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5. Sports Medicine MCQs

Practice Set 237 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 4721

Topic: Knee Sports

A 45-year-old marathon runner feels a sharp 'pop' in the posterior aspect of his knee while performing a deep squat. MRI reveals a posterior root tear of the medial meniscus. Radiographs show no significant osteoarthritis (Kellgren-Lawrence grade 1). Which of the following best describes the biomechanical consequence of leaving this tear untreated?

. It decreases peak tibiofemoral contact pressures by 25%.
. It alters knee kinematics similar to an anterior cruciate ligament tear.
. It is biomechanically equivalent to a total medial meniscectomy.
. It leads to isolated patellofemoral compartment overload.
. It restricts internal rotation of the tibia during terminal knee extension.

Correct Answer & Explanation

. It is biomechanically equivalent to a total medial meniscectomy.

Explanation

A posterior root tear of the medial meniscus disrupts the circumferential hoop stresses that normally distribute axial loads across the joint. Biomechanical studies have demonstrated that a medial meniscus posterior root tear is functionally and biomechanically equivalent to a total medial meniscectomy. This results in significantly decreased contact area and increased peak contact pressures, leading to rapid chondral wear and extrusion of the meniscus if left unmanaged. Surgical repair is indicated in active patients without advanced osteoarthritis.

Question 4722

Topic: 5. Sports Medicine

A 9-year-old gymnast sustains an acute anterior cruciate ligament (ACL) rupture confirmed by MRI. She is Tanner stage 1 with wide-open physes and substantial remaining growth. She experiences recurrent giving-way episodes during daily activities despite a rigorous conservative management trial. Which of the following surgical techniques is most appropriate to minimize the risk of iatrogenic growth arrest?

. Transphyseal bone-patellar tendon-bone autograft
. Iliotibial band extra-articular physeal-sparing reconstruction
. Standard transphyseal hamstring autograft with interference screws
. All-inside ACL reconstruction using suspensory fixation on the tibial side only
. Primary repair of the ACL with rigid internal bracing

Correct Answer & Explanation

. Iliotibial band extra-articular physeal-sparing reconstruction

Explanation

In prepubescent children with wide-open physes (Tanner stage 1 or 2), standard transphyseal ACL reconstructions carry a significant risk of physeal injury, potentially leading to limb length discrepancy or angular deformity. Physeal-sparing techniques, such as the iliotibial band (ITB) extra-articular reconstruction (e.g., MacIntosh or modified MacIntosh procedure), are highly recommended. These techniques avoid drilling across the distal femoral and proximal tibial physes while restoring knee stability.

Question 4723

Topic: Shoulder & Hip Sports

A 26-year-old professional hockey player presents with chronic groin pain exacerbated by hip flexion, adduction, and internal rotation. Radiographs demonstrate an alpha angle of 65 degrees on the Dunn lateral view. Which of the following best describes the pathophysiology and typical location of the primary osseous deformity?

. Pincer impingement due to focal retroversion of the acetabulum
. Cam impingement due to an osseous prominence at the anterosuperior femoral head-neck junction
. Cam impingement due to an osseous prominence at the posteroinferior femoral head-neck junction
. Pincer impingement due to global acetabular overcoverage
. Combined impingement primarily driven by excessive femoral anteversion

Correct Answer & Explanation

. Cam impingement due to an osseous prominence at the anterosuperior femoral head-neck junction

Explanation

An alpha angle greater than 50-55 degrees is diagnostic of Cam-type femoroacetabular impingement (FAI). Cam morphology is characterized by an aspherical femoral head with an osseous bump or decreased offset, most commonly located at the anterosuperior aspect of the femoral head-neck junction. During hip flexion and internal rotation, this prominence is driven into the acetabulum, causing shear forces on the anterosuperior labrum and adjacent articular cartilage. Pincer impingement refers to acetabular overcoverage, not femoral-sided deformities.

Question 4724

Topic: Knee Sports

A 17-year-old female dancer suffers her third lateral patellar dislocation. Evaluation reveals normal lower extremity alignment and a tibial tubercle-trochlear groove (TT-TG) distance of 14 mm. An isolated medial patellofemoral ligament (MPFL) reconstruction is planned.

Which of the following statements is true regarding the biomechanics of the MPFL?

. It is the primary restraint to lateral patellar translation at 90 degrees of knee flexion.
. Its femoral origin is located anterior to the medial epicondyle and distal to the adductor tubercle.
. Its isolated rupture is rarely associated with acute lateral patellar dislocations.
. It provides the greatest restraint to lateral patellar translation from 0 to 30 degrees of knee flexion.
. Over-tensioning the graft will cause a medial patellar subluxation exclusively in deep flexion.

Correct Answer & Explanation

. It provides the greatest restraint to lateral patellar translation from 0 to 30 degrees of knee flexion.

Explanation

The medial patellofemoral ligament (MPFL) is the primary passive soft-tissue restraint against lateral patellar translation, providing 50% to 60% of the total restraining force from 0 to 30 degrees of knee flexion. Beyond 30 degrees of flexion, the patella engages the trochlear groove, and bony architecture becomes the primary stabilizer. The anatomic femoral origin of the MPFL (Schottle's point) is located between the medial epicondyle and the adductor tubercle. Over-tensioning an MPFL graft typically restricts flexion and increases medial compartment contact pressures.

Question 4725

Topic: Shoulder & Hip Sports

A 32-year-old male weightlifter presents with vague posterior shoulder pain and selective weakness in external rotation. An MRI reveals a large paralabral cyst located strictly in the spinoglenoid notch, extending from a posterior superior labral tear. Based on the anatomic location of this cyst, which examination finding is most expected?

. Weakness in abduction with isolated atrophy of the supraspinatus
. Weakness in internal rotation with a positive lift-off test
. Weakness in external rotation with isolated atrophy of the infraspinatus
. Paresthesias in the lateral aspect of the upper arm
. Winging of the scapula with forward elevation

Correct Answer & Explanation

. Weakness in external rotation with isolated atrophy of the infraspinatus

Explanation

Paralabral cysts associated with superior or posterior labral tears can compress the suprascapular nerve. The location of the compression dictates the clinical deficit. Compression at the suprascapular notch affects both the supraspinatus and infraspinatus muscles. However, compression strictly at the spinoglenoid notch affects the nerve after it has already given off its motor branches to the supraspinatus. Therefore, it results in isolated denervation and atrophy of the infraspinatus, leading to weakness in external rotation with preserved abduction.

Question 4726

Topic: Knee Sports

A 28-year-old downhill skier sustains a high-energy multi-ligamentous knee dislocation (KD-III L) involving the anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner. In the emergency department, the patient exhibits a complete foot drop and cannot actively extend the toes. Given the expected nerve injury, which of the following sensory deficits is most likely to accompany this motor finding?

. Numbness over the medial aspect of the lower leg and medial malleolus
. Numbness over the dorsum of the foot and the lateral aspect of the lower leg
. Numbness isolated to the plantar aspect of the foot and heel
. Numbness over the posterior calf and lateral aspect of the fifth toe
. Numbness extending into the anterior thigh

Correct Answer & Explanation

. Numbness over the dorsum of the foot and the lateral aspect of the lower leg

Explanation

Knee dislocations involving the posterolateral corner have a high association (up to 40%) with common peroneal nerve injury due to traction or direct trauma as the nerve winds around the fibular neck. The common peroneal nerve bifurcates into the deep and superficial peroneal nerves. Injury results in loss of ankle dorsiflexion and toe extension (foot drop) and a sensory deficit over the lateral aspect of the lower leg (superficial peroneal nerve) and the dorsum of the foot, specifically including the first web space (deep peroneal nerve). Medial numbness indicates saphenous nerve involvement, while plantar numbness suggests tibial nerve injury.

Question 4727

Topic: Knee Sports

A 25-year-old male sustains a severe twisting injury to his right knee while playing soccer. On physical examination, the dial test reveals 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of knee flexion, the dial test shows 20 degrees of increased external rotation compared to the normal knee. Based on these examination findings, which of the following injury patterns is most likely present?

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

Correct Answer & Explanation

. Combined injury to the posterolateral corner and posterior cruciate ligament

Explanation

The dial test is utilized to evaluate for posterolateral instability. Increased external rotation (>10 degrees compared to the contralateral side) isolated at 30 degrees of flexion indicates an isolated posterolateral corner (PLC) injury. However, if there is increased external rotation at both 30 degrees and 90 degrees of flexion, it signifies a combined injury to both the PLC and the posterior cruciate ligament (PCL). Isolated PCL injuries may show slight asymmetry at 90 degrees but are not the primary driver of the marked external rotation seen in combined injuries.

Question 4728

Topic: 5. Sports Medicine

A 28-year-old male undergoes right hip arthroscopy for femoroacetabular impingement (cam lesion and labral tear). The procedure requires 90 minutes of traction. In the recovery room, he complains of numbness over the dorsum of his right foot and demonstrates weakness in ankle dorsiflexion. What is the most likely pathophysiologic mechanism for this specific complication?

. Direct trocar injury to the femoral nerve during portal placement
. Neuropraxia of the sciatic nerve (peroneal division) secondary to excessive longitudinal traction
. Pudendal nerve palsy due to prolonged compression against a poorly padded perineal post
. Extravasation of irrigation fluid into the retroperitoneal space compressing the lumbosacral plexus
. Ischemic insult to the anterior tibial artery from prolonged positioning

Correct Answer & Explanation

. Neuropraxia of the sciatic nerve (peroneal division) secondary to excessive longitudinal traction

Explanation

Sciatic nerve palsy, specifically affecting the peroneal division, is a known complication of hip arthroscopy related to excessive or prolonged longitudinal traction. The peroneal division is more susceptible to stretch injury because it is tethered at both the sciatic notch and the fibular head. Pudendal nerve injury is also a well-known complication but presents with perineal numbness or sexual dysfunction, driven by compression against the perineal post rather than traction.

Question 4729

Topic: Knee Sports

A 50-year-old active female experiences a 'pop' in the back of her knee while descending stairs. An MRI demonstrates a complete radial tear at the posterior root of the medial meniscus with no significant osteoarthritis (Outerbridge grade II). If left untreated, what is the primary biomechanical consequence of this specific injury pattern?

. Increased anterior tibial translation during the pivot shift test
. Altered patellofemoral tracking leading to lateral facet overload
. Complete loss of meniscal hoop stresses, resulting in tibiofemoral contact pressures equivalent to a total meniscectomy
. Increased varus alignment due to failure of the lateral collateral ligament
. Decreased internal rotation of the tibia on the femur during the gait cycle

Correct Answer & Explanation

. Complete loss of meniscal hoop stresses, resulting in tibiofemoral contact pressures equivalent to a total meniscectomy

Explanation

A complete meniscal root tear disrupts the circumferential collagen fibers of the meniscus. Biomechanically, this results in meniscal extrusion under axial load and a complete loss of meniscal hoop stresses. The resulting peak tibiofemoral contact pressures in the affected compartment are equivalent to those seen after a total meniscectomy, leading to rapid progression of articular cartilage degeneration.

Question 4730

Topic: 5. Sports Medicine

A 35-year-old recreational athlete sustains an acute, closed Achilles tendon rupture. He is evaluating treatment options with his orthopedic surgeon. Based on current high-level evidence and AAOS guidelines regarding the comparison between operative and nonoperative management utilizing modern early functional rehabilitation protocols, which of the following statements is most accurate?

. Operative management has a significantly higher rate of deep vein thrombosis compared to nonoperative management.
. Nonoperative management has a significantly higher rate of rerupture even when early functional rehabilitation is utilized.
. Operative management is associated with a higher risk of sural nerve injury and wound-related complications, with similar rerupture rates.
. Nonoperative management leads to a clinically significant, permanent reduction in plantarflexion strength at 1 year.
. Operative management eliminates the need for postoperative bracing and allows immediate full weight-bearing barefoot.

Correct Answer & Explanation

. Operative management is associated with a higher risk of sural nerve injury and wound-related complications, with similar rerupture rates.

Explanation

Recent high-level randomized controlled trials and meta-analyses have demonstrated that when a strict, early functional rehabilitation protocol is employed, the rerupture rates between operative and nonoperative management of acute Achilles tendon ruptures are statistically similar. However, operative management carries a higher risk of surgical complications, including wound infections, delayed healing, and sural nerve injury.

Question 4731

Topic: Shoulder & Hip Sports

A 42-year-old recreational tennis player presents with vague, deep anterior shoulder pain exacerbated by overhead serving. Examination reveals a positive O'Brien's test and dynamic labral shear test. MRI arthrogram confirms an isolated type II SLAP tear. After 6 months of failed conservative management, surgical intervention is planned. Based on recent literature for patients in this age demographic (>40 years), which procedure is recommended to minimize postoperative stiffness and maximize the rate of return to sport?

. Arthroscopic SLAP repair using multiple knotless suture anchors
. Arthroscopic debridement of the superior labrum without stabilization
. Subpectoral or arthroscopic biceps tenodesis
. Biceps tenotomy without tenodesis
. Arthroscopic capsulorrhaphy and coracoid transfer

Correct Answer & Explanation

. Subpectoral or arthroscopic biceps tenodesis

Explanation

In patients older than 35 to 40 years of age with symptomatic Type II SLAP tears that fail conservative treatment, biceps tenodesis is highly favored over SLAP repair. Studies have shown that SLAP repair in this older demographic is associated with higher rates of postoperative stiffness, lower patient satisfaction, and a higher rate of revision surgery compared to primary biceps tenodesis.

Question 4732

Topic: Knee Sports

A 17-year-old female presents with recurrent lateral patellar instability.

Radiographs demonstrate a Caton-Deschamps ratio of 1.1 and normal trochlear depth. A CT scan measures the tibial tubercle-trochlear groove (TT-TG) distance at 14 mm. MRI reveals an incompetent medial patellofemoral ligament (MPFL) with no loose bodies. What is the most appropriate surgical management for this patient?

. Isolated MPFL reconstruction
. Tibial tubercle medialization osteotomy
. Tibial tubercle distalization osteotomy
. Sulcus-deepening trochleoplasty
. Lateral retinacular release alone

Correct Answer & Explanation

. Isolated MPFL reconstruction

Explanation

This patient has recurrent patellar instability with an incompetent MPFL, which is the primary restraint to lateral patellar translation at early flexion. Her anatomic risk factors are within normal limits: a normal TT-TG distance (<20 mm indicates no need for medialization), normal patellar height (Caton-Deschamps ratio 0.8-1.2, no need for distalization), and no significant trochlear dysplasia. Therefore, isolated MPFL reconstruction is the most appropriate and biomechanically sound surgical treatment.

Question 4733

Topic: 5. Sports Medicine

A 23-year-old male presents with a re-rupture of his hamstring autograft anterior cruciate ligament (ACL) reconstruction, sustained during a non-contact pivoting event 2 years postoperatively.

Standing lateral knee radiographs demonstrate a posterior tibial slope (PTS) of 16 degrees. He is planned for a revision ACL reconstruction. To minimize the risk of a second graft failure, which of the following concomitant procedures is most strongly indicated based on his radiographic findings?

. High tibial opening wedge osteotomy
. Anterior closing wedge osteotomy of the proximal tibia
. Lateral extra-articular tenodesis (LET) alone without osteotomy
. Distal femoral extension osteotomy
. Medial meniscal allograft transplantation

Correct Answer & Explanation

. Anterior closing wedge osteotomy of the proximal tibia

Explanation

An abnormally increased posterior tibial slope (PTS), typically defined as greater than 12 to 14 degrees, is a significant biomechanical risk factor for ACL graft failure because it dramatically increases the anterior shear forces on the tibia during axial loading. In the setting of a revision ACL reconstruction with a high PTS (>12-14 degrees), an anterior closing wedge osteotomy of the proximal tibia is indicated to flatten the slope, thereby protecting the revision graft.

Question 4734

Topic: 5. Sports Medicine

A 52-year-old female presents with the sudden onset of posteromedial knee pain and a "pop" that occurred while deep squatting to lift a box. She has no significant history of knee pain. An MRI scan reveals a medial meniscus extrusion of 4 mm and a radial defect at the posterior root attachment. What is the most appropriate management to prevent the rapid progression of osteoarthritis in this patient?

. Arthroscopic partial meniscectomy
. Nonoperative management with physical therapy and NSAIDs
. Arthroscopic transtibial pull-out repair of the meniscus root
. Meniscal allograft transplantation
. High tibial osteotomy

Correct Answer & Explanation

. Arthroscopic transtibial pull-out repair of the meniscus root

Explanation

Medial meniscus posterior root tears result in the loss of hoop stresses, rendering the knee biomechanically similar to a total meniscectomy. This leads to increased peak contact pressures and rapid progression of osteoarthritis. In a patient without severe pre-existing osteoarthritis, the recommended treatment is surgical repair, commonly utilizing a transtibial pull-out technique or suture anchors, to restore meniscal hoop stresses.

Question 4735

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player presents with recurrent anterior shoulder instability. A 3D reconstructed CT scan reveals a 26% anterior glenoid bone loss with an engaging Hill-Sachs lesion. What is the most appropriate surgical management to minimize his risk of recurrent instability?

. Arthroscopic Bankart repair with suture anchors
. Arthroscopic Bankart repair with remplissage
. Latarjet procedure (coracoid transfer)
. Open capsular shift
. Humeral head osteochondral allograft

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

Critical anterior glenoid bone loss (>20-25%) in a contact athlete is an indication for a bony augmentation procedure. Soft-tissue repairs alone (like a Bankart repair) have an unacceptably high failure rate in the setting of critical bone loss. The Latarjet procedure transfers the coracoid process and the attached conjoint tendon to the anterior glenoid, providing both a bony block and a dynamic sling effect.

Question 4736

Topic: Shoulder & Hip Sports

A 24-year-old minor league baseball pitcher presents with chronic posterior shoulder pain during the late cocking phase of throwing. Physical examination reveals a 25-degree loss of internal rotation (GIRD) compared to the contralateral shoulder, with normal total arc of motion.

What is the most appropriate initial management for this condition?

. Arthroscopic posteroinferior capsular release
. Arthroscopic superior labrum anterior-posterior (SLAP) repair
. Physical therapy focusing on sleeper stretches
. Subacromial corticosteroid injection
. Open anterior capsulorrhaphy

Correct Answer & Explanation

. Physical therapy focusing on sleeper stretches

Explanation

Glenohumeral internal rotation deficit (GIRD) is common in overhead throwing athletes and is caused by a contracture of the posterior band of the inferior glenohumeral ligament (posterior capsule). This leads to a posterosuperior shift of the humeral head during the cocking phase, causing internal impingement. Initial management is always nonoperative, primarily focusing on stretching the posterior capsule using the "sleeper stretch."

Question 4737

Topic: General Sports & Tendon

A 42-year-old competitive water skier fell forward with his knee extended and hip flexed. He presents with severe posterior thigh pain, profound ecchymosis, and a palpable defect at the ischial tuberosity. MRI reveals a complete avulsion of the proximal hamstring conjoined tendon with 6 cm of distal retraction. What is the most appropriate treatment?

. Non-weight bearing with crutches for 6 weeks and physical therapy
. Platelet-rich plasma (PRP) injection and eccentric strengthening
. Endoscopic sciatic nerve neurolysis
. Open surgical repair of the proximal hamstring
. Corticosteroid injection and immediate return to play

Correct Answer & Explanation

. Open surgical repair of the proximal hamstring

Explanation

Acute, complete, multi-tendon proximal hamstring avulsions with significant retraction (>2 cm) in active patients are best treated with early open surgical repair. Surgery restores the length-tension relationship for strength, minimizes the risk of chronic sciatic nerve tethering/neuralgia, and provides the best chance of returning to high-level athletic function.

Question 4738

Topic: Knee Sports

A 12-year-old skeletally immature male presents with vague anterior knee pain. Radiographs demonstrate an osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. MRI confirms an intact cartilage cap with no T2 fluid signal behind the bony fragment.

What is the most appropriate initial management?

. Arthroscopic transarticular drilling of the lesion
. Arthroscopic fixation with bioabsorbable screws
. Activity modification and non-weight bearing for 3 to 6 months
. Osteochondral autograft transfer (OATS)
. Arthroscopic microfracture

Correct Answer & Explanation

. Activity modification and non-weight bearing for 3 to 6 months

Explanation

In skeletally immature patients, a stable OCD lesion (intact cartilage cap, absence of fluid behind the fragment on MRI) has a high propensity for spontaneous healing. The standard initial management is a 3- to 6-month trial of nonoperative treatment consisting of activity restriction, immobilization, and/or weight-bearing modifications before considering surgical intervention.

Question 4739

Topic: Knee Sports

A 19-year-old female gymnast undergoes an acute lateral patellar dislocation which is reduced in the emergency department. This is her first dislocation. MRI reveals a tear of the medial patellofemoral ligament (MPFL) at its femoral origin, with no osteochondral fractures. There is no evidence of severe trochlear dysplasia. What is the primary patellar restraint provided by the MPFL, and what is the recommended initial management?

. Primary restraint to medial translation at 0-30 degrees of flexion; manage with immediate MPFL reconstruction
. Primary restraint to lateral translation at 0-30 degrees of flexion; manage with physical therapy and bracing
. Primary restraint to lateral translation at 60-90 degrees of flexion; manage with immediate MPFL reconstruction
. Primary restraint to medial translation at 60-90 degrees of flexion; manage with physical therapy and bracing
. Primary restraint to superior translation at full extension; manage with immediate MPFL reconstruction

Correct Answer & Explanation

. Primary restraint to lateral translation at 0-30 degrees of flexion; manage with physical therapy and bracing

Explanation

The MPFL is the primary soft-tissue restraint against lateral patellar translation, providing over 50% of the restraining force, and it functions maximally in early flexion (0 to 30 degrees) before the patella fully engages the trochlear groove. For a first-time dislocator without osteochondral loose bodies or severe anatomic variants, nonoperative treatment with brief immobilization, physical therapy, and bracing is the recommended initial standard of care.

Question 4740

Topic: 5. Sports Medicine

A 19-year-old female collegiate soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Compared to a hamstring autograft, which of the following is the most commonly reported long-term complication associated specifically with this graft choice?

. Higher risk of graft rupture
. Anterior knee pain
. Deep surgical site infection
. Femoral tunnel widening
. Permanent loss of knee extension

Correct Answer & Explanation

. Anterior knee pain

Explanation

Bone-patellar tendon-bone (BPTB) autografts are considered a gold standard for ACL reconstruction but are historically associated with a significantly higher incidence of anterior knee pain and kneeling pain (donor site morbidity) compared to hamstring autografts. Both grafts provide excellent functional stability, and recent studies show similar re-rupture rates when properly sized and positioned.

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