Set 153 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 3041

Topic: Shoulder & Hip Sports

A 45-year-old heavy laborer presents with persistent anterior shoulder pain. MR arthrogram confirms an isolated Type II SLAP tear. Nonoperative management has failed. Which of the following surgical interventions is most likely to yield the best functional outcome and lowest revision rate in this specific patient profile?

. Arthroscopic SLAP repair with suture anchors
. Open anterior capsular shift
. Biceps tenodesis
. Arthroscopic debridement of the labrum
. Coracoclavicular ligament reconstruction

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In older patients (typically >40 years) or heavy laborers/workers' compensation patients, biceps tenodesis has been shown to have superior clinical outcomes, better pain relief, and lower revision rates compared to arthroscopic SLAP repair.

Question 3042

Topic: Knee Sports

During the physical examination of a knee with a suspected multi-ligamentous injury, the Dial test is performed. The patient demonstrates 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of flexion, the external rotation is symmetric bilaterally. This finding indicates an isolated injury to the:

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

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

A positive Dial test (asymmetry of >10 degrees of external rotation) at 30 degrees of flexion, but negative at 90 degrees, is indicative of an isolated posterolateral corner (PLC) injury. If the test is positive at both 30 and 90 degrees, it suggests a combined injury of the PLC and PCL.

Question 3043

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, a surgical error results in the femoral tunnel being placed too anteriorly (shallow) in the intercondylar notch. What specific kinematic abnormality will this graft exhibit during knee range of motion?

. The graft will be tight in flexion and loose in extension
. The graft will be tight in extension and loose in flexion
. The graft will be symmetrically tight throughout the entire range of motion
. The graft will impinge on the posterior cruciate ligament (PCL)
. The graft will cause obligatory excessive external rotation of the tibia

Correct Answer & Explanation

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

Explanation

An anteriorly placed (shallow) femoral tunnel causes the distance between the femoral and tibial insertion sites to increase as the knee moves into flexion. Consequently, the graft captures the joint, becoming overly tight in flexion (limiting ROM) and remaining loose in extension.

Question 3044

Topic: Knee Sports

A Segond fracture observed on an AP radiograph of the knee is widely recognized as pathognomonic for an anterior cruciate ligament (ACL) tear. This bony avulsion occurs at the tibial insertion of the anterolateral ligament (ALL). Where does the ALL anatomically originate?

. Medial femoral epicondyle, distal to the adductor tubercle
. Gerdy's tubercle, merging with the iliotibial band
. Posterolateral corner of the fibular head
. Lateral femoral epicondyle, anterior and distal to the fibular collateral ligament origin
. Posterior aspect of the lateral femoral condyle, superior to the popliteus insertion

Correct Answer & Explanation

. Lateral femoral epicondyle, anterior and distal to the fibular collateral ligament origin

Explanation

The Segond fracture is a cortical avulsion fracture off the proximal anterolateral tibia, associated with ACL injuries. Anatomical studies identify this as the tibial insertion of the anterolateral ligament (ALL) or the lateral capsular ligament. The ALL originates on the lateral femoral epicondyle, slightly anterior and distal to the origin of the fibular collateral ligament (FCL), and inserts on the anterolateral tibia midway between Gerdy's tubercle and the fibular head.

Question 3045

Topic: 5. Sports Medicine
A 25-year-old baseball pitcher undergoes shoulder arthroscopy for chronic shoulder pain. The surgeon visualizes a bucket-handle tear of the superior labrum that also splits and extends into the long head of the biceps tendon, with the remaining biceps anchor still attached to the glenoid. According to the Snyder classification, what type of SLAP tear is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type IV

Explanation

The Snyder classification of Superior Labrum Anterior and Posterior (SLAP) tears: Type I: Fraying of the superior labrum with an intact biceps anchor. Type II: Detachment of the superior labrum and biceps anchor from the superior glenoid. Type III: Bucket-handle tear of the superior labrum with an intact biceps anchor. Type IV: Bucket-handle tear of the superior labrum that extends into the long head of the biceps tendon. This patient has a Type IV lesion.

Question 3046

Topic: Knee Sports

An 11-year-old male with widely open physes sustains a mid-substance anterior cruciate ligament (ACL) tear. To avoid physeal injury, an all-epiphyseal ACL reconstruction is planned. During preparation of the femoral tunnel, the starting point should be correctly established in which of the following locations?

. Proximal to the lateral epicondyle and directed distally
. Distal to the lateral femoral physis and directed medially within the epiphysis
. Transphyseal, crossing through the center of the intercondylar notch
. Proximal to the medial epicondyle and directed laterally
. Through the center of the distal femoral physis to minimize peripheral growth arrest

Correct Answer & Explanation

. Distal to the lateral femoral physis and directed medially within the epiphysis

Explanation

An all-epiphyseal ACL reconstruction is designed to completely avoid crossing the distal femoral and proximal tibial physes. On the femoral side, the tunnel is drilled strictly within the epiphysis, distal to the lateral femoral physis. The trajectory goes from the lateral aspect of the lateral femoral condyle, aiming medially toward the native ACL footprint on the inner wall of the lateral condyle, remaining entirely within the epiphyseal bone.

Question 3047

Topic: 5. Sports Medicine

When comparing operative repair to nonoperative management for acute Achilles tendon ruptures, high-quality meta-analyses have demonstrated that operative management is associated with which of the following outcomes?

. A lower incidence of deep vein thrombosis
. A decreased time to return to previous level of competitive sports
. A lower rate of overall complications
. A decreased rate of rerupture when compared to nonoperative regimens that do not utilize early functional mobilization
. Significantly increased plantar flexion strength at 2-year follow-up

Correct Answer & Explanation

. A decreased rate of rerupture when compared to nonoperative regimens that do not utilize early functional mobilization

Explanation

Meta-analyses of acute Achilles tendon ruptures indicate that operative repair significantly decreases the rerupture rate when compared to traditional nonoperative management involving prolonged cast immobilization. However, when nonoperative management includes early functional rehabilitation, the difference in rerupture rates between the two groups is not statistically significant. Operative repair consistently carries a higher rate of overall complications, specifically wound-related and soft-tissue issues. Differences in return to sport and long-term strength are often negligible when functional rehab is used.

Question 3048

Topic: Knee Sports

A 50-year-old female presents with the sudden onset of medial knee pain and a popping sensation while performing a deep squat. MRI reveals a complete radial tear of the posterior horn of the medial meniscus exactly at its root attachment. Biomechanically, this injury is equivalent to which of the following conditions?

. An intact, functional meniscus
. A partial medial meniscectomy
. A total medial meniscectomy
. An isolated anterior cruciate ligament tear
. An isolated posterior cruciate ligament tear

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A complete tear of the meniscal root disrupts the circumferential hoop stresses that allow the meniscus to convert axial loads into tensile stresses. Biomechanically, a complete posterior root tear renders the meniscus completely nonfunctional, leading to contact pressures and joint kinematics that are equivalent to a total meniscectomy. This results in accelerated articular cartilage wear and rapid progression of osteoarthritis.

Question 3049

Topic: Knee Sports
A patient with a multi-ligamentous knee injury undergoes a dial test. There is >10 degrees of increased external rotation on the injured side compared to the normal side at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees of knee flexion. Which structure is isolated as injured?
. Posterolateral corner (PLC) only
. Posterior cruciate ligament (PCL) only
. Both PLC and PCL
. Anterior cruciate ligament (ACL) and PLC
. Medial collateral ligament (MCL) and posterior oblique ligament (POL)

Correct Answer & Explanation

. Both PLC and PCL

Explanation

In the dial test, increased external rotation at 30 degrees only indicates an isolated posterolateral corner (PLC) injury. If increased external rotation is present at both 30 degrees and 90 degrees, it indicates a combined PLC and posterior cruciate ligament (PCL) injury.

Question 3050

Topic: Knee Sports

A 24-year-old football player sustains a high-energy knee injury. Clinical examination reveals a grade 3 positive dial test at 30 degrees of flexion, which reduces to a grade 1 at 90 degrees. He also exhibits an abnormal varus thrust during gait. Which structure is most likely disrupted?

. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Medial collateral ligament (MCL)
. Posterolateral corner (PLC)
. Posteromedial corner (PMC)

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

An isolated posterolateral corner (PLC) injury is characterized by increased external rotation (positive dial test) at 30 degrees of flexion, but not at 90 degrees. If the dial test is positive at both 30 and 90 degrees, it suggests a combined PCL and PLC injury. A varus thrust during gait is a classic dynamic clinical finding for PLC deficiency.

Question 3051

Topic: Knee Sports

Which of the following statements correctly describes the tensioning patterns of the two functional bundles of the anterior cruciate ligament (ACL) during knee range of motion?

. The anteromedial (AM) bundle is tightest in flexion, and the posterolateral (PL) bundle is tightest in extension
. The anteromedial (AM) bundle is tightest in extension, and the posterolateral (PL) bundle is tightest in flexion
. Both the AM and PL bundles reach maximum tension in full flexion
. Both the AM and PL bundles reach maximum tension in full extension
. The AM bundle primarily controls external rotation, while the PL bundle primarily controls internal rotation

Correct Answer & Explanation

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

Explanation

The ACL is composed of two main bundles: the anteromedial (AM) bundle and the posterolateral (PL) bundle. The AM bundle is primarily tight in flexion and provides the main restraint to anterior tibial translation at 90 degrees of flexion. The PL bundle is tight in extension and is the primary restraint to rotatory loads.

Question 3052

Topic: 5. Sports Medicine
A 28-year-old overhead athlete presents with mechanical shoulder pain. An MRI arthrogram demonstrates a bucket-handle tear of the superior labrum that extends into the long head of the biceps tendon. According to the Snyder classification, what type of SLAP tear is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

In the Snyder classification of SLAP tears: Type I is fraying of the superior labrum; Type II is detachment of the labrum and biceps anchor; 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 3053

Topic: Shoulder & Hip Sports

A 24-year-old rugby player undergoes revision surgery for recurrent anterior shoulder instability. Diagnostic arthroscopy reveals 25% anterior glenoid bone loss and a deep Hill-Sachs lesion that engages the anterior glenoid rim in abduction and external rotation. Which of the following is the most appropriate surgical intervention?

. Arthroscopic Bankart repair with labral advancement
. Open Bankart repair and inferior capsular shift
. Latarjet procedure
. Arthroscopic Remplissage alone
. Proximal humerus derotational osteotomy

Correct Answer & Explanation

. Latarjet procedure

Explanation

For recurrent instability with significant anterior glenoid bone loss (>20-25%) and an engaging Hill-Sachs lesion (an 'off-track' lesion), an isolated soft tissue repair is insufficient. The Latarjet procedure (coracoid transfer) is the standard of care as it restores the glenoid arc and provides a sling effect to prevent engagement.

Question 3054

Topic: Knee Sports

During an anatomical reconstruction of the posterolateral corner (PLC) of the knee, a fibular-based technique is utilized. Which three primary static stabilizing structures are being reconstructed?

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament
. Fibular collateral ligament, iliotibial band, and biceps femoris tendon
. Popliteus tendon, lateral meniscus posterior horn, and arcuate ligament
. Fibular collateral ligament, arcuate ligament, and fabellofibular ligament
. Popliteofibular ligament, lateral gastrocnemius tendon, and popliteus tendon

Correct Answer & Explanation

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

Anatomical reconstructions of the posterolateral corner of the knee focus on restoring the three primary static stabilizers: the fibular collateral ligament (FCL, also known as the LCL), the popliteus tendon (PLT), and the popliteofibular ligament (PFL). These structures primarily resist varus opening and external rotation.

Question 3055

Topic: Knee Sports

A 25-year-old soccer player sustains a twisting injury to his knee. On physical examination, the dial test reveals 15 degrees of increased external rotation on the injured side 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 anatomic structure(s) is/are injured?

. Isolated posterior cruciate ligament (PCL)
. Isolated posterolateral corner (PLC)
. Combined PCL and PLC
. Combined ACL and PLC
. Isolated medial patellofemoral ligament (MPFL)

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

The dial test is used to differentiate isolated posterolateral corner (PLC) injuries from combined PLC and PCL injuries. An increase in external rotation of >10 degrees at 30 degrees of flexion, but not at 90 degrees, indicates an isolated PLC injury. If the asymmetry is present at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.

Question 3056

Topic: Shoulder & Hip Sports

In the setting of massive posterosuperior rotator cuff tears, which muscle uniquely demonstrates a high degree of rapid fat accumulation and atrophy due to suprascapular nerve retraction and compression via the 'sling effect' at the spinoglenoid notch?

. Subscapularis
. Infraspinatus
. Supraspinatus
. Teres minor
. Teres major

Correct Answer & Explanation

. Infraspinatus

Explanation

While both the supraspinatus and infraspinatus are innervated by the suprascapular nerve, massive posterosuperior rotator cuff tears lead to severe medial retraction. The suprascapular nerve takes a sharp turn at the spinoglenoid notch to reach the infraspinatus. Medial retraction of the cuff causes traction on the nerve at this unyielding notch (the 'sling effect'), disproportionately causing profound denervation and rapid fatty infiltration in the infraspinatus compared to the supraspinatus.

Question 3057

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, the surgeon inadvertently places the femoral tunnel too anteriorly in the intercondylar notch. Which of the following kinematic abnormalities will most likely result?

. The graft is tight in flexion and loose in extension
. The graft is tight in extension and loose in flexion
. The graft is tight throughout the entire range of motion
. The graft is loose throughout the entire range of motion
. The graft impinges in the intercondylar notch in extension

Correct Answer & Explanation

. The graft is tight in flexion and loose in extension

Explanation

Placing the femoral tunnel too anteriorly in the intercondylar notch causes the ACL graft to be tight in knee flexion and loose in extension. This error restricts full knee flexion and may cause early graft failure or stretching.

Question 3058

Topic: 5. Sports Medicine

A 22-year-old athlete sustains a longitudinal tear in the peripheral one-third of the medial meniscus. This specific zone has the highest healing potential following a meniscal repair primarily because:

. It receives nourishment exclusively from synovial fluid diffusion
. It is directly supplied by the middle genicular artery
. It has a rich blood supply from the perimeniscal capillary plexus
. It contains type II collagen organized in a radial pattern
. It is completely devoid of neurovascular structures

Correct Answer & Explanation

. It has a rich blood supply from the perimeniscal capillary plexus

Explanation

The peripheral one-third of the meniscus (the 'red-red' zone) is highly vascularized by the perimeniscal capillary plexus, which arises from branches of the medial and lateral inferior genicular arteries. This rich blood supply affords this region excellent healing potential. The central zones are avascular and rely on diffusion.

Question 3059

Topic: Knee Sports

In Posterior Cruciate Ligament (PCL) anatomy, which of the following statements accurately describes the biomechanical function of its bundles?

. The anterolateral bundle is tight in extension and lax in flexion.
. The posteromedial bundle is tight in flexion and lax in extension.
. The anterolateral bundle is the primary restraint to posterior tibial translation at 90 degrees of flexion.
. The posteromedial bundle is the primary restraint to posterior tibial translation at 90 degrees of flexion.
. Both bundles maintain constant tension throughout the arc of motion.

Correct Answer & Explanation

. The anterolateral bundle is the primary restraint to posterior tibial translation at 90 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 tight in flexion and lax in extension, serving as the primary restraint to posterior tibial translation at 90 degrees of flexion. The PM bundle is tight in extension and lax in flexion.

Question 3060

Topic: Shoulder & Hip Sports
In the Snyder classification of Superior Labrum Anterior and Posterior (SLAP) lesions, a Type II tear is defined by which of the following characteristics?
. Fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and biceps anchor from the superior glenoid
. A bucket-handle tear of the superior labrum with an intact biceps anchor
. A bucket-handle tear of the superior labrum with detachment of the biceps anchor
. An anterior labral tear extending into the middle glenohumeral ligament

Correct Answer & Explanation

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

Explanation

The Snyder classification describes SLAP tears: Type I is fraying of the superior labrum with an intact anchor. Type II is detachment of the superior labrum and biceps anchor from the glenoid. Type III is a bucket-handle tear of the labrum with an intact anchor. Type IV is a bucket-handle tear extending into the biceps tendon.

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