Menu

5. Sports Medicine MCQs

Practice Set 242 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 4821

Topic: Knee Sports
A 28-year-old trauma patient undergoes reconstruction of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and posterolateral corner (PLC) following a knee dislocation (KD-III L). During the PLC reconstruction, anatomic placement of the femoral tunnels is essential. Which of the following best describes the anatomic location of the femoral footprint of the popliteus tendon?
. Proximal and posterior to the lateral epicondyle
. Anterior and distal to the lateral epicondyle
. Posterior and distal to the lateral epicondyle
. Proximal and anterior to the lateral epicondyle
. Directly on the prominence of the lateral epicondyle

Correct Answer & Explanation

. Anterior and distal to the lateral epicondyle

Explanation

For an anatomic reconstruction of the posterolateral corner, precise identification of the femoral attachments is critical. Based on anatomic studies by LaPrade et al., the popliteus tendon inserts at the proximal aspect of the popliteus sulcus, which is located 18.5 mm anterior and distal to the fibular collateral ligament (FCL) attachment. Relative to the main osseous landmark (the lateral epicondyle), the popliteus footprint is found anterior and distal. Conversely, the FCL attachment is located slightly proximal and posterior to the lateral epicondyle.

Question 4822

Topic: 5. Sports Medicine

A 65-year-old female presents with an inability to actively extend her knee 3 years following a TKA. Radiographs show patella baja and a broken patellar component. What is the most reliable reconstructive option for a chronic patellar tendon rupture following TKA?

. Primary repair with heavy nonabsorbable suture
. Achilles tendon allograft with bone block
. Semitendinosus autograft
. Gastrocnemius rotation flap
. Nonoperative management with a drop-lock brace

Correct Answer & Explanation

. Achilles tendon allograft with bone block

Explanation

Chronic patellar tendon ruptures after TKA have a notoriously high failure rate with primary repair. Reconstruction using an extensor mechanism allograft (such as an Achilles tendon allograft with a calcaneal bone block or synthetic mesh) is the preferred and most reliable surgical option for restoring active extension.

Question 4823

Topic: 5. Sports Medicine

A 68-year-old woman presents with an inability to actively extend her knee 3 years following a primary TKA. Radiographs demonstrate a high-riding patella with an intact tibial tubercle. Which of the following is the most reliable reconstructive option to restore extensor mechanism function?

. Direct primary repair with heavy nonabsorbable suture
. Hamstring autograft augmentation
. Reconstruction using a synthetic mesh (e.g., Marlex)
. Gastrocnemius rotation flap
. Patellar tendon advancement

Correct Answer & Explanation

. Reconstruction using a synthetic mesh (e.g., Marlex)

Explanation

Rupture of the patellar tendon following TKA is a devastating complication. Direct primary repair has a very high failure rate and is generally not recommended. Reconstruction with a synthetic mesh (such as Marlex mesh) or a whole extensor mechanism allograft are the most reliable current options, with synthetic mesh showing excellent functional results and fewer risks of disease transmission or late allograft failure compared to allografts.

Question 4824

Topic: 5. Sports Medicine

A 72-year-old woman presents with persistent lateral hip pain and a positive Trendelenburg sign 2 years after a primary THA done via a direct lateral approach. An MRI demonstrates complete avulsion and severe fatty atrophy (Goutallier grade 4) of the gluteus medius and minimus tendons. Nonoperative management has failed. Which of the following surgical options offers the most reliable improvement in gait and pain?

. Primary repair of the abductor tendons using suture anchors
. Constrained liner placement
. Gluteus maximus muscle transfer
. Revision to a dual-mobility construct
. Achilles tendon allograft reconstruction

Correct Answer & Explanation

. Gluteus maximus muscle transfer

Explanation

Chronic abductor deficiency with severe fatty infiltration (Goutallier grade 3 or 4) indicates irreversible muscle damage, making primary repair or allograft reconstruction prone to failure. A gluteus maximus or vastus lateralis muscle transfer is considered the most reliable option to restore dynamic abductor function and improve gait. Constrained liners address instability but do not restore active abduction.

Question 4825

Topic: Knee Sports

A randomized controlled trial compares a new NSAID to a placebo for postoperative pain after ACL reconstruction. The study fails to find a statistically significant difference between the two groups (p = 0.08), despite a true clinically significant difference actually existing in the general population. This scenario represents which of the following, and how could it have been prevented?

. Type I error; decreasing the alpha level
. Type II error; increasing the sample size
. Type I error; using a two-tailed rather than one-tailed test
. Type II error; decreasing the beta level to 0.5
. Confounding bias; strict randomization

Correct Answer & Explanation

. Type II error; increasing the sample size

Explanation

A Type II error (false negative) occurs when a study fails to reject the null hypothesis when it is actually false (i.e., missing a true difference). This typically happens when a study is underpowered. Power is calculated as 1 - Beta (where Beta is the probability of a Type II error). Increasing the sample size is the standard way to increase statistical power and reduce the risk of a Type II error.

Question 4826

Topic: 5. Sports Medicine

During an osteochondral allograft transplantation, the surgeon notes the complex multi-layered architecture of articular cartilage.

Which specific zone of articular cartilage is characterized by containing the highest concentration of proteoglycans, the lowest water content, and chondrocytes arranged in vertical columns?

. Superficial (tangential) zone
. Middle (transitional) zone
. Deep (radial) zone
. Calcified cartilage zone
. Tidemark

Correct Answer & Explanation

. Deep (radial) zone

Explanation

Articular cartilage is divided into four structural zones. The deep (radial) zone contains the highest concentration of proteoglycans and the lowest water content. The collagen fibers are oriented perpendicularly to the joint surface, and the chondrocytes are arranged in vertical columns. In contrast, the superficial zone has the highest water content, the lowest proteoglycan content, and chondrocytes are flattened parallel to the joint surface.

Question 4827

Topic: 5. Sports Medicine

An orthopedic research team conducts a randomized controlled trial comparing a novel synthetic bone graft to autograft for posterolateral lumbar fusion. The study fails to find a statistically significant difference in fusion rates between the two groups (p = 0.12). However, a subsequent massive multi-center trial unequivocally demonstrates that the novel graft has a significantly lower fusion rate than autograft. What statistical concept best describes the initial trial's failure to detect this actual difference?

. Type I error
. Type II error
. Selection bias
. Confounding
. Hawthorne effect

Correct Answer & Explanation

. Type II error

Explanation

A Type II error (beta error) occurs when a statistical test fails to reject a false null hypothesis—in clinical terms, failing to detect a true difference that actually exists between two groups. This is typically due to an inadequate sample size, resulting in insufficient statistical power (Power = 1 - beta). A Type I error (alpha error) occurs when a true null hypothesis is incorrectly rejected (a "false positive").

Question 4828

Topic: Shoulder & Hip Sports
Following an arthroscopic rotator cuff repair, healing of the tendon to the greater tuberosity footprint progresses through several specific histologic zones to minimize stress concentrations at the interface. Which of the following histologic zones directly connects the unmineralized fibrocartilage to the underlying subchondral bone?
. Tendon proper
. Sharpey's fibers
. Mineralized fibrocartilage
. Tidemark
. Woven bone

Correct Answer & Explanation

. Mineralized fibrocartilage

Explanation

The direct insertion of a tendon to bone (enthesis), such as the rotator cuff footprint, consists of four distinct transitional zones designed to gradually transmit mechanical forces: 1) Tendon proper (Type I collagen), 2) Unmineralized fibrocartilage (Type II and III collagen), 3) Mineralized fibrocartilage (Type II and X collagen), and 4) Bone (Type I collagen). The mineralized fibrocartilage zone directly connects the unmineralized fibrocartilage to the underlying bone. The tidemark is the basophilic line that visually separates the unmineralized and mineralized fibrocartilage zones.

Question 4829

Topic: 5. Sports Medicine

A 25-year-old athlete undergoes an anterior cruciate ligament (ACL) reconstruction. The native ACL has a direct insertion into the bone of the femur and tibia. Which of the following represents the correct order of histological transition zones at a direct ligamentous insertion (enthesis)?

. Ligament, calcified fibrocartilage, uncalcified fibrocartilage, bone
. Ligament, uncalcified fibrocartilage, calcified fibrocartilage, bone
. Ligament, uncalcified fibrocartilage, tidemark, calcified fibrocartilage, bone
. Ligament, tidemark, uncalcified fibrocartilage, calcified fibrocartilage, bone
. Ligament, Sharpey's fibers, periosteum, bone

Correct Answer & Explanation

. Ligament, uncalcified fibrocartilage, tidemark, calcified fibrocartilage, bone

Explanation

A direct ligament or tendon insertion into bone (enthesis) is designed to gradually transmit forces from a pliable soft tissue to a rigid bone, thereby mitigating stress concentrations that could lead to avulsion. It consists of four distinct, progressively stiffening histological zones. The correct transitional order from soft tissue to bone is: 1) Tendon/Ligament proper, 2) Uncalcified fibrocartilage, 3) Tidemark (a distinct, highly basophilic line separating uncalcified and calcified tissue), and 4) Calcified fibrocartilage, which ultimately interdigitates with the subchondral bone. Indirect insertions do not have this distinct four-zone transition and often insert over a broader area via Sharpey's fibers directly into the periosteum.

Question 4830

Topic: Knee Sports

When evaluating an MRI of the knee to confirm a suspected anterior cruciate ligament (ACL) tear, a specific sequence is chosen wherein the repetition time (TR) is 2500 ms and the echo time (TE) is 100 ms. On this sequence, the joint effusion appears uniformly bright (hyperintense). What type of sequence is being utilized?

. T1-weighted sequence
. T2-weighted sequence
. Proton density sequence
. Short tau inversion recovery (STIR) sequence
. Gradient-recalled echo (GRE) sequence

Correct Answer & Explanation

. T2-weighted sequence

Explanation

A T2-weighted MRI sequence is defined by a long Repetition Time (TR > 2000 ms) and a long Echo Time (TE > 80 ms). On T2-weighted images, tissues with high water content, such as joint effusions, CSF, or edema, appear hyperintense (bright), making it excellent for evaluating pathology. T1 sequences (short TR, short TE) show fat as bright and fluid as dark.

Question 4831

Topic: Shoulder & Hip Sports

A 22-year-old professional rugby player presents with recurrent anterior shoulder instability. Advanced imaging reveals a bony Bankart lesion with 28% glenoid bone loss and an engaging Hill-Sachs lesion. What is the most appropriate surgical management for this patient to prevent recurrent dislocation?

. Arthroscopic Bankart repair with capsulorrhaphy
. Open Bankart repair
. Arthroscopic Remplissage without labral repair
. Latarjet procedure (coracoid transfer)
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

Critical glenoid bone loss (typically defined as >20-25%) in a contact athlete with recurrent instability dictates the need for a bony augmentation procedure. Soft-tissue repairs (arthroscopic or open Bankart) have an unacceptably high failure rate in the setting of critical bone loss and an engaging Hill-Sachs lesion. The Latarjet procedure (coracoid transfer) extends the glenoid arc and provides a "sling" effect from the conjoint tendon, making it the standard of care for this clinical scenario.

Question 4832

Topic: Shoulder & Hip Sports

A 72-year-old woman sustains a 3-part proximal humerus fracture after a ground-level fall. Nonoperative management is initiated. During her first follow-up visit, she is found to have weakness with shoulder abduction and decreased sensation over the lateral aspect of her shoulder. Which of the following muscles shares its innervation with the muscle primarily affected by this neurological injury?

. Teres major
. Teres minor
. Supraspinatus
. Infraspinatus
. Subscapularis

Correct Answer & Explanation

. Teres minor

Explanation

The patient exhibits classic signs of an axillary nerve palsy (deltoid weakness limiting abduction, and numbness over the lateral shoulder or 'regimental badge' area). The axillary nerve, a branch of the posterior cord of the brachial plexus, innervates both the deltoid and the teres minor. The teres major is innervated by the lower subscapular nerve, while supraspinatus and infraspinatus are innervated by the suprascapular nerve.

Question 4833

Topic: 5. Sports Medicine
A collegiate football player sustains a hyper-dorsiflexion injury to his first metatarsophalangeal joint. MRI demonstrates a complete tear of the plantar plate with proximal retraction of the sesamoids. What is the most appropriate management?
. Stiff-soled shoe and play as tolerated
. Cast immobilization for 6 weeks
. Surgical repair of the plantar plate
. Corticosteroid injection and immediate return to play
. Metatarsophalangeal arthrodesis

Correct Answer & Explanation

. Surgical repair of the plantar plate

Explanation

A complete rupture of the plantar plate with proximal retraction of the sesamoids is a Grade III turf toe injury. In high-level athletes, this generally requires surgical repair to restore push-off strength and prevent chronic instability.

Question 4834

Topic: Knee Sports

A 35-year-old man presents with chronic medial ankle pain. MRI reveals an isolated 1.5 cm osteochondral lesion of the medial talar dome with significant subchondral cystic changes. He has failed 6 months of conservative treatment. What is the most appropriate surgical option?

. Arthroscopic bone marrow stimulation (microfracture)
. Osteochondral autograft transfer (OATS)
. Total ankle replacement
. Tibiotalar arthrodesis
. Subtalar arthrodesis

Correct Answer & Explanation

. Osteochondral autograft transfer (OATS)

Explanation

For larger osteochondral lesions (>1.5 cm) or those with significant subchondral cysts that fail conservative treatment, structural grafting such as OATS is indicated over microfracture due to improved success rates.

Question 4835

Topic: 5. Sports Medicine

A professional football player sustained a hyperextension injury to his first MTP joint. MRI shows a complete tear of the plantar plate with proximal retraction of the sesamoids. What is the most appropriate management?

. Taping, stiff-soled shoe, and return to play.
. First MTP joint arthrodesis.
. Surgical repair of the plantar plate and capsuloligamentous complex.
. Cheilectomy.
. Excision of the fibular sesamoid.

Correct Answer & Explanation

. Surgical repair of the plantar plate and capsuloligamentous complex.

Explanation

A Grade 3 turf toe injury involves complete disruption of the plantar plate and sesamoid retraction. In an elite athlete, this requires primary surgical repair to restore push-off strength and joint stability.

Question 4836

Topic: 5. Sports Medicine

A 40-year-old recreational athlete sustains an acute Achilles tendon rupture. After discussing treatment options, the patient opts for nonoperative management utilizing a functional rehabilitation protocol. Compared to traditional nonoperative cast immobilization, what is the primary benefit of utilizing an early functional rehabilitation protocol?

. Re-rupture rates comparable to operative management without the surgical risks
. Faster return to competitive contact sports compared to surgical repair
. Complete elimination of deep vein thrombosis risk
. Superior peak torque generation compared to operative repair
. Guaranteed elongation of the Achilles tendon

Correct Answer & Explanation

. Re-rupture rates comparable to operative management without the surgical risks

Explanation

High-level evidence demonstrates that nonoperative management utilizing early functional rehabilitation (early weight-bearing in a functional brace with active range of motion) results in re-rupture rates that are comparable to operative management, and significantly lower than traditional nonoperative management with prolonged rigid cast immobilization. Operative management still carries inherent risks of wound complications and sural nerve injury.

Question 4837

Topic: 5. Sports Medicine

A 22-year-old professional football player sustains a hyperextension injury to his right great toe. MRI demonstrates a complete disruption of the plantar plate with proximal retraction of the sesamoids of 5 mm compared to the contralateral side. What is the most appropriate management for this athlete?

. Stiff-soled shoe and return to play as tolerated
. Taping in plantarflexion for 6 weeks
. Corticosteroid injection into the first MTP joint
. Surgical repair of the plantar plate
. Resection of the medial sesamoid

Correct Answer & Explanation

. Surgical repair of the plantar plate

Explanation

This is a Grade 3 turf toe injury (complete tear of the plantar plate complex). While Grade 1 and 2 injuries are generally managed non-operatively, indications for surgical management in high-level competitive athletes include a Grade 3 sprain with >3 mm of proximal sesamoid retraction, intra-articular loose bodies, traumatic hallux valgus, or gross instability. Surgical repair restores the anatomy and tension of the plantar plate to allow return to explosive push-off activities.

Question 4838

Topic: 5. Sports Medicine

A 22-year-old American football player sustains a severe hyperextension injury to his first metatarsophalangeal (MTP) joint. Clinical examination reveals marked ecchymosis, swelling, and plantar tenderness over the joint. MRI confirms a complete rupture of the plantar plate complex with 5 mm proximal retraction of the sesamoids. What is the most appropriate management?

. Immediate weight-bearing in a stiff-soled shoe or carbon fiber insert
. Cast immobilization for 6 weeks followed by progressive return to play
. Corticosteroid injection into the first MTP joint to reduce inflammation
. Excision of the medial sesamoid and repair of the flexor hallucis brevis
. Surgical repair of the plantar plate

Correct Answer & Explanation

. Surgical repair of the plantar plate

Explanation

The patient has a Grade 3 turf toe injury (complete rupture of the plantar plate complex). Indications for surgical repair include a complete tear with retraction of the sesamoids (loss of normal sesamoid tracking), large intra-articular loose bodies, traumatic hallux valgus, or failure of conservative treatment. Nonoperative treatment is appropriate for Grade 1 and 2 injuries, but a displaced Grade 3 tear in a high-level athlete requires surgery to restore push-off strength.

Question 4839

Topic: 5. Sports Medicine

A 38-year-old recreational athlete sustains an acute Achilles tendon rupture and elects for nonoperative management. Based on recent high-level evidence, which of the following nonoperative protocols is most strongly recommended to minimize the risk of re-rupture while optimizing functional outcome?

. Strict non-weight-bearing in a short leg cast in equinus for 8 weeks
. Early functional rehabilitation with controlled early weight-bearing in a functional brace
. Immobilization in a rigid equinus splint for 12 weeks
. Serial casting with gradual manipulation into dorsiflexion over 10 weeks
. Delayed weight-bearing until ultrasound confirms continuous tendon healing at 6 weeks

Correct Answer & Explanation

. Early functional rehabilitation with controlled early weight-bearing in a functional brace

Explanation

Recent high-quality randomized controlled trials and meta-analyses have demonstrated that nonoperative management of acute Achilles tendon ruptures using an early functional rehabilitation protocol (early weight-bearing in a functional brace/boot with heel wedges and early active ROM) yields re-rupture rates comparable to operative management. Traditional prolonged non-weight-bearing cast immobilization is associated with higher re-rupture rates and greater calf atrophy.

Question 4840

Topic: 5. Sports Medicine

A 40-year-old male sustains an acute, closed midsubstance Achilles tendon rupture. He is treated with functional bracing and an early mobilization rehabilitation protocol. Compared to surgical repair, which of the following statements is true regarding his non-operative management?

. He has a significantly higher risk of deep infection.
. He has a higher risk of re-rupture but similar functional outcomes.
. He will experience significantly lower plantarflexion strength at 1 year.
. He will return to high-level sports significantly faster.
. He requires a significantly longer duration of absolute non-weight-bearing.

Correct Answer & Explanation

. He has a higher risk of re-rupture but similar functional outcomes.

Explanation

Current literature, including high-quality randomized controlled trials, indicates that non-operative treatment of Achilles tendon ruptures utilizing early functional rehabilitation results in similar functional outcomes and plantarflexion strength compared to surgical repair. However, non-operative management is associated with a slightly higher risk of re-rupture (historically, though modern functional rehab minimizes this difference), whereas surgical repair carries surgical risks such as wound necrosis and sural nerve injury.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page