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5. Sports Medicine MCQs

Practice Set 289 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 5761

Topic: 5. Sports Medicine

A surgeon is repairing a chronic rotator cuff tear using an allograft. For optimal biologic incorporation and healing, which of the following processes is crucial for the allograft to be integrated into the host tendon, beyond simple mechanical fixation?

. Immunosuppression of the host
. Complete encapsulation of the graft by fibrous tissue without cellular invasion
. Recruitment of host tenocytes and vascular invasion into the graft matrix
. Immediate re-establishment of the original elastic fiber network
. Activation of the complement cascade to clear residual donor cells

Correct Answer & Explanation

. Recruitment of host tenocytes and vascular invasion into the graft matrix

Explanation

For optimal biologic incorporation and healing of a soft tissue allograft (like a tendon graft), the process involves remodeling by the host. This necessitates the recruitment of host cells, primarily tenocytes and fibroblasts, which migrate into the graft matrix. Concurrently, vascular invasion provides nutrients and enables cellular trafficking. These host cells then progressively resorb the existing donor matrix and synthesize new host-specific collagen and other extracellular matrix components, ultimately integrating the graft into the host tissue. Immunosuppression is typically not required for decellularized or processed allografts. Complete encapsulation without cellular invasion implies isolation and poor integration. Immediate re-establishment of the original elastic fiber network is biologically unrealistic. Activation of the complement cascade would be part of a rejection response, which is undesirable.

Question 5762

Topic: Knee Sports

The presence of microfractures in the subchondral bone is hypothesized to contribute to the progression of osteoarthritis (OA) primarily by:

. Directly stimulating chondrocyte proliferation in the overlying cartilage
. Altering the mechanical properties of the subchondral bone, leading to increased stiffness and altered load transmission to cartilage
. Inducing systemic inflammation that targets articular cartilage
. Enhancing venous outflow from the subchondral bone, decreasing intraosseous pressure
. Promoting the synthesis of Type I collagen within the articular cartilage

Correct Answer & Explanation

. Altering the mechanical properties of the subchondral bone, leading to increased stiffness and altered load transmission to cartilage

Explanation

Microfractures and other pathologies in the subchondral bone are increasingly recognized as critical factors in OA progression. Damage to the subchondral bone, including microfractures and bone marrow lesions, often leads to increased bone stiffness and sclerosis. This altered mechanical environment beneath the cartilage results in abnormal load transmission to the overlying articular cartilage, subjecting chondrocytes to excessive or abnormal mechanical stress. This stress can initiate or accelerate chondrocyte catabolism, leading to cartilage degeneration. Furthermore, changes in subchondral bone can affect nutrient supply to the cartilage. Direct stimulation of chondrocyte proliferation is not a primary effect. While inflammation is involved in OA, microfractures primarily cause local rather than systemic inflammation in this context. They typically increase intraosseous pressure, not decrease it. Type I collagen synthesis in articular cartilage is indicative of fibrocartilage repair, not typically a direct result of subchondral microfractures in OA progression.

Question 5763

Topic: 5. Sports Medicine

During the repair of a torn anterior cruciate ligament (ACL) with an autograft, the process of 'ligamentization' occurs. This process primarily involves:

. The complete replacement of the graft with a new synovial membrane
. Remodeling of the graft from a tendon-like structure into a tissue histologically and biomechanically resembling a ligament
. Calcification of the graft tissue to increase its stiffness
. Fibrotic encapsulation of the graft without internal cellular changes
. Rapid revascularization of the central portion of the graft within weeks

Correct Answer & Explanation

. Remodeling of the graft from a tendon-like structure into a tissue histologically and biomechanically resembling a ligament

Explanation

Ligamentization is the complex biological process where an autogenous tendon graft (commonly hamstring or patellar tendon) used for ACL reconstruction gradually transforms over months to years into a tissue that histologically, biochemically, and biomechanically resembles the native ACL. This involves initial avascular necrosis of the graft, followed by revascularization and cellular repopulation by host cells, and subsequent collagen remodeling, orientation, and maturation. It does not involve replacement with a synovial membrane, calcification, or mere fibrotic encapsulation. Rapid revascularization of the entire graft within weeks is not typical; it's a slower process.

Question 5764

Topic: Shoulder & Hip Sports
Following a rotator cuff repair, a patient undergoes rehabilitation. During the early proliferative phase of tendon healing, the newly formed granulation tissue is primarily characterized by an increased synthesis of which type of collagen, before remodeling shifts towards the mature tendon composition?
. Type II collagen
. Type V collagen
. Type III collagen
. Type IX collagen
. Type XI collagen

Correct Answer & Explanation

. Type III collagen

Explanation

During the initial stages of tendon healing (inflammatory and proliferative phases), there is an upregulation of Type III collagen synthesis. Type III collagen forms thinner, more disorganized fibrils compared to the mature Type I collagen. As healing progresses and the tissue remodels, Type III collagen is gradually replaced by Type I collagen, which is the predominant collagen (approximately 90-95%) in healthy, mature tendons, providing tensile strength. Type II, IX, and XI collagens are primarily found in cartilage. Type V collagen is a minor fibrillar collagen that co-polymerizes with Type I and II collagen, important for fibril assembly, but not the primary temporary collagen in healing.

Question 5765

Topic: Shoulder & Hip Sports
The enthesis, the specialized interface where tendons and ligaments attach to bone, varies in its structural complexity. A 'fibrocartilaginous enthesis' is characterized by distinct zones that transition from tendon/ligament to bone. Which sequence correctly describes these zones, moving from the tendon/ligament into the bone?
. Collagen fibers β†’ Mineralized fibrocartilage β†’ Unmineralized fibrocartilage β†’ Bone
. Tendon/Ligament β†’ Unmineralized fibrocartilage β†’ Mineralized fibrocartilage β†’ Bone
. Tendon/Ligament β†’ Mineralized fibrocartilage β†’ Unmineralized fibrocartilage β†’ Bone β†’ Cement line
. Collagen fibers β†’ Bone β†’ Unmineralized fibrocartilage β†’ Mineralized fibrocartilage
. Tendon/Ligament β†’ Sharpey's fibers β†’ Bone β†’ Marrow

Correct Answer & Explanation

. Tendon/Ligament β†’ Unmineralized fibrocartilage β†’ Mineralized fibrocartilage β†’ Bone

Explanation

A fibrocartilaginous enthesis, typical for high-load attachments (e.g., rotator cuff tendons, Achilles tendon), consists of four distinct zones: 1) Tendon/Ligament proper (dense fibrous connective tissue), 2) Unmineralized fibrocartilage, 3) Mineralized fibrocartilage (separated from unmineralized by a 'tidemark'), and 4) Bone. This gradual transition helps dissipate stress and prevent acute stress concentrations at the bone-tendon interface. Option B correctly represents this four-zone transition. Options A, C, D, and E are incorrect sequences or omit critical zones/details.

Question 5766

Topic: Knee Sports

Compared to the medial collateral ligament (MCL), the anterior cruciate ligament (ACL) demonstrates a poor healing capacity after complete rupture. This difference in healing potential is primarily attributed to:

. The ACL's intrinsic vascular supply being significantly poorer than the MCL's.
. The ACL being an intra-articular ligament, exposed to synovial fluid that inhibits fibrin clot formation.
. The MCL having a greater proportion of Type I collagen compared to the ACL.
. The ACL's inability to recruit sufficient mesenchymal stem cells to the injury site.
. The MCL being subjected to lower tensile forces compared to the ACL.

Correct Answer & Explanation

. The ACL being an intra-articular ligament, exposed to synovial fluid that inhibits fibrin clot formation.

Explanation

The poor healing of the ACL is primarily due to its intra-articular location. Synovial fluid contains high levels of proteases that quickly degrade the hematoma and fibrin clot necessary for initiating the healing cascade, preventing the formation of a robust scaffold for repair cells. This 'washout' effect is a major contributor to its inability to heal. While vascularity can play a role, the ACL does have some blood supply, and its poorer healing is more dominantly attributed to the synovial fluid environment. The MCL, being extra-articular, forms a stable hematoma and has a more organized healing response. Type I collagen is dominant in both. Stem cell recruitment is impaired but is a consequence of the disrupted healing environment. Tensile forces contribute to re-rupture but not necessarily the initial failure to heal.

Question 5767

Topic: Knee Sports
The healing of a ruptured anterior cruciate ligament (ACL) in the knee is notoriously poor, often leading to non-union or a functionally inferior scar. This outcome, when compared to the robust healing seen in the medial collateral ligament (MCL), is best explained by:
. The ACL's intra-articular location and lack of a distinct synovial sheath.
. Lower collagen type III to type I ratio in the ACL scar compared to MCL.
. The higher vascularity of the ACL compared to the MCL.
. The different biomechanical loading profiles, with ACL experiencing more shear forces.
. The inherent differences in the resident fibroblast populations, specifically their regenerative capacity.

Correct Answer & Explanation

. The ACL's intra-articular location and lack of a distinct synovial sheath.

Explanation

The poor healing capacity of the ACL is primarily attributed to its intra-articular location. Unlike extra-articular ligaments like the MCL, the ACL is bathed in synovial fluid. While synovial fluid provides nutrition, it also dilutes and washes away critical components (e.g., fibrin clot, growth factors, inflammatory cells) necessary for effective primary healing. The lack of a distinct synovial sheath that can contain and organize the healing response further contributes to this. Option A is correct. Option B is incorrect; a robust scar often has a higher initial Type III collagen which is later remodeled to Type I. Option C is incorrect; the ACL actually has relatively poor vascularity, which contributes to poor healing, but the intra-articular environment is a more critical factor for its specific challenges. Option D describes loading but isn't the primary biological reason for the difference in healing potential. Option E is plausible but less definitively established as the primary distinguishing factor than the intra-articular environment and synovial fluid effects.

Question 5768

Topic: Knee Sports

During an anatomic anterior cruciate ligament (ACL) reconstruction, the surgeon specifically addresses both the anteromedial (AM) and posterolateral (PL) bundles.

Which of the following best describes the biomechanical role and tension pattern of the PL bundle?

. It is tight in flexion and primarily controls anteroposterior translation.
. It is tight in extension and primarily controls rotatory stability.
. It is tight in flexion and primarily controls rotatory stability.
. It is tight in extension and primarily controls anteroposterior translation.
. It remains isometric throughout the entire range of motion.

Correct Answer & Explanation

. It is tight in extension and primarily controls rotatory stability.

Explanation

The ACL consists of the Anteromedial (AM) and Posterolateral (PL) bundles. The AM bundle tightens in flexion and is the primary restraint to anterior tibial translation. The PL bundle tightens in extension and is the primary restraint to rotatory loads (e.g., pivot shift). Thus, the PL bundle is most critical for rotatory stability near extension.

Question 5769

Topic: Knee Sports

The posterior cruciate ligament (PCL) consists of two distinct bundles: the anterolateral (AL) and the posteromedial (PM). Which of the following statements accurately describes the tension pattern of these bundles?

. The AL bundle is tight in flexion, and the PM bundle is tight in extension.
. The AL bundle is tight in extension, and the PM bundle is tight in flexion.
. Both bundles are tightest in full extension.
. Both bundles are tightest in 90 degrees of flexion.
. The PM bundle is isometric, while the AL bundle tightens in extension.

Correct Answer & Explanation

. The AL bundle is tight in flexion, and the PM bundle is tight in extension.

Explanation

The PCL has two main bundles. The Anterolateral (AL) bundle is larger and stronger; it is tight in flexion and lax in extension. The Posteromedial (PM) bundle is smaller; it is tight in extension and lax in flexion.

Question 5770

Topic: 5. Sports Medicine

During a knee arthroscopy, a distinct ligamentous structure is identified passing directly anterior to the posterior cruciate ligament (PCL). It originates from the posterior horn of the lateral meniscus and inserts onto the lateral aspect of the medial femoral condyle. What is the proper anatomical name of this structure?

. Ligament of Wrisberg
. Ligament of Humphry
. Coronary ligament
. Transverse meniscal ligament
. Oblique popliteal ligament

Correct Answer & Explanation

. Ligament of Humphry

Explanation

The meniscofemoral ligaments attach the posterior horn of the lateral meniscus to the medial femoral condyle. The Ligament of Humphry passes Anterior to the PCL, whereas the Ligament of Wrisberg passes Posterior to the PCL. (Mnemonic: 'H' comes before 'W' in the alphabet, just as Anterior comes before Posterior).

Question 5771

Topic: 5. Sports Medicine
An 8-year-old girl with SMA Type III (Kugelberg-Welander disease) presents to the clinic. Based on her SMA classification, what is her expected maximum lifetime motor milestone?
. Will never sit independently
. Will sit independently but never stand
. Will stand and walk independently at some point
. Will run and participate in competitive sports without limitations
. Will maintain normal gait but develop severe upper extremity weakness

Correct Answer & Explanation

. Will stand and walk independently at some point

Explanation

SMA Type III is characterized by the ability to stand and walk independently, although these skills may be lost later in life due to progressive weakness. In contrast, Type I patients never sit, and Type II patients sit but never walk independently.

Question 5772

Topic: 5. Sports Medicine

A 9-year-old boy (Tanner stage I) sustains a complete mid-substance tear of the anterior cruciate ligament (ACL) while playing soccer. He has recurrent episodes of instability despite extensive physical therapy and bracing. To minimize the risk of growth arrest and severe angular deformity, which of the following ACL reconstruction techniques is most appropriate for this patient?

. Bone-patellar tendon-bone autograft using transphyseal tunnels
. Iliotibial band extra-articular tenodesis combined with a transphyseal hamstring graft
. All-epiphyseal (physeal-sparing) hamstring autograft reconstruction
. Primary ACL repair with suture augmentation
. Conservative management with hinged bracing until skeletal maturity

Correct Answer & Explanation

. All-epiphyseal (physeal-sparing) hamstring autograft reconstruction

Explanation

In a Tanner stage I (skeletally immature) patient with significant remaining growth, transphyseal drilling carries a high risk of physeal arrest, which can lead to limb length discrepancy and angular deformity. The all-epiphyseal (physeal-sparing) technique using a hamstring autograft keeps the drill tunnels, graft, and fixation entirely within the epiphysis, completely avoiding the distal femoral and proximal tibial physes. This technique is considered the gold standard for prepubescent children with symptomatic ACL insufficiency who have failed conservative management.

Question 5773

Topic: 5. Sports Medicine

A 45-year-old recreational athlete presents with acute medial knee pain after feeling a 'pop' while deep squatting. MRI demonstrates an extrusion of the medial meniscus of 4 mm and a complete radial tear at the posterior root.

Which of the following best describes the primary biomechanical consequence of this specific injury pattern?

. Increased anterior tibial translation at 30 degrees of knee flexion
. Loss of hoop stresses leading to peak contact pressures equivalent to a total meniscectomy
. Increased varus laxity in full extension
. Decreased contact area restricted primarily to the patellofemoral joint
. Increased shear forces leading directly to a rupture of the anterior cruciate ligament

Correct Answer & Explanation

. Loss of hoop stresses leading to peak contact pressures equivalent to a total meniscectomy

Explanation

A posterior medial meniscus root tear disrupts the circumferential hoop stresses that the intact meniscus relies on to dissipate axial loads. Biomechanical studies demonstrate that a posterior root tear is functionally equivalent to a total meniscectomy in terms of decreasing contact area and dramatically increasing peak tibiofemoral contact pressures, leading to rapid chondrolysis and osteoarthritis if left untreated.

Question 5774

Topic: Knee Sports
A 16-year-old female undergoes medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. Intraoperative fluoroscopy is used to determine the anatomic femoral attachment site (SchΓΆttle's point). Which of the following radiographic landmarks correctly identifies this location on a strict lateral radiograph?
. 2 mm anterior to the posterior cortex line, 5 mm distal to the medial epicondyle, and on Blumensaat's line
. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line
. 5 mm posterior to the posterior cortex line, exactly on Blumensaat's line
. Directly over the adductor tubercle, 10 mm proximal to the medial epicondyle
. 1 mm posterior to the posterior cortex line, 5 mm proximal to the medial epicondyle, and distal to Blumensaat's line

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line

Explanation

SchΓΆttle's point is the radiographic landmark for the femoral origin of the MPFL. On a strict lateral radiograph, it is found 1 mm anterior to a line extending from the posterior femoral cortex, 2.5 mm distal to the posterior articular border of the medial femoral condyle, and proximal to the posterior projection of Blumensaat's line.

Question 5775

Topic: Shoulder & Hip Sports

A 24-year-old collegiate hockey player presents with persistent anterior 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 best describes the primary pathomechanical pattern of chondral damage associated with this morphology?

. Global full-thickness chondrolysis of the femoral head
. Contrecoup cartilage lesions in the posteroinferior acetabulum due to levering
. Delamination of the anterosuperior acetabular cartilage due to outside-in shear forces
. Crushing of the labrum with secondary ossification of the acetabular rim
. Ligamentum teres avulsion leading to medial joint space narrowing

Correct Answer & Explanation

. Delamination of the anterosuperior acetabular cartilage due to outside-in shear forces

Explanation

An alpha angle > 55 degrees indicates Cam-type femoroacetabular impingement (FAI). Cam morphology causes outside-in shear forces against the anterosuperior acetabular rim during hip flexion and internal rotation. This selectively damages the transitional zone cartilage, causing delamination of the articular cartilage off the subchondral bone while often leaving the labrum initially intact. Pincer impingement typically causes labral crushing and contrecoup chondral lesions.

Question 5776

Topic: Knee Sports

During surgical reconstruction of the posterolateral corner (PLC) of the knee, anatomic placement of the fibular collateral ligament (FCL) and popliteus tendon (PT) grafts is critical.

What is the precise anatomical relationship of the femoral footprint of the popliteus tendon relative to the FCL femoral footprint?

. Popliteus originates 18.5 mm anterior and inferior (distal) to the FCL
. Popliteus originates 10 mm posterior and superior (proximal) to the FCL
. Popliteus originates 18.5 mm posterior and inferior (distal) to the FCL
. Popliteus originates directly medial to the FCL within the same footprint
. Popliteus originates 10 mm anterior and superior (proximal) to the FCL

Correct Answer & Explanation

. Popliteus originates 18.5 mm anterior and inferior (distal) to the FCL

Explanation

The anatomic footprint of the popliteus tendon (PT) on the lateral femoral condyle is located approximately 18.5 mm anterior and inferior (distal) to the footprint of the fibular collateral ligament (FCL). Recognizing this relationship is essential to restore proper biomechanics during anatomic PLC reconstruction.

Question 5777

Topic: Shoulder & Hip Sports

During arthroscopic evaluation of the shoulder for an overhead athlete, the surgeon encounters an isolated, full-thickness tear of the subscapularis tendon.

The 'comma sign' is prominently observed. What specific anatomic structures compose this arthroscopic landmark?

. The coracoacromial ligament and the long head of the biceps tendon
. The medial edge of the supraspinatus tendon retracting from the greater tuberosity
. The superior glenohumeral ligament (SGHL) and the coracohumeral ligament (CHL)
. The middle glenohumeral ligament (MGHL) and the inferior glenohumeral ligament (IGHL) complex
. The transverse humeral ligament and the superior labrum

Correct Answer & Explanation

. The superior glenohumeral ligament (SGHL) and the coracohumeral ligament (CHL)

Explanation

The 'comma sign' is a highly reliable arthroscopic indicator of a subscapularis tear. It is formed by the superior glenohumeral ligament (SGHL) and the coracohumeral ligament (CHL), which avulse from their attachments on the lesser tuberosity and retract medially with the superolateral corner of the torn subscapularis tendon, creating a comma-shaped tissue band.

Question 5778

Topic: Shoulder & Hip Sports

A 25-year-old tennis player presents with posterior shoulder pain during the cocking phase of serving. Exam shows profound Glenohumeral Internal Rotation Deficit (GIRD). MR arthrogram shows articular-sided fraying of the posterior supraspinatus.

What is the primary underlying pathomechanism for internal impingement in this athlete?

. Subacromial spurring causing bursal-sided cuff tearing
. Posteroinferior capsular contracture leading to obligate posterosuperior shift of the humeral head in maximal external rotation
. Anterior capsular laxity resulting in obligate anteroinferior subluxation during external rotation
. Hypertrophy of the coracoacromial ligament impinging the subscapularis
. Congenital glenoid retroversion causing dynamic instability

Correct Answer & Explanation

. Posteroinferior capsular contracture leading to obligate posterosuperior shift of the humeral head in maximal external rotation

Explanation

Internal impingement is primarily caused by a posteroinferior capsular contracture (associated with GIRD) which creates a dynamic tether. When the arm is brought into maximal abduction and external rotation (late cocking phase), this tether forces an obligate posterosuperior shift of the humeral head, pinching the posterosuperior labrum and the articular surface of the supraspinatus/infraspinatus.

Question 5779

Topic: Knee Sports

During posterior cruciate ligament (PCL) reconstruction, understanding bundle biomechanics is essential.

Which of the following best describes the function and tensioning pattern of the native PCL bundles?

. The anterolateral bundle is the primary restraint to posterior translation in extension and is lax in flexion
. The posteromedial bundle is the primary restraint to posterior translation at 90 degrees of flexion
. The anterolateral bundle is the primary restraint to posterior translation at 90 degrees of flexion and tightens in flexion
. The posteromedial bundle is the primary restraint to internal rotation at 30 degrees of flexion
. Both bundles are equally tensioned throughout the entire arc of motion

Correct Answer & Explanation

. The anterolateral bundle is the primary restraint to posterior translation at 90 degrees of flexion and tightens in flexion

Explanation

The PCL consists of the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle is lax in extension and becomes tight in flexion, acting as the primary restraint to posterior tibial translation at 90 degrees of knee flexion. Conversely, the PM bundle is tight in extension and lax in flexion.

Question 5780

Topic: Shoulder & Hip Sports

A 29-year-old overhead athlete presents with vague posterior shoulder pain, weakness in external rotation, and no sensory deficits. MRI reveals isolated atrophy and fatty infiltration of the teres minor.

The neurovascular structure most likely compressed in this condition exits through an anatomical space. Which of the following defines the borders of this space?

. Teres minor (superior), teres major (inferior), long head of triceps (medial), humeral shaft (lateral)
. Teres major (superior), latissimus dorsi (inferior), long head of triceps (lateral), short head of biceps (medial)
. Teres minor (superior), teres major (inferior), long head of triceps (lateral), humeral shaft (medial)
. Supraspinatus (superior), infraspinatus (inferior), spine of scapula (medial), glenoid neck (lateral)
. Subscapularis (superior), teres major (inferior), coracobrachialis (lateral), rib cage (medial)

Correct Answer & Explanation

. Teres minor (superior), teres major (inferior), long head of triceps (lateral), humeral shaft (medial)

Explanation

The patient has Quadrilateral Space Syndrome, causing compression of the axillary nerve and posterior circumflex humeral artery. This leads to isolated teres minor atrophy. The quadrilateral space is bordered by the teres minor (superior), teres major (inferior), long head of the triceps (medial), and surgical neck of the humerus (lateral).

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