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5. Sports Medicine MCQs

Practice Set 274 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 5461

Topic: 5. Sports Medicine

A 29-year-old elite volleyball attacker reports deep, poorly localized shoulder pain during the cocking phase of his swing. An MR arthrogram demonstrates a Type II SLAP tear. If non-operative management fails, what is the most appropriate surgical intervention to optimize his return to overhead sports?

. Open biceps tenodesis
. Arthroscopic SLAP repair
. Subpectoral biceps tenodesis
. Arthroscopic labral debridement
. Coracoid transfer

Correct Answer & Explanation

. Arthroscopic SLAP repair

Explanation

In young overhead athletes (typically <35 years), arthroscopic SLAP repair remains the procedure of choice for symptomatic Type II SLAP tears. Biceps tenodesis is often preferred for older patients or those failing primary repair.

Question 5462

Topic: 5. Sports Medicine

A 6-year-old boy presents with a painless 'clunking' in his left knee. Examination reveals a lateral joint line prominence that reduces with knee flexion. MRI confirms an abnormally thickened and wide lateral meniscus. What is the most appropriate management for this asymptomatic, stable discoid meniscus?

. Observation
. Total meniscectomy
. Partial meniscectomy (saucerization)
. Meniscal repair
. Osteochondral autograft transfer

Correct Answer & Explanation

. Observation

Explanation

An asymptomatic discoid meniscus discovered incidentally or presenting solely with painless popping requires no surgical intervention. Observation preserves meniscal tissue and prevents early progression to osteoarthritis.

Question 5463

Topic: 5. Sports Medicine
A 24-year-old professional football player hyperextends his great toe on artificial turf. Examination shows extreme tenderness over the plantar aspect of the first MTP joint. MRI confirms a complete rupture of the plantar plate with retraction of the sesamoids. What is the most appropriate treatment?
. Rigid carbon fiber shoe insert and play as tolerated
. Corticosteroid injection and immediate return to play
. Operative repair of the plantar plate
. First MTP arthrodesis
. Excision of the sesamoids

Correct Answer & Explanation

. Operative repair of the plantar plate

Explanation

A Grade III turf toe injury with complete plantar plate rupture and sesamoid retraction in a high-level athlete requires surgical repair. Non-operative management typically leads to chronic instability and weak push-off.

Question 5464

Topic: 5. Sports Medicine

A 22-year-old collegiate athlete reports persistent "giving way" of his knee 9 months after an anterior cruciate ligament (ACL) reconstruction. Physical examination reveals a negative Lachman test but a markedly positive pivot shift test. What is the most likely technical error made during the index procedure?

. Tibial tunnel placed too posterior
. Femoral tunnel placed too vertically (at the 12 o'clock position)
. Graft tensioning performed in excessive extension
. Femoral tunnel placed too low on the lateral wall (at the 3 o'clock position)
. Failure to recognize a concomitant medial collateral ligament injury

Correct Answer & Explanation

. Femoral tunnel placed too vertically (at the 12 o'clock position)

Explanation

A vertically oriented femoral tunnel restores sagittal stability (negative Lachman) but fails to restore rotational stability, resulting in a persistent positive pivot shift. Anatomic placement requires positioning the femoral footprint lower on the lateral notch wall (e.g., 10 o'clock or 2 o'clock).

Question 5465

Topic: Knee Sports
A 19-year-old gymnast is scheduled for a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. To avoid altering normal patellofemoral kinematics and restricting flexion, the femoral tunnel must be placed at the anatomic footprint. Where is this point located anatomically?
. Proximal to the adductor tubercle and anterior to the medial epicondyle
. Distal to the medial epicondyle and anterior to the adductor tubercle
. On the medial joint line deep to the superficial MCL
. Between the medial epicondyle and the adductor tubercle
. Directly over the center of the medial femoral condyle articular cartilage

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle

Explanation

The anatomic femoral footprint of the MPFL (the Schöttle point) is located just proximal and posterior to the medial epicondyle, and distal to the adductor tubercle. Non-anatomic placement leads to graft mal-tensioning, abnormal tracking, and loss of knee flexion.

Question 5466

Topic: 5. Sports Medicine

A 28-year-old competitive weightlifter feels a sudden pop in his anterior chest wall while performing a heavy bench press. Examination reveals loss of the anterior axillary fold contour and weakness in internal rotation. MRI confirms a pectoralis major rupture. Which of the following statements regarding this injury is true?

. The clavicular head is the most commonly injured component.
. Conservative management yields equal strength outcomes to surgical repair in competitive athletes.
. The sternal head typically avulses from its humeral insertion.
. The muscle is innervated solely by the lateral pectoral nerve.
. Surgical reconstruction should be delayed until full range of motion is restored nonoperatively.

Correct Answer & Explanation

. The sternal head typically avulses from its humeral insertion.

Explanation

Pectoralis major ruptures most commonly involve the sternal head avulsing from its insertion on the humerus during eccentric loading. Early surgical repair in athletes provides significantly superior strength and functional outcomes compared to nonoperative management.

Question 5467

Topic: 5. Sports Medicine

A 48-year-old recreational tennis player presents with vague, deep shoulder pain exacerbated by serving. MRI demonstrates an isolated Type II Superior Labrum Anterior and Posterior (SLAP) tear. Which of the following surgical approaches is most supported by current literature for this specific demographic?

. Arthroscopic SLAP repair using suture anchors
. Primary biceps tenodesis
. Open anterior capsular shift
. Diagnostic arthroscopy with subacromial decompression only
. Thermal shrinkage of the superior labrum

Correct Answer & Explanation

. Primary biceps tenodesis

Explanation

In patients older than 35-40 years, primary biceps tenodesis for Type II SLAP tears results in better patient-reported outcomes, lower revision rates, and less postoperative stiffness compared to arthroscopic SLAP repair. SLAP repair is generally reserved for younger, high-demand overhead athletes.

Question 5468

Topic: Shoulder & Hip Sports

A 21-year-old collegiate baseball pitcher presents with a 5-mph decrease in throwing velocity and posterior shoulder pain during the late cocking phase. Examination reveals a Glenohumeral Internal Rotation Deficit (GIRD) of 25 degrees compared to the contralateral shoulder, but a symmetric total arc of motion. What is the most appropriate initial management?

. Arthroscopic posterior capsular release
. Anterior capsulorrhaphy
. Targeted posterior capsular stretching program (e.g., sleeper stretches)
. Arthroscopic SLAP repair
. Coracoid transfer (Latarjet procedure)

Correct Answer & Explanation

. Targeted posterior capsular stretching program (e.g., sleeper stretches)

Explanation

GIRD in throwers is characterized by a loss of internal rotation with a preserved total arc of motion, typically caused by a contracted posteroinferior capsule. The initial and most effective management is a targeted physical therapy program utilizing posterior capsular stretching, which resolves symptoms in the vast majority of cases.

Question 5469

Topic: Shoulder & Hip Sports

A 25-year-old ice hockey player presents with chronic groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate an alpha angle of 72 degrees on the Dunn view. Which of the following accurately describes the pathophysiology of his condition?

. Global acetabular overcoverage causes posterior labral crushing.
. An aspherical femoral head-neck junction creates shear forces, leading to anterosuperior labral tearing and chondral delamination.
. A retroverted femur causes anterior subluxation of the femoral head during extension.
. A prominent anterior inferior iliac spine (AIIS) impinges directly on the distal femoral neck.
. Excessive femoral anteversion leads to posterior ischiofemoral impingement.

Correct Answer & Explanation

. An aspherical femoral head-neck junction creates shear forces, leading to anterosuperior labral tearing and chondral delamination.

Explanation

An elevated alpha angle (>55 degrees) is diagnostic of a Cam deformity, characterized by an aspherical femoral head-neck junction. During hip flexion, this prominence enters the joint, creating shear stresses that predictably cause anterosuperior labral tears and adjacent acetabular cartilage delamination.

Question 5470

Topic: Knee Sports

A 26-year-old running back sustains a direct blow to the anteromedial tibia. Examination reveals increased varus laxity at 30 degrees of knee flexion. A dial test demonstrates 15 degrees of increased external rotation at 30 degrees of flexion compared to the uninjured side, but symmetric external rotation at 90 degrees. What is the most likely diagnosis?

. Isolated anterior cruciate ligament (ACL) injury
. Isolated posterolateral corner (PLC) injury
. Combined posterolateral corner (PLC) and posterior cruciate ligament (PCL) injury
. Isolated posterior cruciate ligament (PCL) injury
. Combined anterior cruciate ligament (ACL) and lateral collateral ligament (LCL) injury

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

The dial test measures external tibial rotation to evaluate the PLC and PCL. An asymmetry of >10 degrees at 30 degrees of flexion, but symmetric rotation at 90 degrees, is diagnostic of an isolated posterolateral corner (PLC) injury. Combined PLC and PCL injuries show asymmetry at both 30 and 90 degrees.

Question 5471

Topic: Knee Sports

A 9-year-old boy (Tanner stage 1) sustains a complete anterior cruciate ligament (ACL) tear. He experiences recurrent instability episodes despite 3 months of physical therapy. Which surgical option minimizes the risk of growth arrest?

. Nonoperative management until skeletal maturity
. Transphyseal ACL reconstruction using bone-patellar tendon-bone autograft
. All-epiphyseal physeal-sparing ACL reconstruction
. Extra-articular tenodesis alone
. Primary suture repair of the ACL

Correct Answer & Explanation

. All-epiphyseal physeal-sparing ACL reconstruction

Explanation

In prepubescent children (Tanner stage 1) with recurrent instability, an all-epiphyseal or extra-articular physeal-sparing reconstruction minimizes the risk of premature growth arrest. Delaying surgery until skeletal maturity significantly increases the risk of secondary meniscal and chondral damage.

Question 5472

Topic: 5. Sports Medicine

A 10-year-old boy with wide-open physes sustains an ACL tear. After a 6-month trial of conservative management, he experiences recurrent giving-way episodes. Surgical reconstruction is planned. Which technique minimizes the risk of growth arrest?

. Bone-patellar tendon-bone autograft via transphyseal tunnels
. Iliotibial band extra-articular tenodesis combined with intra-articular over-the-top reconstruction
. Quadriceps tendon autograft via standard transphyseal tunnels
. Synthetic graft augmentation
. Primary ACL repair without augmentation

Correct Answer & Explanation

. Iliotibial band extra-articular tenodesis combined with intra-articular over-the-top reconstruction

Explanation

In prepubescent children with significant remaining growth (Tanner stage 1 or 2), a physeal-sparing technique, such as an IT band extra-articular tenodesis with an over-the-top intra-articular graft, minimizes the risk of physeal injury.

Question 5473

Topic: Knee Sports
A 10-year-old girl falls while skiing and sustains a completely displaced (Meyers and McKeever Type III) fracture of the anterior tibial spine. Attempted closed reduction is unsuccessful. During arthroscopic management, what structure is most commonly found entrapped, blocking anatomic reduction?
. Medial meniscus
. Lateral meniscus
. Anterior cruciate ligament
. Posterior cruciate ligament
. Transverse intermeniscal ligament

Correct Answer & Explanation

. Medial meniscus

Explanation

The anterior horn of the medial meniscus is the most common soft-tissue structure to become entrapped beneath a displaced Type III tibial eminence fracture. This interposition prevents anatomic closed reduction and necessitates arthroscopic or open reduction.

Question 5474

Topic: Shoulder & Hip Sports

A 12-year-old elite baseball pitcher complains of vague right shoulder pain that worsens during pitching. Radiographs demonstrate widening, demineralization, and sclerosis of the proximal humeral physis on the dominant arm. What is the most appropriate initial management?

. Arthroscopic evaluation for SLAP tear
. Corticosteroid injection into the subacromial space
. Absolute rest from throwing for 3 months followed by a structured return program
. Surgical pinning of the proximal humeral physis
. Immediate physical therapy focused on aggressive stretching

Correct Answer & Explanation

. Absolute rest from throwing for 3 months followed by a structured return program

Explanation

Little League Shoulder (proximal humeral epiphysiolysis) is an overuse injury in skeletally immature throwers. The mainstay of treatment is absolute rest from throwing for typically 3 months, followed by a gradual return-to-throwing program.

Question 5475

Topic: 5. Sports Medicine
An 11-year-old boy falls while skiing and sustains a twisting injury to his knee. Radiographs show a completely displaced, non-comminuted avulsion fracture of the anterior tibial eminence (Meyers and McKeever Type III). What is the preferred definitive treatment?
. Immobilization in a long leg cast in 20 degrees of flexion
. Immobilization in a long leg cylinder cast in full extension
. Arthroscopic or open reduction and internal fixation
. Excision of the avulsed bony fragment
. Primary anterior cruciate ligament reconstruction using autograft

Correct Answer & Explanation

. Arthroscopic or open reduction and internal fixation

Explanation

Meyers and McKeever Type III (completely displaced) anterior tibial eminence fractures fail to heal properly with closed management due to interposition of structures like the anterior horn of the medial meniscus. They require arthroscopic or open reduction and internal fixation.

Question 5476

Topic: Knee Sports

A 13-year-old boy presents with vague anterior knee pain and intermittent catching. Radiographs reveal an osteochondritis dissecans (OCD) lesion. Where is the most common anatomical location for this lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Lateral aspect of the lateral femoral condyle
. Medial aspect of the lateral femoral condyle
. Central articular surface of the patella

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for an osteochondritis dissecans (OCD) lesion in the knee is the lateral aspect of the medial femoral condyle. It accounts for approximately 70-80% of all knee OCD lesions.

Question 5477

Topic: 5. Sports Medicine

An 8-year-old girl presents with lateral knee pain and a painful snapping sensation in her left knee. MRI confirms a complete discoid lateral meniscus without a tear. She has mechanical symptoms that restrict sports participation. Management should consist of:

. Observation alone
. Physical therapy and NSAIDs
. Arthroscopic partial meniscectomy (saucerization) with or without stabilization
. Arthroscopic total meniscectomy
. Open meniscal allograft transplant

Correct Answer & Explanation

. Arthroscopic partial meniscectomy (saucerization) with or without stabilization

Explanation

Symptomatic discoid menisci with mechanical symptoms are treated with partial meniscectomy (saucerization) to create a more normal C-shaped meniscus. Total meniscectomy is avoided due to the high risk of early-onset osteoarthritis.

Question 5478

Topic: Knee Sports

A 13-year-old boy has an osteochondritis dissecans (OCD) lesion of the medial femoral condyle. MRI shows a 1.5 cm lesion with intact overlying cartilage and no high T2 signal behind the fragment. His distal femoral physis is wide open. What is the best initial management?

. Arthroscopic transarticular drilling
. Subchondral bone grafting
. Excision of the fragment with microfracture
. Autologous chondrocyte implantation
. Non-weight bearing and restriction of athletic activities

Correct Answer & Explanation

. Non-weight bearing and restriction of athletic activities

Explanation

Stable OCD lesions in skeletally immature patients with open physes have a high rate of spontaneous healing. Initial management should be conservative, prioritizing activity restriction and protected weight bearing.

Question 5479

Topic: Shoulder & Hip Sports

A 28-year-old hockey player complains of insidious onset anterior groin pain exacerbated by hip flexion and internal rotation. Figure 11 shows a lateral radiograph demonstrating an abnormal alpha angle. What is the most likely diagnosis?

. Pincer-type femoroacetabular impingement
. Cam-type femoroacetabular impingement
. Slipped capital femoral epiphysis
. Acetabular retroversion
. Subspine impingement

Correct Answer & Explanation

. Cam-type femoroacetabular impingement

Explanation

An increased alpha angle (typically > 50-55 degrees) on a lateral hip radiograph is indicative of a lack of femoral head-neck offset. This is the radiological hallmark of Cam-type femoroacetabular impingement.

Question 5480

Topic: Shoulder & Hip Sports

A 24-year-old professional hockey player presents with insidious onset groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate an alpha angle of 68 degrees on the Dunn lateral view.

Which pathophysiologic mechanism is most responsible for his symptoms?

. Pincer impingement causing posterior labral crushing
. Shear forces at the anterosuperior chondrolabral junction due to a non-spherical femoral head
. Ligamentum teres hypertrophy and mechanical impingement
. Ischiofemoral impingement
. Iliopsoas snapping over the iliopectineal eminence

Correct Answer & Explanation

. Shear forces at the anterosuperior chondrolabral junction due to a non-spherical femoral head

Explanation

An elevated alpha angle indicates Cam-type FAI, characterized by an aspherical femoral head. This mismatch causes shear stress at the anterosuperior chondrolabral junction during flexion and internal rotation, frequently leading to cartilage delamination.

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