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5. Sports Medicine MCQs

Practice Set 156 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 3101

Topic: Knee Sports

A 25-year-old male sustains a twisting knee injury during a rugby match. On physical examination, the dial test reveals 20 degrees of increased external rotation of the tibia compared to the contralateral leg when the knee is flexed to 30 degrees. However, when the knee is flexed to 90 degrees, the external rotation is symmetric bilaterally. This physical exam finding is most consistent with an isolated injury to which structure(s)?

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

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

The dial test assesses the integrity of the posterolateral corner (PLC) and posterior cruciate ligament (PCL). Increased external rotation (>10 degrees difference compared to the normal side) at 30 degrees of flexion, but symmetric rotation at 90 degrees, indicates an isolated injury to the PLC. If the dial test demonstrates increased external rotation at both 30 degrees and 90 degrees of flexion, it indicates a combined injury to both the PLC and the PCL.

Question 3102

Topic: 5. Sports Medicine

Which of the following best represents the initial ultimate tensile strength of a 10-mm central third bone-patellar tendon-bone (BPTB) autograft compared to the native anterior cruciate ligament (ACL)?

. 50% of the native ACL
. 100% of the native ACL
. 160% of the native ACL
. 250% of the native ACL
. 300% of the native ACL

Correct Answer & Explanation

. 160% of the native ACL

Explanation

Biomechanical studies by Noyes et al. demonstrated that a 10-mm bone-patellar tendon-bone (BPTB) graft has an ultimate tensile strength of approximately 2977 N, which is roughly 138% to 160% of the strength of the native ACL (which is approximately 2160 N). A quadrupled hamstring graft is even stronger, measuring around 200-250% of the native ACL strength.

Question 3103

Topic: 5. Sports Medicine

Following an uncomplicated Zone II flexor digitorum profundus (FDP) tendon repair, an early active motion rehabilitation protocol is initiated. What is the primary clinical advantage of early active motion over early passive motion protocols?

. Decreased risk of acute tendon rupture
. Increased ultimate tensile strength of the repair at 3 weeks
. Decreased formation of restrictive peritendinous adhesions
. Accelerated healing exclusively through secondary intention
. Elimination of the need for a protective orthosis

Correct Answer & Explanation

. Decreased formation of restrictive peritendinous adhesions

Explanation

Early active motion protocols after flexor tendon repair generate differential glide between the FDP and FDS tendons. The primary advantage of this differential excursion is the decreased formation of restrictive peritendinous adhesions, resulting in improved final functional range of motion. It does not decrease the risk of acute rupture (which is actually higher if the repair isn't robust enough) and still requires a protective orthosis.

Question 3104

Topic: Knee Sports

A 45-year-old female undergoes an MRI of the knee which reveals a complete radial tear at the posterior root of the medial meniscus, associated with 4 mm of meniscal extrusion. Biomechanically, this root injury alters knee joint loading in a manner most equivalent to which of the following?

. A stable longitudinal tear of the posterior horn
. A total meniscectomy
. A reducible bucket-handle meniscal tear
. A parameniscal cyst
. Normal age-related meniscal degeneration

Correct Answer & Explanation

. A total meniscectomy

Explanation

The meniscal roots anchor the meniscus to the tibial plateau, allowing it to convert axial compressive loads into circumferential 'hoop stresses'. A root tear completely disrupts these hoop stresses, leading to meniscal extrusion. Biomechanical studies have proven that a posterior root tear effectively renders the meniscus non-functional, altering contact areas and peak contact pressures to a degree equivalent to a total meniscectomy.

Question 3105

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player presents with recurrent anterior shoulder instability. A 3D CT scan of the shoulder demonstrates 28% anterior glenoid bone loss and an engaging Hill-Sachs lesion. Which of the following surgical interventions is most appropriate to prevent recurrent dislocation?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with remplissage
. Latarjet procedure (coracoid transfer)
. Open capsular shift
. Humeral head osteochondral allograft

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

In the setting of critical anterior glenoid bone loss (>20-25%) and an engaging Hill-Sachs lesion in a high-demand contact athlete, an arthroscopic soft-tissue Bankart repair alone has an unacceptably high failure rate. A bony augmentation procedure, such as the Latarjet procedure (transfer of the coracoid process with the attached conjoint tendon to the anterior glenoid), is the gold standard to restore stability.

Question 3106

Topic: Knee Sports

A 25-year-old athlete undergoes a physical examination after a knee injury. The 'dial test' reveals 15 degrees of increased external rotation of the tibia compared to the contralateral side when the knee is flexed to 30 degrees. However, when the knee is flexed to 90 degrees, the external rotation is symmetric bilaterally. This examination pattern indicates an isolated injury to which of the following structures?

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

Correct Answer & Explanation

. Posterolateral corner

Explanation

The dial test assesses external rotation of the tibia. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of knee flexion, but symmetric rotation at 90 degrees of flexion, indicates an isolated posterolateral corner (PLC) injury. If external rotation is increased at both 30 degrees and 90 degrees, it suggests a combined injury to both the PLC and the posterior cruciate ligament (PCL).

Question 3107

Topic: Knee Sports
A 24-year-old football player sustains a knee dislocation (Schenck KD-III) after a high-velocity tackle. On examination, the foot is cool with diminished dorsalis pedis and posterior tibial pulses. His Ankle-Brachial Index (ABI) is 0.7. What is the most appropriate next step in management after emergent closed reduction of the knee?
. Immediate MRI of the knee to evaluate ligamentous injury
. Observation with serial neurovascular checks for 24 hours
. Emergent CT angiography (CTA) of the lower extremity or surgical exploration
. Application of a hinged knee brace and delayed ACL/PCL reconstruction
. Immediate application of an external fixator and discharge

Correct Answer & Explanation

. Emergent CT angiography (CTA) of the lower extremity or surgical exploration

Explanation

An ABI < 0.9 or asymmetric pulses following a knee dislocation is a hard indication for advanced vascular imaging, most commonly CT angiography (CTA), or immediate surgical exploration to rule out a popliteal artery injury. A normal ABI (>0.9) can be observed with serial checks, but an abnormal ABI requires immediate further investigation or intervention.

Question 3108

Topic: 5. Sports Medicine
A 25-year-old athlete sustains a multiligamentous knee injury (KD-III) following a high-energy tackling injury. The knee is reduced in the emergency department. The patient has palpable dorsalis pedis and posterior tibial pulses. The ankle-brachial index (ABI) is measured at 0.85. What is the most appropriate next step in management?
. Discharge with instructions for serial neurovascular checks
. Admit for serial neurovascular examinations every 2 hours
. Perform a CT angiogram of the affected lower extremity
. Proceed to immediate surgical exploration of the popliteal artery
. Perform a diagnostic arthroscopy

Correct Answer & Explanation

. Perform a CT angiogram of the affected lower extremity

Explanation

In the setting of a knee dislocation, an Ankle-Brachial Index (ABI) of less than 0.9 is a strong indicator of a potential vascular injury (popliteal artery) even if pulses are palpable. An ABI < 0.9 mandates further advanced imaging, most commonly a CT angiogram, to rule out an intimal tear or other vascular compromise.

Question 3109

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes surgical stabilization for recurrent anterior shoulder instability. Intraoperatively, he is noted to have an off-track, engaging Hill-Sachs lesion with subcritical glenoid bone loss. The surgeon decides to perform an arthroscopic Bankart repair with a remplissage. Which structure(s) is/are tenodesed into the humeral head defect during a remplissage?

. Supraspinatus tendon
. Long head of the biceps tendon
. Subscapularis tendon and anterior capsule
. Infraspinatus tendon and posterior capsule
. Teres minor tendon

Correct Answer & Explanation

. Infraspinatus tendon and posterior capsule

Explanation

The remplissage (French for 'filling') procedure is used to treat engaging or 'off-track' Hill-Sachs lesions. It involves tenodesis of the infraspinatus tendon and the underlying posterior capsule into the bony defect on the posterolateral humeral head. This prevents the defect from engaging the anterior glenoid rim during abduction and external rotation.

Question 3110

Topic: 5. Sports Medicine

When comparing a 10-mm Bone-Patellar Tendon-Bone (BTB) autograft to a quadrupled hamstring autograft for Anterior Cruciate Ligament (ACL) reconstruction, which of the following statements regarding initial graft biomechanics is true?

. The quadrupled hamstring graft has higher initial ultimate tensile strength and lower stiffness than the native ACL.
. The BTB graft has higher ultimate tensile strength than the quadrupled hamstring graft.
. The quadrupled hamstring graft has higher initial ultimate tensile strength and higher stiffness than the BTB graft.
. Both grafts have an ultimate tensile strength inferior to the native ACL at the time of implantation.
. The BTB graft exhibits lower stiffness than the native ACL.

Correct Answer & Explanation

. The quadrupled hamstring graft has higher initial ultimate tensile strength and higher stiffness than the BTB graft.

Explanation

A quadrupled hamstring autograft has an initial ultimate tensile strength of approximately 4000-4100 N and higher stiffness (~800 N/mm) compared to a 10-mm BTB graft, which has a tensile strength of roughly 2900 N and stiffness of ~620 N/mm. Both grafts are initially stronger and stiffer than the native ACL (strength ~2100 N, stiffness ~242 N/mm).

Question 3111

Topic: 5. Sports Medicine

Which of the following bone graft substitutes possesses osteoinductive properties but lacks both osteogenic and osteoconductive properties when used alone in its standard powder form?

. Demineralized Bone Matrix (DBM)
. Cancellous allograft
. Calcium phosphate cement
. Vascularized fibular autograft
. Cancellous autograft

Correct Answer & Explanation

. Demineralized Bone Matrix (DBM)

Explanation

Demineralized Bone Matrix (DBM) is acid-extracted allograft bone that retains bone morphogenetic proteins (BMPs), giving it osteoinductive properties. However, the demineralization process removes its structural integrity (lacking osteoconduction), and it contains no live cells (lacking osteogenesis).

Question 3112

Topic: 5. Sports Medicine

A 19-year-old female collegiate swimmer presents with bilateral shoulder pain and a sensation of 'slipping' during her freestyle stroke. Examination reveals a positive sulcus sign bilaterally, positive apprehension and relocation tests, and generalized ligamentous laxity. What is the primary focus of the initial non-operative rehabilitation program?

. Stretching of the posterior capsule to improve internal rotation
. Strengthening of the pectoralis major and latissimus dorsi
. Strengthening of the rotator cuff and periscapular stabilizers
. Plyometric throwing exercises to improve proprioception
. Immobilization in internal rotation for 3 weeks followed by progressive range of motion

Correct Answer & Explanation

. Strengthening of the rotator cuff and periscapular stabilizers

Explanation

The patient has Multidirectional Instability (MDI) of the shoulder, often seen in overhead athletes with generalized laxity. The cornerstone of initial management is a prolonged physical therapy program focusing on strengthening the dynamic stabilizers of the shoulder, specifically the rotator cuff and periscapular muscles, to compensate for the static capsular laxity.

Question 3113

Topic: Shoulder & Hip Sports

A 48-year-old manual laborer presents with anterior shoulder pain and popping. MRI arthrogram demonstrates an isolated Type II SLAP lesion. He has no other rotator cuff pathology. After 4 months of failed physical therapy, surgical intervention is planned. What is the most appropriate surgical procedure for this patient?

. Arthroscopic SLAP repair with suture anchors
. Arthroscopic debridement of the superior labrum only
. Biceps tenodesis
. Biceps tenotomy without tenodesis
. Open anterior capsulolabral reconstruction

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In patients over the age of 40 (especially those with physically demanding jobs), primary biceps tenodesis has been shown to yield higher satisfaction rates, lower complication rates, and a more reliable return to work compared to arthroscopic SLAP repair, which carries a higher risk of postoperative stiffness and persistent pain in this demographic.

Question 3114

Topic: Knee Sports

During the physical examination of a patient with a knee injury, the dial test reveals a 15-degree increase in external rotation of the tibia at 30 degrees of knee flexion compared to the uninjured side. However, at 90 degrees of knee flexion, the external rotation is symmetric bilaterally. What injury pattern does this indicate?

. Isolated Posterior Cruciate Ligament (PCL) injury
. Isolated Posterolateral Corner (PLC) injury
. Combined PCL and PLC injury
. Combined ACL and MCL injury
. Isolated Lateral Collateral Ligament (LCL) injury

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). Increased external rotation (>10 degrees compared to the normal side) solely at 30 degrees indicates an isolated PLC injury. If increased external rotation is present at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 3115

Topic: Knee Sports

Biomechanical studies have demonstrated that an un-repaired complete radial tear of the medial meniscus posterior root alters the contact mechanics and joint kinematics of the knee most similarly to which of the following conditions?

. Anterior cruciate ligament tear
. Total medial meniscectomy
. Isolated medial collateral ligament tear
. Partial medial meniscectomy
. Normal intact knee

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus completely disrupts the hoop stresses that allow the meniscus to convert axial loads into circumferential tension. Biomechanically, this failure of hoop stress makes the knee function almost identically to a knee that has undergone a total medial meniscectomy, leading to rapid articular cartilage wear and osteoarthritis.

Question 3116

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. Examination reveals a significant loss of internal rotation (GIRD) and a positive relocation test. MRI shows undersurface fraying of the posterior supraspinatus and anterior superior labrum. What is the most likely diagnosis?

. Subcoracoid impingement
. Primary external impingement
. Internal impingement
. Quadrilateral space syndrome
. Parsonage-Turner syndrome

Correct Answer & Explanation

. Internal impingement

Explanation

Internal impingement (posterosuperior impingement) occurs in overhead athletes during maximal abduction and external rotation (the late cocking phase). The undersurface of the posterior supraspinatus/anterior infraspinatus impinges against the posterosuperior glenoid labrum.

Question 3117

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon seeks the anatomic femoral attachment site (Schöttle's point) using fluoroscopy. Anatomically, where does the MPFL originate on the medial femur?
. Anterior to the medial epicondyle and proximal to the adductor tubercle
. Posterior to the medial epicondyle and distal to the adductor tubercle
. Between the medial epicondyle and adductor tubercle
. Anterior to the adductor tubercle and distal to the medial epicondyle
. Directly on the peak of the adductor tubercle

Correct Answer & Explanation

. Between the medial epicondyle and adductor tubercle

Explanation

The anatomic femoral origin of the MPFL is located in a saddle-shaped depression between the adductor tubercle (proximally) and the medial epicondyle (distally and anteriorly). On a perfect lateral radiograph, Schöttle's point is located 1 mm anterior to the posterior cortex extension 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 3118

Topic: 5. Sports Medicine
A 24-year-old elite overhead throwing athlete presents with deep shoulder pain and mechanical catching sensations. MR arthrography suggests a SLAP (Superior Labrum Anterior Posterior) tear. Diagnostic arthroscopy reveals a Type II SLAP lesion. Which of the following accurately describes a Type II SLAP tear according to the Snyder classification?
. Degenerative fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and the 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 a detached biceps anchor
. An anteroinferior Bankart lesion extending into the superior labrum and biceps anchor

Correct Answer & Explanation

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

Explanation

Snyder classification of SLAP tears: Type I is degenerative fraying of the superior labrum with an intact biceps anchor. Type II (the most common type requiring repair in athletes) is pathologic detachment of the superior labrum and biceps anchor from the superior glenoid. Type III is a bucket-handle tear of the labrum with an intact biceps anchor. Type IV is a bucket-handle tear extending into the biceps tendon.

Question 3119

Topic: 5. Sports Medicine

A 22-year-old collegiate baseball pitcher presents with deep shoulder pain and a 'dead arm' sensation. MR arthrogram demonstrates a Type II SLAP lesion. Following 6 months of failed physical therapy, which of the following is the most generally accepted surgical management for this patient profile?

. Biceps tenotomy
. Biceps tenodesis
. Arthroscopic SLAP repair
. Debridement of the superior labrum only
. Coracoid transfer (Latarjet procedure)

Correct Answer & Explanation

. Arthroscopic SLAP repair

Explanation

In young overhead throwing athletes (e.g., <25 years old), arthroscopic SLAP repair remains the preferred initial surgical treatment for a symptomatic Type II SLAP tear that fails conservative care, aiming to restore the anatomic mechanics critical for throwing. Biceps tenodesis is often preferred in older patients or non-throwers.

Question 3120

Topic: 5. Sports Medicine

A 22-year-old soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. To avoid a postoperative 'cyclops lesion' and loss of terminal knee extension, which technical step is most critical during tunnel preparation?

. Placement of the femoral tunnel at the 12 o'clock position
. Placement of the tibial tunnel entirely anterior to the native footprint
. Positioning the anterior margin of the tibial tunnel posterior to Blumensaat's line
. Tensioning the graft in 90 degrees of flexion
. Using an interference screw larger than the bone block

Correct Answer & Explanation

. Positioning the anterior margin of the tibial tunnel posterior to Blumensaat's line

Explanation

A cyclops lesion (localized anterior arthrofibrosis) and graft impingement in extension occur when the tibial tunnel is placed too far anteriorly. The anterior margin of the tibial tunnel must be placed posterior to the intercondylar roof (Blumensaat's line) with the knee in full extension.

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