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5. Sports Medicine MCQs

Practice Set 269 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 5361

Topic: 5. Sports Medicine

A 25-year-old professional soccer player undergoes ACL reconstruction with a bone-patellar tendon-bone autograft. During the procedure, the femoral tunnel is drilled through the anteromedial portal rather than transtibial. Which of the following is the most likely biomechanical advantage of this technique?

. More vertical graft orientation
. Better restoration of the native ACL footprint
. Decreased risk of posterior wall blowout
. Reduced risk of patellar fracture
. Avoidance of graft mismatch

Correct Answer & Explanation

. Better restoration of the native ACL footprint

Explanation

Drilling the femoral tunnel independently via an anteromedial portal allows for more anatomic placement of the ACL footprint compared to the transtibial technique, which often results in a more vertical graft that primarily controls AP translation but is less effective for rotational instability.

Question 5362

Topic: 5. Sports Medicine

A 19-year-old collegiate football running back presents with an acute knee injury after being tackled. MRI demonstrates a complete, isolated PCL rupture. He has no gross instability with varus or valgus stress and a Grade II posterior drawer. What is the most appropriate initial management?

. Primary PCL repair
. PCL reconstruction with Achilles allograft
. Protected weight-bearing in a hinged brace locked in extension
. Early operative intervention to prevent medial compartment arthrosis
. Casting in 30 degrees of flexion

Correct Answer & Explanation

. Protected weight-bearing in a hinged brace locked in extension

Explanation

Isolated Grade I and II PCL tears are highly amenable to non-operative treatment. Management typically involves bracing in extension to counteract the posterior pull of the hamstrings, followed by aggressive quadriceps strengthening.

Question 5363

Topic: Knee Sports



In Medial Patellofemoral Ligament (MPFL) reconstruction, placing the femoral tunnel too proximal will result in which of the following kinematic abnormalities?

. The graft will be tight in extension and loose in flexion.
. The graft will be tight in flexion and loose in extension.
. The patella will subluxate medially in extension.
. The graft will prevent terminal extension.
. The patella will ride high (patella alta).

Correct Answer & Explanation

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

Explanation

Proximal placement of the femoral tunnel in MPFL reconstruction causes the graft to overtighten during knee flexion. This non-anatomic placement increases patellofemoral contact pressures and can restrict terminal range of motion.

Question 5364

Topic: Shoulder & Hip Sports

A 28-year-old rock climber presents with chronic shoulder pain. An MRI reveals a type II SLAP lesion. He fails conservative management and undergoes arthroscopic repair. Postoperatively, what is the most common complication following SLAP repair in this patient demographic?

. Recurrent instability
. Postoperative stiffness
. Axillary nerve injury
. Rotator cuff tear
. Hardware migration

Correct Answer & Explanation

. Postoperative stiffness

Explanation

Postoperative stiffness, particularly a loss of external rotation, is the most common complication following SLAP repair. This risk is minimized by avoiding overtensioning of the capsulolabral complex.

Question 5365

Topic: General Sports & Tendon



A 45-year-old avid runner presents with deep gluteal pain and posterior thigh radiation that worsens with prolonged sitting. Examination shows tenderness over the ischial tuberosity and pain with resisted knee flexion while the hip is flexed. Which of the following conditions is most likely responsible for his symptoms?

. Piriformis syndrome
. Ischiofemoral impingement
. Proximal hamstring tendinopathy
. Sacroiliac joint dysfunction
. Trochanteric bursitis

Correct Answer & Explanation

. Proximal hamstring tendinopathy

Explanation

Proximal hamstring tendinopathy classically presents with deep, localized buttock pain at the ischial tuberosity. Symptoms are exacerbated by prolonged sitting and activities requiring repetitive deep hip flexion, such as running uphill.

Question 5366

Topic: Shoulder & Hip Sports

During an arthroscopic rotator cuff repair, a massive, retracted, U-shaped tear involving the supraspinatus and infraspinatus is identified. Margin convergence sutures are utilized. What is the primary biomechanical goal of margin convergence?

. To medialize the footprint for easier reach
. To reduce strain on the repair at the greater tuberosity
. To stimulate biologic healing at the tendon-tendon interface
. To prevent suprascapular nerve stretch
. To convert a U-shaped tear into a V-shaped tear

Correct Answer & Explanation

. To reduce strain on the repair at the greater tuberosity

Explanation

Margin convergence side-to-side suturing acts to close a U-shaped tear into a more manageable crescent shape. Biomechanically, this significantly reduces tension and strain at the tendon-to-bone repair site on the greater tuberosity.

Question 5367

Topic: 5. Sports Medicine

A 10-year-old boy (Tanner stage 1) sustains a mid-substance complete tear of his anterior cruciate ligament (ACL) while playing soccer. Non-operative management has failed due to recurrent instability. Which of the following surgical techniques is most appropriate?

. Transphyseal bone-patellar tendon-bone autograft
. Extraphyseal iliotibial (IT) band reconstruction
. Primary repair of the ACL with suture anchors
. Transphyseal quadruple hamstring autograft
. Over-the-top hamstring graft with a tibial bone plug

Correct Answer & Explanation

. Extraphyseal iliotibial (IT) band reconstruction

Explanation

In prepubescent children with significant remaining growth (Tanner 1 or 2), a physeal-sparing technique, such as an extraphyseal IT band reconstruction (e.g., MacIntosh/Kocher technique), minimizes the risk of growth arrest and angular deformity.

Question 5368

Topic: Shoulder & Hip Sports

A 22-year-old male rugby player presents with recurrent anterior shoulder instability. Advanced imaging reveals 25% anterior glenoid bone loss and an engaging Hill-Sachs lesion.

Which of the following is the most appropriate surgical management?

. Arthroscopic Bankart repair
. Arthroscopic remplissage alone
. Open Bankart repair with capsular shift
. Latarjet procedure (coracoid transfer)
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

The Latarjet procedure is indicated for recurrent anterior shoulder instability associated with critical glenoid bone loss (>20-25%). Soft tissue repairs alone in this setting have an unacceptably high failure rate.

Question 5369

Topic: Knee Sports
When reconstructing the medial patellofemoral ligament (MPFL) for recurrent patellar instability, identifying the correct femoral attachment (Schöttle's point) is critical. Where is this anatomic point located radiographically?
. Anterior to the medial epicondyle and proximal to the adductor tubercle
. Between the medial epicondyle and the adductor tubercle
. Distal to the joint line on the medial tibial condyle
. Directly over the center of the medial femoral condyle
. Posterior to the adductor tubercle and distal to the Blumensaat line

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle

Explanation

The MPFL femoral origin is located in a saddle-like depression situated between the medial epicondyle distally and the adductor tubercle proximally.

Question 5370

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player is diagnosed with a posterior labral tear and an associated paralabral cyst located strictly at the spinoglenoid notch. Which of the following clinical exam findings is most expected?

. Isolated weakness in internal rotation
. Weakness in both shoulder abduction and external rotation
. Isolated weakness in external rotation
. Loss of active forward elevation
. Sensory deficit over the lateral deltoid

Correct Answer & Explanation

. Isolated weakness in external rotation

Explanation

A paralabral cyst at the spinoglenoid notch selectively compresses the distal suprascapular nerve branch to the infraspinatus. This spares the supraspinatus (innervated prior to the notch), resulting in isolated external rotation weakness.

Question 5371

Topic: Knee Sports

A 30-year-old male sustains a severe knee injury. On physical examination, the Dial test demonstrates 15 degrees of increased external rotation of the tibia compared to the contralateral leg at 30 degrees of flexion, and 18 degrees of increased external rotation at 90 degrees of flexion. This pattern most strongly suggests injury to which structures?

. Isolated posterolateral corner (PLC)
. Isolated posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL) and PLC
. Posterior cruciate ligament (PCL) and PLC
. Medial collateral ligament (MCL) and PCL

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

The Dial test evaluates external tibial rotation. Increased rotation (>10 degrees compared to the normal side) at 30 degrees only indicates an isolated PLC injury. Increased rotation at both 30 and 90 degrees indicates combined PLC and PCL injuries.

Question 5372

Topic: Shoulder & Hip Sports

A 24-year-old hockey player presents with chronic groin pain. Imaging reveals femoroacetabular impingement (FAI) with a cam lesion. Which radiographic view is best utilized to measure the alpha angle to quantify the cam deformity?

. AP Pelvis
. False profile view
. Dunn lateral view
. Inlet view
. Outlet view

Correct Answer & Explanation

. Dunn lateral view

Explanation

The Dunn lateral or cross-table lateral views provide the best visualization of the anterolateral femoral head-neck junction, which is where cam deformities most commonly occur and the alpha angle is most accurately measured.

Question 5373

Topic: Shoulder & Hip Sports

A 20-year-old female dancer complains of a deep, audible clicking in her groin area when she brings her hip from flexion into extension. The phenomenon is reproducible and mildly painful. This specific form of 'snapping hip' syndrome involves which of the following structures?

. Iliotibial band snapping over the greater trochanter
. Gluteus maximus tendon snapping over the ischial tuberosity
. Iliopsoas tendon snapping over the iliopectineal eminence
. Rectus femoris tendon snapping over the anterior inferior iliac spine
. Biceps femoris tendon snapping over the fibular head

Correct Answer & Explanation

. Iliopsoas tendon snapping over the iliopectineal eminence

Explanation

Internal snapping hip syndrome (coxa saltans interna) occurs when the iliopsoas tendon snaps over the iliopectineal eminence or the femoral head during hip extension.

Question 5374

Topic: 5. Sports Medicine

A healthy 30-year-old professional athlete sustains an acute, mid-substance Achilles tendon rupture. When discussing operative versus non-operative treatment with modern functional rehabilitation protocols, operative management is primarily associated with which of the following outcomes?

. Lower risk of deep vein thrombosis
. Decreased rate of re-rupture
. Decreased risk of sural nerve injury
. Lower rate of surgical site infection
. Faster restoration of baseline calf circumference

Correct Answer & Explanation

. Decreased rate of re-rupture

Explanation

While modern functional rehabilitation has minimized the differences, operative treatment of Achilles tendon ruptures historically and consistently demonstrates a lower re-rupture rate compared to non-operative treatment, albeit with a higher risk of wound complications.

Question 5375

Topic: 5. Sports Medicine

Comparing quadriceps tendon ruptures to patellar tendon ruptures, which of the following demographic or clinical statements is most accurate?

. Quadriceps tendon ruptures occur more frequently in patients older than 40 years.
. Patellar tendon ruptures are more commonly associated with chronic kidney disease.
. Quadriceps tendon ruptures result in a high-riding patella (patella alta).
. Patellar tendon ruptures typically occur at the tibial tubercle insertion.
. Quadriceps tendon ruptures are more common in female athletes.

Correct Answer & Explanation

. Quadriceps tendon ruptures occur more frequently in patients older than 40 years.

Explanation

Quadriceps tendon ruptures typically occur in patients older than 40, while patellar tendon ruptures are more common in patients younger than 40. A patellar tendon rupture yields patella alta, whereas a quadriceps rupture results in patella baja (or neutral).

Question 5376

Topic: 5. Sports Medicine

A 19-year-old female soccer player undergoes an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Which of the following is the most frequently reported complication specific to this graft choice compared to a hamstring autograft?

. Increased rate of graft rupture
. Higher incidence of deep infection
. Anterior knee pain
. Reduced knee extension strength
. Hamstring weakness

Correct Answer & Explanation

. Anterior knee pain

Explanation

Bone-patellar tendon-bone (BTB) autograft is historically associated with a higher incidence of anterior knee pain and donor site morbidity compared to hamstring autograft. Graft rupture rates are comparable or slightly lower for BTB in young, active patients.

Question 5377

Topic: Knee Sports

A 25-year-old male sustains a direct blow to the proximal tibia with the knee flexed. Examination reveals a posterior sag sign and posterior translation of 8 mm at 90 degrees of flexion with a firm endpoint. What is the most appropriate initial management?

. Immediate PCL reconstruction
. Immobilization in extension for 2-4 weeks followed by rehab
. High tibial osteotomy
. Immobilization in 90 degrees of flexion
. Primary PCL repair

Correct Answer & Explanation

. Immobilization in extension for 2-4 weeks followed by rehab

Explanation

This represents a Grade II isolated posterior cruciate ligament (PCL) injury (5-10 mm translation). Isolated Grade I and II PCL injuries are best managed non-operatively with brief immobilization in extension to reduce the posterior sag, followed by progressive quadriceps strengthening.

Question 5378

Topic: Shoulder & Hip Sports

A 24-year-old male presents with recurrent anterior shoulder instability. CT scan with 3D reconstruction reveals a 25% anteroinferior glenoid bone loss. Which of the following is the most appropriate surgical treatment?

. Arthroscopic Bankart repair
. Arthroscopic SLAP repair
. Open inferior capsular shift
. Latarjet procedure
. Remplissage procedure alone

Correct Answer & Explanation

. Latarjet procedure

Explanation

In patients with recurrent anterior shoulder instability and significant glenoid bone loss (typically >20-25%), isolated soft-tissue repair (Bankart) has an unacceptably high failure rate. The Latarjet procedure (coracoid transfer) is the standard of care for restoring stability.

Question 5379

Topic: 5. Sports Medicine

A 36-year-old recreational weightlifter complains of persistent deep anterior shoulder pain. MRI arthrogram demonstrates a Type II SLAP tear. Non-operative management has failed. What is the most appropriate surgical intervention for this patient?

. Subpectoral biceps tenodesis
. Arthroscopic SLAP repair with suture anchors
. Biceps tenotomy
. Coracoacromial ligament release
. Superior capsular reconstruction

Correct Answer & Explanation

. Subpectoral biceps tenodesis

Explanation

In older patients or those not participating in overhead throwing sports, primary biceps tenodesis provides superior pain relief and functional outcomes with lower complication rates compared to SLAP repair for Type II SLAP tears.

Question 5380

Topic: Shoulder & Hip Sports

A 45-year-old tennis player presents with shoulder pain. MRI shows a partial articular-sided supraspinatus tendon avulsion (PASTA) involving 60% of the tendon thickness. What is the recommended surgical management if conservative treatment fails?

. Arthroscopic debridement of the tendon without repair
. Takedown of the remaining tendon and formal repair
. Subacromial decompression alone
. Latissimus dorsi tendon transfer
. Open reduction and internal fixation

Correct Answer & Explanation

. Takedown of the remaining tendon and formal repair

Explanation

For partial articular-sided rotator cuff tears involving greater than 50% of the tendon thickness, standard treatment involves taking down the remaining intact tendon and performing a formal full-thickness repair, or completing a transtendon (in situ) repair.

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