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5. Sports Medicine MCQs

Practice Set 172 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 3421

Topic: 5. Sports Medicine

A 35-year-old recreational athlete sustains an acute Achilles tendon rupture. He discusses nonoperative versus operative management with his orthopedic surgeon. What does current high-level evidence indicate regarding functional rehabilitation (nonoperative) versus surgical repair?

. Surgery has a significantly lower re-rupture rate with no difference in complication rates
. Functional nonoperative management has a similar re-rupture rate to surgery but lower wound complication rates
. Surgery provides superior plantarflexion strength but higher re-rupture rates
. Nonoperative management guarantees return to pre-injury sports faster
. Surgery is contraindicated in patients under 40 years of age

Correct Answer & Explanation

. Functional nonoperative management has a similar re-rupture rate to surgery but lower wound complication rates

Explanation

Recent trials indicate that with early functional rehabilitation protocols, nonoperative management of Achilles tendon ruptures yields re-rupture rates equivalent to operative repair while avoiding surgical wound complications.

Question 3422

Topic: Shoulder & Hip Sports

A 24-year-old overhead throwing athlete complains of deep shoulder pain during the late cocking phase of throwing. MRI arthrography reveals a Type II SLAP tear. Which of the following mechanisms is most responsible for this specific injury pattern in the overhead athlete?

. Direct traumatic impact to the glenohumeral joint
. Peel-back mechanism from torsional forces of the biceps anchor
. Eccentric overload of the supraspinatus tendon
. Subcoracoid impingement
. Internal impingement of the subscapularis

Correct Answer & Explanation

. Peel-back mechanism from torsional forces of the biceps anchor

Explanation

The peel-back mechanism occurs in the late cocking phase of throwing, where the biceps vector shifts posteriorly. This torsional force leads to the detachment of the superior labrum, resulting in a Type II SLAP tear.

Question 3423

Topic: 5. Sports Medicine

When counseling a 19-year-old female collegiate soccer player regarding anterior cruciate ligament (ACL) reconstruction, she asks about the differences between bone-patellar tendon-bone (BPTB) and hamstring autografts. Compared to hamstring autografts, BPTB autografts are associated with a higher incidence of:

. Postoperative anterior knee pain
. Graft rupture
. Deep infection
. Hamstring weakness
. Contralateral ACL tear

Correct Answer & Explanation

. Postoperative anterior knee pain

Explanation

BPTB autografts are associated with a higher incidence of donor-site morbidity, specifically anterior knee pain and kneeling pain. Hamstring grafts generally cause less anterior knee pain but may have slightly higher rates of clinical laxity.

Question 3424

Topic: Shoulder & Hip Sports

A 21-year-old collegiate linebacker presents with recurrent anterior shoulder instability. CT scan indicates 25% anterior glenoid bone loss. What is the most appropriate definitive management?

. Arthroscopic Bankart repair with suture anchors
. Arthroscopic capsular plication
. Latarjet procedure (coracoid transfer)
. Remplissage procedure alone
. Nonoperative management with bracing

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

Anterior glenoid bone loss exceeding 20-25% is a strict indication for a bony augmentation procedure like the Latarjet. Soft tissue repairs alone in this setting carry an unacceptably high recurrence rate.

Question 3425

Topic: Knee Sports

A 26-year-old male undergoes ACL reconstruction and a concurrent peripheral longitudinal tear of the medial meniscus is repaired. The healing rate of this meniscal repair is enhanced compared to an isolated meniscal repair primarily due to:

. Decreased weight-bearing postoperatively
. Release of bone marrow elements and growth factors during tunnel drilling
. Use of a rigid postoperative knee brace
. The stabilizing effect of the intact PCL
. Young age of the patient

Correct Answer & Explanation

. Release of bone marrow elements and growth factors during tunnel drilling

Explanation

Concurrent ACL reconstruction enhances meniscal healing due to the release of pluripotent stem cells and growth factors from the marrow during tunnel drilling. This hemarthrosis acts as an optimal biological environment.

Question 3426

Topic: 5. Sports Medicine

A 28-year-old tennis player exhibits a Glenohumeral Internal Rotation Deficit (GIRD) of 30 degrees compared to the contralateral side. Her total arc of motion is symmetric. Initial management should consist of:

. Arthroscopic posterior capsular release
. Arthroscopic anterior capsular plication
. Sleeper stretches focusing on the posteroinferior capsule
. Rotator interval closure
. SLAP repair

Correct Answer & Explanation

. Sleeper stretches focusing on the posteroinferior capsule

Explanation

GIRD is defined by a loss of internal rotation with a preserved total arc of motion, common in overhead athletes. Initial treatment is nonoperative, focusing on posteroinferior capsular stretching via sleeper stretches.

Question 3427

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction of the knee, the surgeon must be acutely aware of the anatomy to avoid iatrogenic injury. Which nerve is at the greatest risk during the surgical approach and lateral dissection for a PLC reconstruction?

. Tibial nerve
. Saphenous nerve
. Sural nerve
. Common peroneal nerve
. Obturator nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve winds around the fibular neck and is highly vulnerable during the lateral dissection required for PLC reconstruction. Careful identification and neurolysis are mandatory.

Question 3428

Topic: Knee Sports
A 20-year-old gymnast experiences patellar instability. The medial patellofemoral ligament (MPFL) is deemed incompetent. The femoral footprint of the MPFL (Schöttle's point) is anatomically located:
. Proximal to the adductor tubercle and anterior to the medial epicondyle
. Between the adductor tubercle and the medial epicondyle
. Distal to the medial epicondyle
. On the anterior aspect of the medial femoral condyle
. At the medial joint line

Correct Answer & Explanation

. Between the adductor tubercle and the medial epicondyle

Explanation

Schöttle's point represents the anatomical femoral origin of the MPFL. Radiographically and anatomically, it is located just anterior and distal to the adductor tubercle, and proximal to the medial epicondyle.

Question 3429

Topic: Knee Sports

A 29-year-old male sustains an isolated posterior cruciate ligament (PCL) tear after a dashboard injury. If nonoperative management is chosen, physical therapy should primarily focus on strengthening which muscle group to restrict posterior tibial translation?

. Hamstrings
. Quadriceps
. Gastrocnemius
. Hip abductors
. Popliteus

Correct Answer & Explanation

. Quadriceps

Explanation

The quadriceps act as an antagonist to the PCL by dynamically pulling the tibia anteriorly. Strengthening the quadriceps helps stabilize a PCL-deficient knee.

Question 3430

Topic: Shoulder & Hip Sports

A 31-year-old volleyball player complains of isolated painless weakness in external rotation of his dominant shoulder. Examination reveals infraspinatus atrophy but normal supraspinatus strength. MRI is most likely to show a cyst in which location?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Subcoracoid space

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The spinoglenoid notch transmits the suprascapular nerve to the infraspinatus only. A cyst here (often associated with posterior labral tears) causes isolated infraspinatus weakness without affecting the supraspinatus.

Question 3431

Topic: Knee Sports
A 22-year-old football player sustains a multiligamentous knee injury. Physical examination demonstrates >10 degrees of increased external tibial rotation compared to the contralateral knee at both 30 degrees and 90 degrees of knee flexion. This finding indicates injury to the:
. Posterolateral corner (PLC) only
. Posterior cruciate ligament (PCL) only
. Posterolateral corner (PLC) and Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL) and PLC
. Medial collateral ligament (MCL) and PCL

Correct Answer & Explanation

. Posterolateral corner (PLC) and Posterior cruciate ligament (PCL)

Explanation

The dial test evaluates external tibial rotation. Asymmetry of >10 degrees at 30 degrees only indicates an isolated PLC injury, while asymmetry at both 30 and 90 degrees indicates a combined PLC and PCL injury.

Question 3432

Topic: 5. Sports Medicine

A 19-year-old collegiate soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. She successfully returns to sport at 9 months. Which of the following is the most commonly reported long-term complication associated with this specific graft choice compared to hamstring autografts?

. Anterior knee pain
. Increased risk of contralateral ACL tear
. Saphenous nerve injury
. Decreased deep knee flexion
. Higher graft failure rate

Correct Answer & Explanation

. Anterior knee pain

Explanation

The most common complication of BPTB autograft for ACL reconstruction is donor site morbidity, specifically anterior knee pain and kneeling pain. Hamstring autografts have lower rates of anterior knee pain but may be associated with decreased hamstring strength at deep flexion angles.

Question 3433

Topic: 5. Sports Medicine

A 16-year-old high school football player sustains a first-time traumatic anterior shoulder dislocation. Closed reduction is performed in the emergency department. If this patient is treated nonoperatively, which of the following is the most significant risk factor for recurrent instability?

. Patient age less than 20 years
. Presence of a Hill-Sachs lesion
. Immobilization in internal rotation
. Male gender
. Participation in collision sports

Correct Answer & Explanation

. Patient age less than 20 years

Explanation

Patient age is the most critical prognostic factor for recurrent anterior shoulder instability following a first-time dislocation. Patients younger than 20 years have a recurrence rate approaching 70-90% with nonoperative management.

Question 3434

Topic: 5. Sports Medicine

A 52-year-old female presents with sudden onset medial knee pain after stepping down from a curb. She denies mechanical locking but reports an audible "pop." MRI demonstrates a radial tear at the attachment of the medial meniscus posterior horn with meniscal extrusion. If left untreated, this injury most predictably leads to:

. Anterior cruciate ligament insufficiency
. Rapid progression of medial compartment osteoarthritis
. Spontaneous healing of the meniscus
. A locked knee requiring urgent arthroscopy
. Patellofemoral tracking dysfunction

Correct Answer & Explanation

. Rapid progression of medial compartment osteoarthritis

Explanation

A medial meniscus posterior root tear disrupts the hoop stresses of the meniscus, functionally equating to a total meniscectomy. This leads to meniscal extrusion and rapid progression of medial compartment osteoarthritis if left untreated.

Question 3435

Topic: Shoulder & Hip Sports

A 45-year-old recreational tennis player has persistent anterior shoulder pain. MRI confirms a Type II SLAP (Superior Labrum Anterior to Posterior) tear. After failing 6 months of conservative management, surgical intervention is planned. Evidence suggests that which of the following produces the most reliable clinical outcomes and highest return to sport in this age group?

. SLAP repair using suture anchors
. Biceps tenodesis
. Arthroscopic debridement of the superior labrum
. Biceps tenotomy
. Coracoacromial ligament release

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In patients over the age of 40 with a Type II SLAP tear, primary biceps tenodesis provides superior clinical outcomes, higher satisfaction, and more reliable return to sport compared to SLAP repair. SLAP repairs in older patients have higher rates of persistent pain and stiffness.

Question 3436

Topic: 5. Sports Medicine

A 35-year-old male sustains an acute Achilles tendon rupture playing basketball. He is debating between operative and nonoperative management. Recent level I evidence indicates that when an early functional rehabilitation protocol is employed, nonoperative management is associated with:

. A significantly higher rerupture rate compared to surgery
. Decreased plantarflexion strength compared to historical nonoperative protocols
. A higher incidence of deep vein thrombosis
. Similar rerupture rates but fewer soft tissue complications compared to surgery
. A faster return to competitive sports than surgical repair

Correct Answer & Explanation

. Similar rerupture rates but fewer soft tissue complications compared to surgery

Explanation

Recent high-quality studies demonstrate that nonoperative management with early functional rehabilitation (weight-bearing and early mobilization) yields rerupture rates similar to operative management. However, nonoperative treatment avoids surgical complications such as infection and wound breakdown.

Question 3437

Topic: Knee Sports

A 28-year-old male is diagnosed with an isolated Grade II posterior cruciate ligament (PCL) tear following a dashboard injury. He is prescribed a physical therapy program. To optimize dynamic stabilization of the knee, the rehabilitation protocol should heavily emphasize strengthening of which muscle group?

. Quadriceps
. Hamstrings
. Gastrocnemius
. Popliteus
. Iliotibial band

Correct Answer & Explanation

. Quadriceps

Explanation

The quadriceps act as dynamic antagonists to the PCL by providing an anterior translational force on the tibia. Strengthening the quadriceps is the cornerstone of nonoperative rehabilitation for PCL injuries to prevent posterior tibial sag.

Question 3438

Topic: Knee Sports
A 15-year-old female requires medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. Anatomic femoral graft placement is critical to avoid anisometry. Radiographically, the anatomic femoral origin of the MPFL (Schöttle's point) is located:
. Proximal to the adductor tubercle and posterior to the posterior femoral cortical line
. Anterior to the posterior femoral cortical line and distal to the medial epicondyle
. Between the medial epicondyle and the adductor tubercle, anterior to the posterior femoral cortical line
. Distal to the medial epicondyle and posterior to the Blumensaat line
. Proximal to the medial epicondyle and anterior to the Blumensaat line

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle, anterior to the posterior femoral cortical line

Explanation

Schöttle's point, the radiographic anatomic origin of the MPFL, is located 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the medial epicondyle (between the medial epicondyle and adductor tubercle).

Question 3439

Topic: Shoulder & Hip Sports

A 21-year-old collegiate baseball pitcher presents with vague posterior shoulder pain. Physical exam reveals a Glenohumeral Internal Rotation Deficit (GIRD) of 25 degrees compared to the contralateral side, with a total arc of motion deficit of 15 degrees. What is the most appropriate initial treatment?

. Arthroscopic posterior capsular release
. Stretching of the posterior capsule utilizing sleeper stretches
. Superior labral repair
. Corticosteroid injection into the subacromial space
. Rotator interval closure

Correct Answer & Explanation

. Stretching of the posterior capsule utilizing sleeper stretches

Explanation

Pathologic GIRD is defined by a loss of internal rotation >20 degrees with a corresponding loss of total arc of motion >5 degrees. The first-line treatment is a dedicated physical therapy program emphasizing posterior capsular stretching (e.g., sleeper stretches, cross-body adduction).

Question 3440

Topic: Knee Sports

During an ACL reconstruction, the surgeon evaluates the two functional bundles of the anterior cruciate ligament. Which of the following accurately describes the anatomy and biomechanics of the ACL bundles?

. The anteromedial bundle is tight in extension and controls anterior translation.
. The posterolateral bundle controls rotatory stability and is tight in extension.
. The anteromedial bundle is the primary restraint to pivot shift in full extension.
. The posterolateral bundle is tight in flexion and loose in extension.
. The anteromedial and posterolateral bundles are named for their tibial insertions but cross in the intercondylar notch in extension.

Correct Answer & Explanation

. The posterolateral bundle controls rotatory stability and is tight in extension.

Explanation

The ACL has two main bundles named for their tibial footprint: anteromedial (AM) and posterolateral (PL). The PL bundle is tight in extension, loose in flexion, and is the primary restraint to rotatory loads (tested via the pivot shift).

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