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5. Sports Medicine MCQs

Practice Set 154 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 3061

Topic: Knee Sports

The healing potential of the anterior cruciate ligament (ACL) is notoriously poor. Which of the following arteries provides the primary blood supply to the native ACL?

. Medial inferior genicular artery
. Lateral inferior genicular artery
. Middle genicular artery
. Descending genicular artery
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Middle genicular artery

Explanation

The primary blood supply to the anterior cruciate ligament (ACL) is derived from the middle genicular artery, a branch of the popliteal artery that pierces the posterior capsule to supply the cruciate ligaments. The inferior genicular arteries (medial and lateral) primarily supply the menisci via the perimeniscal capillary plexus.

Question 3062

Topic: Knee Sports

The medial patellofemoral ligament (MPFL) is the primary restraint to lateral patellar translation at 0 to 30 degrees of knee flexion. Which of the following best describes the anatomical femoral attachment of the MPFL?

. Anterior to the medial epicondyle and distal to the adductor tubercle
. Posterior to the medial epicondyle and proximal to the adductor tubercle
. Distal to the medial epicondyle and anterior to the superficial MCL
. In the saddle area between the medial epicondyle and the adductor tubercle
. Directly on the tip of the adductor tubercle

Correct Answer & Explanation

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

Explanation

Anatomically, the femoral origin of the MPFL is located in the saddle (or groove) between the adductor tubercle (which is proximal and posterior) and the medial epicondyle (which is distal and anterior). Schottle's point defines this radiographically.

Question 3063

Topic: 5. Sports Medicine
During shoulder arthroscopy, a surgeon visualizes tearing of the superior labrum with complete detachment of the biceps anchor from the superior glenoid tubercle. The labrum is not bucket-handle torn, and the tear does not extend into the biceps tendon. What type of SLAP lesion is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

According to the Snyder classification of SLAP tears: Type I is degenerative fraying with an intact biceps 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 biceps anchor. Type IV is a bucket-handle tear that extends into the biceps tendon.

Question 3064

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary functional bundles. Which of the following best describes the specific biomechanical roles and tensioning patterns of the anteromedial (AM) and posterolateral (PL) bundles during knee range of motion?

. The AM bundle tightens in extension and controls translation; the PL bundle tightens in flexion and controls rotation.
. The AM bundle tightens in flexion and controls rotation; the PL bundle tightens in flexion and controls translation.
. The AM bundle tightens in extension and controls rotation; the PL bundle tightens in extension and controls translation.
. The AM bundle tightens to resist varus stress; the PL bundle tightens to resist valgus stress.
. The AM bundle tightens in flexion and primarily controls anterior translation; the PL bundle tightens in extension and primarily controls rotation.

Correct Answer & Explanation

. The AM bundle tightens in flexion and primarily controls anterior translation; the PL bundle tightens in extension and primarily controls rotation.

Explanation

The ACL's two functional bundles are the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle increases in tension during knee flexion and is the primary restraint to anterior tibial translation. The PL bundle is taut in extension and is the primary restraint to rotatory loads (pivot shift).

Question 3065

Topic: 5. Sports Medicine

In overhead-throwing athletes, a Type II Superior Labrum Anterior to Posterior (SLAP) tear is often propagated by the 'peel-back' mechanism during the throwing motion. In which of the following shoulder positions does the maximum peel-back force occur?

. Maximum internal rotation and forward elevation
. Adduction and internal rotation
. Extension and internal rotation
. Abduction and maximum external rotation
. Maximum forward flexion and adduction

Correct Answer & Explanation

. Abduction and maximum external rotation

Explanation

The 'peel-back' mechanism is a primary contributor to SLAP tears in overhead athletes. During the late cocking phase of throwing, the shoulder is in abduction and maximum external rotation. This position causes the biceps vector to shift posteriorly, creating a torsional force that 'peels back' the superior labrum from the glenoid.

Question 3066

Topic: Knee Sports

A 14-year-old male soccer player presents with chronic anterior knee pain and occasional mechanical catching. Radiographs and MRI confirm a stable osteochondritis dissecans (OCD) lesion. Statistically, what is the most common anatomical location for an OCD lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Lateral aspect of the lateral femoral condyle
. Central aspect of the trochlea
. Inferior pole of the patella

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for osteochondritis dissecans (OCD) in the knee is the lateral aspect of the medial femoral condyle. This classic location accounts for approximately 70-80% of knee OCD lesions. A helpful mnemonic is 'LAME' (Lateral Aspect Medial Epicondyle/Condyle).

Question 3067

Topic: 5. Sports Medicine

During the 'ligamentization' process of a bone-patellar tendon-bone autograft following an ACL reconstruction, at which post-operative timeline is the graft at its weakest biomechanically?

. 1 to 2 weeks
. 6 to 8 weeks
. 12 to 16 weeks
. 6 months
. 12 months

Correct Answer & Explanation

. 6 to 8 weeks

Explanation

The autograft undergoes a process of necrosis, revascularization, and remodeling known as ligamentization. The graft is mechanically weakest during the revascularization and repopulation phase, which typically reaches its nadir around 6 to 8 weeks post-operatively. During this time, the graft is highly susceptible to elongation or rupture.

Question 3068

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes stabilization for recurrent anterior shoulder instability. Arthroscopy reveals 15% anterior glenoid bone loss and a large, engaging Hill-Sachs lesion. An arthroscopic Bankart repair is planned along with a 'remplissage' procedure. What structure is transferred or tenodesed into the humeral defect during a remplissage?

. Long head of the biceps tendon
. Subscapularis tendon
. Infraspinatus tendon and posterior capsule
. Teres minor tendon
. Coracoacromial ligament

Correct Answer & Explanation

. Infraspinatus tendon and posterior capsule

Explanation

The remplissage procedure involves tenodesis of the infraspinatus tendon and the underlying posterior joint capsule into a large, engaging Hill-Sachs defect. This essentially converts an intra-articular defect into an extra-articular one and acts as a posterior checkrein, preventing the humeral head defect from engaging the anterior glenoid rim during external rotation.

Question 3069

Topic: Knee Sports

During an anatomical reconstruction of the posterolateral corner (PLC) of the knee, accurate tunnel placement is critical. Which of the following accurately describes the femoral attachment site of the fibular collateral ligament (FCL)?

. Proximal and posterior to the lateral epicondyle
. Distal and anterior to the lateral epicondyle
. Directly on the lateral epicondyle
. Proximal and anterior to the lateral epicondyle
. Distal and posterior to the lateral epicondyle

Correct Answer & Explanation

. Proximal and posterior to the lateral epicondyle

Explanation

The femoral footprint of the fibular collateral ligament (FCL) is situated slightly proximal and posterior to the lateral epicondyle. The popliteus tendon (PLT) femoral attachment is located slightly anterior and distal to the FCL attachment, within the popliteal sulcus. Identifying the lateral epicondyle is a key surgical landmark for accurate isometric reconstruction of the PLC.

Question 3070

Topic: Shoulder & Hip Sports

During a Latarjet procedure for recurrent anterior shoulder instability with significant glenoid bone loss, the transferred coracoid block provides both a static bony block and a dynamic 'sling effect'. Which anatomical structure is primarily responsible for generating this dynamic sling effect?

. Long head of the biceps brachii
. Conjoint tendon (short head of the biceps and coracobrachialis)
. Pectoralis minor
. Subscapularis tendon
. Latissimus dorsi

Correct Answer & Explanation

. Conjoint tendon (short head of the biceps and coracobrachialis)

Explanation

The Latarjet procedure provides stability through three distinct mechanisms: 1) the static bony block of the transferred coracoid, 2) the dynamic 'sling effect' of the conjoint tendon (comprising the short head of the biceps and the coracobrachialis), and 3) the capsular repair (usually the CA ligament stump to the capsule). When the arm is abducted and externally rotated, the conjoint tendon tightens and acts as a sling against the lower subscapularis and anterior-inferior capsule, reinforcing anterior stability.

Question 3071

Topic: Knee Sports

Following an anterior cruciate ligament (ACL) reconstruction, a patient complains of a loss of terminal knee extension. A sagittal MRI reveals the tibial tunnel is positioned significantly anterior to the Blumensaat line with the knee in full extension. What is the most likely complication associated with this tunnel malposition?

. Posterior cruciate ligament impingement
. Roof impingement
. Severe rotational instability
. Posterior cruciate ligament rupture
. Graft stretching in deep flexion

Correct Answer & Explanation

. Roof impingement

Explanation

If the tibial tunnel is placed too anteriorly, the ACL graft will impinge against the roof of the intercondylar notch (the Blumensaat line) during terminal knee extension. This leads to a loss of extension (extension deficit), localized pain, and potential graft attrition or failure.

Question 3072

Topic: Shoulder & Hip Sports

In a patient with anterior shoulder instability, a bipolar bone loss lesion is identified. The 'glenoid track' concept is utilized to determine the risk of engagement. A Hill-Sachs lesion is considered 'engaging' (off-track) if its medial margin falls in which of the following locations relative to the glenoid track?

. Medial to the medial margin of the glenoid track
. Lateral to the medial margin of the glenoid track
. Inferior to the inferior pole of the glenoid
. Superior to the superior rim of the glenoid
. Directly within the center of the glenoid track

Correct Answer & Explanation

. Medial to the medial margin of the glenoid track

Explanation

The glenoid track represents the contact area of the glenoid on the humeral head during abduction and external rotation. If the medial margin of the Hill-Sachs lesion extends more medial than the medial margin of the glenoid track, it is considered 'off-track' and will engage the anterior glenoid rim, necessitating a procedure like Remplissage or a bone block.

Question 3073

Topic: Knee Sports

An 18-year-old soccer player sustains a severe twisting injury to his knee. Radiographs reveal a small, elliptic bone fragment avulsed from the lateral aspect of the proximal tibia just distal to the articular surface. This pathognomonic finding is most commonly associated with which primary ligamentous injury, and what anatomical structure does the bony fragment represent?

. Posterior cruciate ligament tear; Medial capsular avulsion
. Anterior cruciate ligament tear; Anterolateral ligament / lateral capsular avulsion
. Lateral collateral ligament tear; Fibular head avulsion
. Medial collateral ligament tear; Medial femoral epicondyle avulsion
. Lateral meniscal root tear; Tibial plateau avulsion

Correct Answer & Explanation

. Anterior cruciate ligament tear; Anterolateral ligament / lateral capsular avulsion

Explanation

The described radiographic finding is a Segond fracture, which is an avulsion of the anterolateral ligament (ALL) and lateral capsule from the lateral aspect of the proximal tibia. It occurs due to internal rotation and varus stress. The presence of a Segond fracture is highly predictive (up to 75-100% in various studies) of an anterior cruciate ligament (ACL) rupture.

Question 3074

Topic: Shoulder & Hip Sports

During a Latarjet procedure for recurrent anterior shoulder instability, the transferred coracoid process confers stability via a 'triple blocking' effect. Which of the following anatomical structures provides the critical dynamic 'sling' effect when the arm is placed in abduction and external rotation?

. Coracoacromial ligament
. Conjoined tendon (short head of the biceps and coracobrachialis)
. Pectoralis minor
. Subscapularis
. Long head of the biceps

Correct Answer & Explanation

. Conjoined tendon (short head of the biceps and coracobrachialis)

Explanation

The Latarjet procedure provides stability through three mechanisms: 1) The bony block of the coracoid extending the glenoid arc; 2) The dynamic 'sling' effect of the conjoined tendon (short head of biceps and coracobrachialis) acting across the inferior subscapularis when the arm is abducted and externally rotated, effectively tensioning the capsule and subscapularis; 3) The capsule repair to the stump of the coracoacromial ligament. The conjoined tendon provides the sling effect.

Question 3075

Topic: Knee Sports

During the physical examination of a patient with a suspected multiligamentous knee injury, varus stress testing at 30 degrees of knee flexion demonstrates significant gapping. Which anatomical structure is the primary static restraint preventing this displacement?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Popliteus tendon
. Fibular collateral ligament (LCL)
. Popliteofibular ligament

Correct Answer & Explanation

. Fibular collateral ligament (LCL)

Explanation

The Fibular Collateral Ligament (LCL) is the primary static stabilizer to varus stress at both 0 and 30 degrees of knee flexion. While the popliteus complex (popliteus tendon and popliteofibular ligament) contributes to external rotation stability, the LCL is the primary check against varus displacement.

Question 3076

Topic: Shoulder & Hip Sports

A 24-year-old professional baseball pitcher complains of vague posterior shoulder pain. Physical examination demonstrates a Glenohumeral Internal Rotation Deficit (GIRD) of 25 degrees on his throwing arm compared to the contralateral side. What is the primary anatomical driver responsible for this physical exam finding?

. Contracture of the anterior-inferior capsule
. Contracture of the posterior band of the inferior glenohumeral ligament
. Hyperlaxity of the superior glenohumeral ligament
. Tightness of the pectoralis minor tendon
. Subclinical tearing of the subscapularis

Correct Answer & Explanation

. Contracture of the posterior band of the inferior glenohumeral ligament

Explanation

GIRD is frequently seen in overhead throwing athletes and is driven by repetitive microtrauma during the extreme eccentric loading of the deceleration phase of throwing. This leads to reactive fibroplasia, thickening, and contracture of the posterior-inferior capsule, specifically the posterior band of the inferior glenohumeral ligament (IGHL). This shifts the glenohumeral center of rotation posterosuperiorly, putting the athlete at risk for SLAP tears.

Question 3077

Topic: Knee Sports

A 24-year-old athlete sustains a twisting injury to his left knee. Physical examination reveals a positive Dial test with 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of knee flexion, the external rotation is equal bilaterally. This examination finding is most consistent with an isolated injury to which of the following structures?

. Posterior cruciate ligament (PCL)
. Posterolateral corner (PLC)
. Combined PCL and PLC
. Anterior cruciate ligament (ACL)
. Combined ACL and PLC

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

The Dial test evaluates external rotation of the tibia relative to the femur. 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). If external rotation is increased at both 30 and 90 degrees, it indicates a combined injury to both the PLC and the posterior cruciate ligament (PCL).

Question 3078

Topic: 5. Sports Medicine

The 'peel-back' mechanism is a primary pathophysiologic etiology for superior labrum anterior-posterior (SLAP) tears in overhead throwing athletes. During which specific phase of the throwing motion does the peel-back mechanism place the greatest torsional stress on the biceps anchor?

. Wind-up
. Early cocking
. Late cocking
. Acceleration
. Follow-through

Correct Answer & Explanation

. Late cocking

Explanation

The 'peel-back' mechanism occurs during the late cocking phase of throwing, when the shoulder is in maximum abduction and external rotation. In this position, the vector of the biceps tendon changes, shifting posteriorly and creating a torsional force that 'peels' the superior labrum off the posterior glenoid rim.

Question 3079

Topic: 5. Sports Medicine

Which of the following autografts used for anterior cruciate ligament (ACL) reconstruction possesses the highest ultimate tensile strength and stiffness compared to the native ACL?

. 10-mm bone-patellar tendon-bone
. Quadrupled hamstring
. Single-strand semitendinosus
. Quadriceps tendon without a bone block
. Iliotibial band

Correct Answer & Explanation

. Quadrupled hamstring

Explanation

The native ACL has an ultimate load of approximately 2160 N. A quadrupled hamstring graft (semitendinosus and gracilis) is mechanically the strongest commonly used autograft, with an ultimate load exceeding 4000 N. A 10-mm bone-patellar tendon-bone (BPTB) graft has an ultimate load of around 2977 N. Despite biomechanical differences, clinical outcomes and stability between BPTB and quadrupled hamstring are generally equivalent.

Question 3080

Topic: Knee Sports

A 25-year-old athlete sustains a twisting injury to the knee. On physical examination, the Dial test reveals 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the uninjured side, but symmetric external rotation at 90 degrees of knee flexion. Which of the following structures is most likely injured?

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

Correct Answer & Explanation

. Posterior cruciate ligament and posterolateral corner

Explanation

The Dial test evaluates external rotation of the tibia. Increased external rotation (>10-15 degrees compared to the normal side) isolated only at 30 degrees of knee flexion indicates an isolated injury to the posterolateral corner (PLC). If increased external rotation is present at both 30 degrees and 90 degrees of flexion, it indicates a combined injury to the PLC and the posterior cruciate ligament (PCL).

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