Menu

5. Sports Medicine MCQs

Practice Set 248 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 4941

Topic: Shoulder & Hip Sports

A 42-year-old woman is evaluated for a 'frozen shoulder' (adhesive capsulitis). Surgical capsular release is considered after 6 months of failed conservative management. The surgeon plans to release the rotator cuff interval. Which of the following structures is NOT a boundary or content of the rotator cuff interval?

. Supraspinatus tendon
. Subscapularis tendon
. Coracohumeral ligament
. Middle glenohumeral ligament
. Teres minor tendon

Correct Answer & Explanation

. Coracohumeral ligament

Explanation

The rotator cuff interval is a triangular anatomic space in the anterior shoulder. Its boundaries are the anterior margin of the supraspinatus tendon (superiorly), the superior margin of the subscapularis tendon (inferiorly), and the base of the coracoid process (medially). The contents of the interval include the long head of the biceps tendon, the coracohumeral ligament (CHL), and the superior glenohumeral ligament (SGHL). The middle glenohumeral ligament (MGHL) often blends with the inferior aspect of the interval. The teres minor is located posteriorly and is not associated with the rotator cuff interval.

Question 4942

Topic: Knee Sports

A 25-year-old football player sustains a direct blow to the anteromedial aspect of the knee while hyperextended. Examination reveals increased external tibial rotation at 30 degrees of knee flexion but symmetrical external rotation at 90 degrees compared to the contralateral knee. Which of the following structures is most likely injured?

. Posterior cruciate ligament alone
. Posterolateral corner structures alone
. Anterior cruciate ligament and posterolateral corner
. Posterior cruciate ligament and posterolateral corner
. Medial collateral ligament and posterior oblique ligament

Correct Answer & Explanation

. Posterior cruciate ligament and posterolateral corner

Explanation

The Dial test evaluates external tibial rotation to diagnose injuries to the posterolateral corner (PLC) and posterior cruciate ligament (PCL). Increased external rotation at 30 degrees of knee flexion, with symmetrical rotation at 90 degrees, indicates an isolated posterolateral corner injury. If increased external rotation is present at both 30 and 90 degrees, it suggests a combined PCL and PLC injury. The primary stabilizers of the PLC are the fibular collateral ligament, popliteus tendon, and popliteofibular ligament.

Question 4943

Topic: Knee Sports

The semimembranosus tendon has a complex insertion at the posteromedial corner of the knee, providing dynamic stabilization. Which of the following is NOT a recognized major insertion arm of the semimembranosus tendon?

. Direct arm to the posterior aspect of the medial tibial condyle
. Anterior arm deep to the superficial medial collateral ligament (MCL)
. Oblique popliteal ligament extension
. Arcuate ligament
. Inferior arm to the popliteal fascia

Correct Answer & Explanation

. Arcuate ligament

Explanation

The semimembranosus tendon has five primary insertions: (1) direct insertion into the posteromedial tibia, (2) an anterior arm extending deep to the superficial MCL, (3) the oblique popliteal ligament extending laterally across the posterior joint capsule, (4) an inferior arm inserting down the popliteal fascia, and (5) a capsular arm. The arcuate ligament is a key structure of the posterolateral corner (PLC) of the knee and is not an extension of the semimembranosus.

Question 4944

Topic: Shoulder & Hip Sports

A 24-year-old professional volleyball player presents with isolated weakness in external rotation of the shoulder. Electromyography reveals isolated denervation of the infraspinatus muscle with normal supraspinatus function. Entrapment of the affected nerve is most likely occurring at the spinoglenoid notch. Which of the following structures forms the roof of this anatomical space?

. Transverse scapular ligament
. Coracoacromial ligament
. Inferior transverse scapular ligament
. Coracoclavicular ligament
. Acromioclavicular ligament

Correct Answer & Explanation

. Inferior transverse scapular ligament

Explanation

The suprascapular nerve first passes through the suprascapular notch, under the superior transverse scapular ligament, where it innervates the supraspinatus. It then courses around the base of the scapular spine through the spinoglenoid notch, passing under the inferior transverse scapular ligament (also known as the spinoglenoid ligament), to innervate the infraspinatus. Compression at the spinoglenoid notch leads to isolated infraspinatus weakness, whereas compression at the suprascapular notch affects both the supraspinatus and infraspinatus.

Question 4945

Topic: Knee Sports

A 30-year-old male undergoes surgical reconstruction of the posterolateral corner (PLC) of the knee following a multiligamentous knee injury. To achieve anatomic reconstruction, the surgeon must identify the exact femoral footprint of the popliteus tendon. Which of the following describes the correct location of the popliteus tendon insertion relative to the lateral collateral ligament (LCL) femoral attachment?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly medial

Correct Answer & Explanation

. Distal and anterior

Explanation

On the lateral femoral condyle, the popliteus tendon inserts into the anterior portion of the popliteal sulcus. Anatomical studies consistently demonstrate that the femoral footprint of the popliteus tendon is situated distal and anterior (typically 18.5 mm anterior and distal) to the femoral origin of the lateral collateral ligament (LCL).

Question 4946

Topic: Knee Sports

Anatomic reconstruction of the posterolateral corner (PLC) of the knee requires precise placement of tunnels. What is the correct anatomical attachment of the fibular collateral ligament (LCL) on the lateral femoral condyle?

. Proximal and posterior to the lateral epicondyle
. Proximal and anterior to the lateral epicondyle
. Distal and posterior to the lateral epicondyle
. Distal and anterior to the lateral epicondyle
. Directly on the lateral epicondyle

Correct Answer & Explanation

. Proximal and posterior to the lateral epicondyle

Explanation

The fibular collateral ligament (LCL) originates slightly proximal and posterior to the lateral femoral epicondyle. The popliteus tendon inserts into the popliteal sulcus, which is located anterior and distal to the LCL attachment. Recognizing this anatomy is critical to avoid non-anatomic graft placement during PLC reconstruction, which can lead to early failure.

Question 4947

Topic: Knee Sports
A 19-year-old female presents with recurrent patellar dislocations. Imaging shows a tibial tubercle-trochlear groove (TT-TG) distance of 14 mm and a normal Insall-Salvati ratio. An isolated medial patellofemoral ligament (MPFL) reconstruction is planned. What is the primary biomechanical consequence of placing the femoral tunnel for the MPFL graft significantly proximal to Schöttle's point?
. Increased graft tension in flexion, resulting in medial patellar overload and restriction of knee flexion
. Increased graft tension in extension, resulting in an extensor lag and persistent subluxation
. Decreased graft tension in flexion, leading to persistent lateral instability at 90 degrees of flexion
. Decreased graft tension in extension, leading to a positive J-sign and loss of terminal extension
. Development of patella infera due to uncorrected vastus medialis obliquus vector

Correct Answer & Explanation

. Increased graft tension in flexion, resulting in medial patellar overload and restriction of knee flexion

Explanation

The MPFL is the primary restraint to lateral patellar translation from 0 to 30 degrees of flexion. Proper femoral tunnel placement (Schöttle's point) is critical for graft isometry. If the femoral tunnel is placed too proximal, the distance between the patellar and femoral attachments increases as the knee flexes. This non-isometric placement causes the graft to become excessively tight in flexion, leading to medial patellofemoral cartilage overload, restricted range of motion (loss of flexion), and potentially iatrogenic medial patellar subluxation or increased risk of early osteoarthritis.

Question 4948

Topic: 5. Sports Medicine

A 21-year-old male football player undergoes primary ACL reconstruction with a bone-patellar tendon-bone autograft. Two years later, he presents with an atraumatic graft rupture. Standing lateral radiographs demonstrate a posterior tibial slope (PTS) of 16 degrees. If a revision ACL reconstruction is performed without addressing the bony anatomy, what biomechanical alteration is most responsible for an increased risk of early graft failure?

. Decreased anterior shear force of the tibia relative to the femur during axial loading
. Increased anterior shear force of the tibia relative to the femur during axial loading
. Increased internal rotation torque of the tibia at 90 degrees of flexion
. Decreased varus moment arm during dynamic cutting maneuvers
. Increased posterior sag of the tibia in full extension

Correct Answer & Explanation

. Increased anterior shear force of the tibia relative to the femur during axial loading

Explanation

An increased posterior tibial slope (typically >12-13 degrees is considered abnormal and highly clinically relevant) significantly increases the anterior shear force on the tibia during axial loading (weight-bearing). This increased anterior directed force places higher stress on the native ACL or an ACL graft, predisposing the patient to failure of the reconstruction. In revision scenarios with extreme posterior tibial slope (>12-14 degrees), an anterior closing wedge high tibial osteotomy may be indicated to decrease the slope and protect the revision graft.

Question 4949

Topic: Shoulder & Hip Sports

A 62-year-old laborer presents with chronic, debilitating shoulder pain and pseudoparalysis. MRI reveals a massive, retracted, irreparable tear of the supraspinatus and infraspinatus with Grade 4 fatty infiltration. The subscapularis and teres minor are intact. He undergoes an arthroscopic superior capsular reconstruction (SCR) using a thick dermal allograft.

Biomechanically, how does the SCR primarily restore shoulder kinematics in this specific clinical scenario?

. By actively depressing the humeral head during deltoid contraction via tenodesis effect
. By physically tethering the greater tuberosity to the superior glenoid to limit superior humeral head migration
. By providing a smooth interpositional spacer for the acromion to articulate with directly
. By restoring the dynamic anterior-posterior force couple of the native rotator cuff
. By transferring the active force vector of the intact subscapularis to the superior humeral footprint

Correct Answer & Explanation

. By physically tethering the greater tuberosity to the superior glenoid to limit superior humeral head migration

Explanation

Superior capsular reconstruction (SCR) is designed to address massive, irreparable posterosuperior rotator cuff tears. Biomechanically, it functions primarily as a static restraint. By rigidly attaching a graft from the superior glenoid (replacing the native superior capsule) to the greater tuberosity footprint, the SCR acts as a tether that depresses the humeral head and resists superior migration during deltoid activation. This statically restores the coronal plane force couple, allowing the intact deltoid and remaining rotator cuff to elevate the arm more effectively.

Question 4950

Topic: Knee Sports

A 55-year-old female presents with acute medial knee pain following a squatting maneuver. MRI reveals a complete radial tear directly adjacent to the posterior root attachment of the medial meniscus, with associated meniscal extrusion of 4 mm.

Which of the following best describes the biomechanical consequence of leaving this specific root injury unaddressed?

. It is biomechanically equivalent to a total medial meniscectomy, leading to substantially increased peak contact pressures
. It significantly decreases anterior tibial translation during dynamic Lachman testing
. It leads to isolated medial compartment gapping strictly under valgus load without altering axial forces
. It alters the patellofemoral joint contact forces primarily by medializing the extensor mechanism vector
. It causes an isolated loss of internal rotation stability of the tibia at 90 degrees of flexion

Correct Answer & Explanation

. It is biomechanically equivalent to a total medial meniscectomy, leading to substantially increased peak contact pressures

Explanation

The posterior roots of the menisci are critical for anchoring the meniscus and allowing it to convert axial joint loads into hoop stresses. A posterior medial meniscal root tear disrupts this structural continuity, resulting in meniscal extrusion and complete loss of hoop stress generation. Biomechanical studies have demonstrated that an unaddressed posterior medial meniscal root tear results in contact areas and peak contact pressures that are virtually indistinguishable from a total medial meniscectomy, rapidly leading to accelerated articular cartilage degeneration.

Question 4951

Topic: Shoulder & Hip Sports

A 24-year-old rugby player presents for management of recurrent anterior shoulder instability. He has had four dislocations. Computed tomography (CT) with 3D sagittal reconstruction demonstrates an anteroinferior glenoid bone loss of 22% and a large, engaging Hill-Sachs lesion. Based on current literature and evidence-based treatment algorithms, which of the following is the most appropriate surgical management?

. Arthroscopic Bankart repair with capsular plication
. Arthroscopic remplissage with isolated anterior labral debridement
. Open Latarjet procedure (coracoid transfer)
. Open inferior capsular shift
. Arthroscopic Bankart repair with dermal allograft superior capsular reconstruction

Correct Answer & Explanation

. Open Latarjet procedure (coracoid transfer)

Explanation

In the setting of recurrent anterior shoulder instability with critical glenoid bone loss (typically cited as >15-20% depending on the functional demands) and an engaging Hill-Sachs lesion (off-track lesion), isolated soft tissue repairs (like arthroscopic Bankart) have an unacceptably high failure rate. The Latarjet procedure (transfer of the coracoid process with the attached conjoined tendon to the anterior glenoid) provides a triple blocking effect (bone augmentation, sling effect of the conjoined tendon on the lower subscapularis, and capsular repair) and is the gold standard for subcritical/critical bone loss in collision athletes.

Question 4952

Topic: Knee Sports

A 14-year-old male gymnast with open physes presents with chronic right knee pain. MRI reveals a 2 x 2 cm osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle.

The articular cartilage is intact, and there is no high T2 signal fluid behind the fragment, indicating a stable lesion. He has failed 6 months of strict non-operative management including restricted weight-bearing. What is the most appropriate next step in management?

. Osteochondral autograft transfer system (OATS)
. Autologous chondrocyte implantation (ACI)
. Arthroscopic transarticular extra-cartilaginous or trans-cartilaginous drilling
. Arthroscopic microfracture of the lesion
. Arthroscopic fragment excision and loose body removal

Correct Answer & Explanation

. Arthroscopic transarticular extra-cartilaginous or trans-cartilaginous drilling

Explanation

For a stable juvenile osteochondritis dissecans (JOCD) lesion (intact articular cartilage, no fluid behind the fragment on MRI) that has failed a prolonged course (typically 3-6 months) of non-operative management, arthroscopic drilling is the treatment of choice. Drilling penetrates the sclerotic margin of the lesion to promote vascular ingrowth and healing of the osteochondral fragment. Restorative procedures like OATS or ACI are reserved for unstable lesions, unsalvageable fragments, or large full-thickness defects.

Question 4953

Topic: Knee Sports

A 26-year-old man sustains a dashboard injury resulting in an isolated posterior cruciate ligament (PCL) tear. Following failure of non-operative management, a single-bundle PCL reconstruction is planned. To accurately reproduce the biomechanics of the primary restraint to posterior tibial translation at 90 degrees of flexion, the graft should be placed to reconstruct which specific bundle, and where is its native femoral footprint located?

. Anterolateral bundle; located shallow (anterior) and superior (proximal) on the lateral aspect of the medial femoral condyle
. Posteromedial bundle; located deep (posterior) and inferior (distal) on the lateral aspect of the medial femoral condyle
. Anteromedial bundle; located shallow (anterior) and superior (proximal) on the medial aspect of the lateral femoral condyle
. Posterolateral bundle; located deep (posterior) and inferior (distal) on the medial aspect of the lateral femoral condyle
. Anterolateral bundle; located deep (posterior) and superior (proximal) on the medial aspect of the lateral femoral condyle

Correct Answer & Explanation

. Anterolateral bundle; located shallow (anterior) and superior (proximal) on the lateral aspect of the medial femoral condyle

Explanation

The PCL consists of two main bundles: the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle is tight in flexion (the primary restraint to posterior translation at 90 degrees) and is the bundle reconstructed in a single-bundle PCL reconstruction. Its native femoral footprint is located on the lateral aspect of the medial femoral condyle. Specifically, it is positioned shallow (anterior in the notch) and superior (proximal, near the notch roof) relative to the articular margin.

Question 4954

Topic: Knee Sports

During an anatomic single-bundle anterior cruciate ligament (ACL) reconstruction, the femoral tunnel is drilled through the accessory anteromedial portal. Compared to traditional drilling through a transtibial portal, what is the primary biomechanical advantage of this technique?

. Better restoration of anterior tibial translation in extension
. Better restoration of rotational stability (pivot shift)
. Decreased risk of posterior wall blowout
. Increased isometry of the graft throughout the range of motion
. Shorter graft length required for reconstruction

Correct Answer & Explanation

. Better restoration of rotational stability (pivot shift)

Explanation

Anatomic ACL femoral tunnel placement (drilled lower on the lateral notch wall into the native footprint) better restores rotational stability and resists the pivot shift compared to the traditional high, vertical placement often achieved with the transtibial technique. The more horizontal graft orientation obtained via the anteromedial portal significantly improves rotational control.

Question 4955

Topic: Knee Sports

A 25-year-old male sustains a multiligament knee injury. Examination reveals a grade 3 posterior sag and grade 3 varus opening in full extension and at 30 degrees of flexion. The dial test shows increased external rotation at 30 degrees but is symmetric at 90 degrees. He is planned for PCL and posterolateral corner (PLC) reconstruction.

What anatomic structure of the PLC is the primary restraint to varus gapping at 30 degrees of knee flexion?

. Fibular collateral ligament (LCL)
. Popliteus tendon
. Popliteofibular ligament
. Iliotibial band
. Biceps femoris tendon

Correct Answer & Explanation

. Fibular collateral ligament (LCL)

Explanation

The fibular collateral ligament (LCL) is the primary restraint to varus stress at 30 degrees of knee flexion. The popliteus tendon and the popliteofibular ligament act as the primary restraints to external rotation. In a complete PLC reconstruction, restoring the LCL is critical for coronal plane (varus) stability.

Question 4956

Topic: Shoulder & Hip Sports

A 65-year-old male presents with pseudoparalysis of the shoulder. An MRI reveals an irreparable, chronically retracted tear of the subscapularis tendon with significant fatty infiltration (Goutallier stage 4). The posterosuperior cuff is intact. He is scheduled to undergo a pectoralis major transfer. Which portion of the pectoralis major is typically transferred to best replicate the force vector of the native subscapularis?

. The sternal head routed anterior to the conjoint tendon
. The sternal head routed posterior (deep) to the conjoint tendon
. The clavicular head routed anterior to the conjoint tendon
. The clavicular head routed posterior (deep) to the conjoint tendon
. The entire muscle belly routed anterior to the conjoint tendon

Correct Answer & Explanation

. The sternal head routed posterior (deep) to the conjoint tendon

Explanation

For irreparable subscapularis tears, transferring the sternal head of the pectoralis major, routed deep (posterior) to the conjoint tendon, most closely recreates the line of pull of the native subscapularis muscle and acts to stabilize the anterior joint and restore internal rotation function.

Question 4957

Topic: Shoulder & Hip Sports

A 28-year-old professional hockey player presents with chronic anterior groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate a pistol-grip deformity of the proximal femur.

Which of the following radiographic parameters is most diagnostic of a Cam-type femoroacetabular impingement (FAI)?

. Alpha angle > 55 degrees
. Lateral center edge angle > 40 degrees
. Tonnis angle > 10 degrees
. Positive cross-over sign
. Ischial spine sign

Correct Answer & Explanation

. Alpha angle > 55 degrees

Explanation

An alpha angle greater than 50-55 degrees (often measured on a lateral or Dunn view) is indicative of a decreased femoral head-neck offset characteristic of Cam impingement. A lateral center edge angle > 40 degrees and a positive cross-over sign (acetabular retroversion) are findings associated with Pincer-type impingement.

Question 4958

Topic: 5. Sports Medicine

A 14-year-old female gymnast presents with progressive lateral elbow pain and mechanical catching. Imaging reveals an unstable 1.5 cm osteochondral defect (OCD) of the capitellum with loose bodies in the joint. The lateral radiocapitellar ligament is intact. Which surgical treatment provides the best long-term outcome and highest rate of return to sport for an unstable defect of this size in a high-demand athlete?

. Arthroscopic debridement and microfracture
. In situ retrograde drilling
. Osteochondral autograft transfer (OATS)
. Fixation with bioabsorbable pins
. Capitellar resurfacing arthroplasty

Correct Answer & Explanation

. Osteochondral autograft transfer (OATS)

Explanation

In adolescent overhead athletes and gymnasts, large (>1 cm) and unstable capitellar OCD lesions have poor results with microfracture or debridement alone. Osteochondral autograft transfer (OATS), typically harvested from the lateral femoral condyle, provides the highest rate of return to high-demand sports and superior long-term functional outcomes.

Question 4959

Topic: Shoulder & Hip Sports

A 45-year-old recreational weightlifter presents with deep anterior shoulder pain. An MRI arthrogram demonstrates a Type II SLAP tear without rotator cuff pathology. A trial of physical therapy and injections has failed to provide relief. What is the most appropriate surgical management for this patient to minimize postoperative stiffness and maximize return to pre-injury activity?

. Arthroscopic SLAP repair using two suture anchors
. Arthroscopic SLAP repair using a single suture anchor
. Biceps tenodesis
. Simple biceps tenotomy
. Subpectoral biceps tenodesis with concomitant arthroscopic SLAP repair

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In patients over the age of 35-40, SLAP repair is associated with a significantly higher risk of postoperative stiffness, persistent pain, and lower rates of return to sport compared to biceps tenodesis. Biceps tenodesis is currently the preferred surgical treatment for symptomatic Type II SLAP tears in older or middle-aged patients.

Question 4960

Topic: Knee Sports

A 19-year-old female is undergoing a medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar instability. Correct placement of the femoral tunnel is essential to avoid over-constraining the joint. Which of the following landmarks accurately describes the anatomic femoral footprint of the native MPFL?

. Anterior and distal to the medial epicondyle
. Posterior and proximal to the adductor tubercle
. In the saddle-shaped depression between the medial epicondyle and the adductor tubercle
. Directly on the apex of the medial epicondyle
. Distal to the superficial MCL femoral origin

Correct Answer & Explanation

. In the saddle-shaped depression between the medial epicondyle and the adductor tubercle

Explanation

The anatomic femoral footprint of the MPFL is located in the saddle-shaped depression between the adductor tubercle (proximal) and the medial epicondyle (distal). Non-anatomic placement, particularly too proximal and anterior, increases graft tension in flexion, leading to stiffness, graft failure, or elevated patellofemoral contact pressures.

Test Yourself

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

On this Page