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5. Sports Medicine MCQs

Practice Set 249 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 4961

Topic: 5. Sports Medicine
A 25-year-old male cyclist falls directly onto his right shoulder. Clinical examination reveals a prominent clavicle, and radiographs confirm a 120% superior displacement of the distal clavicle relative to the acromion, with an increased coracoclavicular distance. He is diagnosed with a type III acromioclavicular (AC) joint separation. According to current evidence, what is the recommended initial management for this injury in a non-laboring individual?
. Immediate open reduction and internal fixation with a hook plate
. Arthroscopic coracoclavicular ligament reconstruction using tendon allograft
. Nonoperative management with a brief period of sling immobilization followed by physical therapy
. Acromioclavicular joint pinning with K-wires
. Distal clavicle excision (Mumford procedure)

Correct Answer & Explanation

. Nonoperative management with a brief period of sling immobilization followed by physical therapy

Explanation

Type III AC joint separations (100% to 250% superior displacement) are generally treated nonoperatively initially, especially in non-overhead athletes and non-laborers, as long-term functional outcomes are equivalent to surgery with fewer complications. Surgery is reserved for patients who fail nonoperative treatment or, controversially, for elite overhead athletes and heavy laborers.

Question 4962

Topic: Knee Sports

A 50-year-old female presents with acute-onset medial joint line pain and an effusion after squatting deeply. An MRI shows an extrusion of the medial meniscus on coronal views and an 'empty meniscus' or 'ghost sign' on a single sagittal cut. Figure 1

illustrates a similar pathology. Biomechanically, what is the direct consequence of this specific injury pattern if left untreated?

. Increased anterior translation of the tibia in extension
. Loss of meniscal hoop stresses equivalent to a total meniscectomy
. Increased contact area in the medial compartment
. Medial compartment gap formation in terminal extension
. Rotational instability of the knee during the pivot-shift test

Correct Answer & Explanation

. Loss of meniscal hoop stresses equivalent to a total meniscectomy

Explanation

The scenario describes a posterior medial meniscal root tear. The 'ghost sign' on sagittal MRI is classic for this injury. The meniscal roots are critical for anchoring the meniscus and converting axial loads into circumferential 'hoop stresses.' A complete root tear abolishes these hoop stresses, leading to meniscal extrusion. Biomechanical studies have shown that a posterior medial meniscal root tear results in a loss of contact area and an increase in peak contact pressures equivalent to a total medial meniscectomy, predisposing the patient to rapid-onset osteoarthritis.

Question 4963

Topic: 5. Sports Medicine

A 28-year-old professional hockey player undergoes hip arthroscopy for femoroacetabular impingement (FAI). The surgeon establishes an anterolateral portal, followed by an anterior portal. Which of the following describes the typical sensory deficit expected if the nerve most at risk during the placement of the anterior portal is iatrogenically injured?

. Medial thigh
. Anterolateral thigh
. Lateral lower leg
. Dorsum of the foot
. Plantar aspect of the foot

Correct Answer & Explanation

. Anterolateral thigh

Explanation

The anterior portal in hip arthroscopy places the lateral femoral cutaneous nerve (LFCN) at significant risk. The LFCN provides sensory innervation to the anterolateral thigh. To minimize risk to the LFCN, the anterior portal is typically established under direct arthroscopic visualization from the anterolateral portal, and the capsule is penetrated parallel to the femoral neck. Medial thigh sensation is supplied by the obturator nerve, while the lateral lower leg and foot are innervated by branches of the sciatic nerve.

Question 4964

Topic: Knee Sports

A 24-year-old rugby player sustains a blow to the anteromedial aspect of his fully extended right knee. He complains of posterolateral knee pain, giving way, and difficulty descending stairs. On examination, the dial test reveals 20 degrees of increased external rotation compared to the contralateral normal knee at 30 degrees of flexion, but symmetrical external rotation at 90 degrees of flexion. Based on these physical examination findings, which of the following injury patterns is most likely present?

. Isolated posterior cruciate ligament (PCL) injury
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injury
. Combined ACL and PLC injury
. Isolated lateral collateral ligament (LCL) injury

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

The dial test (tibial external rotation test) evaluates the integrity of the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). Increased external rotation of greater than 10 degrees (compared with the normal side) at 30 degrees of knee flexion, but NOT at 90 degrees of flexion, is indicative of an isolated posterolateral corner (PLC) injury. Increased external rotation at both 30 and 90 degrees of flexion indicates a combined PCL and PLC injury.

Question 4965

Topic: 5. Sports Medicine

A 26-year-old professional baseball pitcher presents with a dull, aching posterior shoulder pain. Examination reveals 20 degrees of internal rotation and 130 degrees of external rotation of the dominant shoulder at 90 degrees of abduction. The contralateral shoulder has 60 degrees of internal rotation and 100 degrees of external rotation. Radiographs are unremarkable. What is the primary underlying anatomic pathology associated with this athlete's Glenohumeral Internal Rotation Deficit (GIRD)?

. Anterior capsular laxity
. Posterior inferior capsular contracture
. Subscapularis tightness
. Pectoralis minor contracture
. Coracohumeral ligament contracture

Correct Answer & Explanation

. Posterior inferior capsular contracture

Explanation

Glenohumeral internal rotation deficit (GIRD) is a common condition in overhead throwing athletes, characterized by a loss of internal rotation (typically >20 degrees compared to the contralateral side) with a corresponding increase in external rotation. The primary underlying pathology is contracture of the posteroinferior joint capsule, often secondary to repetitive microtrauma during the deceleration phase of throwing. The first-line treatment consists of targeted posterior capsular stretching, such as the 'sleeper stretch'.

Question 4966

Topic: 5. Sports Medicine

A 14-year-old male cross-country runner presents with vague, intermittent anterior knee pain and mechanical catching for the past 3 months. Radiographs demonstrate an osteochondral lesion of the lateral aspect of the medial femoral condyle. He has widely open distal femoral physes. Figure 7

demonstrates the MRI findings, which reveal a 1.5 cm by 1.5 cm lesion with intact overlying cartilage and no high T2 fluid signal behind the fragment. What is the most appropriate initial management?

. Arthroscopic antegrade drilling of the lesion
. Arthroscopic fixation with bioabsorbable compression screws
. Osteochondral autograft transfer (OATS)
. Rest, activity modification, and restriction from high-impact sports
. Microfracture of the lesion

Correct Answer & Explanation

. Rest, activity modification, and restriction from high-impact sports

Explanation

The patient has juvenile osteochondritis dissecans (OCD) of the knee, typically located on the lateral aspect of the medial femoral condyle. Because the patient is skeletally immature (open physes) and the MRI demonstrates a stable lesion (no high T2 signal or fluid undermining the fragment, intact cartilage), there is a high potential for spontaneous healing. The most appropriate initial management is non-operative, consisting of rest, activity modification, and restriction from high-impact sports. Surgical intervention (drilling or fixation) is reserved for unstable lesions or failure of prolonged non-operative management.

Question 4967

Topic: Knee Sports
A 16-year-old female gymnast presents with a history of recurrent lateral patellar dislocations. She is indicated for a medial patellofemoral ligament (MPFL) reconstruction. To ensure proper isometry of the graft, the femoral tunnel must be placed at 'Schöttle's point'. Which of the following best describes the anatomic location of the MPFL origin on the femur?
. Anterior and distal to the medial epicondyle
. Between the medial epicondyle and adductor tubercle
. Posterior to the medial epicondyle
. Directly on the adductor tubercle
. On the medial supracondylar ridge superior to the adductor magnus insertion

Correct Answer & Explanation

. Between the medial epicondyle and adductor tubercle

Explanation

The medial patellofemoral ligament (MPFL) provides 50-60% of the restraining force against lateral patellar displacement from 0 to 30 degrees of knee flexion. Its anatomic femoral origin is located in a 'saddle' region situated between the medial epicondyle and the adductor tubercle. Non-anatomic placement of the femoral tunnel during reconstruction (most commonly placed too anterior or too proximal) leads to anisometry, causing increased patellofemoral pressures, graft stretching, or a block to flexion.

Question 4968

Topic: Knee Sports

A 23-year-old male underwent an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft 6 months ago. He has aggressively participated in physical therapy but continues to complain of a painful mechanical block to terminal extension, lacking 10 degrees compared to the uninjured side. Figure 11

displays a sagittal MRI of his knee. What is the most likely diagnosis?

. Graft impingement due to an excessively posterior tibial tunnel
. Localized anterior arthrofibrosis (Cyclops lesion)
. Patellar tendon contracture (Infrapatellar contracture syndrome)
. Hardware prominence from the tibial interference screw
. PCL impingement secondary to an excessively anterior femoral tunnel

Correct Answer & Explanation

. Localized anterior arthrofibrosis (Cyclops lesion)

Explanation

The clinical presentation of a mechanical block to extension along with pain at terminal extension following ACL reconstruction is highly suspicious for a Cyclops lesion. This is a focal, nodular area of anterior arthrofibrosis that forms anterior to the ACL graft, physically blocking extension. It occurs in 1-10% of ACL reconstructions. Although an excessively anterior tibial tunnel can cause roof impingement and a block to extension, the discrete nodule visualized on MRI (often hyperintense on T2 anterior to the graft) defines a Cyclops lesion. Treatment consists of arthroscopic excision.

Question 4969

Topic: 5. Sports Medicine

A 26-year-old male with symptomatic cam-type femoroacetabular impingement undergoes hip arthroscopy with osteochondroplasty. During resection of the cam lesion on the femoral neck, aggressive resection of the posterolateral aspect is avoided to prevent injury to the retinacular vessels. These critical vessels are terminal branches of which artery?

. Medial femoral circumflex artery
. Lateral femoral circumflex artery
. Superior gluteal artery
. Inferior gluteal artery
. Obturator artery

Correct Answer & Explanation

. Medial femoral circumflex artery

Explanation

The medial femoral circumflex artery (MFCA) gives off the retinacular vessels, which provide the primary and most critical blood supply to the adult femoral head. These vessels course along the posterosuperior and posteroinferior aspects of the femoral neck. Resection of the posterolateral femoral neck during cam osteochondroplasty must be carefully monitored to avoid injuring these vessels, which could precipitate avascular necrosis of the femoral head.

Question 4970

Topic: Knee Sports
A 52-year-old female undergoes an MRI of the knee for posterior knee pain after a deep squat. The MRI demonstrates a complete radial tear at the posterior root attachment of the medial meniscus. If left untreated, this specific injury pattern alters the joint biomechanics most similarly to which of the following scenarios?
. Complete anterior cruciate ligament tear
. Total medial meniscectomy
. Partial medial meniscectomy
. Medial collateral ligament grade III sprain
. Lateral meniscus root tear

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A medial meniscus posterior root tear results in a complete loss of circumferential hoop stresses, often leading to meniscal extrusion. Biomechanically, this loss of function decreases the tibiofemoral contact area and significantly increases peak contact pressures to levels that are equivalent to a total medial meniscectomy, leading to rapid development of osteoarthritis.

Question 4971

Topic: Shoulder & Hip Sports

During a classic Latarjet procedure for anterior shoulder instability with significant glenoid bone loss, the coracoid process is transferred to the anterior glenoid rim. To expose the anterior glenoid, how is the subscapularis muscle typically managed in the traditional Latarjet technique described by Walch?

. Tenotomy at its insertion on the lesser tuberosity
. Z-lengthening of the tendon
. Splitting the muscle fibers longitudinally
. Detachment of the superior third only
. Detachment from the glenoid neck

Correct Answer & Explanation

. Splitting the muscle fibers longitudinally

Explanation

The classic Latarjet procedure involves a longitudinal split of the subscapularis muscle (typically at the junction of the superior two-thirds and inferior one-third). This split allows passage of the coracoid graft and the attached conjoint tendon to the anterior glenoid rim. This "sling effect" of the conjoint tendon traversing the subscapularis split provides a dynamic stabilizing effect.

Question 4972

Topic: Knee Sports
A 16-year-old gymnast requires medial patellofemoral ligament (MPFL) reconstruction for recurrent instability. Intraoperative fluoroscopy is used to identify Schöttle's point for the femoral tunnel. Which of the following describes the correct fluoroscopic location of this point on a strictly lateral radiograph?
. 1 mm anterior to the posterior femoral cortical line and just proximal to the posterior extension of Blumensaat's line
. 5 mm posterior to the posterior femoral cortical line and distal to Blumensaat's line
. At the intersection of the posterior femoral cortical line and Blumensaat's line
. 2.5 mm proximal to the adductor tubercle
. 1 mm distal to the medial epicondyle

Correct Answer & Explanation

. 1 mm anterior to the posterior femoral cortical line and just proximal to the posterior extension of Blumensaat's line

Explanation

Schöttle's point is a reliable radiographic landmark used to identify the anatomic femoral origin of the MPFL. On a true lateral radiograph, it is located 1 mm anterior to the posterior cortical extension line, 2.5 mm distal to the posterior border of the medial femoral condyle articular surface, and strictly proximal to the level of the posterior aspect of Blumensaat's line.

Question 4973

Topic: Knee Sports

A 13-year-old male presents with vague anterior knee pain and occasional catching. Radiographs reveal a lesion consistent with osteochondritis dissecans (OCD) in the most classic location within the knee. Which of the following best describes this anatomical location?

. Medial aspect of the lateral femoral condyle
. Lateral aspect of the medial femoral condyle
. Central weight-bearing portion of the medial femoral condyle
. Inferior pole of the patella
. Central trochlea

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for an osteochondritis dissecans (OCD) lesion in the knee is the lateral aspect of the medial femoral condyle, which accounts for approximately 70% to 80% of all cases. This is best visualized on a notch (tunnel) view radiograph.

Question 4974

Topic: Knee Sports

A 22-year-old collegiate soccer player sustains a twisting knee injury. MRI demonstrates a complete anterior cruciate ligament (ACL) tear and a medial meniscus posterior root tear.

Biomechanically, an unrepaired medial meniscus posterior root tear alters knee joint kinematics in a manner most similar to which of the following?

. A peripheral longitudinal tear of the posterior horn
. A radial tear of the anterior horn
. A total medial meniscectomy
. A bucket-handle tear with displacement into the notch
. An isolated posterior horn meniscocapsular separation (ramp lesion)

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

Medial meniscus posterior root tears result in the loss of hoop stresses, leading to medial compartment contact pressures and kinematics that are biomechanically equivalent to a total medial meniscectomy. Repair of the root (e.g., via a trans-tibial pull-out technique) is critical during ACL reconstruction to restore hoop stresses, prevent rapid progression of osteoarthritis, and protect the ACL graft from excessive anterior translation forces.

Question 4975

Topic: Shoulder & Hip Sports

A 24-year-old rugby player presents with recurrent anterior shoulder instability. A CT scan of the shoulder reveals 12% anterior glenoid bone loss and a large Hill-Sachs lesion. Applying the glenoid track concept, the Hill-Sachs lesion is calculated to be 'off-track.' Which of the following is the most appropriate surgical management to minimize the risk of recurrent instability?

. Arthroscopic isolated Bankart repair
. Arthroscopic Bankart repair with remplissage
. Open inferior capsular shift
. Latarjet procedure (coracoid transfer)
. Arthroscopic Hill-Sachs bone grafting

Correct Answer & Explanation

. Arthroscopic Bankart repair with remplissage

Explanation

The glenoid track concept determines whether a Hill-Sachs lesion will engage the anterior glenoid rim. An 'off-track' lesion in the setting of subcritical glenoid bone loss (<15-20%) is best managed with an arthroscopic Bankart repair combined with a remplissage (capsulotenodesis of the infraspinatus into the Hill-Sachs defect). If glenoid bone loss is critical (>20%), a bone-block augmentation procedure such as a Latarjet is indicated.

Question 4976

Topic: Knee Sports

A 28-year-old athlete presents with a hyperextension injury to the knee. On physical examination, the dial test is performed. There is 15 degrees of increased external rotation of the tibia relative to the uninjured contralateral side at 30 degrees of knee flexion. At 90 degrees of knee flexion, the external rotation is symmetric bilaterally. Which structure is most likely injured?

. Isolated anterior cruciate ligament (ACL)
. Isolated posterior cruciate ligament (PCL)
. Isolated posterolateral corner (PLC)
. Combined PCL and PLC
. Medial collateral ligament (MCL) and posteromedial corner (PMC)

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

The dial test assesses the integrity of the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion but symmetric rotation at 90 degrees indicates an isolated PLC injury. If external rotation is increased at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 4977

Topic: 5. Sports Medicine

During hip arthroscopy for femoroacetabular impingement (FAI), standard portals are established. The anterior portal is typically made under direct visualization. Which of the following neurological structures is at greatest risk of iatrogenic injury during the establishment of the anterior portal?

. Femoral nerve
. Sciatic nerve
. Superior gluteal nerve
. Lateral femoral cutaneous nerve
. Obturator nerve

Correct Answer & Explanation

. Lateral femoral cutaneous nerve

Explanation

The lateral femoral cutaneous nerve (LFCN) is at greatest risk during placement of the anterior portal in hip arthroscopy. The anterior portal is typically located at the intersection of a sagittal line drawn distally from the ASIS and a transverse line extending from the tip of the greater trochanter. Variations in LFCN anatomy make it susceptible to injury here. The sciatic nerve is at risk with the posterolateral portal, and the superior gluteal nerve is at risk if the anterolateral portal is placed too far proximal.

Question 4978

Topic: Knee Sports
A 19-year-old female undergoes medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. To avoid non-anatomic graft placement that could result in excessive tension during knee flexion, the surgeon identifies the femoral footprint utilizing Schöttle's point. Anatomically, this footprint is located in relation to which of the following osseous landmarks?
. Proximal to the adductor tubercle and posterior to the medial epicondyle
. Distal to the adductor tubercle, proximal and posterior to the medial epicondyle
. Distal and anterior to the medial epicondyle
. Directly on the medial aspect of the gastrocnemius tubercle
. Anterior to the adductor tubercle and distal to the joint line

Correct Answer & Explanation

. Distal to the adductor tubercle, proximal and posterior to the medial epicondyle

Explanation

The anatomic femoral origin of the MPFL lies in a saddle-like sulcus that is distal to the adductor tubercle, proximal and posterior to the medial epicondyle, and anterior to the gastrocnemius tubercle. Radiographically, Schöttle's point is 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line. Proper placement is essential; a graft placed too proximal or anterior will overtighten in flexion.

Question 4979

Topic: 5. Sports Medicine

A 45-year-old male presents with acute knee pain and inability to actively extend his knee after a fall while playing basketball.

A lateral radiograph of the knee reveals a significantly low-riding patella (patella baja) compared to the contralateral knee. Which of the following is the most likely diagnosis?

. Acute patellar tendon rupture
. Acute quadriceps tendon rupture
. Tibial tubercle avulsion fracture
. Patellar sleeve fracture
. Bipartite patella with disruption of the synchondrosis

Correct Answer & Explanation

. Acute quadriceps tendon rupture

Explanation

A quadriceps tendon rupture leads to unopposed distal pull on the patella by the intact patellar tendon, resulting in an inferiorly displaced patella (patella baja). In contrast, a patellar tendon rupture removes the distal tether, allowing the quadriceps muscle to pull the patella superiorly, resulting in patella alta.

Question 4980

Topic: 5. Sports Medicine

A 42-year-old recreational weightlifter presents with deep shoulder pain exacerbated by overhead activities. Physical therapy has failed after 6 months. An MRI arthrogram reveals an isolated Type II superior labrum anterior-posterior (SLAP) tear. Given the patient's age and activity profile, which surgical intervention is statistically associated with the highest rate of return to sport and the lowest rate of revision surgery?

. Arthroscopic SLAP repair with suture anchors
. Arthroscopic superior labral debridement
. Subpectoral biceps tenodesis
. Arthroscopic thermal capsulorrhaphy
. Open capsulolabral reconstruction

Correct Answer & Explanation

. Subpectoral biceps tenodesis

Explanation

In older athletes and patients (typically > 35-40 years old), isolated repair of a Type II SLAP tear is associated with significant postoperative stiffness, continued pain, and a higher revision rate. Evidence strongly supports primary biceps tenodesis in this demographic, which yields higher patient satisfaction, more reliable pain relief, and better return to activity compared to SLAP repair.

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