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5. Sports Medicine MCQs

Practice Set 167 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 3321

Topic: Shoulder & Hip Sports

A patient with recurrent anterior shoulder instability is found to have an "off-track" Hill-Sachs lesion and 10% anterior glenoid bone loss on advanced imaging. Which of the following procedures is most appropriate to prevent recurrent instability?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with Remplissage
. Open Latarjet procedure
. Humeral head osteochondral allograft
. Latissimus dorsi tendon transfer

Correct Answer & Explanation

. Arthroscopic Bankart repair with Remplissage

Explanation

An "off-track" Hill-Sachs lesion with subcritical (<20%) glenoid bone loss is best treated with an arthroscopic Bankart repair combined with a Remplissage procedure (infraspinatus tenodesis into the defect) to prevent the lesion from engaging the anterior glenoid.

Question 3322

Topic: Knee Sports

A 19-year-old female basketball player feels a "pop" in her knee while pivoting. Plain radiographs demonstrate an elliptic bone fragment adjacent to the lateral tibial plateau. This finding is highly associated with an injury to which of the following structures?

. Posterior cruciate ligament
. Medial patellofemoral ligament
. Anterior cruciate ligament
. Iliotibial band
. Posterolateral corner

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion of the anterolateral complex (specifically the anterolateral ligament/capsule) from the lateral tibia. It is pathognomonic for an anterior cruciate ligament (ACL) tear.

Question 3323

Topic: Shoulder & Hip Sports

A 45-year-old male presents with severe shoulder pain and inability to externally rotate his arm after experiencing a generalized tonic-clonic seizure. An axillary radiograph reveals a posterior glenohumeral dislocation with an impaction fracture on the anteromedial aspect of the humeral head involving 30% of the articular surface. Which of the following is the most appropriate surgical treatment?

. Closed reduction and spica casting
. Arthroscopic Bankart repair
. McLaughlin procedure (transfer of the lesser tuberosity into the defect)
. Latarjet procedure
. Total shoulder arthroplasty

Correct Answer & Explanation

. McLaughlin procedure (transfer of the lesser tuberosity into the defect)

Explanation

Posterior shoulder dislocations are frequently associated with a reverse Hill-Sachs lesion (anteromedial impaction fracture). For defects between 20% and 40%, a McLaughlin procedure (transfer of the subscapularis or lesser tuberosity into the defect) is indicated.

Question 3324

Topic: Knee Sports

Which of the following structures is considered the primary static stabilizer to varus stress of the knee at 30 degrees of flexion?

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

Correct Answer & Explanation

. Fibular collateral ligament (LCL)

Explanation

The fibular (lateral) collateral ligament is the primary static stabilizer to varus stress in the knee, best isolated and tested clinically at 30 degrees of knee flexion.

Question 3325

Topic: 5. Sports Medicine

During arthroscopy for recurrent anterior shoulder instability, the surgeon identifies an Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesion. How does this lesion anatomically differ from a classic Bankart lesion?

. The labrum remains attached to the glenoid but the capsule is torn.
. The labrum is avulsed with the anterior band of the inferior glenohumeral ligament and displaced medially along the scapular neck.
. It involves a bony avulsion of the anterior inferior glenoid rim.
. It represents a tear of the superior labrum extending anteriorly.
. The inferior glenohumeral ligament is avulsed from its humeral insertion.

Correct Answer & Explanation

. The labrum is avulsed with the anterior band of the inferior glenohumeral ligament and displaced medially along the scapular neck.

Explanation

An ALPSA lesion involves an avulsion of the anterior labrum where the intact scapular periosteum allows the labroligamentous complex to strip and displace medially and inferiorly along the glenoid neck. Unlike a Bankart lesion, the periosteal sleeve remains intact.

Question 3326

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, the femoral tunnel is inadvertently placed anterior to the anatomic footprint. What is the expected postoperative complication resulting from this technical error?

. Loss of terminal extension
. Loss of flexion
. Anterior knee pain
. Posterior sag sign
. Patella baja

Correct Answer & Explanation

. Loss of flexion

Explanation

Placing the ACL femoral tunnel too anteriorly results in a graft that is excessively tight in flexion. This typically leads to a loss of knee flexion and increased mechanical stress on the graft, predisposing it to failure.

Question 3327

Topic: Knee Sports

A 24-year-old football player sustains a blow to the anteromedial knee. He demonstrates a positive dial test at 30 degrees of flexion, which normalizes at 90 degrees of flexion. Which of the following structures is most likely injured?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Medial collateral ligament
. Posterolateral corner structures
. Medial patellofemoral ligament

Correct Answer & Explanation

. Posterolateral corner structures

Explanation

A positive dial test (increased external rotation of the tibia) at 30 degrees that normalizes at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If the dial test is positive at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.

Question 3328

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he demonstrates weakness in elbow flexion and decreased sensation over the lateral forearm. Which nerve was most likely injured during the procedure?

. Axillary nerve
. Radial nerve
. Musculocutaneous nerve
. Suprascapular nerve
. Median nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is at highest risk during the Latarjet procedure as it enters the coracobrachialis muscle 3 to 8 cm distal to the coracoid tip. Retraction of the conjoint tendon must be carefully managed to avoid neuropraxia to this nerve.

Question 3329

Topic: 5. Sports Medicine
A 19-year-old collegiate soccer player sustains an isolated grade III medial collateral ligament (MCL) tear. What is the most appropriate initial management?
. Immediate primary surgical repair
. Surgical reconstruction using hamstring autograft
. Hinged knee brace and early functional rehabilitation
. Cast immobilization in 30 degrees of flexion for 6 weeks
. Arthroscopic debridement and thermal shrinkage

Correct Answer & Explanation

. Hinged knee brace and early functional rehabilitation

Explanation

Isolated Grade III MCL tears typically heal well with nonoperative management, including the use of a hinged knee brace to protect against valgus stress while allowing early range of motion. Surgical treatment is generally reserved for chronic instability or multiligamentous knee injuries.

Question 3330

Topic: Knee Sports

The posterior cruciate ligament (PCL) consists of two main bundles. Which of the following statements correctly describes the biomechanics of the anterolateral (AL) bundle?

. It is tight in extension and lax in flexion
. It is tight in flexion and lax in extension
. It provides primary restraint to valgus stress
. It provides primary restraint to external rotation at 30 degrees
. It is primarily vascularized by the inferior geniculate artery

Correct Answer & Explanation

. It is tight in flexion and lax in extension

Explanation

The PCL is composed of the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle is tight in flexion and lax in extension, whereas the PM bundle is tight in extension and lax in flexion.

Question 3331

Topic: Shoulder & Hip Sports

Which of the following is the most significant risk factor for recurrent shoulder dislocation following a primary traumatic anterior shoulder dislocation?

. Male gender
. Mechanism of injury
. Presence of a Hill-Sachs lesion
. Age of the patient at the time of initial injury
. Dominant vs. non-dominant extremity

Correct Answer & Explanation

. Age of the patient at the time of initial injury

Explanation

The patient's age at the time of the initial dislocation is the most significant risk factor for recurrence. Patients under the age of 20 have recurrence rates approaching 80 to 90% when treated with conservative management.

Question 3332

Topic: Knee Sports

What is the primary blood supply to the anterior cruciate ligament (ACL)?

. Superior medial genicular artery
. Inferior medial genicular artery
. Middle genicular artery
. Descending genicular artery
. Recurrent anterior tibial artery

Correct Answer & Explanation

. Middle genicular artery

Explanation

The middle genicular artery, a branch of the popliteal artery, provides the primary blood supply to the ACL. It pierces the posterior capsule to supply both cruciate ligaments and the surrounding synovial tissue.

Question 3333

Topic: 5. Sports Medicine

A 42-year-old manual laborer presents with anterior shoulder pain and a positive O'Brien's test. MRI arthrogram reveals a Type II SLAP tear. During arthroscopy, there is significant fraying of the biceps tendon with detachment of the superior labrum. What is the most appropriate surgical treatment?

. SLAP repair with suture anchors
. Biceps tenodesis
. Biceps tenotomy
. Arthroscopic debridement of the labrum only
. Open capsular shift

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In patients over age 40 or those with significant biceps tendinopathy, biceps tenodesis provides more reliable pain relief and functional improvement than a SLAP repair. SLAP repairs in older patients have a higher rate of postoperative stiffness and clinical failure.

Question 3334

Topic: Knee Sports
A 25-year-old male sustains a contact injury to his knee resulting in a combined ACL and medial collateral ligament (MCL) grade III tear. What is the most appropriate initial management for the MCL injury in the setting of ACL reconstruction?
. Nonoperative management of the MCL followed by delayed ACL reconstruction
. Primary repair of the MCL and delayed ACL reconstruction
. Acute reconstruction of the MCL and ACL
. Nonoperative management of the MCL and acute ACL reconstruction
. Immobilization for 6 weeks followed by staged ACL and MCL reconstructions

Correct Answer & Explanation

. Nonoperative management of the MCL followed by delayed ACL reconstruction

Explanation

Grade III MCL tears combined with ACL injuries are typically managed nonoperatively for the MCL to allow healing, followed by delayed ACL reconstruction once range of motion is restored. This prevents postoperative arthrofibrosis.

Question 3335

Topic: Shoulder & Hip Sports

A 22-year-old rugby player has recurrent anterior shoulder instability. CT reveals 25 percent anterior glenoid bone loss. Which of the following procedures is most appropriate to restore stability?

. Arthroscopic Bankart repair
. Arthroscopic capsular plication
. Open Latarjet procedure
. Arthroscopic remplissage alone
. Open inferior capsular shift

Correct Answer & Explanation

. Open Latarjet procedure

Explanation

In cases of significant anterior glenoid bone loss (greater than 20 percent), isolated soft-tissue procedures like a Bankart repair have an unacceptably high failure rate. The Latarjet procedure restores the bony arc and provides a dynamic sling effect with the conjoint tendon.

Question 3336

Topic: Knee Sports

During an anatomic double-bundle PCL reconstruction, the anterolateral and posteromedial bundles are reconstructed. Which of the following statements regarding the biomechanics of these bundles is true?

. The anterolateral bundle is tight in flexion and the posteromedial bundle is tight in extension.
. The anterolateral bundle is tight in extension and the posteromedial bundle is tight in flexion.
. Both bundles are tightest in full extension.
. Both bundles are tightest at 90 degrees of flexion.
. The anterolateral bundle controls internal rotation, while the posteromedial bundle controls external rotation.

Correct Answer & Explanation

. The anterolateral bundle is tight in flexion and the posteromedial bundle is tight in extension.

Explanation

The anterolateral bundle of the PCL is the larger of the two and becomes tight in knee flexion. The smaller posteromedial bundle is tight in knee extension.

Question 3337

Topic: 5. Sports Medicine

A 28-year-old male presents with a locked knee and lack of full extension 4 months after an ACL reconstruction. MRI shows a nodular soft tissue mass anterior to the ACL graft in the intercondylar notch. What is the primary etiology of this complication?

. Anterior placement of the tibial tunnel
. Posterior placement of the tibial tunnel
. Over-tensioning of the ACL graft
. Failure to clear the infrapatellar fat pad
. Use of a hamstring autograft instead of bone-patellar tendon-bone

Correct Answer & Explanation

. Anterior placement of the tibial tunnel

Explanation

A cyclops lesion is a fibrocartilaginous nodule that forms anterior to the graft, leading to a loss of full terminal extension. It is most commonly associated with anterior placement of the tibial tunnel, causing impingement of the graft in extension.

Question 3338

Topic: 5. Sports Medicine

A 19-year-old college football player presents with posterior shoulder pain. Examination reveals a positive OBrien test and pain with resisted supination. MRI confirms a Type II SLAP tear. What is the most appropriate initial management?

. Arthroscopic SLAP repair
. Open biceps tenodesis
. Biceps tenotomy
. Physical therapy focusing on periscapular stabilization
. Glenohumeral corticosteroid injection

Correct Answer & Explanation

. Physical therapy focusing on periscapular stabilization

Explanation

The initial management for a Type II SLAP tear in a young overhead or contact athlete is nonoperative, focusing on physical therapy to correct glenohumeral internal rotation deficit and scapular dyskinesia. Surgery is reserved for patients who fail an extensive course of targeted rehabilitation.

Question 3339

Topic: Knee Sports

A positive Dial test at 30 degrees of flexion but symmetric at 90 degrees indicates an isolated injury to which of the following?

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

Correct Answer & Explanation

. Posterolateral corner

Explanation

Increased external rotation (a positive Dial test) at 30 degrees of flexion that reduces at 90 degrees indicates an isolated posterolateral corner injury. If the asymmetry persists or increases at 90 degrees, it suggests a combined posterolateral corner and posterior cruciate ligament injury.

Question 3340

Topic: Knee Sports

In the setting of a multiple ligament knee injury, an avulsion of the fibular collateral ligament and biceps femoris tendon from the fibular head is encountered. During surgical repair, which nerve is at greatest risk of iatrogenic injury?

. Tibial nerve
. Common peroneal nerve
. Deep peroneal nerve
. Saphenous nerve
. Sural nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve courses posterior to the biceps femoris tendon and wraps around the fibular neck. It is at high risk of injury during trauma to the posterolateral corner and during surgical approaches in this region.

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