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5. Sports Medicine MCQs

Practice Set 188 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 3741

Topic: Shoulder & Hip Sports

A 21-year-old collegiate baseball pitcher presents with chronic posterior shoulder pain primarily occurring during the late cocking phase of throwing. Magnetic resonance arthrography reveals a partial-thickness articular-sided tear of the posterior supraspinatus and anterior infraspinatus, along with posterosuperior labral fraying. What is the most likely diagnosis?

. Subcoracoid impingement
. Internal impingement
. Primary subacromial impingement
. Parsonage-Turner syndrome
. Quadrilateral space syndrome

Correct Answer & Explanation

. Subcoracoid impingement

Explanation

Internal impingement occurs in overhead athletes during extreme abduction and external rotation (the late cocking phase). This position causes the articular surface of the posterosuperior rotator cuff to impinge between the greater tuberosity and the posterosuperior glenoid labrum.

Question 3742

Topic: Knee Sports

A 28-year-old recreational skier sustains an acute ACL tear. Concurrent injury to the posterior horn of the medial meniscus root is identified on preoperative MRI. If the medial meniscus root tear is left completely untreated at the time of ACL reconstruction, the knee biomechanics will most closely resemble which of the following states?

. A knee with a completely intact functioning meniscus
. A knee with a total medial meniscectomy
. A knee with an isolated bucket-handle meniscal tear
. A knee with an isolated posterior cruciate ligament deficiency
. A knee with a partial lateral meniscectomy

Correct Answer & Explanation

. A knee with a completely intact functioning meniscus

Explanation

A posterior root tear of the medial meniscus completely disrupts the meniscal hoop stresses, causing extrusion of the meniscus under load. Biomechanically, this is equivalent to a total medial meniscectomy, predisposing the joint to rapid compartmental osteoarthritis.

Question 3743

Topic: 5. Sports Medicine

A 25-year-old athlete undergoes an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Which of the following is the most common complication associated with this specific graft choice when compared directly to a hamstring autograft?

. Higher graft rupture rate
. Anterior knee pain
. Increased postoperative laxity
. Deep vein thrombosis
. Hardware prominence

Correct Answer & Explanation

. Higher graft rupture rate

Explanation

Bone-patellar tendon-bone (BTB) autografts are historically associated with a higher incidence of anterior knee pain and kneeling pain (donor site morbidity) compared to hamstring autografts. Both graft types exhibit similar rates of overall clinical stability and graft survival.

Question 3744

Topic: Knee Sports

When assessing a patient with a suspected multiligamentous knee injury, the 'dial test' is performed. Increased external rotation of the tibia of 15 degrees compared to the contralateral side at 30 degrees of flexion, but equal rotation at 90 degrees of flexion, indicates an isolated injury to which of the following structures?

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

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

The dial test assesses for posterolateral instability by measuring external rotation of the tibia. Increased rotation at 30 degrees of flexion only indicates an isolated posterolateral corner (PLC) injury. Increased rotation at both 30 and 90 degrees indicates combined injury to the PLC and the posterior cruciate ligament (PCL).

Question 3745

Topic: Shoulder & Hip Sports

A 45-year-old male presents with weakness in internal rotation and a positive 'lift-off' test following a traumatic shoulder dislocation. MRI confirms an isolated, retracted tear of the subscapularis tendon. During arthroscopic repair, which specific anatomical landmark helps identify the superolateral border of the retracted subscapularis tendon?

. The transverse humeral ligament
. The comma sign
. The coracoclavicular ligaments
. The inferior glenohumeral ligament
. The conjoined tendon

Correct Answer & Explanation

. The transverse humeral ligament

Explanation

The 'comma sign' is formed by the superior glenohumeral ligament and the coracohumeral ligament, which tear away from their insertion and remain attached to the superolateral corner of the retracted subscapularis tendon. Recognizing this comma-shaped arc of tissue is a critical step in retrieving and repairing retracted subscapularis tears.

Question 3746

Topic: Shoulder & Hip Sports

A 30-year-old female undergoes arthroscopic evaluation for persistent shoulder pain. An articular-sided partial-thickness supraspinatus tear (PASTA lesion) is identified. The tear involves 60% of the tendon footprint depth. What is the most appropriate surgical management?

. Debridement of the tear alone
. Acromioplasty and bursectomy alone
. Repair of the tendon
. Open tenodesis of the long head of the biceps
. Superior capsular reconstruction

Correct Answer & Explanation

. Debridement of the tear alone

Explanation

Partial-thickness articular-sided rotator cuff tears involving greater than 50% of the tendon thickness (usually >6mm) are generally treated with surgical repair. Debridement alone is indicated for low-grade tears involving less than 50% of the footprint.

Question 3747

Topic: Knee Sports

During posterior cruciate ligament (PCL) reconstruction, the surgeon targets the primary function of the larger, stronger bundle of the PCL. Which bundle is this, and at what knee position is it most taut?

. Posteromedial bundle, taut in flexion
. Posteromedial bundle, taut in extension
. Anterolateral bundle, taut in flexion
. Anterolateral bundle, taut in extension
. Anteromedial bundle, taut in flexion

Correct Answer & Explanation

. Posteromedial bundle, taut in flexion

Explanation

The PCL consists of the larger anterolateral bundle (ALB) and the smaller posteromedial bundle (PMB). The ALB is most taut in flexion, whereas the PMB is taut in extension. Single-bundle PCL reconstructions primarily aim to restore the ALB.

Question 3748

Topic: 5. Sports Medicine

A 28-year-old skier sustains an isolated Grade III medial collateral ligament (MCL) tear localized entirely to the proximal (femoral) attachment. What is the most appropriate initial management for this injury?

. Primary open repair with suture anchors
. Reconstruction using a hamstring autograft
. Hinged knee brace and early functional rehabilitation
. Immobilization in a cylinder cast in extension for 6 weeks
. Arthroscopic debridement of the medial compartment

Correct Answer & Explanation

. Primary open repair with suture anchors

Explanation

Isolated proximal (femoral) and midsubstance Grade III MCL tears typically heal predictably well with nonoperative management, consisting of a hinged knee brace and early functional rehabilitation. Distal (tibial) avulsions have a higher risk of nonhealing (Stener-like lesion) and may occasionally require acute surgical repair.

Question 3749

Topic: Knee Sports

During an arthroscopic anterior cruciate ligament (ACL) reconstruction using an anteromedial portal technique for femoral tunnel drilling, what is the most significant surgical risk associated with this method compared to a traditional transtibial approach?

. Mismatch between the tunnel and the graft diameter
. Posterior wall blowout of the lateral femoral condyle
. Excessively vertical placement of the femoral tunnel
. Injury to the common peroneal nerve
. Increased incidence of cyclops lesion formation

Correct Answer & Explanation

. Mismatch between the tunnel and the graft diameter

Explanation

Drilling the femoral tunnel through the anteromedial portal allows for more anatomical placement of the ACL graft compared to the transtibial technique. However, it increases the risk of posterior wall blowout, creating a critically short femoral tunnel, and potentially damaging the medial femoral condyle articular cartilage during drilling.

Question 3750

Topic: Shoulder & Hip Sports

A 55-year-old male with a massive rotator cuff tear is being evaluated for surgical repair. The surgeon assesses muscle quality on the preoperative MRI. According to the Goutallier classification, Grade 3 fatty infiltration of the rotator cuff muscles is defined as:

. Some fatty streaks
. More muscle than fat
. Equal amounts of fat and muscle
. More fat than muscle
. Complete replacement of muscle by fat

Correct Answer & Explanation

. Some fatty streaks

Explanation

The Goutallier classification grades fatty infiltration of the rotator cuff muscles. Grade 1 is some fatty streaks, Grade 2 is more muscle than fat, Grade 3 is equal amounts of fat and muscle, and Grade 4 is more fat than muscle. Higher grades correlate with a higher risk of structural failure after repair.

Question 3751

Topic: Knee Sports

A 24-year-old athlete undergoes evaluation for a revision anterior cruciate ligament (ACL) reconstruction. Preoperative computed tomography (CT) reveals significant widening of the previous tibial and femoral tunnels, both measuring 17 mm in diameter. What is the most appropriate surgical strategy?

. Single-stage revision using a doubled bone-patellar tendon-bone graft
. Two-stage revision, starting with bone grafting of the enlarged tunnels
. Extra-articular anterolateral ligament reconstruction alone
. Single-stage revision utilizing only oversized interference screws
. Nonoperative management emphasizing hamstring strengthening

Correct Answer & Explanation

. Single-stage revision using a doubled bone-patellar tendon-bone graft

Explanation

In revision ACL reconstruction, severe tunnel widening (typically greater than 14-15 mm) or malpositioned tunnels that intersect with the planned anatomic tunnels mandate a two-stage approach. The first stage involves bone grafting the enlarged tunnels, followed by a second-stage ACL reconstruction 4 to 6 months later.

Question 3752

Topic: 5. Sports Medicine

A 13-year-old female soccer player with widely open physes sustains a complete anterior cruciate ligament (ACL) tear. Which of the following surgical techniques minimizes the risk of physeal arrest?

. Transphyseal bone-patellar tendon-bone autograft
. All-epiphyseal hamstring autograft
. Transphyseal hamstring autograft with interference screw fixation
. Quadriceps tendon autograft with a patellar bone block

Correct Answer & Explanation

. Transphyseal bone-patellar tendon-bone autograft

Explanation

In skeletally immature patients with widely open physes, physeal-sparing techniques like the all-epiphyseal hamstring autograft or extra-articular iliotibial band procedures are recommended. Transphyseal drilling, especially with bone blocks across the physis, significantly increases the risk of growth arrest and angular deformity.

Question 3753

Topic: Shoulder & Hip Sports

A 21-year-old collegiate rugby player with a history of recurrent anterior shoulder dislocations presents for surgical evaluation. CT imaging demonstrates 26% anterior glenoid bone loss. What is the most appropriate surgical intervention?

. Arthroscopic Bankart repair with Remplissage
. Open Bankart repair
. Latarjet procedure
. Arthroscopic capsular plication

Correct Answer & Explanation

. Arthroscopic Bankart repair with Remplissage

Explanation

The Latarjet procedure (coracoid transfer) is indicated for anterior shoulder instability with critical glenoid bone loss, generally defined as greater than 20-25%. Arthroscopic or open Bankart repairs alone have an unacceptably high failure rate in the setting of critical bone loss.

Question 3754

Topic: 5. Sports Medicine

A high school football player is diagnosed with a concussion. He rests for 3 days and is now completely asymptomatic at rest and at school. According to the standard graduated return-to-play protocol, what is the minimum time before he can return to full-contact game play?

. He can return immediately
. 24 hours
. 5 days
. 14 days

Correct Answer & Explanation

. He can return immediately

Explanation

The standard graduated return-to-play protocol involves a 6-step progression (each step taking a minimum of 24 hours). An athlete must remain asymptomatic at each stage to progress, meaning the fastest return to full-contact games is 5 days from the initiation of the protocol.

Question 3755

Topic: 5. Sports Medicine

A 24-year-old male falls onto a hyperflexed knee during a basketball game. MRI confirms an isolated, complete Grade III tear of the posterior cruciate ligament (PCL). Which of the following is the most appropriate initial management?

. Immediate PCL reconstruction using an Achilles allograft
. Hinged knee brace locked in full extension for 2 to 4 weeks
. Hinged knee brace locked in 90 degrees of flexion for 4 weeks
. Cast immobilization in 30 degrees of flexion

Correct Answer & Explanation

. Immediate PCL reconstruction using an Achilles allograft

Explanation

Isolated PCL tears, even Grade III, have high healing potential and are typically treated nonoperatively initially. A hinged knee brace locked in full extension (or a dynamic PCL brace) is utilized to counteract the posterior tibial sag caused by gravity and hamstring pull.

Question 3756

Topic: 5. Sports Medicine

Which of the following pathophysiological mechanisms defines Second Impact Syndrome in a concussed athlete?

. Delayed expansion of an epidural hematoma
. Loss of cerebral autoregulation leading to malignant brain swelling
. Severe diffuse axonal injury
. Rapid accumulation of phosphorylated tau protein

Correct Answer & Explanation

. Delayed expansion of an epidural hematoma

Explanation

Second Impact Syndrome occurs when an athlete sustains a second head injury before symptoms from a prior concussion have resolved. This triggers a catastrophic loss of cerebral vascular autoregulation, leading to rapid, fatal brain swelling and herniation.

Question 3757

Topic: 5. Sports Medicine

A 23-year-old baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. Arthroscopy reveals undersurface fraying of the posterior supraspinatus and posterosuperior labrum. What is the most likely diagnosis?

. Subacromial impingement
. Internal impingement
. Multidirectional instability
. Adhesive capsulitis

Correct Answer & Explanation

. Subacromial impingement

Explanation

Internal impingement is a condition commonly seen in overhead athletes characterized by posterior shoulder pain in the late cocking phase (abduction and maximal external rotation). It involves pathologic contact between the articular surface of the rotator cuff and the posterosuperior glenoid labrum.

Question 3758

Topic: Knee Sports

A 55-year-old avid runner sustains an acute posterior root tear of the medial meniscus. If left untreated, this injury is biomechanically equivalent to which of the following?

. A total medial meniscectomy
. An isolated anterior cruciate ligament tear
. A medial collateral ligament avulsion
. Normal knee biomechanics

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A complete tear of the medial meniscus posterior root leads to a complete loss of meniscal hoop stresses. Biomechanically, this results in increased contact pressures and cartilage overload equivalent to a total medial meniscectomy, predisposing to rapid osteoarthritis.

Question 3759

Topic: Knee Sports

A 25-year-old rugby player receives a direct blow to the anteromedial aspect of the tibia. On examination, the dial test shows 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the uninjured side, but symmetric rotation at 90 degrees of flexion. Which structure is injured?

. Isolated posterior cruciate ligament
. Isolated posterolateral corner
. Combined posterior cruciate ligament and posterolateral corner
. Anterior cruciate ligament

Correct Answer & Explanation

. Isolated posterior cruciate ligament

Explanation

A positive dial test (increased external rotation of >10 degrees) at 30 degrees of flexion with a negative test at 90 degrees of flexion 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 3760

Topic: 5. Sports Medicine

A 19-year-old female collegiate soccer player is being evaluated in the clinic 4 weeks after sustaining a concussion. She complains of persistent headaches and "fogginess." Which of the following is the strongest predictor of a prolonged recovery (>14 days) in concussed athletes?

. Brief loss of consciousness at the time of injury
. Presence of retrograde amnesia
. High initial symptom severity on the SCAT assessment
. Male sex

Correct Answer & Explanation

. Brief loss of consciousness at the time of injury

Explanation

Numerous studies indicate that the initial symptom severity reported by the athlete in the first few days post-injury is the strongest and most consistent predictor of a prolonged recovery from concussion. Loss of consciousness and amnesia are poor predictive factors.

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