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 5741
Topic: 5. Sports Medicine
Which of the following scenarios is most likely to be mediated by an IgE-dependent Type I hypersensitivity reaction in an orthopedic context?
Correct Answer & Explanation
. Anaphylaxis to an antibiotic (e.g., penicillin) administered during surgery.
Explanation
Type I hypersensitivity, or immediate hypersensitivity, is mediated by IgE antibodies. Anaphylaxis to an antibiotic, such as penicillin, is a classic example. Upon re-exposure, the antibiotic acts as an antigen, binding to IgE on mast cells and basophils, leading to rapid degranulation and release of potent inflammatory mediators (histamine, leukotrienes), causing systemic reactions like bronchospasm, urticaria, and hypotension. Allograft rejection is cell-mediated (Type IV primarily), contact dermatitis is Type IV, immune complexes are Type III, and hemolytic anemia is Type II.
Question 5742
Topic: 5. Sports Medicine
A 28-year-old professional basketball player sustains a non-contact knee injury while cutting. He reports feeling a 'pop' and immediate swelling. Lachman test is positive, and pivot shift test is also positive. What is the most appropriate next step in management?
Correct Answer & Explanation
. MRI of the knee to confirm diagnosis and assess for associated injuries
Explanation
The clinical presentation (pop, swelling, positive Lachman and pivot shift) is highly suggestive of an ACL rupture. While surgery is often indicated in high-demand athletes, an MRI is crucial to confirm the diagnosis, assess the extent of the ACL injury, and, critically, identify any associated injuries such as meniscal tears, collateral ligament injuries, or osteochondral lesions, which frequently co-occur and influence surgical planning and timing. RICE and bracing are initial palliative measures, but MRI guides definitive management. Immediate surgery without MRI is generally not recommended due to the potential for missed concomitant injuries.
Question 5743
Topic: Shoulder & Hip Sports
Which rotator cuff tendon is most commonly involved in degenerative tears?
Correct Answer & Explanation
. Supraspinatus
Explanation
The supraspinatus tendon is by far the most commonly torn rotator cuff tendon. This is attributed to its anatomical position (most susceptible to impingement under the acromion), its critical role in abduction, and its relative hypovascularity in the 'critical zone'.
Question 5744
Topic: Knee Sports
Which ligament is primarily responsible for preventing anterior translation of the tibia on the femur?
Correct Answer & Explanation
. Anterior cruciate ligament (ACL)
Explanation
The anterior cruciate ligament (ACL) is the primary static stabilizer that prevents anterior translation of the tibia on the femur. It also resists internal rotation of the tibia. The PCL prevents posterior translation. The MCL and LCL provide varus/valgus stability.
Question 5745
Topic: Knee Sports
Which of the following ligaments is considered the primary static stabilizer against posterior translation of the tibia on the femur?
Correct Answer & Explanation
. Posterior cruciate ligament (PCL)
Explanation
The posterior cruciate ligament (PCL) is the primary static stabilizer against posterior translation of the tibia on the femur. It is a strong ligament that also limits tibial external rotation. The ACL primarily resists anterior translation.
Question 5746
Topic: Knee Sports
Which of the following physical examination findings is most indicative of a complete tear of the anterior cruciate ligament (ACL)?
Correct Answer & Explanation
. Positive Lachman test
Explanation
The Lachman test is considered the most sensitive and specific clinical test for an acute anterior cruciate ligament (ACL) rupture. It is performed with the knee in 20-30 degrees of flexion, which isolates the ACL better than the anterior drawer test in 90 degrees of flexion, where secondary restraints (menisci, hamstrings) can mask instability. A positive McMurray test indicates meniscal injury. A positive pivot shift maneuver is highly specific but can be difficult to elicit acutely due to pain.
Question 5747
Topic: 5. Sports Medicine
During a complex revision THA for a Vancouver Type B3 periprosthetic femoral fracture, the surgeon encounters a large defect in the proximal femur involving both the greater and lesser trochanters. The remaining host bone is insufficient for stable stem fixation. What is the most biomechanically sound reconstruction technique in this scenario?
Correct Answer & Explanation
. Placement of an extensively porous-coated uncemented stem bypass the defect by at least two cortical diameters.
Explanation
For a Vancouver Type B3 fracture with extensive bone loss and insufficient host bone for stable stem fixation, the most biomechanically sound reconstruction is often an extensively porous-coated uncemented stem (Option B). This stem design achieves diaphyseal fixation distally, bypassing the fracture and areas of bone loss by at least two cortical diameters, providing robust long-term stability. While APC (Option C) is an option for massive proximal femoral defects, it is more complex, has higher complication rates, and is not always necessary for B3 fractures that can be managed with diaphyseal engaging stems. Cortical strut allografts (Option D) are adjunctive and provide cortical reinforcement, but they do not provide primary fixation of the stem itself. A cemented tapered stem (Option A) may not provide sufficient fixation in significant bone loss scenarios, and an extended trochanteric osteotomy is a surgical approach, not a primary fixation method for the stem itself. A calcar-replacing stem (Option E) primarily addresses calcar deficiency and is not typically sufficient for large defects involving the trochanters and compromising stem stability.
Question 5748
Topic: Knee Sports
A 15-year-old male presents with chronic knee pain and mechanical symptoms. An MRI reveals an osteochondritis dissecans (OCD) lesion with fluid surrounding the fragment, indicating instability. What is the most common anatomic location for a pediatric knee OCD lesion?
Correct Answer & Explanation
. Lateral aspect of the medial femoral condyle
Explanation
The classic and most common location for osteochondritis dissecans (OCD) of the knee is the lateral (intercondylar) aspect of the medial femoral condyle, accounting for roughly 70-80% of all knee OCD lesions.
Question 5749
Topic: 5. Sports Medicine
A 28-year-old male sustained a direct blow to the anterior tibia while playing soccer. He presents with posterior knee pain and a positive posterior drawer test at 90 degrees of knee flexion, with increased posterior sag at 90 degrees. MRI confirms an isolated high-grade PCL tear with no other ligamentous or meniscal injuries. The patient has mild functional instability but desires to return to competitive sports. What is the most appropriate initial management?
Correct Answer & Explanation
. Quadriceps-strengthening focused rehabilitation program with a PCL-specific brace.
Explanation
For an isolated PCL tear, even high-grade, the initial management is often non-operative, focusing on an intensive quadriceps-strengthening rehabilitation program (Option C). The quadriceps muscle helps to resist posterior tibial translation. A PCL-specific brace can also aid in preventing posterior sag during healing. Studies show good outcomes with conservative management for isolated PCL injuries. Surgical reconstruction (Option A) is typically reserved for chronic instability, multi-ligament injuries, or failure of conservative treatment. Immobilization (Option B) alone without active rehabilitation is not optimal. PCL repair (Option D) is rarely indicated for mid-substance tears and is generally considered only for bony avulsions. Meniscal repair (Option E) is irrelevant if no meniscal injury is identified.
Question 5750
Topic: 5. Sports Medicine
A 28-year-old semi-professional soccer player presents with a symptomatic, isolated 2.0 cm x 1.5 cm full-thickness articular cartilage defect on the weight-bearing surface of his medial femoral condyle. He has failed conservative management including activity modification and physical therapy. What is the most appropriate next step for cartilage restoration?
Correct Answer & Explanation
. Autologous Chondrocyte Implantation (ACI).
Explanation
The treatment for articular cartilage defects depends on several factors, including patient age, defect size, location, and previous treatments. This patient is a young, active individual with a symptomatic full-thickness defect of moderate size. Option A (Microfracture procedure) is a marrow stimulation technique suitable for smaller defects (typically < 2 cm²) in younger patients. While it is a simple, single-stage procedure, its long-term durability and quality of repair tissue (fibrocartilage) are inferior to other techniques for larger defects, especially in high-demand athletes. For a 2.0 x 1.5 cm defect (3.0 cm²), microfracture may be suboptimal. Option B (Autologous Chondrocyte Implantation (ACI)) is an excellent option for full-thickness cartilage defects typically larger than 2-2.5 cm² in younger, active patients. It involves a two-stage procedure: harvesting chondrocytes, culturing them, and then reimplanting them into the defect. This aims to regenerate hyaline-like cartilage and has good long-term outcomes for appropriate indications. For a 3.0 cm² defect, ACI is considered a good choice. Option C (Osteochondral Autograft Transfer System (OATS), or mosaicplasty) involves transferring bone and cartilage plugs from a non-weight-bearing area to the defect. It is best suited for focal, contained defects, usually up to 2.5-3.0 cm². For a 3.0 cm² defect, it might be pushing the upper limits for a single donor site or requires multiple plugs, which can increase donor site morbidity and create an uneven surface. Option D (Debridement and lavage) provides temporary relief but does not address the underlying cartilage defect and is not a restorative procedure. Option E (Partial knee arthroplasty) is a joint replacement procedure indicated for unicompartmental arthritis, not for an isolated focal cartilage defect in a young athlete. Between ACI and OATS for a 3.0 cm² defect, ACI often provides better fill and a smoother surface for defects of this size in active individuals.
Question 5751
Topic: Shoulder & Hip Sports
A 55-year-old active male presents with chronic insidious onset of right shoulder pain and weakness, especially with overhead activities. He reports occasional clicking and instability, particularly with abduction and external rotation. Physical exam reveals apprehension in the anterior apprehension test, a positive sulcus sign, and hyperlaxity to generalized ligamentous laxity testing (Beighton score 6/9). MRI shows signs of chronic anterior labral damage but no significant bone loss or large rotator cuff tear. What is the MOST appropriate diagnosis and management strategy?
Correct Answer & Explanation
. Multidirectional instability (MDI); non-operative management with extensive rotator cuff and scapular stabilization exercises.
Explanation
This patient's presentation of chronic shoulder pain, weakness, clicking, instability, apprehension test positivity, sulcus sign, and generalized ligamentous laxity (Beighton score 6/9) is highly suggestive of Multidirectional Instability (MDI). The chronic labral damage is likely a secondary finding due to chronic instability, not the primary problem.Option A (Rotator cuff tendinopathy) typically presents with pain and weakness but less often with overt instability or apprehension, and the sulcus sign/hyperlaxity point away from primary tendinopathy.Option B (Primary impingement syndrome) is characterized by pain with overhead activities due to rotator cuff compression but usually without the specific instability signs (apprehension, sulcus) or generalized laxity.Option C (Multidirectional instability (MDI); non-operative management with extensive rotator cuff and scapular stabilization exercises) is the MOST appropriate diagnosis and initial management. MDI is often non-traumatic or microtraumatic in origin and is characterized by instability in more than one direction. Given the generalized laxity, strengthening the dynamic stabilizers (rotator cuff, scapular stabilizers) is the cornerstone of treatment. Surgery (e.g., capsular shift) is reserved for those who fail extensive, supervised non-operative management for at least 6-12 months.Option D (Anterior glenohumeral instability with significant bone loss) is incorrect. The MRI shows no significant bone loss. Latarjet procedure is for recurrent anterior instability with significant glenoid bone loss.Option E (SLAP tear) can cause pain and clicking, but the prominent instability signs (apprehension, sulcus) and generalized laxity point more strongly to MDI as the primary pathology. SLAP tears can coexist but are often secondary to instability or other mechanisms.
Question 5752
Topic: Knee Sports
A 16-year-old male competitive swimmer presents with 8 months of worsening posterior knee pain, especially with knee flexion and descending stairs. Physical exam reveals a posterior sag of the tibia, positive posterior drawer test at 90 degrees of flexion, and a positive quadriceps active test. What is the MOST likely diagnosis and a key consideration for surgical reconstruction?
Correct Answer & Explanation
. Posterior cruciate ligament (PCL) tear; double-bundle reconstruction to restore normal kinematics.
Explanation
The patient's symptoms (posterior knee pain, pain with flexion/stairs), mechanism (competitive swimmer, often associated with hyperextension or direct blows), and physical exam findings (posterior sag, positive posterior drawer at 90 degrees, positive quadriceps active test) are pathognomonic for a Posterior Cruciate Ligament (PCL) tear.Option A (ACL tear) presents with anterior instability, pivoting symptoms, and a positive anterior drawer/Lachman test.Option B (Meniscal tear) can cause pain and mechanical symptoms (locking, catching) but the specific PCL-related instability signs are not characteristic.Option C (Posterior cruciate ligament (PCL) tear; double-bundle reconstruction to restore normal kinematics) is the correct diagnosis and a key consideration for surgical reconstruction. PCL reconstruction aims to restore posterior stability. While single-bundle reconstruction is an option, double-bundle reconstruction is often preferred in high-demand athletes and chronic injuries, as it aims to reproduce the two functional bundles of the PCL (anterolateral and posteromedial) to better restore normal knee kinematics, especially rotational stability and posterior tibial translation throughout the range of motion.Option D (Patellofemoral pain syndrome) causes anterior knee pain, often worse with stairs or prolonged sitting, but does not present with posterior sag or posterior instability signs.Option E (Osteochondritis dissecans) can cause pain and mechanical symptoms but typically localized to the affected condyle and lacks the specific instability findings.
Question 5753
Topic: Shoulder & Hip Sports
A 22-year-old female volleyball player presents with recurrent, multidirectional shoulder instability following an anterior dislocation that occurred during an overhead serve. She reports symptoms of apprehension with abduction-external rotation, as well as a positive sulcus sign and generalized ligamentous laxity. MRI shows a Bankart lesion and a small Hills-Sachs lesion. Conservative management with extensive physical therapy has failed. What is the most appropriate surgical approach?
Correct Answer & Explanation
. Arthroscopic Bankart repair with capsular plication.
Explanation
This patient presents with multidirectional instability (MDI) following an anterior dislocation, characterized by symptoms of apprehension with abduction-external rotation (anterior instability), a positive sulcus sign (inferior instability), and generalized ligamentous laxity. The presence of a Bankart and small Hill-Sachs lesion in the context of MDI suggests a complex instability pattern. While an arthroscopic Bankart repair (Option B) addresses the anterior labral pathology, it may not adequately stabilize the inferior and posterior components of MDI, especially with generalized laxity. A capsular plication or shift is typically required for MDI. An open inferior capsular shift (Option D) or arthroscopic equivalent is often considered the gold standard for MDI to reduce capsular volume globally. However, given the primary anterior dislocation and Bankart lesion, addressing the anterior component robustly is crucial. An arthroscopic posterior capsular shift (Option C) addresses posterior laxity but not the dominant anterior component. A Latarjet procedure (Option A), which involves transferring the coracoid process with its attached conjoined tendons to the anterior glenoid, is primarily indicated for significant anterior glenoid bone loss or failed anterior instability repairs, but it provides excellent anterior stability and can be considered in specific MDI cases with anterior emphasis, especially in collision athletes or those with generalized laxity where soft tissue repair alone might fail. In this scenario, with a Bankart lesion and MDI in an overhead athlete, a comprehensive approach addressing both soft tissue and potentially bony components (if recurrence risk is high) is needed. The question implies a challenging scenario and failed conservative management. Arthroscopic Bankart repair with capsular plication (Option B) is the most common approach for MDI with a Bankart. However, the Latarjet procedure is increasingly considered in cases of MDI with a significant anterior component, especially in high-demand overhead athletes with bone loss or generalized laxity, as it offers a more robust stabilization. Given the options, 'Arthroscopic Bankart repair with capsular plication' addresses the main pathologies and is a common approach for MDI.
Question 5754
Topic: Knee Sports
A 30-year-old male sustains a high-energy knee injury during a skiing accident. Physical examination reveals a positive posterior drawer test and sag sign, indicating a PCL injury. Radiographs reveal a large bony avulsion fracture of the PCL insertion from the tibia, involving a significant fragment (>1 cm) and resulting in demonstrable posterior instability. The patient has no other associated ligamentous injuries. What is the most appropriate surgical management for this injury?
Correct Answer & Explanation
. Open reduction and internal fixation of the avulsion fracture.
Explanation
A PCL avulsion fracture from the tibia that is significantly displaced (often >5 mm or >1 cm fragment size, as in this case) and causes demonstrable posterior instability is an indication for surgical management. Unlike mid-substance PCL tears, which often involve reconstruction, PCL avulsion fractures typically allow for direct repair or fixation of the bony fragment. Open reduction and internal fixation (ORIF) of the avulsion fracture (Option C) is the gold standard for displaced PCL avulsion fractures. This approach allows for anatomical reduction and stable fixation, restoring the PCL's native biomechanics. Arthroscopic techniques can also be used, but the principle is fixation of the bone fragment. Non-operative management (Option A) is reserved for non-displaced or minimally displaced avulsions. PCL reconstruction (Option B) is performed for mid-substance tears, not for bony avulsions where the ligament itself is intact. Primary repair of the PCL substance (Option D) is rarely successful for mid-substance tears and is not applicable to a bony avulsion. Dynamic posterior tibialization (Option E) is an outdated technique and not indicated for acute avulsion fractures.
Question 5755
Topic: Knee Sports
A 45-year-old high-level amateur athlete sustains a complex knee injury involving tears of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL, Grade III), and a lateral meniscal tear. Initial examination reveals significant instability in multiple planes. After initial evaluation and stabilization, what is the most appropriate timing and sequence for definitive surgical management of this multiligamentous knee injury (MLKI)?
Correct Answer & Explanation
. Delayed reconstruction of all ligaments (4-6 weeks after injury) once swelling has subsided and range of motion has improved, with primary repair of the MCL during the same setting.
Explanation
For multiligamentous knee injuries, a delayed reconstruction (4-6 weeks after injury) is generally preferred over immediate surgery. This allows for soft tissue swelling to resolve, improved range of motion, and decreased arthrofibrosis rates. For Grade III MCL tears in MLKI, primary repair or reconstruction within the delayed reconstruction setting is typically performed, often with a combined ACL/PCL reconstruction. Immediate surgery (Option A) has higher rates of arthrofibrosis and worse outcomes. Staged reconstruction (Option B) can be considered, but often the MCL is best addressed concurrently with cruciate reconstruction if a repair or reconstruction is planned. Option D and E advocate for non-operative management of a Grade III MCL in an athlete with MLKI, which is often insufficient for stability and return to high-level function. The evidence supports a delayed, single-stage or possibly staged approach for comprehensive reconstruction of MLKI.
Question 5756
Topic: Shoulder & Hip Sports
A 28-year-old professional football player suffers a traumatic anterior shoulder dislocation. After successful closed reduction, radiographs reveal a large osseous Bankart lesion involving approximately 25% of the glenoid articular surface, along with a significant Hill-Sachs lesion. This is his first dislocation. What is the most appropriate surgical management to minimize the risk of recurrent instability and allow a safe return to high-level sport?
Correct Answer & Explanation
. Open Latarjet procedure.
Explanation
For a professional athlete with a traumatic first-time anterior shoulder dislocation and significant glenoid bone loss (>20-25%), an open Latarjet procedure (Option B) is generally considered the gold standard to restore glenoid bone stock and provide a 'sling effect' for dynamic stability, significantly reducing the risk of recurrence. Arthroscopic Bankart repair (Option A) alone is associated with high failure rates in the presence of significant glenoid bone loss and is insufficient for high-demand athletes with this type of injury. Remplissage (Option C) addresses large Hill-Sachs lesions but does not restore glenoid bone loss. Non-operative management (Option D) is inappropriate for a professional athlete with significant bone loss after a dislocation. Glenoid osteotomy (Option E) is a complex procedure not typically indicated for standard glenoid bone loss from dislocation. Given the 'professional football player' and '25% glenoid loss,' the Latarjet procedure offers the best chance for stability and return to play.
Question 5757
Topic: Knee Sports
A 16-year-old male presents with recurrent episodes of patellar instability. He has a history of prior conservative management with bracing and physical therapy. Physical exam reveals a positive J-sign, increased Q-angle, and patellar apprehension. Radiographs show a trochlear dysplasia (Dejour type B) and a Tibial Tubercle-Trochlear Groove (TT-TG) distance of 20mm. What is the most appropriate surgical intervention to stabilize the patella?
Correct Answer & Explanation
. Trochleoplasty combined with MPFL reconstruction.
Explanation
The patient's presentation includes significant risk factors for recurrent patellar instability: trochlear dysplasia (Dejour type B) and a markedly increased TT-TG distance (20mm, normal < 15mm). Isolated MPFL reconstruction (Option A) is often insufficient when significant bony abnormalities like trochlear dysplasia and increased TT-TG distance are present. A tibial tubercle osteotomy (TTO) (Option B) addresses the increased TT-TG distance by medializing the patellar tendon insertion. However, a TTO alone does not correct severe trochlear dysplasia, which is a major contributor to instability. A trochleoplasty (Option C) directly addresses the trochlear dysplasia by deepening the trochlear groove, and when combined with MPFL reconstruction, provides comprehensive stabilization for severe cases with both trochlear dysplasia and patellar maltracking. Lateral retinacular release (Option D) is rarely indicated as an isolated procedure. Proximal realignment (Option E) is less effective in the presence of bony abnormalities. For a Dejour type B trochlear dysplasia and TT-TG of 20mm, trochleoplasty combined with MPFL reconstruction (and potentially TTO if TT-TG is still a major concern after trochleoplasty planning) provides the most robust solution for long-term stability. Given the options, trochleoplasty with MPFL reconstruction is the most comprehensive and effective approach for this complex case.
Question 5758
Topic: 5. Sports Medicine
A 50-year-old male presents with chronic elbow pain and mechanical symptoms. He has a history of repetitive overhead activities. MRI reveals a large osteochondral lesion of the capitellum, approximately 1.5 cm in diameter, with surrounding edema and subchondral cyst formation. Conservative management has failed. What is the most appropriate surgical treatment?
Correct Answer & Explanation
. Autologous osteochondral transplantation (OATS) or allograft transplantation.
Explanation
The patient has a large (1.5 cm) osteochondral lesion of the capitellum with subchondral changes, indicating a significant and chronic defect. Arthroscopic debridement and microfracture (Option A) is typically reserved for smaller lesions (<1 cm) and less severe defects. Excision of the fragment (Option B) alone might relieve symptoms temporarily but leaves a large defect, risking further degeneration. ORIF (Option C) is considered when the fragment is large, displaced, and viable, allowing for restoration of the articular surface. However, this is foracuteorfreshlesions that are repairable. For a large, chronic lesion with cyst formation, simple ORIF might not be feasible or durable due to poor bone quality and viability of the fragment. Autologous osteochondral transplantation (OATS) or allograft transplantation (Option D) is the most appropriate treatment for large, chronic osteochondral lesions where the fragment is not amenable to repair or the defect is too large for microfracture. These procedures aim to replace the damaged cartilage and bone with healthy tissue. Radial head excision (Option E) is for radial head pathology, not primarily capitellar osteochondral lesions.
Question 5759
Topic: Shoulder & Hip Sports
In the management of proximal humerus fractures, what is the primary role of reverse total shoulder arthroplasty (rTSA) in an elderly patient with a complex 3- or 4-part fracture?
Correct Answer & Explanation
. To improve active elevation in the presence of an irreparable rotator cuff or poor bone quality.
Explanation
Reverse total shoulder arthroplasty (rTSA) (Option C) is increasingly used for complex 3- or 4-part proximal humerus fractures in elderly patients, especially those with poor bone quality, pre-existing rotator cuff dysfunction, or at high risk for avascular necrosis. Its primary advantage is to improve active elevation by medializing and distalizing the center of rotation, which enhances deltoid leverage, essentially bypassing the need for a functional rotator cuff. It does not aim for anatomical reduction and union of the fracture fragments (Option A) in the traditional sense, as the humeral head is resected. It does not preserve rotator cuff function (Option B); rather, it compensates for it. While it may reduce the risk of AVN (Option D) by replacing the humeral head, its primary functional benefit is to restore active motion. Early, aggressive rehabilitation of the rotator cuff (Option E) is not the goal, as the rTSA's function relies on the deltoid, not the rotator cuff.
Question 5760
Topic: 5. Sports Medicine
A 30-year-old professional athlete presents with persistent, symptomatic pain and mechanical symptoms from a large (4 cm²) full-thickness cartilage defect on the medial femoral condyle, which has failed previous microfracture surgery. The patient desires a definitive treatment that can restore a durable articular surface and allow a return to high-level activity. Which of the following is the most appropriate treatment option?
For large, symptomatic, full-thickness cartilage defects (typically > 2-2.5 cm²) that have failed initial reparative procedures like microfracture, fresh osteochondral allograft (OCA) transplantation is often considered the most appropriate option, especially in younger, high-demand patients. OCA provides hyaline cartilage and subchondral bone, which is crucial for structural support and load-bearing. ACI/MACI are good for large defects but lack subchondral bone replacement, and the quality of repair tissue (fibrocartilage or mixed hyaline-like) may not be as robust as an allograft. OATS (mosaicplasty) is typically reserved for smaller defects (<2-2.5 cm²) due to donor site morbidity. Repeat microfracture is unlikely to succeed after initial failure, particularly for a large defect.
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