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5. Sports Medicine MCQs

Practice Set 272 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 5421

Topic: 5. Sports Medicine

A 21-year-old collegiate soccer player sustains a direct blow to the lateral aspect of her right knee. Exam shows grade II medial joint line opening with a firm endpoint at 30 degrees of flexion, but no opening at 0 degrees. MRI confirms an isolated proximal medial collateral ligament (MCL) tear. What is the most appropriate management?

. Acute surgical repair of the MCL using suture anchors.
. MCL reconstruction using semitendinosus autograft.
. Hinged knee brace and early functional rehabilitation.
. Immobilization in a cylinder cast for 6 weeks.
. Diagnostic arthroscopy with medial meniscectomy.

Correct Answer & Explanation

. Hinged knee brace and early functional rehabilitation.

Explanation

Isolated grade I and II MCL tears, particularly those involving the proximal (femoral) attachment, have excellent healing potential. Nonoperative management with functional bracing and early range of motion is the gold standard of care.

Question 5422

Topic: 5. Sports Medicine

A 22-year-old female soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Which of the following is the most commonly reported long-term complication specifically associated with this graft choice compared to a hamstring autograft?

. Increased postoperative knee laxity
. Hamstring weakness at deep flexion
. Anterior knee pain and pain with kneeling
. Saphenous nerve neuropraxia
. Higher risk of graft re-rupture

Correct Answer & Explanation

. Anterior knee pain and pain with kneeling

Explanation

Bone-patellar tendon-bone (BPTB) autografts have excellent survival rates but are associated with a higher incidence of donor site morbidity, specifically anterior knee pain and pain while kneeling, compared to hamstring autografts.

Question 5423

Topic: Knee Sports

A 25-year-old football player sustains a knee injury. On examination, the dial test reveals 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the uninjured side. However, at 90 degrees of knee flexion, the external rotation is equal bilaterally. What is the most likely injured structure?

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

Correct Answer & Explanation

. Isolated posterolateral corner (PLC)

Explanation

Increased external rotation on the dial test at 30 degrees of flexion but normal at 90 degrees indicates an isolated posterolateral corner (PLC) injury. Combined PCL/PLC injuries show increased external rotation at both 30 and 90 degrees.

Question 5424

Topic: Knee Sports

A 55-year-old active female feels a pop in her posterior knee while squatting. MRI reveals a complete posterior root tear of the medial meniscus. If left untreated, the biomechanical consequences of this injury most closely resemble which of the following?

. Isolated anterior cruciate ligament deficiency
. Total medial meniscectomy
. Partial medial meniscectomy
. Posterior cruciate ligament deficiency
. Patellofemoral cartilage loss

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A meniscal root tear disrupts the circumferential hoop stresses of the meniscus, causing it to extrude under load. This results in altered contact mechanics functionally equivalent to a total meniscectomy, leading to rapid joint degeneration.

Question 5425

Topic: 5. Sports Medicine

A 10-year-old male (Tanner stage 1) sustains a complete anterior cruciate ligament (ACL) tear. He experiences recurrent instability despite bracing and physical therapy. What is the most appropriate surgical management to minimize the risk of growth arrest?

. Transphyseal bone-patellar tendon-bone reconstruction
. Standard transphyseal hamstring autograft reconstruction
. Physeal-sparing iliotibial band extra-articular reconstruction
. Primary repair of the ACL with suture augmentation
. Conservative management with a custom derotational brace until skeletal maturity

Correct Answer & Explanation

. Physeal-sparing iliotibial band extra-articular reconstruction

Explanation

In prepubescent patients (Tanner stage 1 or 2) with open physes, physeal-sparing techniques such as the iliotibial band extra-articular reconstruction are recommended. Transphyseal techniques carry a higher risk of physeal arrest, angular deformity, and leg-length discrepancy in this age group.

Question 5426

Topic: 5. Sports Medicine

A 24-year-old professional female soccer player undergoes an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Six months postoperatively, she complains of a persistent loss of terminal extension and a noticeable anterior 'clunk' in the knee. Magnetic resonance imaging demonstrates a localized mass of fibrous tissue anterior to the ACL graft in the intercondylar notch. What is the most likely technical error that led to this complication?

. Anterior placement of the tibial tunnel
. Posterior placement of the tibial tunnel
. Anterior placement of the femoral tunnel
. Posterior placement of the femoral tunnel
. Inadequate tensioning of the graft at fixation

Correct Answer & Explanation

. Anterior placement of the tibial tunnel

Explanation

The scenario describes a 'Cyclops lesion' (localized anterior arthrofibrosis), which presents with loss of terminal extension and a palpable clunk. Anterior placement of the tibial tunnel causes graft impingement against the intercondylar roof during extension, which is the primary biomechanical trigger for this fibrous nodule formation.

Question 5427

Topic: Shoulder & Hip Sports

A 45-year-old recreational weightlifter presents with deep-seated shoulder pain exacerbated by bench press and overhead activities. Examination reveals a positive O'Brien test and tenderness in the bicipital groove. MRI arthrography demonstrates a type II SLAP tear. After failing 6 months of targeted physical therapy, which surgical intervention provides the most reliable return to sport while minimizing postoperative stiffness in this patient?

. Arthroscopic SLAP repair with simple sutures
. Arthroscopic SLAP repair with mattress sutures
. Subpectoral biceps tenodesis
. Arthroscopic debridement of the superior labrum
. Open anterior capsulolabral reconstruction

Correct Answer & Explanation

. Subpectoral biceps tenodesis

Explanation

In active patients older than 35 to 40 years, primary biceps tenodesis for symptomatic type II SLAP tears provides superior clinical outcomes, higher return-to-sport rates, and fewer complications than primary repair. SLAP repair in this older demographic is associated with a significantly higher risk of persistent postoperative stiffness and the need for revision surgery.

Question 5428

Topic: Knee Sports
In medial patellofemoral ligament (MPFL) reconstruction, placing the femoral attachment too proximal and anterior relative to Schöttle's point will result in which of the following kinematic abnormalities?
. Excessive graft tension in early flexion
. Excessive graft tension in deep flexion
. Graft laxity in extension
. Increased patellar tilt in deep flexion
. Patella baja

Correct Answer & Explanation

. Excessive graft tension in deep flexion

Explanation

A femoral tunnel placed too proximal to Schöttle's point leads to increased distance between the attachment sites during knee flexion. This causes excessive graft tension in deep flexion and a potential loss of motion.

Question 5429

Topic: 5. Sports Medicine

A 22-year-old collegiate baseball pitcher presents with vague posterior shoulder pain. Physical examination reveals an internal rotation deficit of 25 degrees compared to the contralateral side, but total arc of motion is symmetric. What is the primary pathoanatomic cause of this condition?

. Contracture of the anterosuperior capsule
. Contracture of the posteroinferior capsule
. Anterior band of the inferior glenohumeral ligament (IGHL) laxity
. Subscapularis tightness
. Rotator interval scarring

Correct Answer & Explanation

. Contracture of the posteroinferior capsule

Explanation

Glenohumeral internal rotation deficit (GIRD) in overhead athletes is primarily caused by contracture and thickening of the posteroinferior capsule. A symmetric total arc of motion suggests a soft tissue adaptation rather than a bony retroversion abnormality.

Question 5430

Topic: Knee Sports

Which of the following biomechanical consequences most accurately describes an unhealed posterior medial meniscal root tear?

. Decreased contact pressure in the medial compartment
. Anterior translation of the medial meniscus during flexion
. Biomechanical equivalence to a total medial meniscectomy
. Decreased tension in the anterior cruciate ligament (ACL)
. Increased varus laxity at 30 degrees of flexion

Correct Answer & Explanation

. Biomechanical equivalence to a total medial meniscectomy

Explanation

A posterior medial meniscal root tear disrupts the hoop stresses of the meniscus, leading to extrusion and altered kinematics. Biomechanically, it is equivalent to a total medial meniscectomy, significantly increasing tibiofemoral peak contact pressures.

Question 5431

Topic: 5. Sports Medicine

A 9-year-old Tanner stage 1 male sustains a complete midsubstance anterior cruciate ligament (ACL) rupture. Which of the following surgical techniques minimizes the risk of growth arrest?

. Transphyseal reconstruction using bone-patellar tendon-bone autograft
. Iliotibial band extra-articular tenodesis combined with partial transphyseal reconstruction
. Epiphyseal-based reconstruction using soft-tissue autograft
. Nonoperative management with a functional brace until skeletal maturity
. Primary repair with synthetic augmentation

Correct Answer & Explanation

. Epiphyseal-based reconstruction using soft-tissue autograft

Explanation

In a Tanner stage 1 child with significant remaining growth, an all-epiphyseal (physeal-sparing) ACL reconstruction using a soft-tissue graft minimizes the risk of physeal injury and subsequent growth arrest. Bone-plug grafts across the physis are contraindicated due to a high risk of premature closure.

Question 5432

Topic: 5. Sports Medicine

A 22-year-old collegiate baseball pitcher complains of vague posterior shoulder pain and a decrease in pitching velocity. Physical examination reveals 20 degrees of internal rotation and 130 degrees of external rotation. Radiographs are normal. What is the most appropriate initial management?

. Posterior capsular release
. Targeted stretching program focusing on the posterior capsule
. Arthroscopic SLAP repair
. Subacromial decompression
. Coracoid transfer (Latarjet procedure)

Correct Answer & Explanation

. Targeted stretching program focusing on the posterior capsule

Explanation

Glenohumeral internal rotation deficit (GIRD) in overhead throwing athletes is characterized by a loss of internal rotation with a concomitant gain in external rotation. Initial management consists of a targeted stretching program, focusing on the posterior capsule (e.g., sleeper stretches).

Question 5433

Topic: Knee Sports

A 50-year-old female experiences an acute pop in her posterior knee while squatting. MRI reveals a complete radial tear of the medial meniscus posterior root. Which of the following is the most likely biomechanical consequence of this untreated injury?

. Decreased anterior tibial translation
. Decreased peak contact pressures in the medial compartment
. Loss of hoop stresses leading to rapid articular cartilage degeneration
. Increased varus alignment of the knee during swing phase
. Hypertrophy of the medial collateral ligament

Correct Answer & Explanation

. Loss of hoop stresses leading to rapid articular cartilage degeneration

Explanation

A posterior medial meniscal root tear results in the complete loss of circumferential hoop stresses, rendering the meniscus biomechanically equivalent to a total meniscectomy. This leads to significantly increased contact pressures and rapid progression of osteoarthritis.

Question 5434

Topic: Knee Sports

During a medial patellofemoral ligament (MPFL) reconstruction, the femoral tunnel is being drilled. To reproduce native isometry, the ideal femoral attachment site should be located:

. Proximal and anterior to the medial epicondyle
. Proximal and posterior to the medial epicondyle
. Distal and anterior to the adductor tubercle
. Distal and posterior to the adductor tubercle
. Directly on the gastrocnemius tubercle

Correct Answer & Explanation

. Proximal and posterior to the medial epicondyle

Explanation

Schottle's point defines the radiographic femoral footprint of the MPFL, which is located just proximal and posterior to the medial epicondyle, and distal to the adductor tubercle. Non-anatomic placement leads to graft tension mismatch and potential failure.

Question 5435

Topic: Shoulder & Hip Sports

A 23-year-old rugby player has recurrent anterior shoulder instability. CT scan shows an off-track Hill-Sachs lesion and 15% anterior glenoid bone loss. Which of the following procedures is most appropriate?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with Remplissage
. Open Bankart repair without bone block
. Subscapularis advancement
. Coracoid transfer (Latarjet)

Correct Answer & Explanation

. Arthroscopic Bankart repair with Remplissage

Explanation

For a patient with subcritical glenoid bone loss (<20%) but an engaging or "off-track" Hill-Sachs lesion, arthroscopic Bankart repair combined with a Remplissage procedure effectively prevents the Hill-Sachs lesion from engaging the anterior glenoid rim. Latarjet is typically reserved for critical glenoid bone loss (>20%).

Question 5436

Topic: Knee Sports

A "ramp lesion" of the knee is most commonly associated with which of the following injury patterns?

. Acute PCL tear
. Acute ACL tear
. Isolated medial collateral ligament sprain
. Patellar dislocation
. Posterolateral corner injury

Correct Answer & Explanation

. Acute ACL tear

Explanation

Ramp lesions represent tears of the peripheral meniscocapsular attachment of the posterior horn of the medial meniscus. They are highly associated with acute ACL tears and can lead to increased anterior tibial translation if left unrepaired.

Question 5437

Topic: Knee Sports

Microfracture for the treatment of full-thickness articular cartilage defects of the knee is most suitable for which of the following lesion characteristics?

. Defects greater than 4 cm^2
. Defects sized 3 to 4 cm^2
. Contained defects less than 2 cm^2
. Kissing lesions of the tibiofemoral joint
. Uncontained osteochondritis dissecans lesions

Correct Answer & Explanation

. Contained defects less than 2 cm^2

Explanation

Microfracture is indicated for small, contained, full-thickness cartilage defects (typically less than 2 cm^2) in young, active patients. Larger lesions or uncontained lesions have unacceptably high failure rates and are better managed with techniques like osteochondral autograft or MACI.

Question 5438

Topic: Knee Sports

Which of the following graft choices for ACL reconstruction has the highest initial ultimate tensile load?

. Single-strand hamstring
. Bone-patellar tendon-bone (10 mm)
. Quadrupled hamstring
. Native anterior cruciate ligament
. Iliotibial band

Correct Answer & Explanation

. Quadrupled hamstring

Explanation

A quadrupled hamstring graft has an ultimate tensile load of approximately 4000 N, which is the highest among common autografts and significantly stronger than the native ACL (approx. 2160 N) or a 10 mm bone-patellar tendon-bone graft (approx. 2977 N).

Question 5439

Topic: 5. Sports Medicine

A 26-year-old weightlifter feels a tearing sensation in his anterior chest while performing a bench press. Examination shows loss of the normal axillary fold and weakness in internal rotation. Surgical repair of a complete pectoralis major tendon rupture typically involves reattachment to which anatomic location?

. Medial lip of the bicipital groove
. Lateral lip of the bicipital groove
. Lesser tuberosity
. Greater tuberosity
. Coracoid process

Correct Answer & Explanation

. Lateral lip of the bicipital groove

Explanation

The pectoralis major inserts onto the lateral lip of the bicipital groove of the humerus. Complete ruptures, especially in active individuals, are typically managed with surgical reattachment to this anatomic footprint to restore strength and cosmesis.

Question 5440

Topic: 5. Sports Medicine

A 17-year-old female soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a quadrupled hamstring autograft. Compared to a bone-patellar tendon-bone (BPTB) autograft, which of the following is the most likely long-term functional deficit associated with this graft choice?

. Anterior knee pain during kneeling
. Decreased knee extension strength
. Decreased knee flexion strength at high flexion angles
. Increased risk of contralateral ACL tear
. Increased rate of osteoarthritis at 10 years

Correct Answer & Explanation

. Decreased knee flexion strength at high flexion angles

Explanation

Hamstring autografts are associated with decreased deep knee flexion strength compared to BPTB autografts. BPTB grafts are more frequently associated with anterior knee pain and kneeling difficulty.

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