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 401
Topic: Shoulder & Hip Sports
A 35-year-old man arrives at the emergency department with a locked shoulder after suffering a grand mal seizure.
He holds his arm in internal rotation and cannot externally rotate. Which of the following osseous lesions is most likely to be present?
Correct Answer & Explanation
. Anteromedial humeral head impaction (Reverse Hill-Sachs lesion)
Explanation
Seizures classically cause posterior shoulder dislocations due to the overpowering strength of the internal rotators. This results in an impaction fracture on the anteromedial aspect of the humeral head, known as a reverse Hill-Sachs or McLaughlin lesion.
Question 402
Topic: Shoulder & Hip Sports
A 55-year-old laborer undergoes a massive, irreparable rotator cuff repair using a latissimus dorsi tendon transfer. For this transfer to be biomechanically effective and successful, which of the following prerequisites MUST be met?
Correct Answer & Explanation
. An intact and functional subscapularis
Explanation
A latissimus dorsi transfer relies on restoring the anterior-posterior force couple. Therefore, a functional and intact anterior cuff (subscapularis) is an absolute prerequisite for a successful outcome.
Question 403
Topic: 5. Sports Medicine
A 32-year-old bodybuilder feels a sudden 'pop' in his anterior chest wall while performing heavy bench presses. He has a loss of the anterior axillary fold and bruising over the medial arm. If operative repair is chosen, what is the anatomic footprint of the ruptured tendon?
Correct Answer & Explanation
. Lateral lip of the bicipital groove
Explanation
The pectoralis major tendon ruptures most commonly at its insertion onto the lateral lip of the bicipital groove of the humerus. Early surgical repair in active patients yields excellent functional results.
Question 404
Topic: Shoulder & Hip Sports
A 65-year-old woman with a massive rotator cuff tear undergoes repair. Six weeks postoperatively, she exhibits profound, isolated weakness of the anterior deltoid and reports a sudden inability to actively elevate her arm after a minor fall, although passive elevation is preserved. An axillary nerve injury is ruled out. What surgical complication most likely occurred?
Correct Answer & Explanation
. Avulsion of the deltoid origin from the acromion
Explanation
Isolated, profound loss of active elevation with preserved passive motion following an open or mini-open cuff repair can indicate failure of the deltoid repair (avulsion from the acromion), a devastating complication resulting in catastrophic anterior deltoid failure.
Question 405
Topic: Shoulder & Hip Sports
A patient is evaluated for Parsonage-Turner syndrome (idiopathic brachial neuritis). Which of the following clinical patterns is the classic hallmark of this condition?
Correct Answer & Explanation
. Acute, severe shoulder pain lasting days to weeks, followed by patchy muscle weakness and atrophy
Explanation
Parsonage-Turner syndrome is characterized by the sudden onset of intense, unremitting shoulder and arm pain that lasts for a few weeks, followed closely by weakness, paralysis, and atrophy of the upper extremity muscles (often the rotator cuff or periscapular muscles).
Question 406
Topic: Knee Sports
Studies have shown that anterior cruciate ligament (AC L) deficiency may result in abnormal meniscal strain found particularly in what region:
Correct Answer & Explanation
. Posterior horn of the medial meniscus
Explanation
While acute anterior cruciate ligament (AC L) injury alters the strain patterns in the lateral meniscus, chronic AC L insufficiency increases the strain in the medial meniscus and often results in tears of the posterior horn. In a study of 176 consecutive patients undergoing AC L reconstruction, there was an increasing incidence of meniscal tears as the AC L injury became more chronic with a significant increase in all medial meniscal tears and a relatively constant incidence of lateral meniscal tears.
Question 407
Topic: Knee Sports
When comparing women to men, the NC AA Injury Surveillance System has demonstrated a higher rate of injury to what structure:
Correct Answer & Explanation
. Anterior cruciate ligament (AC L)
Explanation
Anterior cruciate ligament injury has been observed to be 2 to 3 times more common in female basketball players than in their male counterparts. The higher risk of AC L injury in women may be related to laxity, larger Q angles, excessive pronation, increased hamstring flexibility, decreased notch width index, posture (less knee and hip flexion), and possible hormone influences.
Question 408
Topic: 5. Sports Medicine
When interference screws are used for femoral fixation during an endoscopic anterior cruciate ligament (ACL) reconstruction using autograft patellar tendon, how much divergence between the screw and bone plug is acceptable before pull-out strength is compromised to a clinically significant level?
Correct Answer & Explanation
. 30°
Explanation
Recent studies have indicated that nearly 40% of endoscopic anterior cruciate ligament reconstructions demonstrate screw-bone plug divergence. Divergence angles of less than 30° do not significantly alter pull-out strength clinically.
Question 409
Topic: Knee Sports
In anterior cruciate ligament (AC L) rehabilitation, closed-chain kinetic exercises are associated with all of the following except:
Correct Answer & Explanation
. Improve aerobic power and endurance in the leg
Explanation
Closed-chain exercises for the lower extremity have been shown to be effective following anterior cruciate ligament reconstruction for several reasons. They allow co-contraction of the muscles crossing the knee, stabilize the foot against resistance, apply compressive loads to the knee, and allow for hip motion for stability. Such exercises have not been shown to have any effect on the aerobic capacity of the leg.
Question 410
Topic: Knee Sports
In which of the following anatomic locations have authors described a characteristic MRI edema pattern lesion that occurs with an acute anterior cruciate ligament (AC L) injury:
Correct Answer & Explanation
. Posterolateral aspect of the tibia and the posteriar aspect of the lateral femoral condyle
Explanation
During anterior cruciate ligament (AC L) injury, anterior translation of the tibia and the associated valgus force create a compressive load on the articular cartilage in the posterolateral aspect of the tibia and the anterolateral aspect of the lateral femoral condyle. It has been estimated that approximately 80% of acute AC L injuries demonstrate this pattern on magnetic resonance imaging.
Question 411
Topic: Knee Sports
Six days following anterior cruciate ligament (AC L) reconstruction, a patient returns for follow-up with a fever of 102° F, local incisional drainage, painful decreased knee motion, effusion, erythema, and warmth in the knee. Aspiration of the knee reveals cloudy, blood-tinged synovial fluid. A white blood cell count of the aspirate was 60,000 with 85% polymorphonuclear cells. Appropriate management at this time should include:
Correct Answer & Explanation
. Immediate arthroscopic lavage with incision and drainage of all associated wounds, partial synovectomy, and debridement with graft retention.
Explanation
Although reported infection rates following anterior cruciate ligament (AC L) reconstruction are as low as 0.3%, the treatment of septic arthritis in the early postoperative period can be challenging. In a patient with a suspected infection, immediate arthroscopic lavage with debridement of necrotic tissue and partial synovectomy is paramount. In a recent review of 831 arthroscopically guided AC L reconstructions, McAllister and associates reported complete resolution of all four infected cases with early lavage, debridement, and graft retention followed by IV, then oral antibiotics. However, the clinical outcome of these patients was inferior to that of patients who had undergone uncomplicated AC L reconstruction due to the damage of the articular cartilage as a result of the infection.
Question 412
Topic: Knee Sports
Which of the following statements correctly describes the relationship of screw length to pull-out strength in anterior cruciate ligament (AC L) fixation using hamstring tendon graft fixation with soft tissue interference screws:
Correct Answer & Explanation
. Fixation strength has not been shown to be affected by screw length.
Explanation
A recent study compared the cyclic and time-zero pull-out forces of 7 25 mm and 7 40 mm blunt-threaded metal interference screws for hamstring graft tibial fixation in 8 paired human cadaveric specimens. There were no measurable differences in the mean cyclic failure strength, pull-out strength, or stiffness between the 2 sizes of screws. One potential advantage of using a longer screw is the relative ease with which it can be removed compared with a shorter screw should revision surgery become necessary.
Question 413
Topic: 5. Sports Medicine
Which of the following statements concerning allograft use in anterior cruciate ligament (AC L) reconstruction is incorrect:
Correct Answer & Explanation
. Allograft sterilization using gamma irradiation has not been shown to adversely affect its tensile properties.
Explanation
Secondary sterilization is achieved with the use of ethylene oxide or gamma irradiation, both of which have detrimental effects on the allograft. Ethylene oxide residues remain on the tissue and stimulate an intra-articular reaction. Gamma radiation has been shown to decrease structural and mechanical properties of the tissue. Irradiation also alters the collagen morphology of sterilized tissues. C urrently, the most accepted method of allograft sterilization involves sterile harvesting and deep freezing.
Question 414
Topic: Shoulder & Hip Sports
Which of the following choices represents the correct order of layers in the direct insertion of a human ligament:
Correct Answer & Explanation
. Bone, calcified fibrocartilage, uncalcified fibrocartilage, and ligament
Explanation
Histologic sectioning of a direct ligament insertion of rotator cuffs in cadavers demonstrates 4 discrete layers: ligament, uncalcified fibrocartilage layer, calcified fibrocartilage layer, and bone. Some authors have suggested that the uncalcified fibrocartilage ensures that the tendon fibers do not compress at a hard tissue interface.
Question 415
Topic: Knee Sports
Which of the following anatomic landmarks of the knee represents the contact area between the lateral femoral condyle and the anterior horn of the lateral meniscus when the knee is in full extension?
Correct Answer & Explanation
. Sulcus terminalis
Explanation
The indentation on the lateral femoral condyle often seen on the lateral radiograph of the knee represents the contact area between the femoral condyle and the anterior portion of the lateral meniscus and is often referred to as the sulcus terminalis. After an acute anterior cruciate ligament (ACL) injury or recurrent giving way episode in a chronically ACL deficient knee, the sulcus terminalis is the region in which a bone contusion is typically seen on a magnetic resonance image.
Question 416
Topic: Knee Sports
Which of the following initial treatment regimens is most appropriate for a 12-year-old boy with osteochondritis dissecans and no effusion or mechanical symptoms:
Correct Answer & Explanation
. Moderation of activities
Explanation
Arthroscopic treatment of osteochondritis dissecans is limited to those patients with mechanical symptoms, effusion, and/or radiographic evidence of loose bodies in the joint. Osteochondritis of the femoral condyle may well heal with moderation of activities.
Question 417
Topic: Knee Sports
A 25-year-old male sustains a twisting knee injury. Examination reveals a positive dial test at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees compared to the contralateral knee. Which structure is most likely isolated in this injury?
Correct Answer & Explanation
. Posterolateral corner
Explanation
An increase in external rotation of >10 degrees at 30 degrees of flexion, but not at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. Combined PLC and PCL injuries show increased external rotation at both 30 and 90 degrees.
Question 418
Topic: Knee Sports
A 50-year-old woman hears a "pop" in her knee while squatting. MRI demonstrates a medial meniscus posterior root tear with 4 mm of meniscal extrusion. Biomechanically, this injury is most equivalent to which of the following?
Correct Answer & Explanation
. Total medial meniscectomy
Explanation
A posterior root tear of the medial meniscus severely disrupts hoop stresses, rendering the meniscus functionally incompetent. Biomechanically, contact pressures and areas are equivalent to those seen after a total meniscectomy.
Question 419
Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, the femoral attachment is identified fluoroscopically using Schöttle's point. Where is this point located anatomically?
Correct Answer & Explanation
. Anterior to the posterior femoral cortical line and proximal to the Blumensaat line
Explanation
Schöttle's point is located 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the Blumensaat line. Proper placement is critical to maintain graft isometry.
Question 420
Topic: Knee Sports
The anterior cruciate ligament (ACL) is composed of two primary bundles. Which of the following best describes the tensioning pattern of the anteromedial (AM) and posterolateral (PL) bundles during normal knee range of motion?
Correct Answer & Explanation
. AM is tight in flexion, PL is tight in extension
Explanation
The AM bundle is primarily tight in knee flexion and controls anterior translation, whereas the PL bundle is tight in extension and provides rotational stability.
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