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5. Sports Medicine MCQs

Practice Set 255 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 5081

Topic: Knee Sports

A 45-year-old female presents with sudden onset medial knee pain after deep knee flexion. An MRI reveals the pathology shown in Figure 55.

Assuming this represents a posterior root tear of the medial meniscus, which of the following biomechanical consequences most closely mirrors this injury?

. Total medial meniscectomy
. Partial medial meniscectomy
. Anterior cruciate ligament deficiency
. Posterior cruciate ligament deficiency
. Superficial medial collateral ligament sprain

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus completely disrupts the circumferential hoop stresses of the meniscus. Biomechanical studies have demonstrated that this leads to altered contact areas and peak pressures equivalent to a total meniscectomy.

Question 5082

Topic: 5. Sports Medicine
A 28-year-old hockey player undergoes hip arthroscopy with osteochondroplasty for a Cam-type femoroacetabular impingement (FAI). Which of the following complications is most highly associated with over-resection (resection of >30% of the diameter) of the femoral head-neck junction?
. Avascular necrosis of the femoral head
. Femoral neck fracture
. Sciatic nerve neuropraxia
. Labral ossification
. Heterotopic ossification

Correct Answer & Explanation

. Femoral neck fracture

Explanation

Resection of more than 30% of the femoral neck diameter during osteochondroplasty significantly alters the biomechanics of the proximal femur, drastically increasing the risk of an iatrogenic femoral neck fracture.

Question 5083

Topic: Knee Sports
A 22-year-old basketball player undergoes matrix-induced autologous chondrocyte implantation (MACI) for a 3.5 square-centimeter full-thickness osteochondral defect on the medial femoral condyle. What is the primary histological composition of the optimally generated repair tissue?
. Type I collagen
. Type II collagen
. Type III collagen
. Type IX collagen
. Type X collagen

Correct Answer & Explanation

. Type II collagen

Explanation

MACI is designed to generate hyaline-like cartilage, which is primarily composed of Type II collagen. In contrast, marrow stimulation techniques like microfracture produce fibrocartilage, primarily composed of Type I collagen.

Question 5084

Topic: Knee Sports

An 18-year-old football player sustains a bucket-handle meniscal tear in the red-white zone. Which of the following surgical factors most significantly enhances the biological healing potential of this meniscal repair?

. Use of all-inside rather than inside-out repair devices
. Older patient age at the time of injury
. Concomitant anterior cruciate ligament (ACL) reconstruction
. Involvement of the lateral rather than the medial meniscus
. Excision of the adjacent synovial fringe

Correct Answer & Explanation

. Concomitant anterior cruciate ligament (ACL) reconstruction

Explanation

Concomitant ACL reconstruction significantly enhances meniscal healing. The drilling of osseous tunnels releases bone marrow elements, stem cells, and growth factors into the joint, creating a robust biological environment for repair.

Question 5085

Topic: Shoulder & Hip Sports
Following an arthroscopic rotator cuff repair, tendon-to-bone healing progresses through inflammatory, proliferative, and remodeling phases. During the remodeling phase, which type of collagen is primarily synthesized to replace the provisional matrix?
. Type I
. Type II
. Type III
. Type IV
. Type VI

Correct Answer & Explanation

. Type I

Explanation

During the initial proliferative healing phase of a rotator cuff repair, primarily Type III collagen is deposited as scar tissue. In the remodeling phase, this is gradually replaced by stronger, highly organized Type I collagen.

Question 5086

Topic: Knee Sports
A 16-year-old female suffers a lateral patellar dislocation resulting in an incompetent medial patellofemoral ligament (MPFL). Where is the correct anatomic femoral footprint of the MPFL located radiographically?
. Proximal to the adductor tubercle
. Distal to the medial epicondyle
. Anterior to the medial epicondyle
. Distal to the adductor tubercle and proximal to the medial epicondyle
. Posterior to the adductor magnus insertion

Correct Answer & Explanation

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

Explanation

The femoral attachment of the MPFL (often radiographically defined by Schöttle's point) sits in the saddle between the adductor tubercle (which is proximal) and the medial epicondyle (which is distal).

Question 5087

Topic: 5. Sports Medicine

A 35-year-old recreational athlete sustains an acute Achilles tendon rupture. He elects for nonoperative management utilizing a functional rehabilitation protocol with early weight-bearing. Compared to acute surgical repair, this modern nonoperative approach is associated with:

. A significantly higher re-rupture rate
. Increased risk of sural nerve injury
. Equivalent functional outcomes and similar re-rupture rates
. Significantly decreased plantar flexion strength at 2 years
. A higher risk of deep vein thrombosis

Correct Answer & Explanation

. Equivalent functional outcomes and similar re-rupture rates

Explanation

Recent high-quality literature demonstrates that modern nonoperative management utilizing early functional rehabilitation protocols yields equivalent functional outcomes and similar re-rupture rates compared to surgical repair, while avoiding surgical complications.

Question 5088

Topic: 5. Sports Medicine

In evaluating articular cartilage lesions in the knee of a high-performance athlete, which MRI sequence is most specifically sensitive for detecting early proteoglycan loss before structural morphological changes occur?

. T1-weighted spin echo
. T2 mapping
. Short tau inversion recovery (STIR)
. Proton density-weighted sequence
. Fast spin-echo T2

Correct Answer & Explanation

. T2 mapping

Explanation

Advanced compositional MRI sequences, such as T2 mapping, T1rho, and dGEMRIC, are specifically utilized to assess the biochemical composition of cartilage. They can detect early loss of proteoglycans and collagen network disruption prior to macroscopic cartilage loss.

Question 5089

Topic: Shoulder & Hip Sports

A 25-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 22% anterior glenoid bone loss and an "off-track" Hill-Sachs lesion. Which of the following best describes the primary biomechanical advantage of this specific surgical technique?

. Deepening of the glenoid concavity by the bone block
. The "sling effect" of the conjoint tendon on the inferior capsule
. Tensioning of the superior glenohumeral ligament (SGHL)
. Restoration of the native anterior labral bumper
. Shortening and overtensioning of the subscapularis tendon

Correct Answer & Explanation

. The "sling effect" of the conjoint tendon on the inferior capsule

Explanation

The Latarjet procedure primarily provides stability through the "sling effect" of the conjoint tendon on the anteroinferior capsule during arm abduction and external rotation. This dynamic stabilization accounts for the majority of the procedure's success, supplemented by the bone block increasing the glenoid arc.

Question 5090

Topic: Knee Sports

During a medial patellofemoral ligament (MPFL) reconstruction in a 16-year-old female with recurrent patellar dislocations, the surgeon identifies the anatomic femoral attachment site using fluoroscopy. Where is this anatomic attachment located relative to the medial femoral epicondyle and adductor tubercle?

. Proximal to Blumensaat line and anterior to the posterior femoral cortex
. Distal to the adductor tubercle and anterior to the medial epicondyle
. In a saddle-shaped sulcus between the adductor tubercle and the medial epicondyle
. Distal to Blumensaat line and posterior to the medial epicondyle
. Directly at the center of the medial femoral condyle articular cartilage

Correct Answer & Explanation

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

Explanation

The anatomic femoral attachment of the MPFL is located in a saddle-shaped sulcus just distal to the adductor tubercle and proximal to the medial epicondyle. Precise anatomic graft placement is critical to avoid overtightening the graft in flexion and altering patellofemoral kinematics.

Question 5091

Topic: Knee Sports

A 55-year-old patient experiences a sudden pop in the posterior knee while descending stairs. MRI confirms a complete posterior root tear of the medial meniscus. What is the most significant biomechanical consequence of this specific injury if left untreated?

. Decreased joint space narrowing on standing radiographs
. Conversion of axial loads into physiological hoop stresses
. Altered tibiofemoral contact mechanics equivalent to a total meniscectomy
. Increased secondary stabilization of the anterior cruciate ligament
. Decreased peak contact pressures in the medial compartment

Correct Answer & Explanation

. Altered tibiofemoral contact mechanics equivalent to a total meniscectomy

Explanation

A posterior root tear of the medial meniscus disrupts the continuity of the meniscal ring, abolishing its ability to convert axial loads into hoop stresses. Biomechanically, this failure leads to immediate meniscal extrusion and profoundly increased peak contact pressures equivalent to a total meniscectomy.

Question 5092

Topic: Knee Sports

An 8-year-old male (Tanner stage 1) sustains a complete midsubstance anterior cruciate ligament (ACL) tear while skiing. He has significant subjective instability and giving way with daily activities. What is the most appropriate surgical treatment option to minimize the risk of growth arrest?

. Standard transphyseal bone-patellar tendon-bone (BPTB) reconstruction
. Iliotibial band physeal-sparing extra-articular reconstruction
. Nonoperative management with bracing until skeletal maturity is reached
. Transphyseal quadrupled hamstring reconstruction with suspensory fixation
. Primary repair of the anterior cruciate ligament with internal bracing

Correct Answer & Explanation

. Iliotibial band physeal-sparing extra-articular reconstruction

Explanation

In prepubescent children (Tanner stage 1) with significant remaining growth potential, physeal-sparing ACL reconstruction techniques are indicated to prevent physeal injury and limb deformity. An iliotibial band extra-articular over-the-top reconstruction (e.g., Micheli/Kocher technique) safely addresses instability without crossing the open physes.

Question 5093

Topic: Shoulder & Hip Sports

A 22-year-old elite baseball pitcher complains of posterior shoulder pain exclusively during the late cocking phase of throwing. Physical examination reveals a 25-degree deficit in internal rotation compared to the contralateral side. A superior labrum anterior to posterior (SLAP) tear is identified on MR arthrography. Which mechanism best explains the development of this specific labral pathology?

. Anterior subluxation due to isolated subscapularis insufficiency
. Traction injury from the long head of the biceps during the deceleration phase
. The "peel-back" mechanism driven by a tight posteroinferior capsule
. Superior migration of the humeral head secondary to supraspinatus weakness
. Impingement of the greater tuberosity against the anterior acromion

Correct Answer & Explanation

. The "peel-back" mechanism driven by a tight posteroinferior capsule

Explanation

In overhead throwers, Glenohumeral Internal Rotation Deficit (GIRD) caused by a contracted posteroinferior capsule shifts the glenohumeral contact point posterosuperiorly. During the late cocking phase (abduction and maximal external rotation), this shift causes the biceps root to twist and transmit torsional forces, known as the peel-back mechanism, tearing the superior labrum.

Question 5094

Topic: Shoulder & Hip Sports

During hip arthroscopy for a patient with symptomatic femoroacetabular impingement (FAI), the surgeon addresses a large Cam lesion. Which intra-articular pathologic pattern is most classically associated with this specific femoral morphology?

. Anterosuperior acetabular cartilage delamination and adjacent labral tearing
. Posteroinferior labral tearing and isolated ligamentum teres rupture
. Diffuse global cartilage thinning and secondary psoas impingement
. Acetabular overcoverage leading to a contre-coup posterior cartilage lesion
. Hypertrophy of the pulvinar causing central capsular laxity

Correct Answer & Explanation

. Anterosuperior acetabular cartilage delamination and adjacent labral tearing

Explanation

Cam morphology, defined by a loss of spherical head-neck offset, engages the anterosuperior acetabular rim during hip flexion and internal rotation. This repetitive shear stress leads to an "inside-out" pattern of acetabular articular cartilage delamination from the subchondral bone, often accompanied by an adjacent labral detachment.

Question 5095

Topic: 5. Sports Medicine

A 24-year-old active male presents with persistent medial knee pain. MRI demonstrates a 4.5 cm squared full-thickness uncontained chondral defect on the weight-bearing surface of the medial femoral condyle, with an underlying 12 mm deep subchondral bone cyst. What is the most appropriate surgical intervention?

. Arthroscopic microfracture
. Matrix-induced autologous chondrocyte implantation (MACI)
. Osteochondral allograft transplantation (OCA)
. Osteochondral autograft transfer (OATS)
. Arthroscopic debridement and extensive chondroplasty

Correct Answer & Explanation

. Osteochondral allograft transplantation (OCA)

Explanation

Osteochondral allograft transplantation (OCA) is the treatment of choice for large (>2-3 cm squared) full-thickness cartilage defects associated with significant underlying subchondral bone loss or cyst formation. Procedures like MACI address the cartilage surface but do not adequately replace structurally compromised subchondral bone.

Question 5096

Topic: 5. Sports Medicine

When evaluating graft options for primary anterior cruciate ligament (ACL) reconstruction, which of the following grafts possesses the highest initial ultimate tensile load to failure in a controlled biomechanical testing environment?

. Bone-patellar tendon-bone (BPTB) autograft
. Quadrupled hamstring tendon autograft
. Central third quadriceps tendon autograft without bone block
. Achilles tendon allograft
. Native uninjured anterior cruciate ligament

Correct Answer & Explanation

. Quadrupled hamstring tendon autograft

Explanation

A quadrupled hamstring tendon autograft has the highest initial ultimate tensile load to failure (exceeding 4000 N), which is significantly higher than the native ACL (~2160 N) and BPTB autograft (~2977 N). However, clinical success depends heavily on biological healing, initial graft fixation, and precise tunnel placement.

Question 5097

Topic: 5. Sports Medicine

A 16-year-old female gymnast undergoes an anterior cruciate ligament reconstruction with a hamstring autograft. Which of the following accurately describes a known biomechanical or clinical consequence of choosing a hamstring autograft compared to a bone-patellar tendon-bone (BTB) autograft in this specific demographic?

. Higher risk of postoperative anterior knee pain
. Increased risk of graft rupture in young, highly active females
. Superior ultimate load to failure in clinical outcomes at 5 years
. Increased incidence of contralateral ACL rupture
. Greater limitation in terminal knee extension

Correct Answer & Explanation

. Increased risk of graft rupture in young, highly active females

Explanation

Hamstring autografts in young, high-activity female athletes have a significantly higher revision rate and graft rupture risk compared to BTB autografts. BTB is more frequently associated with higher anterior knee pain but offers better graft survivorship in this high-risk group.

Question 5098

Topic: Knee Sports

A 45-year-old male presents with acute medial knee pain and a "pop" felt while deep squatting. MRI reveals a medial meniscal posterior root tear with 4 mm of meniscal extrusion. If left untreated, this injury alters knee biomechanics most similarly to which of the following?

. Total medial meniscectomy
. Anterior cruciate ligament tear
. Partial medial meniscectomy
. Posterior cruciate ligament tear
. Medial collateral ligament sprain

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A complete posterior root tear of the medial meniscus eliminates hoop stresses, resulting in tibiofemoral contact pressures equivalent to a total medial meniscectomy. This biomechanical failure leads to rapid progression of osteoarthritis if not surgically repaired.

Question 5099

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder dislocations. CT scan demonstrates an engaging Hill-Sachs lesion and 27% anterior glenoid bone loss. Which of the following is the most appropriate surgical management?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with remplissage
. Latarjet procedure
. Open capsular shift
. Biceps tenodesis

Correct Answer & Explanation

. Latarjet procedure

Explanation

Critical glenoid bone loss (>20-25%) in a collision athlete with recurrent anterior instability is an absolute indication for a bony augmentation procedure, such as the Latarjet procedure. Arthroscopic soft tissue stabilization has unacceptably high failure rates in this setting.

Question 5100

Topic: 5. Sports Medicine

A 25-year-old ice hockey player reports chronic anterior groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate a crossover sign and an alpha angle of 70 degrees. During hip arthroscopy, addressing the femoral head-neck junction abnormality aims primarily to prevent which of the following?

. Ischiofemoral impingement
. Chondral delamination of the anterosuperior acetabulum
. Avascular necrosis of the femoral head
. Paralabral cyst formation
. Iliopsoas snapping

Correct Answer & Explanation

. Chondral delamination of the anterosuperior acetabulum

Explanation

Cam morphology (alpha angle >55-60 degrees) causes abnormal shear forces on the anterosuperior acetabular cartilage during hip flexion and internal rotation. This repetitive impingement characteristically leads to chondral delamination and subsequent labral tears.

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