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5. Sports Medicine MCQs

Practice Set 268 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 5341

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. Postoperatively, he presents with an inability to actively flex his elbow or supinate his forearm. Which nerve is most likely injured?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is at high risk during the Latarjet procedure due to its proximity to the coracoid process and conjoint tendon, which are retracted during exposure. Injury results in weakness of elbow flexion and forearm supination.

Question 5342

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the femoral attachment must be accurately positioned. Which of the following describes the correct radiographic landmark (Schöttle's point) for the femoral footprint on a true lateral view?
. Anterior to the posterior femoral cortex line and distal to the Blumensaat line
. Anterior to the posterior femoral cortex line and proximal to the Blumensaat line
. Posterior to the posterior femoral cortex line and proximal to the Blumensaat line
. Posterior to the posterior femoral cortex line and distal to the Blumensaat line
. Directly over the adductor tubercle

Correct Answer & Explanation

. Anterior to the posterior femoral cortex line and proximal to the Blumensaat line

Explanation

Schöttle's point identifies the anatomic femoral footprint of the MPFL. It is located approximately 1 mm anterior to the posterior femoral cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the Blumensaat line.

Question 5343

Topic: 5. Sports Medicine
A 26-year-old athlete presents with a symptomatic 4.0 cm² osteochondral defect of the medial femoral condyle with 5 mm of subchondral bone loss. Nonoperative management has failed. Which of the following is the most appropriate surgical intervention?
. Microfracture
. Matrix-induced autologous chondrocyte implantation (MACI)
. Osteochondral autograft transfer (OATS)
. Osteochondral allograft transplantation
. Autologous chondrocyte implantation (ACI)

Correct Answer & Explanation

. Osteochondral allograft transplantation

Explanation

Osteochondral allograft transplantation is indicated for large (>2 cm²) defects, especially when there is significant subchondral bone loss. Procedures like MACI and ACI are typically reserved for pure chondral defects without substantial bony involvement.

Question 5344

Topic: Shoulder & Hip Sports

A 25-year-old hockey player presents with anterior hip pain exacerbated by hip flexion, adduction, and internal rotation. Radiographs reveal a crossover sign and an alpha angle of 65 degrees. What is the most likely combination of pathomorphologies?

. Cam impingement only
. Pincer impingement only
. Mixed Cam and Pincer impingement
. Developmental dysplasia of the hip
. Slipped capital femoral epiphysis

Correct Answer & Explanation

. Mixed Cam and Pincer impingement

Explanation

An alpha angle greater than 55 degrees indicates a Cam deformity (femoral head-neck junction abnormality). The crossover sign on an AP pelvis radiograph indicates cranial retroversion of the acetabulum, typical of Pincer impingement. Together, they represent mixed femoroacetabular impingement (FAI).

Question 5345

Topic: Shoulder & Hip Sports

A 60-year-old male presents with a massive, irreparable posterosuperior rotator cuff tear. He has an intact subscapularis, no glenohumeral arthritis (Hamada grade 1), but demonstrates a positive hornblower's sign. Which of the following joint-preserving procedures is most indicated to restore active external rotation?

. Superior capsular reconstruction
. Latissimus dorsi tendon transfer
. Pectoralis major tendon transfer
. Arthroscopic partial repair with margin convergence
. Reverse total shoulder arthroplasty

Correct Answer & Explanation

. Latissimus dorsi tendon transfer

Explanation

In an active patient with an irreparable posterosuperior rotator cuff tear and severe active external rotation weakness, a latissimus dorsi tendon transfer is indicated. Superior capsular reconstruction improves superior stability but does not actively restore external rotation.

Question 5346

Topic: General Sports & Tendon

A 45-year-old water skier sustains a hyperflexion injury of the hip with the knee extended. He has severe posterior thigh pain and a palpable defect at the ischial tuberosity. MRI shows a complete 3-tendon proximal hamstring avulsion with 4 cm of retraction. What is the most appropriate management?

. Nonoperative management with physical therapy
. Acute surgical repair
. Delayed surgical repair after 12 weeks
. Ischial tuberosity osteoplasty
. Platelet-rich plasma (PRP) injection and bracing

Correct Answer & Explanation

. Acute surgical repair

Explanation

Complete proximal hamstring avulsions involving all three tendons with significant retraction (>2 cm) in an active patient are best treated with acute surgical repair. This prevents chronic weakness, debilitating pain, and secondary sciatic nerve tethering.

Question 5347

Topic: Shoulder & Hip Sports

A 48-year-old recreational tennis player presents with vague anterior shoulder pain. An MRI arthrogram reveals a Type II SLAP tear. He has failed 6 months of nonoperative management. What is the currently recommended surgical intervention for this specific demographic?

. Arthroscopic SLAP repair with suture anchors
. Biceps tenodesis
. Coracoid transfer (Latarjet)
. Anterior capsulolabral reconstruction
. Arthroscopic debridement only

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In older patients (typically >40 years) with a symptomatic Type II SLAP tear, primary biceps tenodesis is strongly preferred. SLAP repair in this older demographic is associated with higher rates of postoperative stiffness, persistent pain, and revision surgery.

Question 5348

Topic: Knee Sports

A 30-year-old male sustains a severe varus and hyperextension injury to his knee. Examination reveals a positive dial test (increased external rotation) at 30 degrees of knee flexion, but the external rotation normalizes to match the contralateral knee at 90 degrees of flexion. What is the primary injured structure?

. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Posterolateral corner (PLC)
. Medial collateral ligament (MCL)
. Iliotibial band

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

A positive dial test at 30 degrees of flexion that normalizes at 90 degrees indicates an isolated injury to the posterolateral corner (PLC). If the test remains positive at both 30 and 90 degrees, it suggests a combined PLC and PCL injury.

Question 5349

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability. Postoperatively, he presents with numbness over the lateral aspect of his forearm and weakness in elbow flexion. Which nerve is most likely injured?

. Axillary nerve
. Musculocutaneous nerve
. Radial nerve
. Median nerve
. Ulnar nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is at high risk during the Latarjet procedure due to its proximity to the conjoint tendon and coracoid process. Vigorous medial retraction of the conjoint tendon places traction on this nerve, causing lateral forearm numbness and biceps weakness.

Question 5350

Topic: Knee Sports

During clinical examination of a multiligamentous knee injury, the dial test is performed. At 30 degrees of knee flexion, the primary restraint to external rotation of the tibia is the:

. Popliteofibular ligament
. Lateral collateral ligament (LCL)
. Iliotibial band
. Anterior cruciate ligament (ACL)
. Biceps femoris tendon

Correct Answer & Explanation

. Popliteofibular ligament

Explanation

The popliteofibular ligament (PFL) and popliteus complex are the primary restraints to external tibial rotation at 30 degrees of flexion. The LCL is the primary restraint to varus stress.

Question 5351

Topic: Knee Sports

If a femoral tunnel is placed too anteriorly (high in the notch in extension) during an anterior cruciate ligament (ACL) reconstruction, what is the resulting biomechanical effect on the graft?

. Loose in flexion and tight in extension
. Tight in flexion and loose in extension
. Tight in both flexion and extension
. Loose in both flexion and extension
. Impingement on the posterior cruciate ligament (PCL)

Correct Answer & Explanation

. Tight in flexion and loose in extension

Explanation

An anteriorly placed femoral tunnel (anterior to the anatomic footprint) creates a graft that is excessively tight in flexion and loose in extension, often leading to restricted knee flexion and eventual graft failure.

Question 5352

Topic: 5. Sports Medicine

The peel-back mechanism responsible for Type II SLAP lesions in overhead-throwing athletes occurs maximally in which shoulder position?

. Abduction and maximal external rotation
. Flexion and internal rotation
. Adduction and internal rotation
. Extension and external rotation
. Forward elevation and adduction

Correct Answer & Explanation

. Abduction and maximal external rotation

Explanation

The peel-back mechanism occurs during the late cocking phase of throwing, characterized by abduction and maximal external rotation. In this position, the biceps vector shifts posteriorly, transmitting torsional forces that peel the posterosuperior labrum off the glenoid.

Question 5353

Topic: 5. Sports Medicine

Following hip arthroscopy for femoroacetabular impingement utilizing a perineal traction post, the patient reports severe numbness in the groin and scrotum. Neuropraxia of which nerve is the most likely cause?

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

Correct Answer & Explanation

. Pudendal nerve

Explanation

Pudendal nerve neuropraxia is a well-documented complication of hip arthroscopy due to direct compression from the perineal post against the groin during sustained traction.

Question 5354

Topic: Knee Sports

Biomechanical studies show that a complete, unrepaired tear of the posterior root of the medial meniscus alters knee contact mechanics equivalent to:

. Total medial meniscectomy
. A normal knee with intact menisci
. Anterior cruciate ligament deficiency
. Isolated partial medial meniscectomy
. Posterior cruciate ligament deficiency

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A medial meniscus posterior root tear destroys the meniscal hoop stresses, allowing radial extrusion of the meniscus. Biomechanically, this results in peak tibiofemoral contact pressures identical to a total medial meniscectomy.

Question 5355

Topic: Shoulder & Hip Sports

A 21-year-old collegiate rugby player presents with recurrent anterior shoulder instability. CT scan demonstrates 28% anterior glenoid bone loss. What is the most appropriate definitive surgical management?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with remplissage
. Open Bankart repair
. Latarjet procedure
. Proximal humerus derotational osteotomy

Correct Answer & Explanation

. Latarjet procedure

Explanation

In contact athletes with critical glenoid bone loss (typically >20-25%), a Latarjet procedure (coracoid transfer) is indicated. Arthroscopic soft tissue repairs alone have an unacceptably high failure rate in this setting.

Question 5356

Topic: Knee Sports

When performing a single-bundle posterior cruciate ligament (PCL) reconstruction, which native bundle is recreated to restore primary restraint against posterior tibial translation in flexion?

. Anteromedial bundle
. Anterolateral bundle
. Posteromedial bundle
. Posterolateral bundle
. Central core bundle

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The native PCL consists of two distinct bundles. The anterolateral bundle is the larger of the two, is tight in flexion, and is the primary target for single-bundle PCL reconstructions.

Question 5357

Topic: 5. Sports Medicine

A 28-year-old female undergoes hip arthroscopy for femoroacetabular impingement. Postoperatively, she reports profound numbness in the perineal region and labia. Which nerve was most likely injured due to intraoperative traction on the perineal post?

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

Correct Answer & Explanation

. Pudendal nerve

Explanation

The pudendal nerve can be compressed against the perineal post during traction in hip arthroscopy. This typically presents as transient numbness or pain in the perineum and genitalia that resolves with conservative management.

Question 5358

Topic: Knee Sports

A 17-year-old female experiences recurrent lateral patellar instability and is scheduled for a medial patellofemoral ligament (MPFL) reconstruction. Where is the exact anatomical location of the femoral origin of the MPFL (Schottle's point)?

. Anterior to the medial epicondyle and distal to the adductor tubercle
. Posterior to the medial epicondyle and proximal to the adductor tubercle
. Between the medial epicondyle and the adductor tubercle
. Directly on the medial collateral ligament superficial fibers
. Anterior to the adductor tubercle

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle

Explanation

The anatomic femoral origin of the MPFL lies in a saddle-shaped depression between the medial epicondyle and the adductor tubercle. Proper isometric graft placement at this location is critical to prevent abnormal patellofemoral tracking.

Question 5359

Topic: Knee Sports

A 24-year-old football player sustained a direct blow to the anteromedial aspect of his knee. Physical examination reveals increased external tibial rotation of 15 degrees compared to the contralateral side at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees. What is the most likely injury pattern?

. Isolated posterior cruciate ligament tear
. Isolated posterolateral corner injury
. Combined ACL and posterolateral corner injury
. Combined PCL and posterolateral corner injury
. Isolated medial collateral ligament tear

Correct Answer & Explanation

. Isolated posterolateral corner injury

Explanation

The dial test evaluates for excessive external rotation. Increased rotation at 30 degrees only indicates an isolated posterolateral corner (PLC) injury, whereas increased rotation at both 30 and 90 degrees indicates a combined PLC and PCL injury.

Question 5360

Topic: 5. Sports Medicine
A 25-year-old athlete undergoes an arthroscopic microfracture for a 1.5 cm² full-thickness chondral defect on the medial femoral condyle. What is the predominant type of collagen in the reparative tissue generated by this procedure?
. Type I collagen
. Type II collagen
. Type III collagen
. Type IV collagen
. Type IX collagen

Correct Answer & Explanation

. Type I collagen

Explanation

Marrow stimulation techniques like microfracture produce fibrocartilage, which is predominantly composed of Type I collagen. This differs from native hyaline articular cartilage, which is predominantly composed of Type II collagen.

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