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Question 3541

Topic: 5. Sports Medicine

Which of the following bone graft substitutes possesses osteoinductive properties but lacks both osteoconductive structural support and osteogenic cells?

. Cancellous autograft
. Calcium phosphate cement
. Demineralized bone matrix (DBM)
. Structural cortical allograft
. Tricalcium phosphate

Correct Answer & Explanation

. Cancellous autograft


Explanation

Demineralized bone matrix (DBM) is produced by acid extraction of bone, leaving behind collagen and BMPs that provide osteoinductive potential. However, it lacks structural integrity (osteoconduction) and viable cells (osteogenesis).

Question 3542

Topic: Knee Sports

Following a microfracture procedure for a focal full-thickness articular cartilage defect in the knee, what type of tissue predominantly fills the defect?

. Hyaline cartilage rich in Type II collagen
. Fibrocartilage rich in Type I collagen
. Elastic cartilage rich in elastin
. Calcified cartilage rich in Type X collagen
. Lamellar bone

Correct Answer & Explanation

. Hyaline cartilage rich in Type II collagen


Explanation

Microfracture penetrates the subchondral bone, releasing marrow elements and mesenchymal stem cells. These cells differentiate to form a repair tissue predominantly composed of fibrocartilage (rich in Type I collagen) rather than native hyaline cartilage.

Question 3543

Topic: 5. Sports Medicine

Which of the following bone graft or graft substitute options distinctly possesses osteoinductive, osteoconductive, and osteogenic properties simultaneously?

. Demineralized bone matrix (DBM)
. Calcium phosphate cement
. Cancellous autograft
. Cancellous allograft
. Recombinant human bone morphogenetic protein-2 (rhBMP-2)

Correct Answer & Explanation

. Demineralized bone matrix (DBM)


Explanation

Cancellous autograft provides all three properties essential for bone healing: osteogenic (viable donor cells), osteoinductive (native growth factors), and osteoconductive (a structural scaffold). Synthetics and allografts generally lack the osteogenic cellular component.

Question 3544

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with isolated weakness of external rotation in the dominant shoulder. MRI shows an isolated paralabral cyst. Compression of the suprascapular nerve at the spinoglenoid notch will result in denervation of which of the following muscles?

. Supraspinatus only
. Infraspinatus only
. Both supraspinatus and infraspinatus
. Teres minor
. Deltoid

Correct Answer & Explanation

. Supraspinatus only


Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch. Therefore, compression at the spinoglenoid notch results in isolated infraspinatus denervation.

Question 3545

Topic: 5. Sports Medicine

When creating an anterolateral portal during ankle arthroscopy, the superficial peroneal nerve is at risk. At what approximate level does this nerve typically pierce the crural fascia to become subcutaneous in the leg?

. 5 cm distal to the fibular head
. 10-12 cm proximal to the lateral malleolus
. 2-3 cm proximal to the lateral malleolus
. At the level of the anterior joint line
. Over the dorsum of the midfoot

Correct Answer & Explanation

. 5 cm distal to the fibular head


Explanation

The superficial peroneal nerve provides motor innervation to the lateral compartment and then typically pierces the deep fascia to become superficial approximately 10 to 12 cm proximal to the lateral malleolus.

Question 3546

Topic: Knee Sports

During harvest of the semitendinosus and gracilis tendons for ACL reconstruction, the saphenous nerve is at risk. The saphenous nerve exits the adductor (Hunter's) canal by penetrating the vastoadductor membrane. Which artery accompanies it as it exits?

. Superficial femoral artery
. Deep femoral artery
. Descending genicular artery
. Medial superior genicular artery
. Popliteal artery

Correct Answer & Explanation

. Superficial femoral artery


Explanation

The saphenous nerve travels in the adductor canal with the superficial femoral artery. However, before the artery passes through the adductor hiatus to become the popliteal artery, the saphenous nerve exits the canal anteriorly, accompanied by the descending genicular artery.

Question 3547

Topic: 5. Sports Medicine

A 28-year-old overhead athlete presents with poorly localized posterior shoulder pain and deltoid weakness. MRI reveals a paralabral cyst in the quadrilateral space. Which of the following structures forms the superior border of this anatomic space?

. Teres major
. Teres minor
. Long head of triceps
. Surgical neck of humerus
. Infraspinatus

Correct Answer & Explanation

. Teres major


Explanation

The quadrilateral space is bounded superiorly by the teres minor, inferiorly by the teres major, medially by the long head of the triceps, and laterally by the surgical neck of the humerus. It contains the axillary nerve and posterior humeral circumflex artery.

Question 3548

Topic: Shoulder & Hip Sports

Compression of the suprascapular nerve at the spinoglenoid notch will result in isolated weakness of which of the following muscles?

. Supraspinatus
. Infraspinatus
. Teres minor
. Deltoid
. Subscapularis

Correct Answer & Explanation

. Supraspinatus


Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch. Therefore, compression at the spinoglenoid notch results in isolated infraspinatus weakness.

Question 3549

Topic: Shoulder & Hip Sports

During a Latarjet procedure, the conjoined tendon is retracted to expose the anterior glenoid. The musculocutaneous nerve must be protected. At what average distance distal to the coracoid process does this nerve enter the coracobrachialis muscle?

. 1-2 cm
. 3-8 cm
. 10-12 cm
. 14-16 cm
. 18-20 cm

Correct Answer & Explanation

. 1-2 cm


Explanation

The musculocutaneous nerve typically enters the coracobrachialis approximately 5 cm (range 3-8 cm) distal to the tip of the coracoid process. Aggressive distal retraction of the conjoined tendon can cause traction neuropraxia.

Question 3550

Topic: 5. Sports Medicine

A 25-year-old athlete develops isolated weakness in external rotation of the shoulder after a direct blow to the posterior axilla. MRI reveals a mass in the quadrilateral space. What are the borders of the space where the axillary nerve is most likely compressed?

. Teres minor (superior), teres major (inferior), long head of triceps (medial), humerus (lateral)
. Teres major (superior), latissimus dorsi (inferior), long head of triceps (medial), humerus (lateral)
. Teres minor (superior), teres major (inferior), lateral head of triceps (medial), humerus (lateral)
. Subscapularis (superior), teres major (inferior), long head of triceps (lateral), humerus (medial)
. Teres minor (superior), teres major (inferior), short head of biceps (lateral), humerus (medial)

Correct Answer & Explanation

. Teres minor (superior), teres major (inferior), long head of triceps (medial), humerus (lateral)


Explanation

The quadrilateral space is bordered superiorly by the teres minor, inferiorly by the teres major, laterally by the surgical neck of the humerus, and medially by the long head of the triceps. The axillary nerve and posterior circumflex humeral artery exit the axilla through this space.

Question 3551

Topic: Shoulder & Hip Sports

A 22-year-old collegiate volleyball player presents with isolated weakness of the infraspinatus without supraspinatus involvement. Entrapment of the suprascapular nerve is suspected. At what anatomical location does this isolated compression typically occur?

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

Correct Answer & Explanation

. Suprascapular notch


Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus because the branches to the supraspinatus depart proximal to this notch. Compression at the suprascapular notch affects both the supraspinatus and infraspinatus.

Question 3552

Topic: 5. Sports Medicine

A 28-year-old overhead athlete is diagnosed with quadrilateral space syndrome, presenting with vague posterior shoulder pain and isolated atrophy of the teres minor. The structures forming the borders of this anatomical space are the:

. Teres minor (superior), teres major (inferior), long head of triceps (medial), and humerus (lateral)
. Teres major (superior), teres minor (inferior), lateral head of triceps (medial), and humerus (lateral)
. Supraspinatus (superior), infraspinatus (inferior), long head of triceps (medial), and humerus (lateral)
. Teres minor (superior), teres major (inferior), short head of biceps (medial), and humerus (lateral)
. Infraspinatus (superior), teres major (inferior), long head of triceps (lateral), and humerus (medial)

Correct Answer & Explanation

. Teres minor (superior), teres major (inferior), long head of triceps (medial), and humerus (lateral)


Explanation

The quadrangular space transmits the axillary nerve and posterior circumflex humeral artery. It is bounded superiorly by the teres minor, inferiorly by the teres major, medially by the long head of the triceps, and laterally by the surgical neck of the humerus.

Question 3553

Topic: Shoulder & Hip Sports

A 35-year-old volleyball player is found to have a large paralabral ganglion cyst extending into the spinoglenoid notch. Physical examination is most likely to demonstrate which of the following isolated findings?

. Weakness in shoulder abduction and external rotation
. Weakness in shoulder external rotation with normal abduction
. Weakness in shoulder abduction with normal external rotation
. Weakness in shoulder internal rotation
. Complete loss of active forward elevation

Correct Answer & Explanation

. Weakness in shoulder abduction and external rotation


Explanation

A cyst at the spinoglenoid notch compresses the suprascapular nerve after it has already innervated the supraspinatus. This leads to isolated denervation of the infraspinatus, causing weakness in external rotation with preserved abduction.

Question 3554

Topic: Shoulder & Hip Sports

A patient presents with isolated weakness in external rotation of the shoulder. An MRI reveals a paralabral cyst in the spinoglenoid notch. Which of the following muscles is most likely affected?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Deltoid

Correct Answer & Explanation

. Supraspinatus


Explanation

The suprascapular nerve innervates the supraspinatus, then passes through the spinoglenoid notch to innervate the infraspinatus. Compression at the spinoglenoid notch causes isolated infraspinatus weakness.

Question 3555

Topic: Knee Sports

During a posterolateral corner reconstruction of the knee, the surgeon isolates the popliteus tendon. Where is the femoral attachment of the popliteus tendon located relative to the fibular collateral ligament (FCL)?

. Proximal and posterior
. Distal and posterior
. Proximal and anterior
. Distal and anterior
. Directly deep to the FCL origin

Correct Answer & Explanation

. Proximal and posterior


Explanation

The popliteus tendon inserts on the lateral femoral condyle distal and anterior to the origin of the fibular collateral ligament (LCL).

Question 3556

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two main bundles. Which of the following best describes the function of the anteromedial (AM) bundle?

. Tight in extension, controls rotational stability
. Tight in flexion, controls anterior translation
. Tight in extension, controls anterior translation
. Tight in flexion, controls rotational stability
. Slack in flexion, tight in extension

Correct Answer & Explanation

. Tight in extension, controls rotational stability


Explanation

The anteromedial (AM) bundle of the ACL is primarily tight in flexion and controls anterior tibial translation, whereas the posterolateral (PL) bundle is tight in extension and controls rotatory stability.

Question 3557

Topic: Knee Sports

An MRI of the knee demonstrates an avulsion of the popliteus tendon from its femoral insertion. Where is the normal anatomic footprint of the popliteus tendon on the femur relative to the lateral collateral ligament (LCL) origin?

. Anterior and inferior
. Posterior and inferior
. Anterior and superior
. Posterior and superior
. Directly medial

Correct Answer & Explanation

. Anterior and inferior


Explanation

The popliteus tendon inserts on the lateral femoral condyle anterior and inferior to the origin of the lateral collateral ligament (LCL). This spatial relationship is critical during posterolateral corner reconstructions.

Question 3558

Topic: Shoulder & Hip Sports

During an arthroscopic rotator interval release for adhesive capsulitis, the surgeon must identify the structures comprising the interval. Which two tendons form the superior and inferior borders of the rotator interval, respectively?

. Supraspinatus and Subscapularis
. Supraspinatus and Infraspinatus
. Infraspinatus and Teres Minor
. Subscapularis and Teres Minor
. Long head of biceps and Supraspinatus

Correct Answer & Explanation

. Supraspinatus and Subscapularis


Explanation

The rotator interval is a triangular anatomical space bordered superiorly by the anterior margin of the supraspinatus tendon and inferiorly by the superior margin of the subscapularis tendon. It contains the long head of the biceps tendon and coracohumeral ligament.

Question 3559

Topic: Knee Sports

An orthopedic surgeon is performing an anatomical ACL reconstruction. The anteromedial (AM) bundle of the ACL is tightest in which knee position, and where does it insert on the tibia relative to the posterolateral (PL) bundle?

. Flexion; inserts anteromedial to the PL bundle
. Extension; inserts anteromedial to the PL bundle
. Flexion; inserts posterolateral to the PL bundle
. Extension; inserts posterolateral to the PL bundle
. Extension; inserts directly posterior to the PL bundle

Correct Answer & Explanation

. Flexion; inserts anteromedial to the PL bundle


Explanation

The anteromedial (AM) bundle of the ACL is tightest in flexion and controls anterior translation. It inserts anteromedial to the posterolateral (PL) bundle on the tibial footprint.

Question 3560

Topic: Shoulder & Hip Sports

When performing a surgical dislocation of the hip for a femoroacetabular impingement procedure, the deep branch of the medial femoral circumflex artery is protected by preserving which of the following muscles?

. Piriformis
. Obturator externus
. Quadratus femoris
. Gluteus medius
. Superior gemellus

Correct Answer & Explanation

. Piriformis


Explanation

The deep branch of the MFCA runs anterior to the quadratus femoris and posterior to the obturator externus. Preserving the obturator externus during surgical dislocation protects the main blood supply to the femoral head.