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5. Sports Medicine MCQs

Practice Set 270 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 5381

Topic: Shoulder & Hip Sports

A 28-year-old male hockey player presents with insidious onset groin pain. Radiographs demonstrate a pistol-grip deformity and an alpha angle of 65 degrees. What is the primary pathoanatomy in this condition?

. Overcoverage of the femoral head by the acetabulum
. Aspherical femoral head-neck junction abutting the acetabular rim
. Dysplastic shallow acetabulum leading to instability
. Avulsion of the rectus femoris
. Hypertrophy of the ligamentum teres

Correct Answer & Explanation

. Aspherical femoral head-neck junction abutting the acetabular rim

Explanation

An increased alpha angle (>55 degrees) and pistol-grip deformity indicate Cam-type femoroacetabular impingement (FAI). This is characterized by an aspherical femoral head-neck junction that impinges against the anterosuperior acetabular rim during hip flexion.

Question 5382

Topic: 5. Sports Medicine

A 55-year-old woman experiences a sudden pop in the back of her knee while descending stairs. MRI shows a medial meniscus posterior root tear with 4 mm of meniscal extrusion. If left untreated, this condition most closely simulates the biomechanical effects of:

. An ACL tear
. A complete medial meniscectomy
. Patellofemoral osteoarthritis
. A PCL tear
. Popliteus tendon rupture

Correct Answer & Explanation

. A complete medial meniscectomy

Explanation

A complete meniscal root tear disrupts the hoop stresses of the meniscus, causing it to extrude and fail to distribute weight. Biomechanically, the contact pressures in the tibiofemoral compartment become equivalent to those following a total meniscectomy, leading to rapid chondrolysis.

Question 5383

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, identifying the correct femoral attachment is crucial. According to Schöttle's method, where is the radiographic femoral footprint located on a strict lateral radiograph?
. Anterior to the posterior cortex line and distal to Blumensaat's line
. Anterior to the posterior cortex line and proximal to the posterior femoral condyle origin
. Posterior to the posterior cortex line and distal to the adductor tubercle
. On the medial epicondyle exactly
. At the distal pole of the patella

Correct Answer & Explanation

. Anterior to the posterior cortex line and proximal to the posterior femoral condyle origin

Explanation

The Schöttle point for MPFL femoral insertion is located radiographically 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior portion of Blumensaat's line.

Question 5384

Topic: Shoulder & Hip Sports

A 26-year-old professional baseball pitcher complains of vague posterior shoulder pain during the late cocking phase of throwing. Physical examination reveals a loss of 25 degrees of internal rotation compared to the non-throwing shoulder, with a positive O'Brien test. What is the initial recommended treatment for this condition?

. Arthroscopic SLAP repair
. Arthroscopic posterior capsular release
. Sleeper stretch program focusing on posterior capsular stretching
. Biceps tenodesis
. Latarjet procedure

Correct Answer & Explanation

. Sleeper stretch program focusing on posterior capsular stretching

Explanation

The patient presents with Glenohumeral Internal Rotation Deficit (GIRD) and possible internal impingement. The initial management for GIRD in overhead athletes is a supervised posterior capsular stretching program, such as sleeper stretches.

Question 5385

Topic: Knee Sports

During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, identifying the anatomic femoral footprint is critical. According to Schottle's method on a true lateral radiograph, where is the femoral attachment of the MPFL located?

. Anterior to the posterior cortical line and proximal to the posterior border of the Blumensaat line
. Anterior to the posterior cortical line and distal to the posterior border of the Blumensaat line
. Posterior to the posterior cortical line and proximal to the posterior border of the Blumensaat line
. Anterior to the posterior cortical line and intersecting the Blumensaat line
. Posterior to the posterior cortical line and distal to the posterior border of the Blumensaat line

Correct Answer & Explanation

. Anterior to the posterior cortical line and proximal to the posterior border of the Blumensaat line

Explanation

The Schottle point indicates the anatomic femoral origin of the MPFL. It is located 1 mm anterior to the posterior cortical line of the femur and proximal to the level of the posterior Blumensaat line.

Question 5386

Topic: 5. Sports Medicine

A 16-year-old female high school soccer player is planning to undergo an anterior cruciate ligament (ACL) reconstruction. Which of the following graft choices is associated with the highest risk of graft failure in this specific patient population?

. Bone-patellar tendon-bone autograft
. Hamstring autograft
. Quadriceps tendon autograft
. Tibialis posterior allograft
. Iliotibial band autograft

Correct Answer & Explanation

. Tibialis posterior allograft

Explanation

Multiple studies demonstrate that allografts have a significantly higher failure rate in young, active athletes (especially under 20 years old) compared to autograft options.

Question 5387

Topic: Knee Sports

A 24-year-old gymnast presents with chronic lateral elbow pain. She has pain with valgus stress and a 15-degree extension deficit. Radiographs demonstrate a radiolucent lesion in the capitellum with a sclerotic margin. MRI shows a 12mm osteochondral defect with a detached fragment and fluid behind the fragment. What is the most appropriate definitive management?

. Six weeks of rest and throwing restriction
. Arthroscopic debridement and microfracture
. Corticosteroid injection and physical therapy
. Ulnar collateral ligament reconstruction
. Open reduction and internal fixation of the fragment

Correct Answer & Explanation

. Arthroscopic debridement and microfracture

Explanation

This patient has an unstable osteochondritis dissecans (OCD) of the capitellum, indicated by fluid behind the fragment. For small to moderate unstable lesions that are chronic, arthroscopic debridement and marrow stimulation (microfracture) is indicated.

Question 5388

Topic: Shoulder & Hip Sports

A 20-year-old collegiate rugby player sustains an anterior shoulder dislocation. After reduction, a CT scan shows a glenoid bone loss of 25%. He is indicated for a Latarjet procedure. The primary stabilizing mechanism of the Latarjet procedure in this setting is:

. The conjoint tendon acting as a sling across the anterior capsule when the arm is abducted and externally rotated
. The bone block strictly increasing the articular surface area
. The transfer of the coracoacromial ligament to the lesser tuberosity
. The repair of the superior labrum anterior to posterior (SLAP)
. Medialization of the subscapularis footprint

Correct Answer & Explanation

. The conjoint tendon acting as a sling across the anterior capsule when the arm is abducted and externally rotated

Explanation

The primary stabilizing mechanism of the Latarjet procedure is the 'sling effect' of the conjoint tendon compressing the anteroinferior capsule during abduction and external rotation. The osseous expansion plays a secondary role.

Question 5389

Topic: Knee Sports

A 50-year-old male presents with acute severe pain in the posterior knee after stepping off a curb. MRI demonstrates a complete radial tear of the posterior root of the medial meniscus with 4 mm of meniscal extrusion. If left untreated, this injury biomechanically behaves most similarly to:

. A complete anterior cruciate ligament (ACL) rupture
. An isolated medial collateral ligament (MCL) sprain
. A total medial meniscectomy
. A bucket-handle medial meniscus tear
. A discoid lateral meniscus

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus disrupts the circumferential hoop stresses, leading to functional incompetence and meniscal extrusion. Biomechanically, it is equivalent to a total medial meniscectomy.

Question 5390

Topic: 5. Sports Medicine

A 28-year-old professional dancer undergoes hip arthroscopy for a symptomatic cam-type femoroacetabular impingement (FAI). Postoperatively, she reports numbness over the perineum and labia majora. This complication is most likely related to:

. Direct thermal injury from the radiofrequency wand
. Over-resection of the femoral neck
. Traction against the perineal post
. Extravasation of arthroscopy fluid into the pelvis
. Direct injury to the lateral femoral cutaneous nerve (LFCN)

Correct Answer & Explanation

. Traction against the perineal post

Explanation

Pudendal nerve neurapraxia is a known complication of hip arthroscopy due to prolonged compression against the perineal post during traction. It typically presents as transient numbness in the groin and perineal area.

Question 5391

Topic: General Sports & Tendon

A 35-year-old water skier falls forcefully while accelerating and sustains an avulsion of the proximal hamstring origin. MRI demonstrates a complete avulsion of the conjoined tendon and semimembranosus with 4 cm of distal retraction. During the surgical exposure, which of the following nerves is at greatest risk of injury and must be carefully protected?

. Superior gluteal nerve
. Inferior gluteal nerve
. Pudendal nerve
. Sciatic nerve
. Posterior femoral cutaneous nerve

Correct Answer & Explanation

. Sciatic nerve

Explanation

The sciatic nerve lies immediately lateral to the ischial tuberosity and the proximal hamstring origin. In cases of significant tendon retraction and scarring, the nerve is at high risk of iatrogenic injury.

Question 5392

Topic: Knee Sports

A 25-year-old athlete sustains a posterolateral corner (PLC) injury of the knee. During a surgical reconstruction of the PLC using a fibular-based technique, care must be taken to avoid injury to the common peroneal nerve. Where does the common peroneal nerve typically cross in relation to the fibular head?

. It runs strictly anterior to the fibular head and neck
. It runs posterior to the biceps femoris tendon and wraps around the fibular neck
. It penetrates the medial head of the gastrocnemius before crossing the fibula
. It courses medial to the popliteus tendon
. It passes superior to the lateral collateral ligament origin

Correct Answer & Explanation

. It runs posterior to the biceps femoris tendon and wraps around the fibular neck

Explanation

The common peroneal nerve courses posterior to the long head of the biceps femoris tendon and wraps around the fibular neck from posterior to anterior, making it highly vulnerable during PLC reconstruction.

Question 5393

Topic: Knee Sports

Which of the following statements regarding the anatomy and biomechanics of the posterior cruciate ligament (PCL) is true?

. The posteromedial bundle is tight in flexion.
. The anterolateral bundle is tight in extension.
. The anterolateral bundle is the primary restraint to posterior tibial translation in flexion.
. The PCL originates on the lateral femoral condyle.
. The posteromedial bundle is larger than the anterolateral bundle.

Correct Answer & Explanation

. The anterolateral bundle is tight in extension.

Explanation

The PCL consists of the larger anterolateral bundle (tight in flexion) and the smaller posteromedial bundle (tight in extension). The anterolateral bundle provides the primary restraint to posterior tibial translation at 90 degrees of knee flexion.

Question 5394

Topic: Shoulder & Hip Sports

A 21-year-old collegiate rugby player with a history of recurrent anterior shoulder instability presents for surgical evaluation. A 3D CT scan reveals 26% anterior glenoid bone loss. What is the most appropriate surgical management?

. Arthroscopic Bankart repair with suture anchors
. Arthroscopic Remplissage
. Open Latarjet procedure
. Arthroscopic capsular shift
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Open Latarjet procedure

Explanation

In collision athletes with critical anterior glenoid bone loss (typically greater than 20-25%), isolated soft-tissue repair has an unacceptably high failure rate. The Latarjet procedure (coracoid transfer) is required to restore the bony arc and provide a dynamic sling effect.

Question 5395

Topic: 5. Sports Medicine

A 19-year-old collegiate female soccer player tears her ACL and elects to undergo reconstruction using a bone-patellar tendon-bone (BTB) autograft. Which of the following is the most common postoperative complication specific to this graft choice?

. Anterior knee pain
. Patellar fracture
. Hamstring weakness
. Graft rupture
. Arthrofibrosis

Correct Answer & Explanation

. Anterior knee pain

Explanation

Anterior knee pain and pain with kneeling are the most frequent complications following BTB autograft ACL reconstruction. While patellar fractures can occur, they are relatively rare.

Question 5396

Topic: Shoulder & Hip Sports

A 22-year-old rugby player with recurrent anterior shoulder instability and 25% glenoid bone loss undergoes a Latarjet procedure. Which nerve is at greatest risk of iatrogenic injury during the coracoid preparation and transfer?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve enters the coracobrachialis 5 to 8 cm distal to the coracoid tip. It is highly susceptible to traction or direct injury during the mobilization and transfer of the conjoint tendon in a Latarjet procedure.

Question 5397

Topic: Shoulder & Hip Sports

A 45-year-old man falls onto his outstretched arm and subsequently demonstrates weakness in internal rotation. Physical examination reveals a positive lift-off test and increased passive external rotation compared to the contralateral shoulder. Which structure is most likely injured?

. Supraspinatus tendon
. Infraspinatus tendon
. Teres minor tendon
. Subscapularis tendon
. Long head of the biceps tendon

Correct Answer & Explanation

. Subscapularis tendon

Explanation

A positive lift-off test, weakness in internal rotation, and increased passive external rotation are classic clinical indicators of a subscapularis tendon tear.

Question 5398

Topic: 5. Sports Medicine

A 28-year-old male presents with a dashboard injury and a positive posterior drawer test at 90 degrees of flexion. Radiographs reveal a displaced bony avulsion fragment from the posterior tibia. What is the recommended optimal treatment?

. Hinged knee brace locked in extension
. Open reduction and internal fixation of the avulsion
. Arthroscopic PCL reconstruction using an allograft
. Nonoperative management with early range of motion
. High tibial osteotomy

Correct Answer & Explanation

. Open reduction and internal fixation of the avulsion

Explanation

A displaced PCL tibial avulsion fracture is best treated with acute open reduction and internal fixation (ORIF). This restores the native PCL footprint and normal knee biomechanics better than nonoperative treatment or reconstruction.

Question 5399

Topic: Knee Sports
A 17-year-old female undergoes medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar dislocations. If the femoral tunnel is placed too proximal and anterior to Schöttle's point, what is the expected clinical consequence?
. Increased graft tension in flexion
. Increased graft tension in extension
. Patella baja
. Medial patellar subluxation in extension
. Graft laxity throughout the entire range of motion

Correct Answer & Explanation

. Increased graft tension in flexion

Explanation

Non-anatomic placement of the MPFL femoral tunnel too proximal and anterior causes the graft to act non-isometrically, becoming overly tight as the knee moves into flexion. This can lead to stiffness, pain, and increased patellofemoral contact pressures.

Question 5400

Topic: 5. Sports Medicine

A 25-year-old hockey player undergoes hip arthroscopy with femoral neck osteochondroplasty for a cam-type femoroacetabular impingement. Resection of more than what percentage of the femoral neck diameter significantly increases the risk of an iatrogenic postoperative fracture?

. 10%
. 20%
. 30%
. 40%
. 50%

Correct Answer & Explanation

. 30%

Explanation

Biomechanical studies have shown that resecting more than 30% of the anterolateral femoral neck diameter during an osteochondroplasty significantly decreases load-bearing capacity, increasing the risk of a femoral neck stress fracture.

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