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5. Sports Medicine MCQs

Practice Set 158 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 3141

Topic: 5. Sports Medicine
A quarterback sustains a rough tackle after which he appears confused, has a dazed look on his face, and an unsteady gait on standing. He denies loss of consciousness. Reexamination within 10 minutes is normal, the patient is lucid, and he wants to return to play. The coach and the player should be advised that he may:
. return to play immediately.
. return to play in 1 week, if asymptomatic.
. return to play in 1 month, if asymptomatic.
. return only after a screening CT scan.
. not return to play for the season.

Correct Answer & Explanation

. return to play immediately.

Explanation

The patient has a grade I (mild) concussion that can result in confusion and disorientation, without loss of consciousness. This concussion syndrome is completely reversible, with no long-term sequelae. Athletes who sustain a grade I concussion may return to play after 15 minutes if there are no lingering symptoms, such as headache or vertigo. A grade II concussion is characterized by loss of consciousness of less than 5 minutes. With this type of injury, the athlete can return to play in 1 week, if asymptomatic. If a grade III (severe) concussion is sustained, the athlete should avoid contact for a minimum of 1 month before considering a return to competition. A grade III concussion is characterized by a loss of consciousness of greater than 5 minutes or posttraumatic amnesia of greater than 24 hours. A CT scan is not indicated in a grade I injury. An athlete who sustains three grade I or grade II concussions, or two grade III concussions may not return to play for the season.

Question 3142

Topic: Shoulder & Hip Sports

Figure 55 shows the radiograph of a 30-year-old man who sustained a closed comminuted fracture of the right clavicle. Examination reveals decreased sensation in the radial nerve distribution. Weakness is noted with shoulder abduction, internal rotation, and wrist extension. A displaced bone fragment is most likely pressing on what portion of the brachial plexus?

General Orthopedics Board Review 2026: High-Yield MCQs (Set 12) - Figure 81

. C5 and C6 spinal roots
. Superior trunk
. Anterior division of the inferior trunk
. Posterior cord
. Lateral and posterior cords

Correct Answer & Explanation

. Posterior cord

Explanation

Clavicular fractures are occasionally complicated by injury to the brachial plexus. A displaced bone fragment pressing on the posterior cord proximal to the upper subscapularis nerve would account for these findings. Jobe CM, Coen MJ: Gross anatomy of the shoulder, in Rockwood CA, Matsen FA, Wirth MA, et al (eds): The Shoulder. Philadelphia, PA, WB Saunders, 2004, vol 2, pp 1078-1079.

Question 3143

Topic: Shoulder & Hip Sports

A 24-year-old patient undergoes arthroscopic stabilization for recurrent anterior shoulder instability. Preoperative imaging reveals a large Hill-Sachs lesion that engages the anterior glenoid rim with the arm in abduction and external rotation. Glenoid bone loss is estimated at 10%. In addition to an arthroscopic Bankart repair, which of the following procedures is most appropriate to address the humeral head defect?

. Coracoid transfer (Latarjet procedure)
. Arthroscopic tenodesis of the infraspinatus and posterior capsule into the defect (Remplissage)
. Humeral head osteochondral allograft
. Iliac crest bone grafting of the glenoid
. Subscapularis advancement

Correct Answer & Explanation

. Arthroscopic tenodesis of the infraspinatus and posterior capsule into the defect (Remplissage)

Explanation

For an engaging Hill-Sachs lesion in the setting of subcritical glenoid bone loss (<20%), an arthroscopic Remplissage (tenodesis of the infraspinatus and posterior capsule into the humeral head defect) combined with an anterior Bankart repair is indicated. This prevents the defect from engaging the anterior glenoid rim. If significant glenoid bone loss (>20-25%) was present, a bony augmentation procedure like a Latarjet would be required.

Question 3144

Topic: Shoulder & Hip Sports

A 54-year-old male sustains a traumatic anterior shoulder dislocation. Post-reduction radiographs demonstrate a concentric reduction of the glenohumeral joint, but reveal an associated greater tuberosity fracture with 8 mm of superior displacement. What is the most appropriate management plan?

. Sling immobilization for 4 weeks followed by physical therapy
. Immediate open reduction and internal fixation of the greater tuberosity
. Closed reduction and percutaneous pinning of the greater tuberosity
. Arthroscopic Bankart repair
. Total shoulder arthroplasty

Correct Answer & Explanation

. Immediate open reduction and internal fixation of the greater tuberosity

Explanation

The greater tuberosity serves as the attachment site for the supraspinatus, infraspinatus, and teres minor. Superior displacement of >5 mm in active individuals (or >10 mm in older, less active patients) is an absolute indication for surgical fixation. Failure to reduce and fix the tuberosity leads to subacromial impingement and severe rotator cuff dysfunction.

Question 3145

Topic: Knee Sports

According to the Thoracolumbar Injury Classification and Severity (TLICS) score, which of the following factors is given the highest point value when determining the need for surgical stabilization?

. Compression fracture morphology
. Intact posterior ligamentous complex (PLC)
. Suspected PLC injury
. Complete spinal cord injury
. Definite posterior ligamentous complex (PLC) disruption

Correct Answer & Explanation

. Definite posterior ligamentous complex (PLC) disruption

Explanation

In the TLICS system, an unequivocally disrupted posterior ligamentous complex (PLC) is assigned 3 points. Incomplete spinal cord injury is also assigned 3 points. Surgical management is generally indicated for a total score of 5 or more.

Question 3146

Topic: 5. Sports Medicine

A 21-year-old collegiate basketball player sustains a zone 2 (Jones) fracture of the proximal fifth metatarsal. He wishes to return to play as safely and quickly as possible. What is the recommended treatment?

. Non-weight-bearing cast for 6-8 weeks
. Immediate weight-bearing in a hard-soled shoe
. Percutaneous intramedullary screw fixation
. Open bone grafting without fixation
. Excision of the proximal pole

Correct Answer & Explanation

. Percutaneous intramedullary screw fixation

Explanation

Zone 2 (Jones) fractures in elite or competitive athletes are best treated with intramedullary screw fixation. This provides a faster return to play and a lower nonunion rate compared to conservative management.

Question 3147

Topic: 5. Sports Medicine

A 25-year-old female presents with persistent ankle pain following a severe sprain 8 months ago. MRI demonstrates a 1.0 cm by 1.0 cm osteochondral lesion of the medial talar dome with intact overlying cartilage but deep edema. After failing conservative care, what is the best initial surgical intervention?

. Arthroscopic bone marrow stimulation (microfracture)
. Osteochondral autograft transfer system (OATS)
. Fresh osteochondral allograft transplantation
. Total ankle arthroplasty
. Ankle arthrodesis

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

For primary, symptomatic osteochondral lesions of the talus smaller than 1.5 cm squared, arthroscopic bone marrow stimulation (microfracture) is the gold standard initial surgical treatment, providing excellent results with low morbidity.

Question 3148

Topic: 5. Sports Medicine

A 42-year-old recreational athlete sustains an acute closed Achilles tendon rupture. He is evaluating operative versus nonoperative management. Based on recent Level I evidence incorporating early functional rehabilitation, which of the following statements is true?

. Operative treatment has a significantly lower re-rupture rate.
. Nonoperative treatment has a higher rate of deep vein thrombosis.
. There is no significant difference in re-rupture rates between the two groups.
. Operative treatment leads to a faster return to sports by 3 months.
. Nonoperative treatment results in significantly decreased plantarflexion strength.

Correct Answer & Explanation

. There is no significant difference in re-rupture rates between the two groups.

Explanation

Recent studies utilizing early functional weight-bearing rehabilitation protocols show no significant difference in re-rupture rates between operative and nonoperative management. However, operative management carries higher risks of soft tissue and wound complications.

Question 3149

Topic: 5. Sports Medicine

A 28-year-old male complains of deep ankle pain. MRI reveals a 1.8 cm^2 osteochondral lesion of the posteromedial talar dome. Nonoperative management has failed. What is the most appropriate surgical intervention?

. Arthroscopic microfracture
. Ankle arthrodesis
. Osteochondral autograft transfer system (OATS)
. Subchondral retrograde drilling without grafting
. Excision of the fragment and open debridement alone

Correct Answer & Explanation

. Osteochondral autograft transfer system (OATS)

Explanation

For osteochondral lesions of the talus larger than 1.5 cm^2, microfracture has a high failure rate. Osteochondral autograft transfer (OATS) or autologous chondrocyte implantation (ACI) is indicated for lesions of this size.

Question 3150

Topic: 5. Sports Medicine

A 25-year-old male presents with persistent deep ankle pain following an inversion sprain 8 months ago. MRI reveals a 1.0 cm x 1.0 cm osteochondral lesion on the anterolateral talar dome. After failing conservative management, what is the preferred initial surgical intervention?

. Osteochondral autograft transfer system (OATS)
. Ankle arthroscopy with debridement and bone marrow stimulation (microfracture)
. Fresh osteochondral allograft transplantation
. Autologous chondrocyte implantation (ACI)
. Tibiotalar arthrodesis

Correct Answer & Explanation

. Ankle arthroscopy with debridement and bone marrow stimulation (microfracture)

Explanation

For symptomatic osteochondral defects of the talus that are less than 1.5 cm in diameter (or < 150 mm squared), arthroscopic debridement and microfracture is the gold standard primary surgical treatment.

Question 3151

Topic: 5. Sports Medicine

A 35-year-old recreational athlete sustains an acute Achilles tendon rupture. He is considering non-operative management with a functional rehabilitation protocol versus surgical repair. According to recent high-level evidence, what is the most significant difference in outcomes between these two treatments?

. Significantly higher re-rupture rate with non-operative management
. Higher rate of deep venous thrombosis with surgical management
. Increased rate of sural nerve injury with non-operative management
. Higher rate of soft-tissue complications with surgical management
. Greater loss of plantarflexion strength with surgical management

Correct Answer & Explanation

. Higher rate of soft-tissue complications with surgical management

Explanation

Modern studies have demonstrated that early functional rehabilitation for non-operative management yields re-rupture rates equivalent to surgical repair. However, surgical repair remains associated with a significantly higher rate of soft-tissue complications, including infection and wound breakdown.

Question 3152

Topic: 5. Sports Medicine

A 25-year-old athlete sustains a severe twisting injury to the ankle. Radiographs show widening of the medial clear space and a high fibular fracture. Which test performed intraoperatively is most reliable for evaluating syndesmotic instability after fibular fixation?

. Cotton test
. External rotation stress test under fluoroscopy
. Squeeze test
. Anterior drawer test
. Dorsiflexion stress test

Correct Answer & Explanation

. External rotation stress test under fluoroscopy

Explanation

The external rotation stress test under fluoroscopy is the most sensitive and reliable intraoperative method to detect syndesmotic instability. The Cotton test (lateral pull on the fibula) is also used but is less sensitive.

Question 3153

Topic: 5. Sports Medicine

A 28-year-old professional soccer player sustains an isolated syndesmotic injury without fracture. Despite 6 weeks of conservative management, he continues to have pain and instability. Stress radiographs show a widened medial clear space. What is the most appropriate surgical management?

. Open reduction and rigid fixation with two quad-cortical syndesmotic screws.
. Suture button fixation of the syndesmosis.
. Deltoid ligament repair alone.
. Anterior inferior tibiofibular ligament (AITFL) reconstruction with allograft.
. Arthrodesis of the distal tibiofibular joint.

Correct Answer & Explanation

. Suture button fixation of the syndesmosis.

Explanation

Suture button fixation provides dynamic stabilization of the syndesmosis, allowing physiologic motion while maintaining reduction. This is particularly beneficial in athletes for a faster return to play and avoiding the need for hardware removal.

Question 3154

Topic: 5. Sports Medicine
A 24-year-old man presents with chronic anterolateral ankle pain. MRI demonstrates a 12 mm x 10 mm osteochondral lesion of the anterolateral talar dome with intact overlying cartilage. What is the most appropriate initial surgical management?
. Osteochondral autograft transfer (OATS)
. Arthroscopic bone marrow stimulation (microfracture)
. Fresh osteochondral allograft transplantation
. Primary ankle arthrodesis
. Open retrograde drilling with bone grafting

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

For symptomatic primary osteochondral lesions of the talus smaller than 1.5 cm² (150 mm²), arthroscopic bone marrow stimulation (microfracture) is the initial surgical treatment of choice. Larger or cystic lesions often require OATS or allografting.

Question 3155

Topic: 5. Sports Medicine

A 45-year-old weekend warrior sustains an acute Achilles tendon rupture. He elects for non-operative management with functional bracing. Compared to operative repair, which of the following is true regarding his outcomes?

. Higher risk of deep infection
. Higher risk of sural nerve injury
. Lower rate of re-rupture
. Equivalent functional outcomes at 1 year
. Faster return to full contact sports

Correct Answer & Explanation

. Equivalent functional outcomes at 1 year

Explanation

Recent literature shows that with functional rehabilitation protocols, non-operative management of acute Achilles tendon ruptures yields equivalent functional outcomes to surgery. It has a comparable or only slightly higher re-rupture rate, while avoiding surgical complications.

Question 3156

Topic: 5. Sports Medicine

A 26-year-old professional football player sustains a hyperextension injury to his first MTP joint. MRI reveals a complete tear of the plantar plate with proximal retraction of the sesamoids. He is unable to push off. What is the most appropriate treatment?

. Stiff-soled shoe and immediate return to play
. Corticosteroid injection into the MTP joint
. Surgical repair of the plantar plate
. Cheilectomy
. Sesamoidectomy

Correct Answer & Explanation

. Surgical repair of the plantar plate

Explanation

This is a Grade 3 turf toe injury with a complete tear of the plantar plate/capsule complex and sesamoid retraction. In high-level athletes, this necessitates surgical repair to restore push-off strength and prevent chronic instability.

Question 3157

Topic: 5. Sports Medicine

A 21-year-old Division I basketball player sustains an acute foot injury during a game. Radiographs demonstrate a transverse fracture of the proximal fifth metatarsal at the metaphyseal-diaphyseal junction, extending into the fourth-fifth intermetatarsal articulation. What is the most appropriate management to ensure the fastest and most reliable return to play?

. Non-weight-bearing cast immobilization for 6 weeks
. Weight-bearing as tolerated in a stiff-soled boot
. Closed reduction and percutaneous K-wire fixation
. Intramedullary screw fixation
. Primary excision of the proximal fragment and peroneus brevis advancement

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

This is a Zone 2 proximal fifth metatarsal fracture (Jones fracture). In an elite athlete, intramedullary screw fixation is recommended to reduce the risk of nonunion and expedite the return to competitive sports.

Question 3158

Topic: Shoulder & Hip Sports

In evaluating a patient with recurrent anterior shoulder instability, what degree of critical glenoid bone loss is generally considered the threshold to proceed with a Latarjet procedure rather than an arthroscopic Bankart repair?

. 5-10%
. 10-15%
. 20-25%
. 35-40%
. Any bipolar bone loss

Correct Answer & Explanation

. 20-25%

Explanation

Critical glenoid bone loss is typically defined as 20-25% of the inferior glenoid width. Defects of this size or greater significantly increase the failure rate of isolated soft tissue (Bankart) stabilization, necessitating a bony augmentation procedure like the Latarjet.

Question 3159

Topic: Shoulder & Hip Sports

A 40-year-old man presents with a locked posterior shoulder dislocation after a seizure. CT imaging reveals an anteromedial humeral head defect (reverse Hill-Sachs lesion) involving 35% of the articular surface. What is the most appropriate surgical management?

. Closed reduction and sling immobilization in internal rotation
. Arthroscopic posterior Bankart repair
. Transfer of the lesser tuberosity and subscapularis into the defect
. Latarjet procedure
. Total shoulder arthroplasty

Correct Answer & Explanation

. Transfer of the lesser tuberosity and subscapularis into the defect

Explanation

For reverse Hill-Sachs lesions involving 20-40% of the articular surface, a modified McLaughlin procedure (transfer of the lesser tuberosity with the attached subscapularis tendon into the defect) provides excellent stability. Defects >40-50% generally require arthroplasty.

Question 3160

Topic: Shoulder & Hip Sports

A 22-year-old male presents with recurrent anterior shoulder dislocations. A 3D CT scan reveals 10% anterior glenoid bone loss and a large, engaging Hill-Sachs lesion that is classified as 'off-track'. Which of the following procedures effectively converts this lesion to an 'on-track' lesion without requiring bony augmentation of the glenoid?

. Arthroscopic Bankart repair alone
. Arthroscopic Remplissage combined with Bankart repair
. Open Latarjet procedure
. Capsular shift and thermal shrinkage
. Putti-Platt procedure

Correct Answer & Explanation

. Arthroscopic Remplissage combined with Bankart repair

Explanation

An off-track Hill-Sachs lesion will engage the anterior glenoid rim, causing failure of isolated Bankart repair. Arthroscopic Remplissage (tenodesis of the infraspinatus into the defect) fills the defect, effectively converting it to an on-track lesion.

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