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5. Sports Medicine MCQs

Practice Set 185 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 3681

Topic: Shoulder & Hip Sports

A 19-year-old collegiate football player sustains a primary anterior shoulder dislocation.

Imaging demonstrates an anteroinferior labral tear accompanied by 25% glenoid bone loss. What is the most appropriate definitive management for this athlete?

. Arthroscopic Bankart repair
. Open Bankart repair
. Latarjet procedure
. Arthroscopic remplissage
. Sling immobilization and physical therapy

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

The Latarjet procedure (coracoid transfer) is indicated for anterior shoulder instability in the setting of significant glenoid bone loss (>20-25%). Arthroscopic or open Bankart repairs alone have unacceptably high failure rates when critical bone loss is present.

Question 3682

Topic: Knee Sports

A 22-year-old female soccer player sustains a noncontact twisting injury to her knee, feeling a "pop."

MRI confirms an isolated anterior cruciate ligament (ACL) tear. Which of the following is an established intrinsic anatomic risk factor for this injury?

. Increased intercondylar notch width
. Decreased intercondylar notch width
. Decreased posterior tibial slope
. Varus knee alignment
. Increased hamstring-to-quadriceps ratio

Correct Answer & Explanation

. Increased intercondylar notch width

Explanation

A decreased (narrow) intercondylar notch width is a well-established anatomic risk factor for ACL tears. Increased posterior tibial slope and a decreased hamstring-to-quadriceps strength ratio are also known risk factors.

Question 3683

Topic: 5. Sports Medicine

A 25-year-old professional baseball pitcher complains of deep shoulder pain primarily occurring during the late cocking phase of throwing.

An MR arthrogram reveals a Type II SLAP lesion. What is the primary pathomechanical basis for his symptoms during this specific throwing phase?

. Anterior translation of the humeral head
. Superior migration of the humeral head
. Peel-back mechanism of the biceps anchor
. Subcoracoid impingement
. Scapular dyskinesia

Correct Answer & Explanation

. Anterior translation of the humeral head

Explanation

In the late cocking phase (abduction and maximal external rotation), the biceps vector shifts posteriorly, creating a "peel-back" force on the superior labrum. This mechanism is the classic cause of Type II SLAP lesions in overhead athletes.

Question 3684

Topic: Knee Sports

A 26-year-old rugby player presents with posterior knee pain and a positive posterior drawer test.

The dial test demonstrates 15 degrees of increased external rotation at 30 degrees of flexion and 15 degrees of increased external rotation at 90 degrees of flexion compared to the contralateral side. Which structures are injured?

. Isolated posterior cruciate ligament (PCL)
. Isolated posterolateral corner (PLC)
. Posterior cruciate ligament (PCL) and posterolateral corner (PLC)
. Posterior cruciate ligament (PCL) and medial collateral ligament (MCL)
. Anterior cruciate ligament (ACL) and posterolateral corner (PLC)

Correct Answer & Explanation

. Isolated posterior cruciate ligament (PCL)

Explanation

A dial test showing increased external rotation at both 30 and 90 degrees of knee flexion indicates a combined injury to the posterior cruciate ligament (PCL) and the posterolateral corner (PLC). An isolated PLC injury would show asymmetry only at 30 degrees.

Question 3685

Topic: 5. Sports Medicine

A 19-year-old gymnast presents with chronic anterolateral ankle pain unresponsive to bracing and therapy.

MRI reveals a 9 mm x 9 mm uncontained osteochondral lesion of the anterolateral talar dome. What is the surgical treatment of choice?

. Observation and permanent activity modification
. Arthroscopic bone marrow stimulation (microfracture)
. Osteochondral autograft transfer (OATS)
. Fresh osteochondral allograft
. Autologous chondrocyte implantation

Correct Answer & Explanation

. Observation and permanent activity modification

Explanation

Arthroscopic bone marrow stimulation (microfracture/drilling) is the first-line surgical treatment for symptomatic, small osteochondral lesions of the talus (typically less than 1.5 cm^2). Larger lesions (>1.5 cm^2) or cystic lesions often require OATS or allograft.

Question 3686

Topic: Shoulder & Hip Sports

A 22-year-old collegiate pitcher complains of posterior shoulder pain and decreased velocity.

Physical examination reveals 20 degrees of internal rotation and 130 degrees of external rotation in the dominant arm (contralateral internal rotation is 60 degrees). Initial treatment should emphasize which of the following?

. Anterior capsular stretching
. Posteroinferior capsular stretching
. Rotator cuff strengthening only
. Arthroscopic SLAP repair
. Subacromial corticosteroid injection

Correct Answer & Explanation

. Anterior capsular stretching

Explanation

The patient has Glenohumeral Internal Rotation Deficit (GIRD), characterized by a loss of internal rotation due to posteroinferior capsular contracture. The first-line treatment is posteroinferior capsular stretching (e.g., "sleeper" stretches).

Question 3687

Topic: Knee Sports
A 17-year-old female experiences recurrent lateral patellar instability and fails conservative management. Surgery is planned to reconstruct the medial patellofemoral ligament (MPFL). During reconstruction, where should the femoral tunnel be placed anatomically to avoid non-isometric graft tension?
. Anterior to the medial epicondyle
. Between the medial epicondyle and adductor tubercle
. Proximal to the adductor tubercle
. Distal to the medial epicondyle
. On the anterior aspect of the medial femoral condyle

Correct Answer & Explanation

. Between the medial epicondyle and adductor tubercle

Explanation

The anatomic femoral attachment of the MPFL (often described radiographically by the Schöttle point) lies in a saddle-like depression between the medial epicondyle and the adductor tubercle. Accurate placement is critical to ensure isometry of the graft throughout knee flexion.

Question 3688

Topic: 5. Sports Medicine

A 17-year-old football player continues to have discomfort after sustaining a blow to his midthigh during a game 8 weeks ago. A plain radiograph is shown in Figure 13. What is the most appropriate management?

. Immobilization
. Rest with range-of-motion exercises
. Steroid injection
. Excision
. Irradiation

Correct Answer & Explanation

. Immobilization

Explanation

The patient has myositis ossificans. Rest of the involved area is important to help limit the continued irritation of the muscle, but range-of-motion exercises are important to limit stiffness. While immobilization for 1 or 2 days following a muscle contusion is appropriate, longer periods of immobilization result in muscle atrophy and fibrosis. Injections and irradiation have not been found to be of benefit for myositis ossificans. Excision is rarely required, and if performed, it should not be performed prior to maturation of the lesion, which is a minimum of 6 months. Lipscomb AB, Thomas ED, Johnston RK: Treatment of myositis ossificans traumatica in athletes. Am J Sports Med 1976;4:111-120. Beiner JM, Jokl P: Muscle contusion injuries: Current treatment options. J Am Acad Orthop Surg 2001;9:227-237.

Question 3689

Topic: 5. Sports Medicine

An 18-year-old high school football player sustains a left posterior hip dislocation that is reduced in the emergency department under IV sedation. Postreduction radiographs reveal a concentric reduction with no evidence of fracture or loose bodies within the joint. What is the most common complication of hip dislocations?

. Femoral nerve palsy
. Sciatic nerve palsy
. Recurrent hip dislocation
. Osteonecrosis of the femoral head
. Immediate chondrolysis of the hip joint

Correct Answer & Explanation

. Femoral nerve palsy

Explanation

Traumatic dislocation of the hip in sports injuries is uncommon, and 85% to 92% occur in a posterior direction. In dislocations without fractures, osteonecrosis is the most common complication occurring in 10% to 20% of patients. MRI should be performed at 3 months postreduction to rule out osteonecrosis. Nerve injuries are rare in this setting, and recurrent dislocations are unusual without acetabular fractures. Chondrolysis has been reported as a rare occurrence. Anderson K, Strickland S, Warren R: Hip and groin injures in athletes. Am J Sports Med 2001;29:521-533.

Question 3690

Topic: 5. Sports Medicine

An 18-year-old lacrosse player sustained a hamstring pull during a game. Examination the next day reveals ecchymosis through the posterior thigh and a palpable defect in the hamstring musculature in the middle third of the thigh. What is the most likely site of anatomic injury?

. Rupture of the biceps femoris at the myotendinous junction
. Rupture of the biceps femoris muscle belly
. Avulsion of the common hamstring origin from the ischium
. Complete rupture of the semimembranosus muscle belly
. Complete tear of all hamstring muscles

Correct Answer & Explanation

. Rupture of the biceps femoris at the myotendinous junction

Explanation

Hamstring strains are common in athletes. Basic science research and clinical data indicate that the majority of these injuries occur at the myotendinous junction, not within the muscle belly. Avulsion of hamstring origin from the ischial tuberosity does occur but is less common. Complete tearing of all hamstring muscles is unlikely to occur. Griffin LY (ed): Orthopaedic Knowledge Update: Sports Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 17-33.

Question 3691

Topic: 5. Sports Medicine

Which of the following statements regarding the biomechanical properties of commonly used anterior cruciate ligament (ACL) grafts is true?

. Bone-patellar tendon-bone (BPTB) grafts have a lower initial stiffness than the native ACL.
. Quad tendon grafts have a significantly lower ultimate failure load than the native ACL.
. A 10-mm BPTB graft exhibits a higher ultimate load and stiffness compared to the native ACL.
. Hamstring autografts heal to the bone tunnels faster than BPTB grafts.
. Quad tendon grafts require a longer period of remodeling before revascularization compared to allografts.

Correct Answer & Explanation

. Bone-patellar tendon-bone (BPTB) grafts have a lower initial stiffness than the native ACL.

Explanation

A 10-mm bone-patellar tendon-bone (BPTB) graft has an ultimate failure load of roughly 2900 N and stiffness of 300-400 N/mm, both of which are higher than the native ACL (roughly 2100 N and 242 N/mm).

Question 3692

Topic: Shoulder & Hip Sports

During arthroscopic repair of a massive, retracted superior rotator cuff tear, extensive medial mobilization is required. What is the generally accepted "safe zone" distance from the superior glenoid rim to avoid injury to the suprascapular nerve at the suprascapular notch?

. 5 mm
. 10 mm
. 15 mm
. 25 mm
. 30 mm

Correct Answer & Explanation

. 5 mm

Explanation

The suprascapular nerve is located approximately 1.5 cm (15 mm) medial to the superior glenoid rim at the suprascapular notch. Dissection medial to this distance increases the risk of iatrogenic nerve injury.

Question 3693

Topic: Knee Sports

Which bundle of the posterior cruciate ligament (PCL) serves as the primary restraint to posterior tibial translation at 90 degrees of knee flexion?

. Anterolateral bundle
. Posteromedial bundle
. Posterior oblique ligament
. Ligament of Wrisberg
. Ligament of Humphrey

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The anterolateral bundle of the PCL is tightest in flexion and is the primary restraint to posterior translation at 90 degrees. The posteromedial bundle is tightest in extension.

Question 3694

Topic: Knee Sports

A 22-year-old football player sustains a valgus blow to the lateral aspect of his knee. Physical examination reveals medial joint line opening at 30 degrees of flexion but a stable knee in full extension. Which anatomical structure is the primary restraint being tested?

. Deep medial collateral ligament
. Posterior oblique ligament
. Superficial medial collateral ligament
. Anterior cruciate ligament
. Medial patellofemoral ligament

Correct Answer & Explanation

. Deep medial collateral ligament

Explanation

The superficial MCL is the primary restraint to valgus stress at 30 degrees of knee flexion. Stability in full extension indicates that the secondary stabilizers (like the posterior oblique ligament and posterior capsule) remain intact.

Question 3695

Topic: Shoulder & Hip Sports

In a young, active patient with an irreparable posterosuperior rotator cuff tear (supraspinatus and infraspinatus) but an intact subscapularis, which of the following tendon transfers is biomechanically and clinically most appropriate to restore external rotation and elevation?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Teres major transfer
. Pectoralis minor transfer
. Conjoined tendon transfer

Correct Answer & Explanation

. Pectoralis major transfer

Explanation

Latissimus dorsi transfer (or lower trapezius transfer) is indicated for irreparable posterosuperior rotator cuff tears to restore external rotation and forward elevation. Pectoralis major transfers are typically reserved for irreparable subscapularis tears.

Question 3696

Topic: 5. Sports Medicine

A 24-year-old athlete sustains a combined ACL and posterolateral corner (PLC) injury. If the surgeon reconstructs only the ACL and fails to address the PLC, what is the most likely biomechanical consequence?

. Early arthrofibrosis of the knee
. Failure of the ACL graft due to increased varus and external rotation forces
. Development of a symptomatic medial meniscus root tear
. Patellar tendon rupture during rehabilitation
. Progressive medial compartment osteoarthritis

Correct Answer & Explanation

. Early arthrofibrosis of the knee

Explanation

Failure to recognize and treat a posterolateral corner injury results in increased varus and external rotation laxity. This subjects an ACL reconstruction graft to excessive forces, predictably leading to early graft failure.

Question 3697

Topic: Shoulder & Hip Sports

Understanding the anatomical "footprint" of the rotator cuff is essential for proper repair. The supraspinatus footprint on the greater tuberosity is best described by which of the following medial-to-lateral dimensions?

. 5 to 7 mm
. 14 to 16 mm
. 22 to 24 mm
. 28 to 30 mm
. 32 to 35 mm

Correct Answer & Explanation

. 5 to 7 mm

Explanation

Anatomical studies demonstrate that the medial-to-lateral dimension of the supraspinatus footprint on the greater tuberosity is approximately 14 to 16 mm. Its anterior-to-posterior dimension is roughly 25 mm.

Question 3698

Topic: Shoulder & Hip Sports

Which of the following patient factors has been clinically demonstrated to have the most significant negative impact on tendon-to-bone healing and functional outcomes following arthroscopic rotator cuff repair?

. Controlled diabetes mellitus
. Current tobacco smoking
. Hyperlipidemia
. Body Mass Index of 29
. Occasional NSAID use

Correct Answer & Explanation

. Controlled diabetes mellitus

Explanation

Smoking (nicotine) significantly impairs microvascular perfusion and cellular proliferation, leading to higher rates of delayed healing, nonhealing, and re-tears following rotator cuff repair.

Question 3699

Topic: Shoulder & Hip Sports

During clinical examination of a patient with shoulder pain, the examiner places the palm of the patient's hand on the opposite shoulder and attempts to pull the hand anteriorly while the patient resists. This test is highly specific for a tear of which tendon?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Long head of the biceps

Correct Answer & Explanation

. Supraspinatus

Explanation

This describes the "bear-hug" test, which is a highly sensitive and specific clinical examination maneuver for evaluating the integrity and strength of the subscapularis tendon.

Question 3700

Topic: 5. Sports Medicine

Which of the following functional criteria is widely accepted as a minimum objective requirement before an athlete is cleared to return to cutting sports following an ACL reconstruction?

. Limb Symmetry Index (LSI) > 90% on single-leg hop testing
. Complete MRI remodeling of the graft into a ligamentous structure
. Isokinetic quadriceps strength > 70% of the uninjured limb
. Absence of any measurable anterior translation on a Lachman test
. Patient-reported psychological readiness score > 50%

Correct Answer & Explanation

. Limb Symmetry Index (LSI) > 90% on single-leg hop testing

Explanation

Return to play criteria typically require an objective Limb Symmetry Index (LSI) > 90% on functional hop testing, as well as > 90% isokinetic quadriceps and hamstring strength compared to the uninjured leg.

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