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5. Sports Medicine MCQs

Practice Set 236 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 4701

Topic: Knee Sports

A 16-year-old female soccer player undergoes primary ACL reconstruction with a bone-patellar tendon-bone autograft. Which of the following radiographic anatomical factors is most highly associated with an increased risk of primary ACL tear and subsequent graft failure?

. Increased posterior tibial slope
. Decreased Q angle
. Increased intercondylar notch width
. Decreased lateral tibial slope
. Patella baja

Correct Answer & Explanation

. Increased posterior tibial slope

Explanation

Increased posterior tibial slope is a well-documented independent risk factor for both primary anterior cruciate ligament (ACL) tears and subsequent ACL reconstruction graft failure. A steeper slope increases the anterior translational force on the tibia during axial loading, placing higher strain on the native ACL or the graft. Decreased intercondylar notch width (stenosis), not increased width, is also a recognized risk factor.

Question 4702

Topic: Shoulder & Hip Sports

A 19-year-old female gymnast presents with bilateral shoulder pain and a sensation of 'slipping.' Clinical examination demonstrates a positive sulcus sign and apprehension in multiple positions. Initial management has included 6 months of supervised physical therapy focusing on periscapular strengthening, with no improvement.

What is the most appropriate next step in management?

. Open anterior capsulolabral shift
. Arthroscopic capsular plication
. Latarjet procedure
. Remplissage procedure
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Arthroscopic capsular plication

Explanation

For multidirectional instability (MDI) that has failed an extensive (typically >6 months) course of physical therapy, capsular shift or plication is indicated. Arthroscopic capsular plication has become the modern gold standard, replacing open capsular shifts, yielding equivalent outcomes with less morbidity. The Latarjet procedure is reserved for recurrent anterior instability with significant anterior glenoid bone loss. Thermal capsulorrhaphy is no longer recommended due to high failure rates and capsular necrosis.

Question 4703

Topic: Knee Sports

A 45-year-old male recreational tennis player presents with acute posterior knee pain after a deep lunge. MRI reveals a complete radial tear of the posterior horn of the medial meniscus at its root attachment.

Biomechanically, this injury is equivalent to which of the following?

. A structurally intact meniscus
. A 50% partial meniscectomy
. A total meniscectomy
. An isolated ACL tear
. An isolated PCL tear

Correct Answer & Explanation

. A total meniscectomy

Explanation

A complete radial tear at the meniscal root completely disrupts the circumferential hoop stresses of the meniscus. Biomechanically, it leads to extrusion of the meniscus and an increase in peak tibiofemoral contact pressures that is equivalent to a total meniscectomy. This severely predisposes the knee to rapid articular cartilage degeneration and early-onset osteoarthritis if left untreated.

Question 4704

Topic: 5. Sports Medicine

A 14-year-old male baseball pitcher complains of lateral elbow pain. MRI reveals an osteochondritis dissecans (OCD) lesion of the capitellum with fluid tracking behind the subchondral bone, but the articular cartilage cap remains intact. What is the most appropriate surgical management?

. Fragment excision and microfracture
. In situ retrograde drilling
. Arthroscopic fragment fixation
. Osteochondral autograft transfer (OATS)
. Diagnostic arthroscopy and debridement only

Correct Answer & Explanation

. Arthroscopic fragment fixation

Explanation

The presence of fluid tracking behind the OCD fragment on MRI indicates an unstable lesion. Because the articular cartilage cap is intact and the patient is young, the fragment is salvageable. Unstable, salvageable OCD lesions are best treated with internal fixation (e.g., bioabsorbable pins or screws) to promote healing while preserving the native hyaline cartilage. Retrograde drilling is indicated for stable lesions without fluid tracking. Excision/microfracture or OATS are reserved for unsalvageable fragments or frank osteochondral defects.

Question 4705

Topic: Shoulder & Hip Sports

A 22-year-old female dancer complains of a painful, audible 'snap' in her lateral right hip when extending her hip from a flexed position. Clinical examination demonstrates a reproducible snap over the greater trochanter. An ultrasound-guided corticosteroid injection provided transient relief. What anatomical structure is most commonly implicated in this specific condition?

. Iliopsoas tendon
. Rectus femoris tendon
. Iliotibial band
. Ischiofemoral ligament
. Gluteus medius tendon

Correct Answer & Explanation

. Iliotibial band

Explanation

This clinical scenario describes external snapping hip syndrome (coxa saltans externa), which is caused by the iliotibial band (ITB) or the anterior border of the gluteus maximus snapping over the greater trochanter during hip flexion and extension. Internal snapping hip is caused by the iliopsoas tendon snapping over the iliopectineal eminence or the femoral head.

Question 4706

Topic: Knee Sports

A 17-year-old female suffers an acute lateral patellar dislocation. MRI shows a tear of the medial patellofemoral ligament (MPFL). During an MPFL reconstruction, identifying the isometric point on the femur is critical. According to Schöttle's radiographic landmarks, where is the anatomic femoral attachment of the MPFL on a true lateral radiograph?

. Anterior to the posterior cortical line of the femur and proximal to Blumensaat's line
. Anterior to the posterior cortical line of the femur and distal to Blumensaat's line
. Posterior to the posterior cortical line of the femur and proximal to Blumensaat's line
. Anterior to the posterior cortical line of the femur and strictly on Blumensaat's line
. Distal to the medial epicondyle

Correct Answer & Explanation

. Anterior to the posterior cortical line of the femur and proximal to Blumensaat's line

Explanation

Schöttle's point reliably identifies the femoral footprint of the MPFL on a true lateral radiograph. It is located 1.3 mm anterior to the posterior cortical line of the femur, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior aspect of Blumensaat's line. Misplacement of the femoral tunnel, particularly too proximal or anterior, leads to abnormal graft tensioning and high failure rates.

Question 4707

Topic: Shoulder & Hip Sports

A 38-year-old male construction worker presents with deep anterior shoulder pain, particularly when lifting heavy objects. An MRI reveals a type II SLAP (Superior Labrum Anterior and Posterior) tear. After failing 4 months of conservative management, he undergoes arthroscopic evaluation. Given his age and occupation, what is the most appropriate surgical management for an isolated type II SLAP tear?

. SLAP repair with suture anchors
. Biceps tenotomy
. Biceps tenodesis
. Debridement of the superior labrum only
. Coracoid transfer (Latarjet)

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In patients over the age of 35-40, particularly those with heavy manual labor occupations, primary biceps tenodesis is preferred over SLAP repair for type II SLAP tears. SLAP repairs in this older demographic have significantly higher rates of postoperative stiffness, residual pain, and subsequent revision surgery. Biceps tenodesis provides reliable pain relief while maintaining strength and avoiding the 'Popeye' deformity associated with tenotomy.

Question 4708

Topic: Knee Sports

A 26-year-old male sustains an isolated grade III posterior cruciate ligament (PCL) injury during a motorcycle collision. Biomechanically, the anterolateral (AL) bundle of the PCL is tightest in which position, and what is its primary role?

. Tightest in extension, primary restraint to posterior translation in extension
. Tightest in flexion, primary restraint to posterior translation in flexion
. Tightest in extension, primary restraint to internal rotation
. Tightest in flexion, primary restraint to external rotation
. Tightest in mid-flexion, primary restraint to varus stress

Correct Answer & Explanation

. Tightest in flexion, primary restraint to posterior translation in flexion

Explanation

The PCL consists of two main functional bundles: the anterolateral (AL) bundle and the posteromedial (PM) bundle. The AL bundle is larger and stronger, and it is tightest in knee flexion (typically between 80 to 90 degrees). Its primary role is to act as the primary restraint to posterior tibial translation when the knee is flexed. The PM bundle is tightest in knee extension.

Question 4709

Topic: Knee Sports

A 24-year-old professional rugby player undergoes a multiligament knee reconstruction, including an anatomic posterolateral corner (PLC) reconstruction using a fibular-based technique. During the creation of the fibular tunnel, the drill is passed from anterolateral to posteromedial.

Which of the following structures is at greatest risk of iatrogenic injury during this specific step, and what is its primary clinical manifestation if injured?

. Common peroneal nerve; weakness in ankle plantar flexion
. Common peroneal nerve; decreased sensation over the dorsum of the foot and weakness in ankle dorsiflexion
. Tibial nerve; decreased sensation over the plantar aspect of the foot
. Saphenous nerve; decreased sensation over the medial aspect of the leg
. Deep peroneal nerve; isolated weakness in great toe extension

Correct Answer & Explanation

. Common peroneal nerve; decreased sensation over the dorsum of the foot and weakness in ankle dorsiflexion

Explanation

The common peroneal nerve is intimately associated with the fibular head and neck. During anatomic posterolateral corner (PLC) reconstruction, creating the fibular tunnel (especially when dissecting distally on the fibular head or drilling from anterolateral to posteromedial) places the common peroneal nerve at significant risk. Injury to the common peroneal nerve leads to weakness in ankle dorsiflexion and eversion (foot drop) and decreased sensation over the anterolateral leg and the dorsum of the foot. The deep peroneal nerve branches further distally and isolated injury here during a fibular tunnel drill is less likely than a main trunk injury.

Question 4710

Topic: Shoulder & Hip Sports

A 19-year-old female collegiate gymnast presents with chronic, bilateral shoulder pain and a sensation of her shoulders 'sliding out of place' during routines. She denies any specific traumatic event. Physical examination reveals a 2+ sulcus sign bilaterally, positive apprehension, and positive relocation tests. If this patient fails a comprehensive 6-month physical therapy program emphasizing periscapular stabilization and proceeds to surgical intervention, what is the primary pathoanatomic target that must be addressed?

. A detached anterior labrum with associated periosteal stripping (Bankart lesion)
. An avulsed anteroinferior labrum with a medially displaced periosteal sleeve (ALPSA lesion)
. Rotator interval laxity and a patulous inferior capsule
. A bony defect of the anteroinferior glenoid exceeding 20% of the glenoid width
. A superior labral tear from anterior to posterior (SLAP type II)

Correct Answer & Explanation

. Rotator interval laxity and a patulous inferior capsule

Explanation

This patient's presentation is classic for multidirectional instability (MDI), which is primarily characterized by generalized capsular redundancy rather than a specific traumatic labral detachment. The essential pathoanatomy in MDI is a patulous inferior capsule and a widened rotator interval. Surgical management, if conservative measures fail, typically involves an arthroscopic or open inferior capsular shift to reduce capsular volume, combined with closure or plication of the rotator interval.

Question 4711

Topic: 5. Sports Medicine

A 22-year-old collegiate hockey player undergoes hip arthroscopy for symptomatic CAM-type femoroacetabular impingement (FAI). Intraoperatively, extensive osteochondroplasty of the femoral head-neck junction is performed to restore the femoral head-neck offset.

Three weeks postoperatively, the patient reports a sudden onset of severe groin pain and an inability to bear weight. What is the most likely catastrophic complication, and what is the generally accepted biomechanical threshold for the maximum recommended depth of the femoral neck resection to prevent it?

. Avascular necrosis; resection exceeding 10% of the femoral neck diameter
. Femoral neck fracture; resection exceeding 30% of the femoral neck diameter
. Heterotopic ossification; resection exceeding 20% of the femoral neck diameter
. Chondrolysis; resection exceeding 10% of the femoral neck diameter
. Hip dislocation; resection exceeding 30% of the femoral neck diameter

Correct Answer & Explanation

. Femoral neck fracture; resection exceeding 30% of the femoral neck diameter

Explanation

Extensive osteochondroplasty of the femoral head-neck junction can weaken the proximal femur, predisposing the patient to an iatrogenic femoral neck fracture. Biomechanical studies have demonstrated that resecting more than 30% of the femoral neck diameter significantly reduces the load to failure and dramatically increases the risk of postoperative fracture. Therefore, a 30% depth limit is strictly advised during CAM resection.

Question 4712

Topic: 5. Sports Medicine

During the 'ligamentization' process of a free tendon autograft used for an anterior cruciate ligament (ACL) reconstruction, what is the correct temporal sequence of the biologic phases?

. Necrosis, revascularization, cellular proliferation, remodeling
. Cellular proliferation, necrosis, revascularization, remodeling
. Revascularization, cellular proliferation, necrosis, remodeling
. Necrosis, cellular proliferation, remodeling, revascularization
. Remodeling, necrosis, cellular proliferation, revascularization

Correct Answer & Explanation

. Necrosis, revascularization, cellular proliferation, remodeling

Explanation

The ligamentization process of a free tendon autograft in ACL reconstruction typically occurs in four overlapping phases: necrosis, revascularization, cellular proliferation, and remodeling. Initially, the graft undergoes ischemic necrosis and cellular death. This is followed by a period of revascularization originating from the synovial tissue and infrapatellar fat pad, which supports cellular proliferation (fibroblast infiltration). The final phase is remodeling (maturation), where the collagen cross-linking and architecture adapt to resemble a native ligament, although it never fully regains the identical histological or mechanical properties of an intact ACL.

Question 4713

Topic: Knee Sports

When performing an anatomic reconstruction of the posterolateral corner (PLC) of the knee, identifying the exact femoral attachments is critical to restore native biomechanics. Which of the following describes the correct anatomic location of the fibular collateral ligament (FCL) origin relative to the popliteus tendon origin on the lateral femoral condyle?

. 10.6 mm distal and anterior
. 10.6 mm proximal and posterior
. 18.5 mm proximal and posterior
. 18.5 mm distal and anterior
. 5.0 mm proximal and anterior

Correct Answer & Explanation

. 18.5 mm proximal and posterior

Explanation

Based on quantitative anatomic studies by LaPrade et al., the femoral attachment of the fibular collateral ligament (FCL) is consistently located 18.5 mm proximal and 4.3 mm posterior to the popliteus tendon attachment on the lateral femoral condyle. Recognizing this relationship is crucial during anatomic PLC reconstructions to avoid graft anisometry and subsequent failure.

Question 4714

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability with significant anterior glenoid bone loss. Postoperatively, he has profound weakness in shoulder external rotation, but abduction initiation and elbow flexion are intact. Sensation over the lateral shoulder is normal. Which nerve was most likely injured, and what is the typical mechanism in this setting?

. Axillary nerve; during aggressive splitting of the subscapularis
. Musculocutaneous nerve; during vigorous retraction of the conjoined tendon
. Suprascapular nerve; due to posterior screw over-penetration injuring the nerve at the spinoglenoid notch
. Radial nerve; during exposure of the inferior glenoid neck
. Long thoracic nerve; during dissection medial to the coracoid process

Correct Answer & Explanation

. Suprascapular nerve; due to posterior screw over-penetration injuring the nerve at the spinoglenoid notch

Explanation

The patient exhibits isolated weakness in external rotation (infraspinatus) with intact abduction initiation (supraspinatus) and intact sensation. This points to a distal injury of the suprascapular nerve at the spinoglenoid notch. During a Latarjet procedure, if the coracoid graft screws are too long and directed too posteriorly or inferiorly, they can penetrate the posterior cortex of the glenoid neck and directly injure the suprascapular nerve as it courses toward the infraspinatus fossa. Musculocutaneous nerve injury is a common complication but would present with elbow flexion weakness. Axillary nerve injury would result in deltoid weakness and lateral sensory loss.

Question 4715

Topic: 5. Sports Medicine

A 26-year-old male hockey player undergoes hip arthroscopy for symptomatic femoroacetabular impingement (FAI). A prominent anterolateral cam lesion is identified and resected. To minimize the risk of a catastrophic post-operative femoral neck fracture, the maximum recommended depth of the osteochondroplasty relative to the native femoral neck diameter should not exceed:

. 10%
. 20%
. 30%
. 40%
. 50%

Correct Answer & Explanation

. 30%

Explanation

Biomechanical studies have demonstrated that resecting more than 30% of the anterolateral femoral neck diameter significantly alters the load-bearing capacity of the proximal femur. Exceeding this 30% threshold exponentially increases peak stresses, putting the patient at a highly elevated risk for an iatrogenic femoral neck fracture, especially in athletes returning to high-impact activities.

Question 4716

Topic: Shoulder & Hip Sports

A 45-year-old recreational tennis player presents with persistent deep shoulder pain. MRI arthrogram demonstrates an isolated Type II superior labrum anterior and posterior (SLAP) tear. He has failed 6 months of conservative management. According to current evidence-based guidelines, which surgical intervention provides the most reliable clinical outcomes and lowest revision rate for this patient demographic?

. Arthroscopic SLAP repair with suture anchors
. Biceps tenodesis
. Arthroscopic debridement of the superior labrum
. Biceps tenotomy
. Coracoid transfer (Latarjet)

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In patients older than 35-40 years with a symptomatic Type II SLAP tear, primary biceps tenodesis has been shown to have superior clinical outcomes, more reliable pain relief, and significantly lower revision and complication rates compared to arthroscopic SLAP repair. SLAP repair in this older demographic has a notably high risk of postoperative stiffness, persistent pain, and subsequent need for revision surgery.

Question 4717

Topic: Knee Sports

During reconstruction of the medial patellofemoral ligament (MPFL) for recurrent patellar instability, identifying the anatomic femoral attachment is critical to avoid graft anisometry. Radiographically, Schöttle's point is best described on a true lateral radiograph of the knee as:

. 1 mm posterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior notch
. 1 mm anterior to the posterior cortex extension line, 2.5 mm proximal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior notch
. 1 mm posterior to the posterior cortex extension line, 2.5 mm proximal to the posterior origin of the medial femoral condyle, and distal to the level of the posterior notch
. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior notch
. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and distal to the level of the posterior notch

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior notch

Explanation

Schöttle's point is the established radiographic landmark for the anatomic femoral origin of the MPFL. On a strict lateral radiograph, it is defined as: 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior origin (articular border) of the medial femoral condyle, and proximal to the posterior point of Blumensaat's line (the posterior notch).

Question 4718

Topic: 5. Sports Medicine



A 12-year-old boy sustains a knee injury while skiing. Radiographs reveal a completely displaced, non-comminuted fracture of the tibial eminence without hinging (Meyers and McKeever Type III injury). What is the most appropriate definitive management to restore joint kinematics and prevent long-term morbidity?

. Cast immobilization in 20 degrees of flexion for 6 weeks
. Immediate physical therapy focusing on hamstring strengthening
. Physeal-sparing ACL reconstruction using hamstring autograft
. Transphyseal ACL reconstruction using bone-patellar tendon-bone autograft
. Arthroscopic or open anatomic reduction and internal fixation

Correct Answer & Explanation

. Arthroscopic or open anatomic reduction and internal fixation

Explanation

Meyers and McKeever Type III tibial eminence (tibial spine) fractures are completely displaced. The standard of care for displaced Type III and Type IV (comminuted) injuries is anatomic reduction and internal fixation (using sutures, screws, or K-wires, often performed arthroscopically) to restore ACL tension and avoid a mechanical block to extension. Nonoperative management is reserved for non-displaced (Type I) or minimally displaced, reducible (Type II) fractures. Primary ACL reconstruction is not indicated for acute, fixable bony avulsions.

Question 4719

Topic: 5. Sports Medicine

A 25-year-old professional football player undergoes an isolated posterior cruciate ligament (PCL) reconstruction using an Achilles tendon allograft following a direct blow to the proximal tibia. Which of the following accurately describes the biomechanical properties of the native PCL bundles and the primary goal of a single-bundle reconstruction?

. The anterolateral bundle is tightest in extension; single-bundle reconstruction aims to recreate this bundle.
. The anterolateral bundle is tightest in flexion; single-bundle reconstruction aims to recreate this bundle.
. The posteromedial bundle is tightest in flexion; single-bundle reconstruction aims to recreate this bundle.
. The posteromedial bundle is tightest in extension; single-bundle reconstruction aims to recreate the anterolateral bundle.
. Both bundles maintain uniform tension throughout the knee's entire range of motion.

Correct Answer & Explanation

. The anterolateral bundle is tightest in flexion; single-bundle reconstruction aims to recreate this bundle.

Explanation

The native PCL consists of two distinct functional bundles: the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. Biomechanically, the AL bundle is tightest in knee flexion and provides the primary restraint to posterior tibial translation at 90 degrees of flexion. The PM bundle is tightest in extension and deep flexion. Standard single-bundle PCL reconstruction techniques aim to restore the larger and biomechanically dominant AL bundle to re-establish posterior stability in flexion, which is critical for athletic function.

Question 4720

Topic: Shoulder & Hip Sports

A 21-year-old collegiate rugby player presents with recurrent anterior shoulder instability, reporting four dislocation events this season. A representative imaging study demonstrates an 'off-track' engaging Hill-Sachs lesion and 22% anterior glenoid bone loss.

What is the most appropriate definitive management to minimize the risk of recurrence?

. Arthroscopic Bankart repair with superior capsule reconstruction
. Arthroscopic Bankart repair with Remplissage
. Open Bankart repair and inferior capsular shift
. Coracoid transfer to the anterior glenoid (Latarjet procedure)
. Arthroscopic labral repair using a minimum of 5 suture anchors

Correct Answer & Explanation

. Coracoid transfer to the anterior glenoid (Latarjet procedure)

Explanation

The patient has significant anterior glenoid bone loss (>20%) and an engaging, off-track Hill-Sachs lesion. Isolated soft-tissue procedures (arthroscopic or open Bankart repairs) have an unacceptably high failure rate in the setting of critical bone loss (>15-20%). The Latarjet procedure (transfer of the coracoid process with the attached conjoined tendon to the anterior glenoid) provides a triple blocking effect (bone block, sling effect of the conjoined tendon, and capsular repair) and is the standard of care for collision athletes with significant bipolar bone loss.

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