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5. Sports Medicine MCQs

Practice Set 258 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 5141

Topic: 5. Sports Medicine
A 10-year-old girl falls while skiing and sustains a completely displaced avulsion fracture of the tibial eminence (Meyers-McKeever Type III). The fragment is superiorly displaced and tilted. What is the most appropriate treatment to restore knee stability and function?
. Long leg cast in full extension
. Long leg cast in 30 degrees of flexion
. Arthroscopic reduction and internal fixation
. Anterior cruciate ligament reconstruction with hamstring autograft
. Physical therapy emphasizing quadriceps strengthening

Correct Answer & Explanation

. Arthroscopic reduction and internal fixation

Explanation

Meyers-McKeever Type III fractures are completely displaced tibial eminence avulsion fractures. They require anatomic reduction and internal fixation (typically performed arthroscopically with sutures or screws) to prevent a mechanical block to extension and restore ACL tension.

Question 5142

Topic: Shoulder & Hip Sports

A 24-year-old male hockey player presents with persistent groin pain exacerbated by hip flexion and internal rotation. Radiographs reveal an alpha angle of 72 degrees.

During operative intervention for this condition, damage to which aspect of the labrum and cartilage is most characteristically found?

. Anterosuperior labrum and adjacent acetabular cartilage delamination
. Posteroinferior labral tear with intact cartilage
. Isolated ligamentum teres avulsion
. Global chondromalacia of the femoral head
. Posterior labral calcification

Correct Answer & Explanation

. Anterosuperior labrum and adjacent acetabular cartilage delamination

Explanation

Cam impingement typically causes shear forces at the chondrolabral junction during flexion and internal rotation. This leads to anterosuperior labral tears and outside-in delamination of the adjacent acetabular cartilage.

Question 5143

Topic: Shoulder & Hip Sports

A 28-year-old professional hockey player complains of insidious onset, activity-related anterior groin pain. An AP pelvis radiograph

shows the anterior rim of the acetabulum crossing the posterior rim in the superior aspect of the joint. What does this radiographic finding indicate?

. Cam impingement
. Acetabular retroversion
. Acetabular anteversion
. Coxa profunda
. Protrusio acetabuli

Correct Answer & Explanation

. Acetabular retroversion

Explanation

The 'crossover sign' occurs when the anterior wall line crosses the posterior wall line on a perfectly positioned AP pelvis radiograph. This indicates acetabular retroversion, a common cause of pincer-type femoroacetabular impingement (FAI).

Question 5144

Topic: Shoulder & Hip Sports

A 28-year-old male hockey player presents with gradual onset of anterior groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate an alpha angle of 75 degrees on the modified Dunn lateral view and normal acetabular version.

What is the underlying pathomorphology?

. Acetabular retroversion leading to pincer impingement
. Decreased femoral head-neck offset leading to cam impingement
. Excessive femoral anteversion
. Coxa profunda
. Ischiofemoral impingement

Correct Answer & Explanation

. Decreased femoral head-neck offset leading to cam impingement

Explanation

An alpha angle greater than 50-55 degrees on a lateral radiograph indicates a loss of femoral head-neck offset, characteristic of cam-type femoroacetabular impingement (FAI). This extra bone abuts the acetabular rim during flexion and internal rotation.

Question 5145

Topic: 5. Sports Medicine

A 28-year-old male athlete presents with deep anterior groin pain exacerbated by hip flexion and internal rotation. An AP pelvis radiograph demonstrates the anterior acetabular rim line crossing the posterior rim line superiorly.

What is the most likely diagnosis, and what is the primary structural abnormality?

. Cam impingement; reduced femoral head-neck offset
. Pincer impingement; focal or global acetabular retroversion
. Dysplasia; insufficient superior acetabular coverage
. Coxa profunda; medialization of the acetabular fossa past the ilioischial line
. Ischiofemoral impingement; narrowing of the space between the lesser trochanter and ischium

Correct Answer & Explanation

. Pincer impingement; focal or global acetabular retroversion

Explanation

The radiographic finding described is the crossover sign, which indicates focal or global acetabular retroversion. This creates overcoverage of the anterior femoral head, leading to pincer-type femoroacetabular impingement.

Question 5146

Topic: Shoulder & Hip Sports

A 24-year-old female presents with chronic groin pain exacerbated by prolonged sitting and deep hip flexion. An anteroposterior (AP) pelvis radiograph demonstrates a 'crossover sign' and a lateral center-edge angle (LCEA) of 45 degrees.

Which of the following describes the most likely underlying pathoanatomy and the appropriate surgical treatment?

. Loss of femoral head-neck offset requiring femoral osteochondroplasty
. Focal or global acetabular overcoverage requiring acetabular rim trimming and labral repair
. Developmental dysplasia of the hip requiring a periacetabular osteotomy
. Slipped capital femoral epiphysis deformity requiring in situ pinning
. Iliopsoas tendon snapping requiring arthroscopic release

Correct Answer & Explanation

. Focal or global acetabular overcoverage requiring acetabular rim trimming and labral repair

Explanation

The patient's clinical presentation and radiographic findings (crossover sign and LCEA > 40 degrees) are diagnostic of pincer-type femoroacetabular impingement (FAI). The crossover sign indicates cranial acetabular retroversion (anterior overcoverage), while an LCEA > 40 degrees indicates global overcoverage (coxa profunda). The surgical management for symptomatic pincer impingement that has failed conservative care is arthroscopic or open acetabular rim trimming with subsequent labral refixation. Cam impingement (Option A) is characterized by an abnormal alpha angle and loss of femoral head-neck offset, not a crossover sign. Dysplasia (Option C) is characterized by undercoverage (LCEA < 20 degrees).

Question 5147

Topic: Shoulder & Hip Sports

A 22-year-old elite hockey player presents with insidious onset right groin pain that is exacerbated by prolonged sitting and deep squatting. Physical examination reveals a positive anterior impingement test (FADIR). Radiographs demonstrate an alpha angle of 65 degrees and normal acetabular version. If left untreated, the intra-articular pathology most characteristic of this specific morphology will primarily result in damage to which of the following structures?

. Posteroinferior acetabular cartilage
. Anterosuperior acetabular cartilage and labrum
. Ligamentum teres and fovea capitis
. Posterior labrum only
. Greater trochanteric bursa

Correct Answer & Explanation

. Anterosuperior acetabular cartilage and labrum

Explanation

The patient has cam-type femoroacetabular impingement (FAI), characterized by an aspherical femoral head-neck junction (alpha angle > 55 degrees). During hip flexion and internal rotation, the non-spherical cam lesion is forced into the acetabulum, creating shear forces that most commonly damage the anterosuperior labrum and lead to chondral delamination of the adjacent anterosuperior acetabular cartilage.

Question 5148

Topic: 5. Sports Medicine

A 35-year-old man undergoes hip arthroscopy for femoroacetabular impingement. Postoperatively, he complains of numbness in his perineum, scrotum, and the medial aspect of his upper thigh. He has no motor deficits. Which of the following factors during the surgical procedure is most likely responsible for this complication?

. Direct injury to the lateral femoral cutaneous nerve via the anterolateral portal
. Direct nerve injury via the mid-anterior portal
. Compression from the perineal traction post
. Fluid extravasation into the retroperitoneal space
. Over-resection of the CAM lesion resulting in capsular instability

Correct Answer & Explanation

. Compression from the perineal traction post

Explanation

The patient is presenting with a pudendal neurapraxia, a well-documented complication of hip arthroscopy due to compression against a perineal traction post. This typically manifests as numbness in the perineum, scrotum (or labia), and medial thigh. To minimize this risk, the traction post should be well-padded, the hip placed in slight flexion and abduction during traction, and traction time limited (ideally under 2 hours). Direct injury via the anterolateral or mid-anterior portals puts the lateral femoral cutaneous nerve at risk, which would cause numbness on the anterolateral thigh, not the perineum.

Question 5149

Topic: General Sports & Tendon

Figure 12 corresponds to a 45-year-old competitive water skier who sustains a severe forced hip flexion injury with the knee extended. He presents with posterior thigh ecchymosis, loss of posterior thigh contour, and profound weakness in knee flexion. He is planned for an open repair of the completely avulsed proximal hamstring tendons. During the surgical approach to the ischial tuberosity, which of the following nerves is at greatest risk of iatrogenic injury?

. Superior gluteal nerve
. Inferior gluteal nerve
. Pudendal nerve
. Sciatic nerve
. Obturator nerve

Correct Answer & Explanation

. Sciatic nerve

Explanation

The patient has a complete proximal hamstring avulsion. During open surgical repair at the ischial tuberosity, the sciatic nerve is at high risk of iatrogenic injury. Anatomically, the sciatic nerve runs an average of 1.2 cm lateral to the ischial tuberosity and the proximal hamstring origin. Excessive medial-to-lateral retraction or aberrant suture placement can easily injure or entrap the nerve. The posterior femoral cutaneous nerve is also at risk but the sciatic nerve is the major critical structure directly adjacent to the repair site.

Question 5150

Topic: 5. Sports Medicine

A 25-year-old male athlete presents with anterior groin pain that is exacerbated by prolonged sitting and deep hip flexion activities. Figure 1 shows his lateral hip radiograph.

His alpha angle is measured at 72 degrees. Which physical examination test is most likely to reproduce his pain, and what is the underlying pathomorphology?

. FADIR test; reduced anterior head-neck offset
. FABER test; focal acetabular retroversion
. Log roll test; global acetabular overcoverage (pincer)
. Scour test; developmental dysplasia of the hip
. Ely test; rectus femoris contracture

Correct Answer & Explanation

. FADIR test; reduced anterior head-neck offset

Explanation

The patient has symptomatic cam-type femoroacetabular impingement (FAI). Cam impingement is caused by a nonspherical femoral head and reduced anterior head-neck offset, classically resulting in an alpha angle greater than 50-55 degrees. The Flexion, Adduction, and Internal Rotation (FADIR) test produces anterior impingement and is the most sensitive physical examination finding for this pathology.

Question 5151

Topic: Shoulder & Hip Sports

A 24-year-old professional hockey player presents with a gradual onset of anterior groin pain exacerbated by hip flexion and internal rotation.

Radiographs show a prominent osseous bump at the anterolateral femoral head-neck junction and an alpha angle of 65 degrees. What pattern of chondral damage is most classically associated with this specific deformity?

. Posteroinferior acetabular cartilage delamination
. Global articular cartilage thinning of the femoral head
. Anterosuperior acetabular cartilage delamination with an initially intact labrum
. Primary tearing of the ligamentum teres with central chondral wear
. Posteromedial acetabular cartilage wear

Correct Answer & Explanation

. Anterosuperior acetabular cartilage delamination with an initially intact labrum

Explanation

This patient has a cam-type femoroacetabular impingement (FAI), characterized by decreased head-neck offset and an elevated alpha angle (>50-55 degrees). Cam impingement creates shear forces at the chondrolabral junction during hip flexion and internal rotation. This classically results in 'carpet breakdown' or delamination of the anterosuperior acetabular cartilage, often leaving the labrum intact or detaching it at the transition zone.

Question 5152

Topic: Shoulder & Hip Sports

A 26-year-old male collegiate hockey player presents with chronic anterior groin pain that is exacerbated by sitting in low chairs. Physical examination reveals a positive flexion, adduction, and internal rotation (FADIR) test. Radiographs demonstrate an alpha angle of 72 degrees on the lateral view with no evidence of acetabular retroversion. What is the primary pathophysiologic mechanism of cartilage damage in this condition?

. Shear forces causing outside-in delamination of the acetabular cartilage at the chondrolabral junction
. Linear impaction leading to intra-substance labral degeneration
. Contrecoup injury to the posteroinferior acetabular cartilage
. Ischemic necrosis of the ligamentum teres
. Global pincer-type impingement from coxa profunda

Correct Answer & Explanation

. Shear forces causing outside-in delamination of the acetabular cartilage at the chondrolabral junction

Explanation

The patient has pure Cam-type femoroacetabular impingement (FAI), indicated by the elevated alpha angle (>55 degrees) and lack of retroversion/pincer signs. Cam lesions cause damage through an 'outside-in' mechanism during hip flexion, where the aspherical femoral head engages the acetabulum, creating shear forces that lead to delamination of the articular cartilage from the subchondral bone, usually at the anterosuperior chondrolabral junction. Pincer impingement typically causes linear impaction and 'inside-out' labral tears.

Question 5153

Topic: 5. Sports Medicine

A 28-year-old male athlete presents with chronic anterior groin pain exacerbated by hip flexion and internal rotation. A Dunn lateral radiograph of the hip reveals an alpha angle of 75 degrees with reduced femoral head-neck offset. This specific morphologic abnormality causes intra-articular damage via which of the following primary pathomechanical processes?

. Pincer impingement causing direct crushing of the anterior labrum and a contrecoup chondral lesion
. Cam impingement causing shear forces that lead to anterosuperior acetabular cartilage delamination
. Global acetabular retroversion leading to posterior labral tearing
. Acetabular dysplasia causing superior edge loading and labral hypertrophy
. Extra-articular impingement of the anterior inferior iliac spine against the distal femoral neck

Correct Answer & Explanation

. Cam impingement causing shear forces that lead to anterosuperior acetabular cartilage delamination

Explanation

An elevated alpha angle (>50-55 degrees) indicates a Cam deformity, representing an aspherical femoral head/neck junction. During hip flexion, this prominence is forced into the acetabulum, creating massive shear forces at the chondrolabral junction. This typically causes outside-in delamination of the anterosuperior acetabular cartilage from the subchondral bone. Pincer impingement (Option 0) involves overcoverage causing direct linear impact and crushing of the labrum.

Question 5154

Topic: Shoulder & Hip Sports

A 24-year-old male hockey player presents with chronic groin pain exacerbated by hip flexion and internal rotation. Imaging reveals a prominent alpha angle of 75 degrees and a normal lateral center-edge angle. Which of the following best describes the primary pathomechanics of his articular cartilage injury?

. Chondral delamination at the anterosuperior chondrolabral junction due to shear forces
. Linear crushing of the labrum between the femoral neck and acetabular rim
. Global joint space narrowing resulting from subchondral sclerosis
. Labral hypertrophy secondary to capsular laxity
. Avascular necrosis of the femoral head from repeated microtrauma

Correct Answer & Explanation

. Chondral delamination at the anterosuperior chondrolabral junction due to shear forces

Explanation

An elevated alpha angle (>50-55 degrees) is indicative of Cam-type femoroacetabular impingement (FAI). Cam impingement creates significant shear forces at the anterosuperior chondrolabral junction as the non-spherical femoral head enters the acetabulum. This typically leads to 'outside-in' chondral delamination, often sparing the labrum itself in the early stages. Linear crushing of the labrum is characteristic of Pincer-type impingement.

Question 5155

Topic: Shoulder & Hip Sports

During arthroscopic management of Femoroacetabular Impingement (FAI) for a symptomatic Cam lesion, the surgeon performs an osteochondroplasty at the femoral head-neck junction. Extending the resection too far posterosuperiorly places which of the following anatomic structures at the highest risk of iatrogenic injury?

. Retinacular branches of the medial femoral circumflex artery (MFCA)
. Ascending branch of the lateral femoral circumflex artery (LFCA)
. Obturator artery
. Inferior gluteal artery
. Sciatic nerve

Correct Answer & Explanation

. Retinacular branches of the medial femoral circumflex artery (MFCA)

Explanation

The major blood supply to the femoral head is provided by the medial femoral circumflex artery (MFCA). Its retinacular branches perforate the joint capsule near the intertrochanteric crest and travel along the posterosuperior aspect of the femoral neck. When performing an osteochondroplasty for a Cam lesion, extending the resection into the posterosuperior quadrant poses a significant risk of injuring these vessels, which could lead to avascular necrosis (AVN) of the femoral head. Resections are typically kept anterior and anterolateral to avoid this vascular territory.

Question 5156

Topic: 5. Sports Medicine

A 25-year-old male athlete presents with chronic groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate a crossover sign, a prominent ischial spine sign, and a center-edge angle of 42 degrees. These radiographic findings indicate a specific pathomorphology. What is the primary mechanism of articular cartilage damage associated with this condition?

. Cam impingement leading to direct delamination of the anterosuperior acetabular cartilage
. Pincer impingement leading to linear crushing of the labrum and contrecoup cartilage injury on the posteroinferior acetabulum
. Cam impingement leading to diffuse thinning of the femoral head articular cartilage
. Pincer impingement leading to avulsion of the ligamentum teres
. Hip dysplasia leading to increased shear forces on the superolateral acetabular rim

Correct Answer & Explanation

. Pincer impingement leading to linear crushing of the labrum and contrecoup cartilage injury on the posteroinferior acetabulum

Explanation

The radiographic findings (crossover sign, prominent ischial spine sign, CE angle >40 degrees) are classic for acetabular retroversion and overcoverage, which result in Pincer-type femoroacetabular impingement (FAI). In Pincer impingement, the primary pathology involves the prominent acetabular rim abutting the femoral neck, causing linear crushing and degeneration of the labrum. This anterior leverage mechanism frequently causes a 'contrecoup' injury, where the femoral head is levered backward, damaging the cartilage on the posteroinferior aspect of the acetabulum.

Question 5157

Topic: 5. Sports Medicine

A 34-year-old male is positioned for hip arthroscopy to address a symptomatic labral tear. The anterior portal is established under fluoroscopic guidance. To minimize the risk of iatrogenic injury to the lateral femoral cutaneous nerve (LFCN), the portal is placed slightly lateral to the longitudinal anatomical line connecting the ASIS and the center of the patella. In the proximal thigh, the LFCN primarily courses between which two muscles?

. Tensor fasciae latae and Gluteus medius
. Tensor fasciae latae and Sartorius
. Sartorius and Rectus femoris
. Rectus femoris and Pectineus
. Pectineus and Adductor longus

Correct Answer & Explanation

. Tensor fasciae latae and Sartorius

Explanation

The lateral femoral cutaneous nerve (LFCN) is a pure sensory nerve that typically enters the anterior thigh by passing under the inguinal ligament, slightly medial to the anterior superior iliac spine (ASIS). As it courses distally, it travels superficially in the intermuscular interval between the tensor fasciae latae (TFL) laterally and the sartorius muscle medially. Proper arthroscopic portal placement accounts for this anatomy to avoid potentially painful neuromas or lateral thigh numbness.

Question 5158

Topic: 5. Sports Medicine

Figure 1 shows the lateral radiograph of a 22-year-old male athlete with chronic groin pain exacerbated by hip flexion and internal rotation. Based on the most likely diagnosis, what radiographic measurement is most appropriate to quantify the underlying structural abnormality?

. Lateral center-edge angle
. Alpha angle
. Tonnis angle
. Femoral neck-shaft angle
. Anterior center-edge angle

Correct Answer & Explanation

. Alpha angle

Explanation

The clinical presentation is classic for Femoroacetabular Impingement (FAI), specifically Cam morphology given the patient's demographics and symptoms. Cam impingement is characterized by a loss of normal sphericity at the femoral head-neck junction. The alpha angle, typically measured on a lateral or Dunn view radiograph (as well as MRI or CT), quantifies the loss of femoral head-neck offset. An alpha angle greater than 50-55 degrees is generally considered indicative of Cam morphology.

Question 5159

Topic: Shoulder & Hip Sports

A 25-year-old male hockey player presents with chronic groin pain exacerbated by hip flexion and internal rotation. An AP pelvis radiograph demonstrates a "crossover sign" and a prominent ischial spine. These radiographic findings are most indicative of which of the following pathomorphologies?

. Femoral retroversion
. Acetabular retroversion
. Coxa profunda
. Protrusio acetabuli
. Cam impingement

Correct Answer & Explanation

. Acetabular retroversion

Explanation

The crossover sign, prominent ischial spine sign, and posterior wall sign on an AP pelvis radiograph are classic indicators of acetabular retroversion. This represents a focal or global overcoverage associated with pincer-type femoroacetabular impingement.

Question 5160

Topic: 5. Sports Medicine

A 28-year-old male athlete presents with anterior groin pain that worsens with deep flexion and internal rotation. Radiographic imaging shows a loss of concavity at the femoral head-neck junction. Which radiographic parameter is most commonly utilized to quantify this specific deformity?

. Lateral center-edge angle
. Tonnis angle
. Alpha angle
. Neck-shaft angle
. Anterior coverage angle

Correct Answer & Explanation

. Alpha angle

Explanation

The alpha angle is used to quantify cam morphology in femoroacetabular impingement (FAI). An angle greater than 50-55 degrees on a lateral or Dunn view indicates an abnormal head-neck offset.

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