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5. Sports Medicine MCQs

Practice Set 252 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 5021

Topic: Knee Sports

Figure 8 shows the MRI of a 45-year-old female who felt a pop in her posterior knee while squatting.

Imaging confirms a medial meniscus posterior root tear with 4 mm of meniscal extrusion. Which of the following biomechanical scenarios most closely mimics the contact mechanics of the knee resulting from this injury?

. Partial medial meniscectomy
. Total medial meniscectomy
. Complete ACL deficiency
. Complete PCL deficiency
. Isolated deep MCL rupture

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A medial meniscus posterior root tear disrupts the circumferential fibers of the meniscus, leading to a complete loss of hoop stresses. Biomechanically, this renders the meniscus functionally incompetent. The resultant increase in peak contact pressures and decrease in contact area are nearly equivalent to those seen following a total medial meniscectomy, predisposing the joint to rapid articular cartilage degeneration.

Question 5022

Topic: Shoulder & Hip Sports

A 24-year-old male rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability associated with 25% glenoid bone loss. During the anterior approach, the conjoined tendon is aggressively retracted medially to obtain adequate exposure of the anterior glenoid neck. Which of the following nerves is at greatest risk of neuropraxia due to this maneuver?

. Axillary nerve
. Musculocutaneous nerve
. Suprascapular nerve
. Radial nerve
. Median nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve typically enters the coracobrachialis muscle 3 to 8 cm distal to the tip of the coracoid process. Overly vigorous medial retraction of the conjoined tendon puts direct traction on this nerve, making it the most commonly injured nerve (usually neuropraxia) during the Latarjet procedure.

Question 5023

Topic: 5. Sports Medicine

A 28-year-old hockey player undergoes hip arthroscopy for cam-type femoroacetabular impingement. Postoperatively, he reports isolated burning pain and numbness over the anterolateral aspect of his operative thigh. He denies any motor weakness, groin numbness, or perineal symptoms. Injury to which of the following structures is the most likely cause of his symptoms?

. Sciatic nerve
. Pudendal nerve
. Lateral femoral cutaneous nerve
. Femoral nerve
. Obturator nerve

Correct Answer & Explanation

. Lateral femoral cutaneous nerve

Explanation

The lateral femoral cutaneous nerve (LFCN) provides sensation to the anterolateral thigh. It is the most commonly injured nerve during hip arthroscopy, usually due to direct trauma during anterior portal placement. Pudendal nerve neurapraxia is associated with perineal post compression from excessive traction time, which typically causes perineal numbness.

Question 5024

Topic: Shoulder & Hip Sports

A 52-year-old recreational tennis player presents with chronic right shoulder pain. MRI shows a massive, retracted, and irreparable tear of the supraspinatus and infraspinatus with Goutallier grade 4 fatty infiltration. The subscapularis and teres minor are completely intact.

Active forward elevation is 150 degrees. The surgeon plans an arthroscopic superior capsular reconstruction (SCR). What are the correct anatomic medial and lateral fixation sites for the graft?

. Superior glenoid tubercle and lesser tuberosity
. Superior glenoid neck and greater tuberosity
. Base of the coracoid process and greater tuberosity
. Undersurface of the acromion and greater tuberosity
. Superior labrum and bicipital groove

Correct Answer & Explanation

. Superior glenoid neck and greater tuberosity

Explanation

Superior capsular reconstruction (SCR) is designed to restore the superior restraints of the glenohumeral joint to prevent superior migration of the humeral head. The graft is anchored medially to the superior glenoid neck (just medial to the superior labrum) and laterally to the superior footprint of the greater tuberosity.

Question 5025

Topic: 5. Sports Medicine
A 21-year-old female soccer player with a symptomatic 4.5 cm² focal full-thickness chondral defect on the medial femoral condyle has failed prior microfracture. She is scheduled for matrix-induced autologous chondrocyte implantation (MACI). Which of the following describes the correct procedural methodology for MACI compared to first-generation ACI?
. A single-stage procedure utilizing minced juvenile allograft cartilage
. A two-stage procedure where cultured chondrocytes are seeded onto a type I/III collagen membrane prior to implantation
. A two-stage procedure where cultured chondrocytes are injected as a liquid suspension under a harvested periosteal patch
. A single-stage procedure utilizing a fresh osteochondral allograft plug
. A two-stage procedure where cultured chondrocytes are injected under a synthetic polylactic acid patch

Correct Answer & Explanation

. A two-stage procedure where cultured chondrocytes are seeded onto a type I/III collagen membrane prior to implantation

Explanation

MACI is a third-generation technique that is performed in two stages. Stage one involves an arthroscopic cartilage biopsy. The chondrocytes are expanded in vitro and seeded onto a type I/III porcine collagen bilayer membrane. Stage two involves securing this cell-seeded membrane into the defect. This contrasts with first-generation ACI, which involved injecting a liquid cell suspension under a sutured periosteal patch (highly prone to periosteal hypertrophy).

Question 5026

Topic: 5. Sports Medicine

A 22-year-old football player undergoes an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Which of the following is the most frequently reported complication specific to this graft choice compared to hamstring autografts?

. Patellar fracture
. Arthrofibrosis
. Anterior knee pain
. Patellar tendon rupture
. Deep vein thrombosis

Correct Answer & Explanation

. Anterior knee pain

Explanation

Anterior knee pain, or donor site morbidity, is the most common complication following BPTB autograft ACL reconstruction, reported in 10% to 30% of patients. While patellar fracture and patellar tendon rupture are severe complications specific to this graft, they are relatively rare (typically <1%). Arthrofibrosis and DVT can occur with any graft type.

Question 5027

Topic: Shoulder & Hip Sports

A 24-year-old rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, the patient reports numbness over the lateral forearm and weakness in elbow flexion. Which nerve was most likely injured during the procedure?

. Axillary nerve
. Suprascapular nerve
. Radial nerve
. Musculocutaneous nerve
. Median nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve typically enters the coracobrachialis 3-8 cm distal to the coracoid process tip. Vigorous medial retraction of the conjoint tendon during the Latarjet procedure places this nerve at high risk of a traction neuropraxia. Clinical signs include lateral forearm numbness (via the lateral antebrachial cutaneous nerve) and weakness in the biceps and brachialis muscles.

Question 5028

Topic: Shoulder & Hip Sports

A 21-year-old hockey player presents with chronic groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate a pistol grip deformity and an alpha angle of 75 degrees. Which of the following is the most likely intra-articular finding associated with this specific morphological variant?

. Chondral delamination of the anterosuperior acetabulum
. Posteromedial labral tear
. Ligamentum teres rupture
. Subspine impingement
. Acetabular retroversion

Correct Answer & Explanation

. Chondral delamination of the anterosuperior acetabulum

Explanation

The patient has a Cam-type femoroacetabular impingement (FAI), indicated by the pistol grip deformity and elevated alpha angle (>50-55 degrees). Cam impingement characteristically causes shear stress on the anterosuperior acetabular cartilage during flexion and internal rotation, leading to chondral delamination from the subchondral bone (the 'peel-back' lesion), often with a relatively intact overlying labrum.

Question 5029

Topic: Shoulder & Hip Sports

A 45-year-old recreational weightlifter presents with deep shoulder pain and clicking. Physical examination reveals positive O'Brien and Crank tests. MRI arthrogram demonstrates a Type II SLAP tear. Six months of physical therapy and injections have failed. What is the most appropriate surgical management for this patient?

. SLAP repair using two suture anchors
. Debridement of the superior labrum only
. Biceps tenodesis
. Glenohumeral arthrodesis
. Coracoid transfer

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In patients older than 40 years with a symptomatic Type II SLAP tear, primary biceps tenodesis has been shown to yield better clinical outcomes, higher rates of return to previous activity levels, and significantly lower complication and stiffness rates compared to primary SLAP repair. SLAP repair in this older demographic is associated with a high rate of postoperative stiffness and clinical failure.

Question 5030

Topic: Knee Sports

A 52-year-old female presents with acute onset medial knee pain after deep squatting. MRI demonstrates a medial meniscus posterior root tear with 4 mm of medial meniscal extrusion. If left completely untreated, the biomechanical consequence of this injury to the knee joint is most equivalent to which of the following?

. Anterior cruciate ligament tear
. Medial collateral ligament sprain
. Partial meniscectomy
. Total meniscectomy
. Isolated chondral defect

Correct Answer & Explanation

. Total meniscectomy

Explanation

A complete medial meniscus posterior root tear disrupts the crucial hoop stresses of the meniscus. Biomechanical studies have unequivocally shown that this leads to altered contact pressures, decreased contact area, and load distributions that are biomechanically equivalent to a total medial meniscectomy. This severely predisposes the patient to rapid progression of osteoarthritis and spontaneous osteonecrosis of the knee (SONK).

Question 5031

Topic: 5. Sports Medicine

A 35-year-old recreational athlete sustains an acute closed Achilles tendon rupture. He is discussing operative versus nonoperative management with his surgeon. Based on current high-level evidence utilizing an accelerated functional rehabilitation protocol, which of the following statements is true?

. Operative management significantly reduces the re-rupture rate compared to nonoperative management
. Nonoperative management has a significantly higher rate of deep vein thrombosis
. Operative management results in significantly greater plantarflexion strength at 2 years
. There is no clinically significant difference in re-rupture rates between the two treatments
. Nonoperative management strictly requires an initial period of 6 weeks of rigid cast immobilization

Correct Answer & Explanation

. There is no clinically significant difference in re-rupture rates between the two treatments

Explanation

Recent high-quality Level I evidence (such as the Willits et al. trial) demonstrates that when an accelerated functional rehabilitation protocol (involving early weight-bearing and early range of motion) is used, there is no clinically significant difference in the re-rupture rate between operative and nonoperative management of acute Achilles tendon ruptures. However, operative management carries a higher risk of complications such as wound infection and nerve injury.

Question 5032

Topic: Knee Sports

A 26-year-old soccer player sustains a twisting injury to his right knee. On examination, the Dial test reveals 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of knee flexion, the external rotation is equal bilaterally. What is the most likely diagnosis?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

The Dial test evaluates external rotation asymmetry of the tibia on the femur. An increase of >10 degrees of external rotation compared to the normal knee is considered positive. If the test is positive at 30 degrees but negative (equalizes) at 90 degrees, it indicates an isolated posterolateral corner (PLC) injury. If it is positive at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 5033

Topic: Shoulder & Hip Sports

A 24-year-old competitive rugby player with recurrent anterior shoulder dislocations undergoes imaging which demonstrates 25% anteroinferior glenoid bone loss and an engaging Hill-Sachs lesion. He is scheduled for a Latarjet procedure.

The conjoint tendon provides a dynamic sling effect. Which nerve is most at risk during the coracoid osteotomy and transfer?

. Musculocutaneous nerve
. Axillary nerve
. Suprascapular nerve
. Radial nerve
. Median nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve typically penetrates the coracobrachialis muscle 3 to 8 cm distal to the tip of the coracoid process, making it highly vulnerable during the Latarjet procedure, particularly during coracoid preparation and retraction of the conjoint tendon.

Question 5034

Topic: Knee Sports

A 55-year-old active female experiences a sudden 'pop' in her posterior knee while squatting. She presents with posterior knee pain but no mechanical locking. MRI

reveals a medial meniscus posterior root tear with a 3-mm extrusion of the medial meniscus. If left untreated, which of the following biomechanical consequences most closely mimics this injury?

. Total meniscectomy
. Partial meniscectomy
. ACL rupture
. PCL rupture
. MCL sprain

Correct Answer & Explanation

. Total meniscectomy

Explanation

A medial meniscus posterior root tear disrupts the crucial hoop stresses of the meniscus, rendering it biomechanically equivalent to a total meniscectomy. This leads to a significant increase in peak contact pressures and a decreased contact area in the medial compartment, strongly predisposing the joint to rapid-onset osteoarthritis.

Question 5035

Topic: Knee Sports

A 17-year-old female presents with recurrent lateral patellar dislocations. Nonoperative management has failed. Imaging demonstrates a Caton-Deschamps index of 1.1, a sulcus angle of 135 degrees, and a tibial tubercle-trochlear groove (TT-TG) distance of 24 mm on MRI. Which of the following surgical interventions is most appropriate?

. MPFL reconstruction alone
. Lateral retinacular release alone
. Medializing tibial tubercle osteotomy with MPFL reconstruction
. Trochleoplasty
. Distal femoral osteotomy

Correct Answer & Explanation

. Medializing tibial tubercle osteotomy with MPFL reconstruction

Explanation

A TT-TG distance greater than 20 mm is a standard indication for a medializing tibial tubercle osteotomy in the setting of recurrent patellar instability. Because the MPFL is virtually always ruptured or incompetent in lateral patellar dislocations, it should be reconstructed concurrently to restore soft-tissue balance.

Question 5036

Topic: Knee Sports

A 30-year-old male fell from a height, sustaining a multiligamentous knee injury. Physical examination

demonstrates an abnormal dial test at 30 degrees of knee flexion but symmetric external rotation at 90 degrees. These findings indicate an isolated injury to which of the following structures?

. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Posterolateral corner (PLC)
. Medial collateral ligament (MCL)
. Both PCL and PLC

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

The dial test evaluates external rotation of the tibia relative to the femur. Increased external rotation (>10 degrees compared to the contralateral side) at 30 degrees of flexion, but not at 90 degrees, indicates an isolated injury to the posterolateral corner (PLC). Increased external rotation at both 30 and 90 degrees indicates a combined PLC and PCL injury.

Question 5037

Topic: 5. Sports Medicine

A 22-year-old female undergoes an uncomplicated anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Postoperatively, she reports a localized area of numbness over the lateral aspect of her proximal leg. Which of the following nerves was most likely injured during the procedure?

. Saphenous nerve
. Infrapatellar branch of the saphenous nerve
. Sural nerve
. Superficial peroneal nerve
. Lateral sural cutaneous nerve

Correct Answer & Explanation

. Infrapatellar branch of the saphenous nerve

Explanation

The infrapatellar branch of the saphenous nerve runs transversely across the anterior knee, distal to the patella. It is highly susceptible to iatrogenic injury during the anterior longitudinal incision used for harvesting the patellar tendon autograft. Injury results in paresthesia or numbness over the lateral aspect of the proximal tibia.

Question 5038

Topic: Shoulder & Hip Sports

A 28-year-old male overhead athlete presents with deep shoulder pain and clicking. The 'peel-back' mechanism is suspected to be the cause of his symptoms. Which of the following best describes the pathophysiology of this mechanism?

. Increased torsional forces at the biceps anchor during late cocking phase of throwing
. Direct compression of the labrum during the follow-through phase
. Traction injury to the inferior glenohumeral ligament during deceleration
. Internal impingement of the rotator cuff against the posterosuperior glenoid
. Subcoracoid impingement of the subscapularis during internal rotation

Correct Answer & Explanation

. Increased torsional forces at the biceps anchor during late cocking phase of throwing

Explanation

The 'peel-back' mechanism occurs in overhead throwing athletes during the late cocking phase (maximal abduction and external rotation). The biceps vector shifts posteriorly, creating a torsional force at the superior labrum-biceps anchor, which can predictably result in a type II SLAP tear.

Question 5039

Topic: Knee Sports

The anterolateral (AL) and posteromedial (PM) bundles of the posterior cruciate ligament (PCL) exhibit distinct tension patterns during knee motion. Which of the following accurately describes the biomechanical behavior of these bundles?

. The AL bundle is tight in flexion, and the PM bundle is tight in extension
. The AL bundle is tight in extension, and the PM bundle is tight in flexion
. Both bundles are tight in full extension
. Both bundles are loose in mid-flexion
. The AL bundle provides primary rotational stability, while the PM bundle provides translational stability

Correct Answer & Explanation

. The AL bundle is tight in flexion, and the PM bundle is tight in extension

Explanation

The PCL is composed of two main bundles: the anterolateral (AL) bundle and the posteromedial (PM) bundle. The larger AL bundle is taut in knee flexion and lax in extension, whereas the smaller PM bundle is taut in extension and lax in flexion. This reciprocal tension pattern ensures continuous posterior translational stability throughout the entire arc of motion.

Question 5040

Topic: Shoulder & Hip Sports

A 24-year-old elite baseball pitcher complains of vague, deep right shoulder pain and a recent decrease in throwing velocity. Physical examination demonstrates normal forward elevation, internal rotation of 25 degrees, and external rotation of 130 degrees. The contralateral shoulder has internal rotation of 60 degrees and external rotation of 95 degrees. MRI arthrogram reveals a type II SLAP tear. What is the most appropriate initial management?

. Arthroscopic SLAP repair
. Open subpectoral biceps tenodesis
. Non-operative management focusing on posterior capsular stretching
. Anterior capsulolabral reconstruction
. Arthroscopic posterior capsular release

Correct Answer & Explanation

. Non-operative management focusing on posterior capsular stretching

Explanation

The patient demonstrates Glenohumeral Internal Rotation Deficit (GIRD) with an essentially normal total arc of motion (155 degrees on the right vs. 155 degrees on the left). In overhead throwers, a type II SLAP tear is often the result of the 'peel-back' mechanism exacerbated by a tight posterior capsule. Initial management must focus on non-operative rehabilitation, specifically utilizing sleeper stretches to address the posterior capsular contracture. Surgical intervention, such as SLAP repair or biceps tenodesis, is reserved for patients who fail an exhaustive trial of targeted physical therapy, as return to prior performance levels after surgery in elite throwers can be unpredictable.

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