5. Sports Medicine MCQs

A 19-year-old collegiate gymnast presents with bilateral shoulder pain and a sensation of the shoulders 'slipping out' during her routines. She denies any specific traumatic event. On examination, she has 3+ sulcus signs bilaterally and positive apprehension tests that spontaneously reduce when she relaxes. Radiographs and MRI are unremarkable. What is the most appropriate initial management?

A surgeon is planning a medial patellofemoral ligament (MPFL) reconstruction for a 17-year-old female with recurrent lateral patellar dislocations. To achieve anatomic reconstruction and isometric graft behavior, the femoral tunnel must be placed at Schöttle's point. Where is this landmark located radiographically on a true lateral view of the distal femur?

A 28-year-old male hockey player presents with chronic, deep groin pain exacerbated by deep hip flexion and internal rotation. An AP pelvis radiograph demonstrates a 'crossover sign.' This radiographic finding is most indicative of which of the following pathomorphologies?

A 12-year-old boy complains of intermittent left knee pain over the past 3 months. Radiographs reveal an osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. MRI confirms the presence of the lesion but demonstrates no high T2 signal (fluid) between the fragment and the underlying bone. The physes are widely open. What is the most appropriate initial management?

A 45-year-old male presents to the emergency department after feeling a 'pop' in his knee while landing from a jump playing basketball. He has a large knee effusion and is unable to perform a straight leg raise. A lateral radiograph of the knee is obtained, revealing patella baja (a low-riding patella) with an Insall-Salvati ratio of 0.6. What is the most likely diagnosis?

A 28-year-old competitive weightlifter feels a sudden tearing sensation and severe pain in his anterior axillary fold while attempting a one-rep max bench press. Examination reveals extensive ecchymosis over the anterior arm and chest, with a visible loss of the normal anterior axillary contour. MRI confirms a complete rupture of the sternal head of the pectoralis major tendon at its humeral insertion. What is the recommended treatment for this patient?

A 45-year-old active female reports a 'pop' in the posterior aspect of her knee while squatting, followed by acute posterior knee pain and mild effusion. Weight-bearing radiographs show no significant osteoarthritis. MRI reveals a radial tear at the posterior horn of the medial meniscus near its tibial attachment, accompanied by a 'ghost sign' on sagittal sequences and 4 mm of medial meniscal extrusion. What is the primary biomechanical consequence if this injury is left untreated?

A 42-year-old recreational weightlifter complains of persistent deep anterior shoulder pain, particularly during bench press and biceps curls. Physical examination reveals a positive O'Brien test that is relieved when the test is repeated with the forearm in supination, and distinct tenderness in the bicipital groove. MRI reveals a Type II SLAP lesion with concomitant severe tenosynovitis and partial tearing of the long head of the biceps tendon. What is the most appropriate definitive surgical management for this patient?

A 19-year-old elite hockey player presents with gradual onset of deep groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate a crossover sign and a prominent ischial spine sign. The alpha angle is measured at 45 degrees. Which of the following best describes the underlying morphologic abnormality and its typical associated labral and chondral pathology?

A 16-year-old female high school soccer player with generalized ligamentous laxity (Beighton score 7/9) undergoes primary anterior cruciate ligament (ACL) reconstruction. Considering her age, sex, and hyperlaxity profile, which of the following graft choices is associated with the lowest risk of graft failure?

A 23-year-old rock climber presents with recurrent anterior shoulder instability. An MRI arthrogram shows an anteroinferior labral tear and a large posterolateral humeral head defect (Hill-Sachs lesion). A 3D CT scan reveals 12% anterior glenoid bone loss. On dynamic arthroscopic evaluation, the Hill-Sachs lesion 'engages' the anterior glenoid rim when the arm is placed in abduction and external rotation. Which of the following is the most appropriate surgical intervention?

A 24-year-old male presents 6 months after an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. He complains of pain at the anterior aspect of the knee during terminal extension. Physical examination reveals a 15-degree extension lag and a palpable, audible clunk when the knee is passively brought into full extension. Sagittal MRI shows a nodular soft-tissue mass anterior to the ACL graft. What is the most likely diagnosis?

A 25-year-old professional hockey player presents with chronic groin pain that worsens with prolonged sitting and deep hip flexion. Physical examination reveals a positive FADIR test. Radiographs demonstrate a pistol grip deformity of the proximal femur and an alpha angle of 65 degrees. Which of the following is the primary pathophysiologic mechanism for his intra-articular pathology?

A 22-year-old collegiate football player is struck on the anteromedial aspect of his knee. He presents with lateral knee pain and a feeling of instability. Physical examination demonstrates excessive external rotation of the tibia compared to the contralateral knee when evaluated at 30 degrees of knee flexion. However, external rotation is symmetric when tested at 90 degrees of knee flexion. Which of the following structures is primarily injured?

A 45-year-old female sustains sudden knee pain while deep squatting. An MRI is obtained, revealing a radial tear at the posterior horn of the medial meniscus, located 5 mm from its tibial attachment, accompanied by a 4 mm medial meniscal extrusion. Biomechanically, this specific injury profile is most equivalent to which of the following conditions?

A 13-year-old male presents with right knee pain and mechanical catching symptoms. Radiographs reveal an osteochondral lesion on the lateral aspect of the medial femoral condyle. MRI confirms the 1.5 cm lesion and demonstrates high T2 signal (fluid) interposing behind the lesion and the native subchondral bone, though the articular cartilage cap appears intact. His physes are wide open. What is the most appropriate initial surgical management?

A 16-year-old female experiences an acute lateral patellar dislocation while dancing. After reduction, she is evaluated for risk factors for recurrent instability. Which of the following radiographic parameters is considered a primary major anatomic risk factor for recurrent lateral patellar dislocation?

A 25-year-old male presents with recurrent knee instability 18 months after an anatomic single-bundle anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. On physical examination, he has a positive pivot shift test but full range of motion. Radiographs demonstrate the femoral tunnel positioned too anteriorly (shallow) on the lateral femoral condyle. What is the most likely clinical consequence of an anteriorly placed femoral tunnel in ACL reconstruction?

A 28-year-old hockey player undergoes hip arthroscopy for a symptomatic cam-type femoroacetabular impingement and labral tear. During the establishment of the anterior portal, the surgeon uses fluoroscopy and anatomic landmarks to ensure safe trajectory. Which of the following nerves is at greatest iatrogenic risk during the placement of the anterior portal?

A 19-year-old female presents with recurrent lateral patellar dislocations after failing 6 months of targeted physical therapy. Imaging demonstrates a normal trochlea, but a CT scan reveals a tibial tubercle-trochlear groove (TT-TG) distance of 22 mm and patella alta (Caton-Deschamps index 1.4). Which of the following surgical strategies is most appropriate to normalize her patellofemoral biomechanics?