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5. Sports Medicine MCQs

Practice Set 271 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 5401

Topic: Knee Sports

A 14-year-old male gymnast presents with lateral elbow pain and catching. MRI shows an unstable osteochondritis dissecans (OCD) lesion of the capitellum with an intra-articular loose body. What is the most appropriate definitive management?

. Casting for 6 weeks
. Loose body removal and marrow stimulation (microfracture)
. Ulnar collateral ligament reconstruction
. Physical therapy focusing on the flexor-pronator mass
. Radial head excision

Correct Answer & Explanation

. Loose body removal and marrow stimulation (microfracture)

Explanation

In adolescents with an unstable capitellar OCD lesion and mechanical symptoms, nonoperative management typically fails. Operative treatment involves loose body removal and microfracture or osteochondral grafting to promote fibrocartilage healing.

Question 5402

Topic: 5. Sports Medicine

A 42-year-old recreational weightlifter fails conservative treatment for a type II SLAP tear. Given his age demographic, what is the generally preferred surgical intervention to achieve reliable pain relief and return to function?

. SLAP repair with suture anchors
. Biceps tenodesis
. Coracoid transfer
. Diagnostic arthroscopy and debridement only
. Distal clavicle excision

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In patients over 35 to 40 years old, primary biceps tenodesis offers more predictable pain relief and functional improvement compared to SLAP repair, which carries a higher risk of postoperative stiffness and revision in this demographic.

Question 5403

Topic: 5. Sports Medicine

A 19-year-old female cross-country runner with 8 months of amenorrhea sustains a femoral neck stress fracture. What is the primary underlying physiological mechanism driving her decreased bone mineral density as part of the female athlete triad?

. Excessive calcitonin production
. Decreased estrogen levels
. Hyperparathyroidism
. Increased testosterone levels
. Vitamin D toxicity

Correct Answer & Explanation

. Decreased estrogen levels

Explanation

The female athlete triad involves low energy availability, which suppresses the hypothalamic-pituitary-ovarian axis. This leads to hypoestrogenemia (amenorrhea), removing estrogen's protective effect on bone and resulting in low bone mineral density.

Question 5404

Topic: General Sports & Tendon

A 42-year-old male sustains a complete 3-tendon proximal hamstring avulsion retracted 4 cm. During the surgical approach for repair, which nerve located immediately lateral to the ischial tuberosity must be explicitly identified and protected?

. Pudendal nerve
. Superior gluteal nerve
. Sciatic nerve
. Femoral nerve
. Obturator nerve

Correct Answer & Explanation

. Sciatic nerve

Explanation

The sciatic nerve descends intimately close to the lateral aspect of the ischial tuberosity and the proximal hamstring origin. It must be carefully neurolysed and protected during proximal hamstring repairs.

Question 5405

Topic: 5. Sports Medicine

A 60-year-old male with an irreparable massive posterosuperior rotator cuff tear undergoes a superior capsule reconstruction (SCR) to restore glenohumeral kinematics. Which of the following is the most commonly utilized biological graft for this procedure?

. Achilles tendon autograft
. Thick human dermal allograft
. Bone-patellar tendon-bone autograft
. Synthetic mesh
. Hamstring autograft

Correct Answer & Explanation

. Thick human dermal allograft

Explanation

Thick human dermal allograft (typically 3 mm) or fascia lata autograft are the primary graft choices for an SCR. They are attached to the glenoid and greater tuberosity to depress the humeral head and prevent superior escape.

Question 5406

Topic: Shoulder & Hip Sports

A 22-year-old male rugby player presents with recurrent anterior shoulder instability. A 3D CT scan of the shoulder reveals an anterior glenoid bone loss of 25% with an engaging Hill-Sachs lesion. What is the most appropriate surgical management?

. Arthroscopic Bankart repair with suture anchors
. Arthroscopic remplissage alone
. Coracoid process transfer (Latarjet procedure)
. Open Bankart repair and inferior capsular shift
. Proximal humeral derotational osteotomy

Correct Answer & Explanation

. Coracoid process transfer (Latarjet procedure)

Explanation

For anterior glenoid bone loss exceeding 20-25%, isolated soft tissue repairs (Bankart) have a high failure rate. A bony augmentation procedure, such as the Latarjet (coracoid transfer), is indicated to restore glenoid articular arc and provide a sling effect.

Question 5407

Topic: Knee Sports
A 45-year-old female experiences a sudden pop in her posterior knee while deep squatting. MRI reveals a >3 mm medial meniscus extrusion and a complete radial tear at the posterior root. Which of the following best describes the biomechanical consequence of this untreated injury?
. It maintains 80% of normal meniscal hoop stresses
. It results in tibiofemoral contact pressures equivalent to a total meniscectomy
. It primarily leads to isolated patellofemoral osteoarthritis
. It causes paradoxical anterior subluxation of the femur during extension
. It does not significantly alter knee kinematics or contact mechanics

Correct Answer & Explanation

. It results in tibiofemoral contact pressures equivalent to a total meniscectomy

Explanation

A posterior meniscal root tear completely disrupts the hoop stresses of the meniscus. Biomechanically, this results in peak contact pressures and contact areas identical to a total meniscectomy, leading to rapid joint degeneration if left untreated.

Question 5408

Topic: Knee Sports

A 28-year-old male sustains a dashboard injury to his right knee. Physical examination reveals a positive posterior drawer test. The dial test shows 15 degrees of increased external rotation on the injured side compared to the normal side at 30 degrees of flexion, but symmetric external rotation at 90 degrees of flexion. What is the most likely diagnosis?

. Isolated posterior cruciate ligament (PCL) tear
. Combined PCL and posterolateral corner (PLC) tear
. Isolated posterolateral corner (PLC) injury
. Combined anterior cruciate ligament (ACL) and PLC tear
. Isolated medial collateral ligament (MCL) tear

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

An increase in external rotation of >10 degrees at 30 degrees of flexion, with symmetric rotation at 90 degrees, is indicative of an isolated posterolateral corner (PLC) injury. Combined PLC and PCL injuries show increased external rotation at both 30 and 90 degrees.

Question 5409

Topic: Knee Sports

An 18-year-old female presents with recurrent lateral patellar dislocations. Advanced imaging reveals a normal patellar height (Caton-Deschamps index 1.0) but a tibial tubercle-trochlear groove (TT-TG) distance of 23 mm. What is the most appropriate surgical treatment?

. Isolated medial patellofemoral ligament (MPFL) reconstruction
. Isolated lateral retinacular release
. Tibial tubercle anteromedialization combined with MPFL reconstruction
. Medial reefing and lateral release
. Trochleoplasty alone

Correct Answer & Explanation

. Tibial tubercle anteromedialization combined with MPFL reconstruction

Explanation

A TT-TG distance >20 mm is a pathologic finding indicating significant lateralization of the tibial tubercle. Optimal treatment requires addressing the bony malalignment with a tibial tubercle transfer (anteromedialization) alongside an MPFL reconstruction.

Question 5410

Topic: Shoulder & Hip Sports

A 25-year-old ice hockey player presents with chronic, deep groin pain exacerbated by hip flexion and internal rotation. An AP pelvis radiograph demonstrates a "crossover sign." This radiographic finding is indicative of which of the following pathomorphologies?

. Cam impingement due to an abnormal head-neck offset
. Pincer impingement secondary to acetabular retroversion
. Ischiofemoral impingement
. Subspine impingement from an enlarged AIIS
. Coxa profunda

Correct Answer & Explanation

. Pincer impingement secondary to acetabular retroversion

Explanation

The crossover sign on an AP pelvis radiograph occurs when the anterior wall of the acetabulum projects lateral to the posterior wall. This indicates acetabular retroversion, a common cause of focal pincer femoroacetabular impingement (FAI).

Question 5411

Topic: General Sports & Tendon

A 40-year-old competitive water skier sustains an acute posterior thigh injury after forceful hip flexion with the knee fully extended. MRI shows an avulsion of the conjoined tendon and semimembranosus from the ischial tuberosity with 3.5 cm of retraction. What is the most appropriate treatment?

. Protected weight-bearing in a hinged knee brace for 6 weeks
. Corticosteroid injection into the ischial tuberosity
. Early surgical repair of the proximal hamstring tendons
. Delayed surgical repair after 3 months to allow scar maturation
. Platelet-rich plasma (PRP) injection and physical therapy

Correct Answer & Explanation

. Early surgical repair of the proximal hamstring tendons

Explanation

Acute, complete 3-tendon proximal hamstring avulsions with >2 cm of retraction in active patients are best treated with early surgical repair (within 3-4 weeks) to prevent permanent weakness, chronic pain, and sciatic nerve tethering.

Question 5412

Topic: 5. Sports Medicine

When counseling a patient on anterior cruciate ligament (ACL) reconstruction, which of the following commonly utilized graft choices possesses the highest ultimate tensile load?

. 10-mm bone-patellar tendon-bone autograft
. Quadriceps tendon autograft
. Quadrupled hamstring autograft
. Native intact ACL
. Fascia lata autograft

Correct Answer & Explanation

. Quadrupled hamstring autograft

Explanation

Biomechanical studies demonstrate that a quadrupled hamstring graft has an ultimate tensile load of approximately 4000 N, which is significantly higher than a 10-mm bone-patellar tendon-bone graft (~2900 N) and the native ACL (~2100 N).

Question 5413

Topic: 5. Sports Medicine

An 11-year-old male soccer player presents with medial knee pain. Radiographs reveal an osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. The physes are widely open, and MRI shows no fluid behind the lesion. What is the most appropriate initial management?

. Arthroscopic microfracture
. Osteochondral autograft transfer
. Cessation of high-impact sports and observation
. In situ screw fixation
. Retrograde drilling

Correct Answer & Explanation

. Cessation of high-impact sports and observation

Explanation

In a skeletally immature patient with a stable osteochondritis dissecans (OCD) lesion (no fluid behind the fragment on MRI), non-operative management consisting of activity modification and observation has a high rate of spontaneous healing.

Question 5414

Topic: Knee Sports

A post-operative lateral radiograph of a 22-year-old male following an ACL reconstruction reveals that the femoral tunnel was placed significantly anterior to the anatomic footprint. What is the expected clinical and biomechanical consequence of this tunnel malposition?

. The graft will be tight in flexion and loose in extension.
. The graft will be tight in extension and loose in flexion.
. The graft will remain isometric but experience earlier failure.
. The graft will be excessively loose in both flexion and extension.
. The patient will experience a fixed flexion contracture.

Correct Answer & Explanation

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

Explanation

A femoral tunnel placed too far anteriorly results in a non-anatomic graft that is excessively tight in flexion and loose in extension. This commonly leads to a loss of terminal knee flexion and gradual stretching of the graft over time.

Question 5415

Topic: Shoulder & Hip Sports

A 22-year-old rugby player with recurrent anterior shoulder instability is found to have 25% anterior glenoid bone loss on a 3D CT scan. A Latarjet procedure is planned. What is the primary stabilizing mechanism of this surgical procedure?

. The osseous block increasing the anteroposterior diameter of the glenoid.
. The conjoined tendon acting as a sling across the anteroinferior capsule when the arm is abducted and externally rotated.
. Repair of the coracoacromial ligament directly to the anterior capsule.
. The pull of the pectoralis minor stabilizing the transferred coracoid graft.
. Increased tensioning of the subscapularis muscle belly.

Correct Answer & Explanation

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

Explanation

The Latarjet procedure provides stability through three mechanisms, known as the triple effect. The most significant of these is the sling effect of the conjoined tendon reinforcing the lower subscapularis and anteroinferior capsule during abduction and external rotation.

Question 5416

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon inadvertently places the femoral tunnel 10 mm proximal to the Schöttle point. What graft tensioning mismatch is expected during the knee arc of motion?
. The graft will be excessively tight in extension and loose in flexion.
. The graft will be excessively tight in flexion and loose in extension.
. The graft will maintain isometric tension throughout the full arc of motion.
. The graft will be loose in both flexion and extension.
. The patella will dislocate medially during terminal extension.

Correct Answer & Explanation

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

Explanation

If the MPFL femoral attachment is placed too proximal to the anatomic footprint (Schöttle point), the distance between the patellar and femoral attachments increases as the knee bends. This causes the graft to become excessively tight in flexion, risking medial patellar overload or graft failure.

Question 5417

Topic: Knee Sports

A 30-year-old male is evaluated for knee pain 6 months following a motor vehicle collision. With the patient supine and the knee flexed to 90 degrees, the tibia rests in a posteriorly subluxated position. When the patient is asked to actively slide his foot forward on the exam table, the tibia translates anteriorly into an anatomic position. This examination finding is diagnostic for an injury to which structure?

. Anterior cruciate ligament.
. Posterolateral corner.
. Posterior cruciate ligament.
. Medial patellofemoral ligament.
. Anterolateral ligament.

Correct Answer & Explanation

. Posterior cruciate ligament.

Explanation

The scenario describes the quadriceps active test. In a posterior cruciate ligament (PCL) deficient knee, the tibia rests in a posteriorly sagged position; active contraction of the quadriceps pulls the tibia anteriorly, confirming PCL insufficiency.

Question 5418

Topic: Shoulder & Hip Sports

A 29-year-old elite volleyball player complains of vague posterior shoulder pain and serving weakness. Physical examination demonstrates isolated atrophy and weakness of the infraspinatus with a normal-appearing supraspinatus. At which anatomic location is nerve compression most likely occurring?

. Suprascapular notch.
. Spinoglenoid notch.
. Quadrilateral space.
. Triangular interval.
. Thoracic outlet.

Correct Answer & Explanation

. Spinoglenoid notch.

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus muscle. In contrast, compression more proximally at the suprascapular notch will affect both the supraspinatus and the infraspinatus.

Question 5419

Topic: Shoulder & Hip Sports

A 22-year-old ice hockey player has chronic groin pain exacerbated by hip flexion and internal rotation. Radiographs reveal a bony prominence at the anterolateral head-neck junction. Which radiographic parameter is specifically used to quantify this cam-type impingement deformity?

. Lateral center-edge angle.
. Alpha angle.
. Tonnis angle.
. Neck-shaft angle.
. Beta angle.

Correct Answer & Explanation

. Alpha angle.

Explanation

The alpha angle is measured on lateral hip radiographs or axial MRI/CT to evaluate the sphericity of the femoral head-neck junction. An alpha angle greater than 50 to 55 degrees is indicative of cam-type femoroacetabular impingement (FAI).

Question 5420

Topic: 5. Sports Medicine

A 24-year-old professional football receiver hyper-extends his great toe on artificial turf. He presents with severe pain, swelling, and gross instability at the first metatarsophalangeal (MTP) joint. MRI shows a complete tear of the plantar plate with proximal retraction. What is the recommended treatment to optimize his return to play?

. Stiff-soled shoe with a Morton's extension and early functional rehabilitation.
. Surgical repair of the plantar plate complex.
. First MTP joint arthrodesis.
. Cheilectomy of the first metatarsal head.
. Taping in plantarflexion for 2 weeks followed by immediate return to play.

Correct Answer & Explanation

. Surgical repair of the plantar plate complex.

Explanation

A Grade 3 turf toe injury involves a complete tear of the plantar plate complex leading to gross joint instability. In elite athletes, surgical repair of the plantar plate is typically recommended to restore push-off strength and joint stability.

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