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5. Sports Medicine MCQs

Practice Set 26 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 501

Topic: Knee Sports

A 16-year-old boy sustains a first-time lateral patellar dislocation. Radiographs reveal a 15-mm osteochondral loose body within the joint. MRI confirms the fragment originated from the lateral femoral condyle. What is the recommended treatment?

. Non-operative management with a hinged knee brace
. Arthroscopic loose body removal and conservative management
. Arthroscopic or open reduction and internal fixation of the osteochondral fragment
. Isolated MPFL reconstruction
. Tibial tubercle osteotomy

Correct Answer & Explanation

. Arthroscopic or open reduction and internal fixation of the osteochondral fragment

Explanation

While first-time patellar dislocations are often treated non-operatively, the presence of a large, fixable osteochondral loose body is an absolute indication for surgery. Fixation of the fragment preserves joint congruity and function.

Question 502

Topic: 5. Sports Medicine

An 8-year-old boy (Tanner stage 1) sustains a complete mid-substance anterior cruciate ligament (ACL) tear. Which of the following surgical techniques is most appropriate to minimize the risk of growth arrest?

. Transphyseal reconstruction with a bone-patellar tendon-bone graft
. Transphyseal reconstruction with a hamstring autograft
. Iliotibial band extra-articular tenodesis (physeal-sparing)
. Partial transphyseal reconstruction with an allograft
. Wait until skeletal maturity before surgical intervention

Correct Answer & Explanation

. Iliotibial band extra-articular tenodesis (physeal-sparing)

Explanation

In prepubescent children (Tanner stage 1) with significant remaining growth, an entirely physeal-sparing extra-articular reconstruction (e.g., modified Micheli-Kocher technique) is recommended. This avoids drilling across open physes, minimizing the risk of growth arrest or angular deformity.

Question 503

Topic: Knee Sports

A 22-year-old woman presents with recurrent lateral patellar instability. A CT scan is obtained to evaluate her tibial tubercle-trochlear groove (TT-TG) distance. Above what TT-TG threshold is a tibial tubercle medialization osteotomy typically indicated?

. 10 mm
. 12 mm
. 15 mm
. 20 mm
. 25 mm

Correct Answer & Explanation

. 20 mm

Explanation

A TT-TG distance greater than 20 mm is widely considered abnormal and is a standard indication for medializing the tibial tubercle (e.g., Fulkerson osteotomy). Normal TT-TG distance is generally less than 15 mm.

Question 504

Topic: Shoulder & Hip Sports

In the setting of recurrent anterior shoulder instability, a large engaging Hill-Sachs lesion is best managed surgically by which of the following procedures?

. Isolated Bankart repair
. Remplissage procedure combined with Bankart repair
. SLAP repair
. Capsular plication alone
. Coracoclavicular ligament reconstruction

Correct Answer & Explanation

. Remplissage procedure combined with Bankart repair

Explanation

An engaging Hill-Sachs lesion can lever the humeral head out of the glenoid, causing recurrent instability. The remplissage procedure fills the defect with the infraspinatus tendon and capsule, preventing engagement when combined with a Bankart repair.

Question 505

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, placing the femoral tunnel too anteriorly will result in which of the following biomechanical consequences?

. The graft will be tight in extension and loose in flexion
. The graft will be tight in flexion and loose in extension
. The graft will be tight throughout the entire arc of motion
. The graft will be loose throughout the entire arc of motion
. The graft will impinge on the PCL

Correct Answer & Explanation

. The graft will be tight in flexion and loose in extension

Explanation

An anteriorly placed femoral tunnel in ACL reconstruction causes the graft distance to increase during knee flexion. This results in the graft being overly tight in flexion, causing restricted knee motion and potential graft stretching or rupture.

Question 506

Topic: Knee Sports

The medial patellofemoral ligament (MPFL) is the primary restraint to lateral patellar translation. Where is its anatomic origin on the femur located (Schottle's point)?

. Anterior to the posterior femoral cortex and between the adductor tubercle and medial epicondyle
. Posterior to the posterior femoral cortex and distal to the medial epicondyle
. Directly on the adductor tubercle
. Proximal to the adductor tubercle along the medial supracondylar ridge
. Anterior to the medial epicondyle and distal to the joint line

Correct Answer & Explanation

. Anterior to the posterior femoral cortex and between the adductor tubercle and medial epicondyle

Explanation

Radiographically, Schottle's point defines the femoral footprint of the MPFL. It is located just anterior to a line extending the posterior femoral cortex, between the adductor tubercle proximally and the medial epicondyle distally.

Question 507

Topic: 5. Sports Medicine

Which sterilization technique for bone allografts provides the greatest reduction in viral transmission risk but significantly reduces the structural and biomechanical integrity of the graft?

. Ethylene oxide
. Lyophilization (freeze-drying)
. Gamma irradiation at doses greater than 3.0 Mrad
. Fresh freezing at -80 C
. Aseptic processing with antibiotic soaking

Correct Answer & Explanation

. Gamma irradiation at doses greater than 3.0 Mrad

Explanation

High-dose gamma irradiation (>3.0 Mrad) is highly effective at eradicating HIV and other viruses from allografts. However, it severely degrades collagen cross-links, drastically reducing the structural and biomechanical properties of the bone.

Question 508

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction via an anteromedial portal, placing the knee in hyperflexion (greater than 110 degrees) while drilling the femoral tunnel primarily prevents which complication?

. Anterior cruciate ligament graft impingement against the PCL
. Posterior cortical blowout of the lateral femoral condyle
. Iatrogenic cartilage damage to the medial femoral condyle
. Misplacement of the tibial tunnel
. Fracture of the patellar articular surface

Correct Answer & Explanation

. Posterior cortical blowout of the lateral femoral condyle

Explanation

Hyperflexing the knee when drilling the femoral tunnel through an anteromedial portal directs the drill trajectory more anteriorly. This prevents violating the posterior cortex of the lateral femoral condyle (posterior blowout).

Question 509

Topic: Shoulder & Hip Sports

A 65-year-old man sustains a first-time anterior shoulder dislocation. After a successful closed reduction, he is noted to have profound weakness in active external rotation and abduction. What is the most likely structural pathology causing this weakness?

. Axillary nerve neurapraxia
. Massive rotator cuff tear
. Bankart lesion
. Hill-Sachs lesion
. Brachial plexus neuropraxia

Correct Answer & Explanation

. Massive rotator cuff tear

Explanation

In patients older than 40-50 years, weakness in external rotation and abduction following an anterior shoulder dislocation is highly suspicious for an acute rotator cuff tear. This should be evaluated promptly with an MRI.

Question 510

Topic: 5. Sports Medicine

Which of the following is most likely to minimize bowing of the femora over the long term in a young patient with polyostotic fibrous dysplasia:

. Bisphosphonates treatment
. Curettage and autograft packing of lesions
. Application of allografts to lesions
. Internal metal fixation
. Injection of demineralized bone graft

Correct Answer & Explanation

. Internal metal fixation

Explanation

Bowing of the femora is a major problem for patients with polyostotic fibrous dysplasia. Bisphosphonates can decrease bone pain and increase bone density somewhat, but they do not prevent bowing. Allograft, autograft, and demineralized matrix are rapidly resorbed in most cases. Internal fixation with metal provides the best long-term protection.

Question 511

Topic: Knee Sports

An 11-year-old girl injures her knee while playing lacrosse and develops a hemarthrosis. The most likely diagnosis is:

. Anterior cruciate ligament tear
. Patellar dislocation
. Physeal injury of the distal femur
. Tibial spine avulsion
. Medial meniscus tear

Correct Answer & Explanation

. Patellar dislocation

Explanation

The most common cause of hemarthrosis of the knee in skeletally immature patients is a patellar dislocation. Anterior cruciate ligament injuries and tibial spine avulsions are less common. Medial meniscus tears are extremely rare in this population.

Question 512

Topic: Knee Sports

In order to see the articular cartilage of the knee in a child who has knee trauma, a magnetic resonance image must include:

. T1-weighted images
. T2-weighted images
. Gradient echo sequences
. Gadolinium contrast
. Flexion and extension images

Correct Answer & Explanation

. Gradient echo sequences

Explanation

Articular cartilage may be injured during trauma to the knee and manifest as either osteochondral fractures or osteochondritis dissecans. The articular cartilage is best visualized using gradient echo sequences. Examples of this technique include fast lowangle shot (FLASH) imaging, fast imaging with steady precession (FISP), and short tau inversion recovery (STIR).

Question 513

Topic: 5. Sports Medicine

A high school basketball player dies suddenly during a game. Which of the following is the least likely cause of death:

. Hypertrophic cardiomyopathy
. Prolonged Q-T interval
. Aortic dissection from Marfan syndrome
. C oronary artery anomalies
. Substance abuse

Correct Answer & Explanation

. Aortic dissection from Marfan syndrome

Explanation

Hypertrophic cardiomyopathy, coronary artery anomalies, and electrical abnormalities are the most common causes of sudden death in athletes. Substance abuse is also common. Marfan syndrome, which can be heralded by skeletal features of arachnodactyly, should also be considered when screening athletes although it is not as likely as the other choices to cause death.

Question 514

Topic: Knee Sports

Which of the following is the most common anatomical location for Osteochondritis Dissecans (OCD) in the pediatric knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central weight-bearing dome of the medial femoral condyle
. Patellar articular surface
. Anterior aspect of the lateral femoral condyle

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for Osteochondritis Dissecans (OCD) of the knee is the lateral aspect of the medial femoral condyle.

Question 515

Topic: Knee Sports

A 10-year-old boy with open physes sustains a complete anterior cruciate ligament (ACL) tear. To minimize the risk of growth arrest, a physeal-sparing reconstruction is planned. Which autograft is most commonly used for this specific extra-articular/intra-articular technique?

. Bone-patellar tendon-bone
. Quad tendon with bone block
. Iliotibial band
. Achilles tendon
. Peroneus brevis

Correct Answer & Explanation

. Iliotibial band

Explanation

The iliotibial (IT) band is frequently used in physeal-sparing ACL reconstructions (such as the Micheli or Kocher techniques) in prepubescent children to avoid drilling across the open physes.

Question 516

Topic: Knee Sports
A 14-year-old boy sustains a Meyers-McKeever Type III anterior tibial eminence fracture during a bicycle accident. What is the most appropriate management for this specific injury pattern?
. Cylindrical cast in 20 degrees of flexion
. Hinged knee brace with full range of motion
. Arthroscopic or open reduction and internal fixation
. Excision of the bony fragment and ACL reconstruction
. Immediate physical therapy for range of motion

Correct Answer & Explanation

. Arthroscopic or open reduction and internal fixation

Explanation

Meyers-McKeever Type III fractures are completely displaced tibial eminence avulsions. They require surgical intervention (arthroscopic or open) for anatomical reduction and fixation to restore ACL competence.

Question 517

Topic: Knee Sports
A 10-year-old boy sustains a Meyers and McKeever Type III anterior tibial spine avulsion fracture. Assuming no meniscal entrapment, what is the primary indication for surgical fixation over cast immobilization?
. To prevent premature physeal closure
. To restore anterior cruciate ligament (ACL) tension and prevent laxity
. To minimize the risk of arthrofibrosis
. To address associated collateral ligament tears
. To prevent patellar subluxation

Correct Answer & Explanation

. To restore anterior cruciate ligament (ACL) tension and prevent laxity

Explanation

A Type III tibial spine fracture is completely displaced. Surgical reduction and fixation are indicated to restore proper ACL tension, prevent chronic anterior knee instability, and remove any interposed tissue that blocks anatomic reduction.

Question 518

Topic: Knee Sports

What is the most common anatomical location for osteochondritis dissecans (OCD) in the pediatric knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central weight-bearing dome of the medial femoral condyle
. Inferior pole of the patella
. Anterior aspect of the tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for OCD lesions in the knee is the lateral aspect of the medial femoral condyle, accounting for approximately 70-80% of cases. This typically occurs due to repetitive microtrauma and vascular watershed vulnerability.

Question 519

Topic: 5. Sports Medicine

A 10-year-old girl presents with a painless "clunk" in her lateral knee during extension. MRI confirms an asymptomatic complete discoid lateral meniscus without any tears. What is the recommended management?

. Immediate total meniscectomy
. Partial meniscectomy with meniscal repair
. Observation
. Arthroscopic saucerization
. Diagnostic arthroscopy

Correct Answer & Explanation

. Observation

Explanation

An incidental, asymptomatic discoid meniscus does not require prophylactic surgical intervention. Observation is the standard of care unless the patient develops pain, mechanical locking, or a meniscal tear.

Question 520

Topic: Shoulder & Hip Sports

A 28-year-old man undergoes arthroscopic Bankart repair for recurrent anterior shoulder instability. To prevent a large, engaging Hill-Sachs lesion from engaging the anterior glenoid rim, the surgeon performs a "remplissage". What does this procedure entail?

. Bone grafting of the anterior glenoid rim
. Capsular plication of the inferior glenohumeral ligament
. Tenodesis of the infraspinatus and posterior capsule into the humeral head defect
. Transfer of the coracoid process to the anterior glenoid
. Osteotomy of the proximal humerus to increase retroversion

Correct Answer & Explanation

. Tenodesis of the infraspinatus and posterior capsule into the humeral head defect

Explanation

The remplissage procedure addresses an engaging Hill-Sachs lesion by filling the defect in the posterolateral humeral head with the infraspinatus tendon and posterior capsule. This converts an intra-articular defect into an extra-articular one.

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