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5. Sports Medicine MCQs

Practice Set 235 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 4681

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he exhibits weakness in elbow flexion and supination, along with decreased sensation over the lateral aspect of the forearm. Which nerve was most likely injured during the procedure?

. Axillary nerve
. Musculocutaneous nerve
. Suprascapular nerve
. Median nerve
. Radial nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is at significant risk during the Latarjet procedure (coracoid transfer) due to its proximity to the conjoined tendon (coracobrachialis and short head of biceps). It typically penetrates the coracobrachialis 5 to 8 cm distal to the coracoid process. Injury to this nerve leads to weakness in elbow flexion (biceps, brachialis) and supination (biceps), as well as sensory loss in the distribution of the lateral antebrachial cutaneous nerve (lateral forearm).

Question 4682

Topic: 5. Sports Medicine

A 32-year-old professional basketball player presents with a symptomatic full-thickness focal chondral defect on the weight-bearing surface of the medial femoral condyle. The lesion measures 3.5 cm in diameter. He has failed conservative management and desires to return to high-impact sports. What is the most appropriate surgical intervention for this specific lesion?

. Microfracture.
. Osteochondral autograft transfer (OATS).
. Fresh osteochondral allograft transplantation.
. Arthroscopic debridement and lavage.
. High tibial osteotomy without cartilage restoration.

Correct Answer & Explanation

. Fresh osteochondral allograft transplantation.

Explanation

For large (>2 to 3 cm^2) full-thickness chondral or osteochondral defects in young, high-demand patients, fresh osteochondral allograft transplantation or Matrix-induced Autologous Chondrocyte Implantation (MACI) are the preferred treatments. Microfracture and OATS (autograft) are generally reserved for smaller lesions (<2 cm^2) due to the poorer biomechanical properties of fibrocartilage (microfracture) and donor site morbidity (OATS). Given the 3.5 cm diameter, fresh osteochondral allograft is highly indicated.

Question 4683

Topic: Shoulder & Hip Sports

A 28-year-old recreational volleyball player presents with deep shoulder pain and clicking. An MR arthrogram demonstrates a SLAP tear characterized by a bucket-handle tear of the superior labrum that extends into the long head of the biceps tendon. According to the Snyder classification, what type of SLAP tear is this?

. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

According to the Snyder classification of SLAP (Superior Labrum Anterior and Posterior) tears: Type I is superior labral fraying with an intact biceps anchor. Type II is detachment of the superior labrum and biceps anchor from the superior glenoid. Type III is a bucket-handle tear of the superior labrum with an intact biceps anchor. Type IV is a bucket-handle tear of the superior labrum that extends into the biceps tendon.

Question 4684

Topic: Knee Sports

A 17-year-old female is undergoing a medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar instability.

Intraoperative fluoroscopy is used to identify the anatomic femoral attachment of the MPFL (Schöttle's point). Which of the following radiographic descriptions best defines this exact location on a true lateral radiograph?

. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior articular border of the medial femoral condyle, and proximal to Blumensaat's line.
. 1 mm posterior to the posterior cortical line, 2.5 mm proximal to the posterior articular border, and distal to Blumensaat's line.
. 5 mm anterior to the posterior cortical line, located exactly on the midpoint of Blumensaat's line.
. Distal to Blumensaat's line and immediately anterior to the adductor tubercle.
. Proximal to the adductor tubercle and 5 mm posterior to the posterior cortical line.

Correct Answer & Explanation

. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior articular border of the medial femoral condyle, and proximal to Blumensaat's line.

Explanation

Schöttle's point is the radiographic landmark for the femoral origin of the MPFL on a true lateral radiograph. It is defined geometrically as: 1 mm anterior to a line extending the posterior cortex of the femoral shaft, 2.5 mm distal to a perpendicular line intersecting the posterior origin of the medial femoral condyle articular surface, and proximal to a perpendicular line intersecting the posterior extent of Blumensaat's line.

Question 4685

Topic: Knee Sports

A 24-year-old male presents with stiffness and loss of terminal knee flexion 6 months after an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Radiographs show the femoral tunnel positioned too anteriorly in the intercondylar notch. What is the primary clinical consequence of this specific tunnel malposition?

. Loss of terminal knee extension due to intercondylar roof impingement
. Loss of terminal knee flexion due to overtensioning of the graft
. Increased anterior tibial translation in full extension
. Patellar fracture due to increased extensor mechanism stress
. Postoperative arthrofibrosis isolated to the suprapatellar pouch

Correct Answer & Explanation

. Loss of terminal knee flexion due to overtensioning of the graft

Explanation

Non-anatomic graft placement is a leading cause of ACL reconstruction failure and stiffness. A femoral tunnel placed too anteriorly (high in the notch) results in the graft being overtensioned as the knee goes into flexion, functionally capturing the joint and causing a loss of terminal knee flexion. Conversely, a tibial tunnel placed too anteriorly leads to graft impingement against the intercondylar roof during extension, resulting in a loss of terminal knee extension.

Question 4686

Topic: Knee Sports

A 28-year-old soccer player sustains a twisting knee injury. Physical examination reveals a positive dial test at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees of knee flexion compared to the uninjured contralateral knee. Which of the following injury patterns is most consistent with these clinical findings?

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

Correct Answer & Explanation

. Combined PCL and PLC injury

Explanation

The dial test is used to evaluate injury to the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). An increase in external rotation of more than 10 degrees compared with the normal knee at 30 degrees of flexion, but not at 90 degrees, is indicative of an isolated PLC injury. If external rotation is increased at both 30 and 90 degrees of flexion, it indicates a combined injury to both the PLC and the PCL.

Question 4687

Topic: Shoulder & Hip Sports

A 20-year-old rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, the patient exhibits weakness with elbow flexion and forearm supination, accompanied by numbness over the lateral aspect of his forearm. Which nerve is most likely to have been injured during the retraction of the conjoint tendon?

. Axillary nerve
. Suprascapular nerve
. Musculocutaneous nerve
. Radial nerve
. Median nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is highly vulnerable during the Latarjet procedure, particularly during the mobilization and medial retraction of the conjoint tendon. It typically penetrates the coracobrachialis muscle 3 to 8 cm distal to the coracoid process. Injury to this nerve leads to denervation of the biceps brachii and brachialis (causing weakness in elbow flexion and supination) and sensory deficits in the lateral antebrachial cutaneous nerve distribution.

Question 4688

Topic: Knee Sports

When performing a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellofemoral instability, identifying the exact isometric femoral attachment point is critical to avoid overtensioning the graft during flexion. Radiographically, where is the anatomic femoral origin of the MPFL (Schöttle's point) located?

. Anterior to the adductor tubercle and proximal to the medial epicondyle
. In the saddle region between the adductor tubercle proximally and the medial epicondyle distally
. Posterior to the gastrocnemius tubercle
. Distal and anterior to the medial epicondyle
. Distal to the superficial medial collateral ligament insertion

Correct Answer & Explanation

. In the saddle region between the adductor tubercle proximally and the medial epicondyle distally

Explanation

The anatomic femoral insertion of the MPFL is located in a distinct saddle region that lies strictly between the adductor tubercle (proximal) and the medial epicondyle (distal). Schöttle et al. described this radiographically on a true lateral x-ray as 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior point of the Blumensaat line. Positioning the femoral tunnel non-anatomically, particularly too far proximally, will inappropriately overtension the graft during knee flexion.

Question 4689

Topic: Shoulder & Hip Sports

A 22-year-old elite collegiate baseball pitcher presents with vague posterior shoulder pain, a 'dead arm' sensation, and a decrease in pitching velocity.

He is diagnosed with a Type II superior labrum anterior and posterior (SLAP) tear. What biomechanical mechanism is primarily responsible for the propagation of this specific lesion during the throwing cycle?

. Internal impingement of the rotator cuff against the anterior-inferior glenoid
. The 'peel-back' mechanism of the biceps-labral complex in maximal external rotation and abduction
. Tensile failure of the long head of the biceps during the follow-through phase
. Eccentric contraction of the posterior rotator cuff during the deceleration phase
. Traction from the coracohumeral ligament during the early cocking phase

Correct Answer & Explanation

. The 'peel-back' mechanism of the biceps-labral complex in maximal external rotation and abduction

Explanation

Type II SLAP tears in overhead throwing athletes are primarily driven by the 'peel-back' mechanism, originally described by Burkhart and Morgan. During the late cocking phase, the arm is in a position of maximal abduction and external rotation. This shifts the vector of the biceps tendon posteriorly, generating significant torsional 'peel-back' forces at the superior labrum, causing it to detach from the superior glenoid rim.

Question 4690

Topic: Shoulder & Hip Sports

A 21-year-old collegiate hockey player complains of deep anterior groin pain exacerbated by hip flexion, adduction, and internal rotation (FADIR test).

An AP pelvis radiograph demonstrates a prominent 'crossover sign.' What specific morphological abnormality is most closely associated with this radiographic finding?

. An aspherical femoral head-neck junction (Cam morphology)
. Focal anterior acetabular overcoverage (Acetabular retroversion)
. Global acetabular overcoverage (Coxa profunda)
. Decreased femoral neck-shaft angle (Coxa vara)
. Increased femoral anteversion

Correct Answer & Explanation

. Focal anterior acetabular overcoverage (Acetabular retroversion)

Explanation

The 'crossover sign' on a properly aligned anteroposterior (AP) pelvis radiograph represents the anterior wall of the acetabulum crossing over the posterior wall before reaching the lateral sourcil. It is the hallmark radiographic indicator of acetabular retroversion, which results in focal anterior overcoverage and predisposes the patient to pincer-type femoroacetabular impingement (FAI).

Question 4691

Topic: Knee Sports

A 45-year-old recreational runner sustains a sudden pop in the posterior aspect of his knee while descending stairs. MRI confirms a complete radial tear immediately adjacent to the medial meniscus posterior root attachment. If managed conservatively, the knee biomechanics will be altered. The resulting tibiofemoral contact mechanics are most equivalent to which of the following conditions?

. A 20% partial medial meniscectomy
. An isolated anterior cruciate ligament tear
. A total medial meniscectomy
. An isolated medial collateral ligament tear
. A focal chondral defect of the medial femoral condyle

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

The posterior root anchors the medial meniscus, allowing it to convert axial loads into circumferential hoop stresses. A complete tear of the meniscal root disrupts this structural continuity, resulting in meniscal extrusion. Biomechanical studies have demonstrated that a medial meniscus posterior root tear leads to a complete loss of meniscal load-sharing ability, causing peak contact pressures in the medial compartment to increase to levels functionally equivalent to those seen after a total medial meniscectomy, accelerating the onset of osteoarthritis.

Question 4692

Topic: Knee Sports

A 13-year-old male gymnast complains of intermittent right knee swelling, pain, and mechanical catching.

Radiographs demonstrate a classic presentation of osteochondritis dissecans (OCD) in the knee. What is the most common anatomic location for this pathology?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Lateral aspect of the lateral femoral condyle
. Central trochlear groove

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

Osteochondritis dissecans (OCD) of the knee predominantly affects the femoral condyles. By far the most common location, accounting for roughly 70-80% of all cases, is the lateral aspect of the medial femoral condyle (often remembered by the acronym LAME - Lateral Aspect Medial Epicondyle/Condyle). This is thought to be related to repetitive microtrauma from the tibial spine impinging upon the condyle during internal tibial rotation.

Question 4693

Topic: Knee Sports

During an anatomic single-bundle anterior cruciate ligament (ACL) reconstruction, identifying the native footprint is critical. With the knee in 90 degrees of flexion, the native ACL femoral footprint is located immediately posterior to which of the following arthroscopic bony landmarks?

. Lateral bifurcate ridge
. Lateral intercondylar ridge (Resident's ridge)
. Medial intercondylar ridge
. Posterior cruciate ligament facet
. Gerdy's tubercle

Correct Answer & Explanation

. Lateral intercondylar ridge (Resident's ridge)

Explanation

The lateral intercondylar ridge, also known as resident's ridge, is the most consistent and reliable anatomic landmark for identifying the anterior border of the ACL on the lateral femoral condyle. The entire ACL femoral footprint is located posterior to this ridge. The lateral bifurcate ridge separates the anteromedial (AM) and posterolateral (PL) bundles of the ACL, but it is less consistently identified than the lateral intercondylar ridge.

Question 4694

Topic: Knee Sports

A 50-year-old female presents with acute medial knee pain and a popping sensation after squatting. MRI reveals a posterior medial meniscus root tear. Biomechanical studies have shown that a complete medial meniscus posterior root tear alters knee joint kinematics most similarly to which of the following?

. Complete ACL tear
. Total medial meniscectomy
. Partial medial meniscectomy
. Complete MCL tear
. Total lateral meniscectomy

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A complete tear of the posterior root of the medial meniscus leads to the complete loss of circumferential hoop stresses within the meniscus, resulting in meniscal extrusion under load. Biomechanical cadaveric studies have demonstrated that this increases peak contact pressures and decreases contact area in the medial compartment to levels equivalent to those seen after a total medial meniscectomy. This accelerates the progression of osteoarthritis if left untreated.

Question 4695

Topic: 5. Sports Medicine

A 24-year-old hockey player underwent right hip arthroscopy for femoroacetabular impingement (cam and pincer resection with labral repair) 3 weeks ago.

He now complains of numbness over the dorsum of his right foot and difficulty extending his toes. Which of the following intraoperative factors most likely contributed to this specific complication?

. Excessive medial portal placement
. Prolonged traction time exceeding 2 hours
. Over-resection of the anterior superior acetabular rim
. Damage to the lateral femoral cutaneous nerve during portal placement
. Fluid extravasation into the retroperitoneal space

Correct Answer & Explanation

. Prolonged traction time exceeding 2 hours

Explanation

The patient's symptoms (dorsal foot numbness, weak toe extension) are classic for a common peroneal nerve neuropraxia, which is a branch of the sciatic nerve. During hip arthroscopy, prolonged traction places the pudendal and sciatic nerves at significant risk for neuropraxia. It is generally recommended to limit traction time to less than 2 hours and use a traction force of less than 50 pounds. Damage to the lateral femoral cutaneous nerve (often during anterolateral portal placement) would cause anterolateral thigh numbness, not foot symptoms.

Question 4696

Topic: Knee Sports

A 17-year-old female experiences recurrent lateral patellar instability, and a medial patellofemoral ligament (MPFL) reconstruction is planned.

To maintain proper graft isometry, the femoral tunnel must be placed accurately at the anatomic footprint. Radiographically, Schöttle's point is best described on a true lateral view as being located:

. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line
. 1 mm anterior to the posterior cortex extension line, 2.5 mm proximal to the posterior articular border, and proximal to Blumensaat's line
. 1 mm posterior to the posterior cortex extension line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line
. Anterior to Blumensaat's line and distal to the adductor tubercle
. Directly at the apex of the medial epicondyle

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line

Explanation

Schöttle's point is a radiographic landmark for the anatomic femoral origin of the MPFL. On a strict true lateral radiograph, it is identified as 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior border of the medial femoral condyle articular surface, and proximal to the posterior extent of Blumensaat's line. Placing the graft at this isometric point prevents over-constraining the patellofemoral joint during flexion.

Question 4697

Topic: Shoulder & Hip Sports

A 19-year-old female collegiate swimmer presents with bilateral shoulder pain and a sensation of "looseness" during her butterfly stroke. Physical examination reveals a positive Beighton score, positive sulcus signs bilaterally that do not reduce with external rotation, and apprehension with both anterior and posterior translation. What is the most appropriate initial management?

. Arthroscopic capsular plication
. Open inferior capsular shift
. Thermal capsulorrhaphy
. Scapular stabilization and rotator cuff strengthening program
. Immobilization in external rotation for 4 weeks

Correct Answer & Explanation

. Scapular stabilization and rotator cuff strengthening program

Explanation

This patient presents with multidirectional instability (MDI) of the shoulder, characterized by generalized ligamentous laxity and a positive sulcus sign. The hallmark of initial management for MDI is a comprehensive, prolonged physical therapy program (typically 3 to 6 months) focusing on strengthening the dynamic stabilizers of the shoulder, particularly the periscapular muscles and rotator cuff. Surgical intervention (such as an open or arthroscopic capsular shift/plication) is reserved for patients who fail an extended course of rigorous nonoperative management.

Question 4698

Topic: 5. Sports Medicine

A 45-year-old manual laborer undergoes shoulder arthroscopy for a massive, irreparable rotator cuff tear with significant long head of the biceps (LHB) tenosynovitis.

Which of the following is an established advantage of performing a biceps tenotomy instead of a biceps tenodesis in this patient population?

. Lower rate of cosmetic deformity (Popeye sign)
. Decreased risk of postoperative cramping and fatigue
. Lower complication rate related to implant failure and postoperative stiffness
. Better preservation of elbow flexion strength
. Superior restoration of forearm supination strength

Correct Answer & Explanation

. Lower rate of cosmetic deformity (Popeye sign)

Explanation

Biceps tenotomy is technically simpler, faster, and avoids the use of implants, thereby eliminating the risk of implant-related failure and pain at the tenodesis site. It also allows for immediate, unrestricted rehabilitation and is associated with a lower incidence of postoperative stiffness. Conversely, tenodesis is associated with a lower rate of cosmetic deformity (Popeye muscle) and cramping. Biomechanical studies have generally shown no clinically significant difference in final elbow flexion or supination strength between tenodesis and tenotomy in non-elite athletes.

Question 4699

Topic: Knee Sports

A 14-year-old male gymnast complains of chronic lateral elbow pain and mechanical catching for the past 6 months. Radiographs demonstrate a radiolucent defect in the capitellum. MRI reveals a fragmented, unstable 1.2 cm osteochondral lesion with fluid tracking behind the fragment. What is the most appropriate definitive management?

. Rest and complete cessation of gymnastics for 6 months
. Corticosteroid injection into the radiocapitellar joint
. Arthroscopic fragment excision and marrow stimulation (microfracture)
. Ulnar collateral ligament reconstruction
. Open reduction and internal fixation with compression screws

Correct Answer & Explanation

. Arthroscopic fragment excision and marrow stimulation (microfracture)

Explanation

The patient has osteochondritis dissecans (OCD) of the capitellum. While nonoperative management (rest, cessation of throwing/weight-bearing) is indicated for stable lesions in patients with open physes, this patient has mechanical symptoms and an MRI showing fluid behind a fragmented lesion, indicating instability. For unstable, non-reconstructable fragments smaller than 1.5 cm, arthroscopic excision, loose body removal, and marrow stimulation (microfracture) of the base is the standard of care to stimulate fibrocartilage repair.

Question 4700

Topic: Knee Sports

The posterior cruciate ligament (PCL) consists of two functional bundles: the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. Which of the following statements accurately describes their respective biomechanical tensioning patterns during knee range of motion?

. The AL bundle is tightest in extension and the PM bundle is tightest in flexion
. The AL bundle is tightest in flexion and the PM bundle is tightest in extension
. Both bundles are maximally taut in full extension
. Both bundles are maximally taut in deep flexion
. The AL bundle primarily restrains valgus stress while the PM bundle restrains varus stress

Correct Answer & Explanation

. The AL bundle is tightest in flexion and the PM bundle is tightest in extension

Explanation

The PCL is the primary restraint to posterior tibial translation. The anterolateral (AL) bundle is the larger and stiffer of the two; it is relatively lax in extension and becomes tight in flexion (maximally taut around 80-90 degrees). The smaller posteromedial (PM) bundle exhibits the opposite pattern: it is tight in full extension and becomes lax as the knee flexes. This reciprocal tensioning allows the PCL to function effectively throughout the entire arc of motion.

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