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5. Sports Medicine MCQs

Practice Set 251 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 5001

Topic: Knee Sports

When performing an anatomic reconstruction of the posterolateral corner (PLC) of the knee, accurate identification of the femoral attachments of the lateral collateral ligament (LCL) and the popliteus tendon is critical for restoring normal kinematics. What is the correct anatomic relationship of the LCL femoral attachment relative to the popliteus tendon attachment?

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

Correct Answer & Explanation

. Distal and anterior

Explanation

The anatomic footprint of the lateral collateral ligament (LCL) on the lateral femoral epicondyle is consistently located proximal and posterior to the attachment of the popliteus tendon. Misplacement of these tunnels during PLC reconstruction alters graft isometry and leads to failure.

Question 5002

Topic: 5. Sports Medicine

A 24-year-old male presents with persistent knee stiffness 7 months following primary anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Physical examination reveals full knee extension, but flexion is limited to 110 degrees (contralateral side flexes to 140 degrees). Sagittal MRI indicates improper femoral tunnel placement. Which of the following tunnel placement errors is the most likely biomechanical cause of this specific range of motion deficit?

. Femoral tunnel placed too anteriorly
. Femoral tunnel placed too posteriorly
. Tibial tunnel placed too anteriorly
. Tibial tunnel placed too posteriorly
. Femoral tunnel placed too laterally

Correct Answer & Explanation

. Femoral tunnel placed too anteriorly

Explanation

A femoral tunnel placed too anteriorly in the intercondylar notch results in the graft tensioning excessively as the knee moves into flexion, leading to a loss of maximal knee flexion. Conversely, an anteriorly placed tibial tunnel typically causes loss of extension due to roof impingement.

Question 5003

Topic: 5. Sports Medicine

A 26-year-old recreational volleyball player undergoes shoulder arthroscopy for persistent anterior shoulder pain. Diagnostic arthroscopy reveals an absent anterosuperior labrum and a thickened, cord-like structure extending from the superior labrum to the anterior margin of the glenoid. If the surgeon mistakenly identifies this structure as a pathological Bankart lesion and surgically secures it to the anterior glenoid rim, what is the most likely postoperative complication?

. Severe restriction of external rotation
. Recurrent posterior instability
. Suprascapular nerve entrapment
. Axillary nerve palsy
. Subscapularis rupture

Correct Answer & Explanation

. Severe restriction of external rotation

Explanation

The anatomic variant described is a Buford complex, occurring in about 1.5% of shoulders. It consists of an absent anterosuperior labrum and a thickened, cord-like middle glenohumeral ligament (MGHL). Mistakenly repairing (tenodesing) this normal variant to the anterior glenoid will severely restrict external rotation and cause significant postoperative pain and iatrogenic stiffness.

Question 5004

Topic: Shoulder & Hip Sports

A 22-year-old hockey player presents with chronic, deep groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate an aspherical femoral head with an alpha angle of 68 degrees. If the patient undergoes hip arthroscopy, what is the most typical pattern of associated intra-articular cartilage damage expected?

. Posteroinferior acetabular labral tearing
. Delamination of the anterosuperior acetabular cartilage
. Diffuse chondromalacia of the femoral head
. Central acetabular full-thickness cartilage loss
. Isolated ligamentum teres avulsion

Correct Answer & Explanation

. Delamination of the anterosuperior acetabular cartilage

Explanation

This patient has Cam-type femoroacetabular impingement (FAI), characterized by a nonspherical femoral head and decreased head-neck offset (high alpha angle). During hip flexion and internal rotation, the cam lesion engages the acetabulum, creating shear forces that classically lead to delamination of the articular cartilage in the anterosuperior quadrant of the acetabulum (frequently causing the 'carpet delamination' sign), often while the overlying labrum remains relatively intact initially.

Question 5005

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon utilizes fluoroscopy to verify the anatomic femoral origin point (Schöttle's point). On a strictly lateral radiograph of the knee, where is this point correctly located?
. 1 mm anterior to the posterior femoral cortex line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line
. 1 mm posterior to the posterior femoral cortex line, 2.5 mm proximal to the posterior articular border, and distal to Blumensaat's line
. 5 mm anterior to the posterior femoral cortex line, directly on Blumensaat's line
. At the center of the medial femoral condyle, 10 mm distal to the adductor tubercle
. 5 mm posterior to the medial epicondyle, distal to Blumensaat's line

Correct Answer & Explanation

. 1 mm anterior to the posterior femoral cortex line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line

Explanation

Schöttle's point serves as the radiographic landmark for the isometric femoral origin of the MPFL. On a perfect lateral radiograph, it is located 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm distal to the posterior articular border of the medial femoral condyle, and proximal to Blumensaat's line.

Question 5006

Topic: Shoulder & Hip Sports

A 17-year-old female swimmer presents with bilateral shoulder pain and a sensation that her shoulders frequently 'slip out of place.' Examination reveals positive sulcus signs bilaterally, positive apprehension and relocation tests, and a Beighton score of 7/9. There is no history of a distinct traumatic dislocation. She has undergone standard rotator cuff strengthening for 3 months with minimal improvement. What is the most appropriate next step in management?

. Arthroscopic anterior capsulolabral repair (Bankart repair)
. Open inferior capsular shift
. Arthroscopic thermal capsulorrhaphy
. Focused physical therapy program emphasizing periscapular stabilizers and proprioception
. Latissimus dorsi tendon transfer

Correct Answer & Explanation

. Focused physical therapy program emphasizing periscapular stabilizers and proprioception

Explanation

This patient's presentation is classic for multidirectional instability (MDI). The hallmark of MDI treatment is a prolonged, focused rehabilitation program. While she had standard rotator cuff strengthening, the rehabilitation for MDI must specifically emphasize periscapular muscle strengthening (serratus anterior, rhomboids, trapezius) and dynamic proprioceptive control. Operative interventions (such as capsular shifts) are strictly reserved for patients who fail at least 6 months of a dedicated, MDI-specific therapy program.

Question 5007

Topic: 5. Sports Medicine

A 16-year-old female soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. Which of the following is the most common postoperative complication specific to this graft choice when compared to hamstring autograft?

. Increased risk of postoperative graft rupture
. Anterior knee pain and pain with kneeling
. Deep vein thrombosis
. Decreased peak hamstring and rotational strength
. Symptomatic femoral tunnel widening

Correct Answer & Explanation

. Anterior knee pain and pain with kneeling

Explanation

Bone-patellar tendon-bone (BTB) autografts are considered a gold standard for ACL reconstruction but are consistently associated with a higher incidence of anterior knee pain and difficulty kneeling compared to hamstring autografts. Hamstring autografts, conversely, are associated with slightly decreased peak flexion strength and internal rotation strength. Tunnel widening is typically more common with suspensory fixation of soft tissue grafts.

Question 5008

Topic: Shoulder & Hip Sports

A 19-year-old collegiate swimmer presents with bilateral shoulder pain and a sensation of 'slipping'. Physical examination reveals a sulcus sign of 2 cm bilaterally, positive apprehension and relocation tests, and generalized ligamentous laxity with a Beighton score of 7/9. Initial management should consist of:

. Arthroscopic Bankart repair
. Open inferior capsular shift
. Periscapular and rotator cuff strengthening program
. Thermal capsulorrhaphy
. Arthroscopic capsular plication

Correct Answer & Explanation

. Periscapular and rotator cuff strengthening program

Explanation

The patient has multidirectional instability (MDI), characterized by generalized laxity and instability in more than one plane (inferior, anterior, posterior). The cornerstone of initial management for MDI is a prolonged, structured physical therapy program emphasizing periscapular stabilizers and rotator cuff strengthening (often for a minimum of 6 months). Surgery is strictly reserved for those who fail extensive nonoperative treatment.

Question 5009

Topic: Knee Sports
A 45-year-old male feels a pop in the posterior aspect of his right knee while squatting to lift a heavy box. He develops a mild effusion and posterior joint line tenderness. Coronal T2-weighted MRI of the affected knee reveals a 'ghost sign' and >3 mm extrusion of the medial meniscus. What is the most likely diagnosis?
. Medial meniscus posterior root tear
. Anterior cruciate ligament tear
. Patellar tendon rupture
. Popliteus tendon avulsion
. Osteochondritis dissecans of the medial femoral condyle

Correct Answer & Explanation

. Medial meniscus posterior root tear

Explanation

Meniscal root tears frequently occur in middle-aged patients during deep flexion activities, such as squatting. The classic MRI findings on coronal T2 imaging include the 'ghost sign' (absence of identifiable meniscal tissue at the root attachment) and meniscal extrusion >3 mm. Biomechanically, a root tear results in a loss of hoop stresses, effectively functioning like a total meniscectomy if left untreated.

Question 5010

Topic: Shoulder & Hip Sports

A 24-year-old baseball pitcher presents with deep shoulder pain and a 'dead arm' sensation. An MRI arthrogram reveals a SLAP tear with detachment of the superior labrum and biceps anchor from the glenoid (Type II SLAP tear). Which of the following physical examination tests is designed to evaluate this pathology by utilizing active compression?

. Positive Neer impingement sign
. Positive O'Brien active compression test
. Positive Speed's test
. Positive Hawkins-Kennedy test
. Positive Hornblower's sign

Correct Answer & Explanation

. Positive O'Brien active compression test

Explanation

The O'Brien test (active compression test) is performed with the arm flexed to 90 degrees, adducted 10 to 15 degrees, and internally rotated (thumb pointing down). Pain elicited in this position that is relieved when the arm is externally rotated (thumb pointing up) suggests a SLAP lesion. Neer and Hawkins-Kennedy tests evaluate subacromial impingement; Hornblower's sign tests teres minor pathology; Speed's test assesses long head of biceps pathology.

Question 5011

Topic: Shoulder & Hip Sports

A 26-year-old professional volleyball player presents with insidious onset of posterior shoulder pain and paresthesias over the lateral aspect of the shoulder. She also reports weakness with external rotation. An MRI demonstrates fatty infiltration and atrophy isolated to the teres minor with no rotator cuff tear. What is the most likely cause of her symptoms?

. Suprascapular nerve entrapment at the suprascapular notch
. Axillary nerve compression in the quadrilateral space
. Suprascapular nerve entrapment at the spinoglenoid notch
. Long thoracic nerve palsy
. Musculocutaneous nerve entrapment

Correct Answer & Explanation

. Axillary nerve compression in the quadrilateral space

Explanation

Quadrilateral space syndrome is caused by compression of the axillary nerve and the posterior humeral circumflex artery within the quadrilateral space. Clinical presentation includes poorly localized posterior shoulder pain, paresthesias over the lateral deltoid, and weakness in external rotation. MRI characteristically shows isolated atrophy and fatty infiltration of the teres minor (and occasionally the deltoid). Suprascapular nerve entrapment at the spinoglenoid notch causes isolated infraspinatus atrophy.

Question 5012

Topic: Knee Sports

A 30-year-old male sustains a severe varus blow to his anteromedial tibia. Clinical examination (Dial test) reveals a 15-degree increase in external rotation of the affected tibia at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of knee flexion, the external rotation is symmetric bilaterally. This finding indicates an isolated injury to which of the following structures?

. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Posterolateral corner (PLC)
. Medial collateral ligament (MCL)
. Posteromedial corner (PMC)

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

The Dial test evaluates for posterolateral corner (PLC) and posterior cruciate ligament (PCL) injuries. An increase in external rotation of greater than 10 degrees (compared to the normal knee) at 30 degrees of flexion, but symmetric rotation at 90 degrees, is pathognomonic for an isolated PLC injury. If external rotation is increased at both 30 and 90 degrees, it indicates a combined injury to the PLC and PCL.

Question 5013

Topic: 5. Sports Medicine

A 25-year-old female undergoes an uncomplicated anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Postoperatively, she reports a well-demarcated area of numbness over the anterolateral aspect of her proximal leg. Motor function is intact. Which of the following nerves was most likely injured during the surgical approach or graft harvest?

. Sural nerve
. Superficial peroneal nerve
. Infrapatellar branch of the saphenous nerve
. Lateral femoral cutaneous nerve
. Tibial nerve

Correct Answer & Explanation

. Infrapatellar branch of the saphenous nerve

Explanation

The infrapatellar branch of the saphenous nerve courses transversely across the anterior aspect of the proximal tibia. It is highly susceptible to injury during the vertical incision used for harvesting a patellar tendon autograft or during anteromedial portal placement. Injury results in sensory loss over the anterolateral aspect of the proximal leg, but motor function remains unaffected.

Question 5014

Topic: Shoulder & Hip Sports

A 19-year-old female collegiate swimmer presents with bilateral shoulder pain and a sensation of 'slipping' with overhead activities. Examination demonstrates a positive sulcus sign, generalized ligamentous laxity with a Beighton score of 6/9, and scapular dyskinesia. Radiographs and an MRI arthrogram (Figure 25) reveal a voluminous capsule but no frank labral tear. What is the most appropriate initial management for this patient?

. Arthroscopic capsular plication
. Open inferior capsular shift
. Prolonged physical therapy focusing on periscapular and rotator cuff strengthening
. Thermal capsulorrhaphy
. Arthroscopic SLAP repair

Correct Answer & Explanation

. Prolonged physical therapy focusing on periscapular and rotator cuff strengthening

Explanation

The patient has multidirectional instability (MDI) of the shoulder, characterized by symptomatic instability in more than one direction (anterior, posterior, inferior) and often associated with generalized ligamentous laxity. The mainstay and initial treatment of choice for MDI is a supervised, prolonged physical therapy program (typically 6 months) emphasizing dynamic stabilizer strengthening (rotator cuff and periscapular muscles). Surgery is reserved for patients who fail extensive conservative management.

Question 5015

Topic: 5. Sports Medicine

A 28-year-old male sustains a bucket-handle tear of the medial meniscus. During arthroscopy, the tear is localized to the peripheral 3 mm of the meniscal body. To optimize healing after a planned inside-out meniscal repair, the surgeon relies on the primary source of vascularity to this region. Which of the following arterial structures is primarily responsible for the blood supply to this area?

. Middle genicular artery
. Medial and lateral superior genicular arteries
. Medial and lateral inferior genicular arteries
. Popliteal artery branches directly piercing the capsule
. Synovial diffusion strictly

Correct Answer & Explanation

. Medial and lateral inferior genicular arteries

Explanation

The peripheral 10% to 30% of the meniscus (the 'red-red' zone) is highly vascularized and highly amenable to repair. This blood supply originates primarily from the perimeniscal capillary plexus, which is fed by the medial and lateral inferior genicular arteries. The middle genicular artery supplies the cruciate ligaments, whereas synovial diffusion provides nutrition to the avascular central ('white-white') zones of the meniscus.

Question 5016

Topic: Knee Sports

A 30-year-old male presents with knee pain following a dashboard injury during a motor vehicle collision. On examination, a posterior sag sign is present. To confirm a posterior cruciate ligament (PCL) injury, the examiner performs a quadriceps active test. Which of the following correctly describes a positive finding for this test in a PCL-deficient knee?

. The tibia shifts anteriorly from a subluxated position when the quadriceps contract at 90 degrees of flexion.
. The tibia shifts posteriorly when the quadriceps contract at 90 degrees of flexion.
. The tibia rotates externally when the quadriceps contract.
. The patella subluxates laterally during eccentric contraction.
. The tibia translates medially under varus stress.

Correct Answer & Explanation

. The tibia shifts anteriorly from a subluxated position when the quadriceps contract at 90 degrees of flexion.

Explanation

In a PCL-deficient knee, the tibia rests in a posteriorly subluxated position due to gravity when the knee is flexed to 90 degrees. The quadriceps active test is performed by asking the patient to slide their foot anteriorly against resistance (firing the quadriceps). The pull of the patellar tendon pulls the tibia anteriorly to its reduced anatomical position. This anterior shift is a positive quadriceps active test, diagnostic of PCL deficiency.

Question 5017

Topic: Shoulder & Hip Sports

A 27-year-old elite volleyball player complains of vague posterior shoulder pain and progressive weakness in external rotation. Examination reveals isolated atrophy of the infraspinatus muscle with normal supraspinatus bulk and strength. An MRI (Figure 12) demonstrates a paralabral cyst. At which of the following anatomical locations is the suprascapular nerve compression most likely occurring?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Spiral groove

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Isolated weakness and atrophy of the infraspinatus muscle point to entrapment of the suprascapular nerve at the spinoglenoid notch, typically caused by a paralabral cyst associated with a posterior superior labral tear. The suprascapular nerve innervates the supraspinatus muscle prior to passing through the spinoglenoid notch; therefore, compression at the suprascapular notch would affect both the supraspinatus and the infraspinatus muscles.

Question 5018

Topic: 5. Sports Medicine

A 14-year-old female gymnast complains of insidious onset lateral elbow pain, clicking, and a 15-degree extension deficit. Radiographs (Figure 3) demonstrate a radiolucent lesion on the capitellum. MRI confirms an unstable osteochondral defect measuring 14 mm x 12 mm with subchondral fluid and a loose body in the joint space. Six months of nonoperative management has failed. What is the most appropriate surgical management for this athlete?

. Diagnostic arthroscopy with loose body removal and microfracture of the lesion
. Osteochondral autograft transfer (OATS)
. Capitellar excision with radial head stabilization
. Ulnar nerve transposition
. Corticosteroid injection and return to play in a brace

Correct Answer & Explanation

. Osteochondral autograft transfer (OATS)

Explanation

Osteochondritis dissecans (OCD) of the capitellum typically affects young athletes subjected to repetitive valgus compression (gymnasts, pitchers). For unstable lesions with subchondral fluid or loose bodies that fail conservative care, surgery is indicated. For lesions larger than 10 mm, osteochondral autograft transfer (OATS) has been shown to provide superior clinical outcomes and higher rates of return to competitive sports compared to marrow stimulation techniques like microfracture.

Question 5019

Topic: Shoulder & Hip Sports

A 24-year-old male hockey player presents with gradual onset of groin pain that worsens with deep flexion and internal rotation of the hip. A diagnostic intra-articular injection completely relieves his pain temporarily. Radiographs demonstrate an alpha angle of 75 degrees and normal acetabular version. Which of the following best describes the pathophysiologic mechanism of his condition?

. Linear contact between a prominent anterior acetabular rim and the femoral head-neck junction leading to labral crushing.
. Shear forces generated by an aspherical femoral head entering the acetabulum leading to anterosuperior chondral delamination.
. Degeneration of the ligamentum teres due to repetitive microtrauma.
. Extra-articular impingement of the anterior inferior iliac spine (AIIS) against the femur.
. Avascular necrosis of the femoral head due to compromised medial circumflex femoral artery.

Correct Answer & Explanation

. Shear forces generated by an aspherical femoral head entering the acetabulum leading to anterosuperior chondral delamination.

Explanation

The patient has Cam-type femoroacetabular impingement (FAI), characterized by an abnormally elevated alpha angle (>50-55 degrees) denoting an aspherical femoral head-neck junction. During hip flexion and internal rotation, this cam lesion is forced into the acetabulum, generating significant shear forces. This mechanism classically causes anterosuperior acetabular cartilage delamination and 'inside-out' tearing of the labrum. Linear crushing of the labrum is characteristic of Pincer impingement.

Question 5020

Topic: 5. Sports Medicine

A 19-year-old collegiate football player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. What is the most common cause of early graft failure (occurring within 6 months) in this patient population?

. Deep surgical site infection
. Missed concomitant posterolateral corner injury
. Technical error, such as non-anatomic tunnel placement
. Arthrofibrosis and secondary graft impingement
. Premature return to competitive sports before biologic integration

Correct Answer & Explanation

. Technical error, such as non-anatomic tunnel placement

Explanation

While all listed options can lead to graft failure, technical error (specifically non-anatomic tunnel placement) remains the single most common cause of early ACL graft failure overall. A femoral tunnel placed too anteriorly or vertically is a classic technical error leading to abnormal graft kinematics, stretching, and eventual early failure.

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