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5. Sports Medicine MCQs

Practice Set 29 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 561

Topic: Knee Sports

During reconstruction of the anterior cruciate ligament (ACL), drilling the femoral tunnel too anteriorly (shallow in the notch) will result in which of the following biomechanical consequences?

. The graft will be tight in extension and loose in flexion
. The graft will be tight in flexion and loose in extension
. The graft will impinge on the roof of the intercondylar notch
. The graft will lack rotational stability only
. The graft will cause severe anterior knee pain without restriction of motion

Correct Answer & Explanation

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

Explanation

A femoral tunnel placed too anteriorly (high in the notch) results in a graft that becomes excessively tight in flexion, potentially limiting knee flexion. It remains relatively loose in extension, compromising stability.

Question 562

Topic: 5. Sports Medicine

A 30-year-old carpenter sustains a volar laceration to his dominant index finger, severing both the FDS and FDP tendons in Zone II. Following primary repair of both tendons, what rehabilitation protocol best minimizes the risk of tendon rupture while preventing adhesion formation?

. 6 weeks of strict cast immobilization
. Early active mobilization with a volar block splint
. Passive flexion and active extension in a dorsal block splint
. Unrestricted active range of motion immediately
. Dynamic extension splinting with static flexion blocks

Correct Answer & Explanation

. Passive flexion and active extension in a dorsal block splint

Explanation

Protocols like the modified Kleinert or Duran utilize a dorsal block splint to prevent excessive extension while allowing passive flexion and active extension. This glides the tendons, preventing adhesions while protecting the newly repaired tissue.

Question 563

Topic: Shoulder & Hip Sports

A 20-year-old collegiate wrestler undergoes an arthroscopic Bankart repair. During the procedure, an engaging Hill-Sachs lesion is noted that drops into the glenoid rim in abduction and external rotation. Which of the following procedures should be added to prevent recurrence?

. Latarjet procedure
. Remplissage procedure
. SLAP repair
. Biceps tenodesis
. Coracoclavicular ligament reconstruction

Correct Answer & Explanation

. Remplissage procedure

Explanation

An engaging Hill-Sachs lesion can lever the humeral head out of the glenoid, leading to failure of an isolated Bankart repair. The arthroscopic remplissage procedure tenodeses the infraspinatus tendon into the defect, converting it to an extra-articular non-engaging lesion.

Question 564

Topic: Knee Sports

A 45-year-old woman falls from a height and sustains an L1 burst fracture. She is neurologically intact. Which of the following radiographic findings is a classic indicator of posterior ligamentous complex (PLC) injury, potentially warranting surgical stabilization?

. Anterior wedge compression of 10%
. Widening of the interspinous distance
. A vertical fracture line through the vertebral body
. Retropulsion of bone into the spinal canal of 20%
. Loss of vertebral body height of 15%

Correct Answer & Explanation

. Widening of the interspinous distance

Explanation

Widening of the interspinous distance on an AP or lateral radiograph suggests tension failure and disruption of the posterior ligamentous complex (PLC). PLC incompetence renders a burst fracture mechanically unstable, often necessitating surgical stabilization.

Question 565

Topic: Shoulder & Hip Sports

A 24-year-old male sustains recurrent anterior shoulder dislocations. Imaging demonstrates an engaging Hill-Sachs lesion and 25% bone loss of the anterior inferior glenoid. What is the most appropriate surgical intervention?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with Remplissage
. Latarjet procedure
. Open capsular shift
. Hemiarthroplasty

Correct Answer & Explanation

. Latarjet procedure

Explanation

In patients with recurrent anterior shoulder instability and significant anterior glenoid bone loss (>20-25%), isolated soft tissue repairs have unacceptably high failure rates. A bony augmentation procedure, such as the Latarjet (coracoid transfer), is required.

Question 566

Topic: Knee Sports

Six months after an anterior cruciate ligament (ACL) reconstruction utilizing a bone-patellar tendon-bone autograft, a patient complains of an audible "clunk" and lack of terminal extension. MRI shows a nodular mass anterior to the tibial tunnel. This lesion is predominantly composed of:

. Hyaline cartilage
. Woven bone
. Fibrovascular tissue
. Crystalline deposits
. Foreign body giant cells

Correct Answer & Explanation

. Fibrovascular tissue

Explanation

The patient is presenting with a "Cyclops" lesion, which causes mechanical impingement and loss of terminal extension post-ACL reconstruction. Pathologically, it is a localized nodule of dense fibrovascular tissue.

Question 567

Topic: 5. Sports Medicine

A 22-year-old female undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. During her postoperative rehabilitation, she develops localized pain. What is the most common long-term complication associated with this specific graft choice?

. Hamstring weakness
. Patellar fracture
. Anterior knee pain
. Septic arthritis
. Arthrofibrosis

Correct Answer & Explanation

. Anterior knee pain

Explanation

Anterior knee pain, particularly with kneeling, is the most common complication and cause of morbidity following BTB autograft ACL reconstruction. Patellar fracture is a known but rare complication.

Question 568

Topic: 5. Sports Medicine

A 28-year-old professional baseball pitcher undergoes shoulder arthroscopy for superior labrum anterior and posterior (SLAP) tear. What is the predominant biomechanical mechanism responsible for Type II SLAP lesions in overhead throwing athletes?

. Direct impaction to the anterior shoulder
. Traction from the biceps during the follow-through phase
. Peel-back mechanism during the late cocking phase
. Internal impingement during the acceleration phase
. Eccentric contraction of the triceps

Correct Answer & Explanation

. Peel-back mechanism during the late cocking phase

Explanation

The "peel-back" mechanism occurs during the late cocking phase of throwing when the shoulder is in maximal abduction and external rotation. This positioning produces a torsional force at the base of the biceps, peeling the superior labrum off the glenoid.

Question 569

Topic: Knee Sports

A 24-year-old soccer player sustains an acute knee injury with an audible "pop." Plain radiographs reveal a small, elliptic bony avulsion fragment just distal to the lateral tibial plateau. This radiographic finding is pathognomonic for a tear of which anatomical structure?

. Posterior cruciate ligament
. Medial collateral ligament
. Anterior cruciate ligament
. Lateral collateral ligament
. Popliteofibular ligament

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

The described radiographic finding is a Segond fracture, which is an avulsion of the anterolateral ligament/capsule. It is highly pathognomonic for an anterior cruciate ligament (ACL) tear.

Question 570

Topic: Shoulder & Hip Sports

During an arthroscopic Bankart repair for recurrent anterior shoulder instability, a large Hill-Sachs lesion is noted. This lesion is anatomically described as an impaction fracture of the:

. Anteroinferior glenoid rim
. Anteromedial humeral head
. Posterosuperior glenoid rim
. Posterolateral humeral head
. Posteromedial humeral head

Correct Answer & Explanation

. Posterolateral humeral head

Explanation

A Hill-Sachs lesion is a cortical impaction fracture of the posterolateral humeral head created when it strikes the firm anterior glenoid rim during an anterior shoulder dislocation.

Question 571

Topic: 5. Sports Medicine

A 25-year-old elite female soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Postoperatively, she successfully returns to sport but complains of localized anterior knee pain, particularly when kneeling. This complication is anatomically related to which of the following?

. Hypertrophy of the infrapatellar fat pad
. Injury to the saphenous nerve infrapatellar branch
. Graft site morbidity at the patellar tendon harvest site
. Improper femoral tunnel placement resulting in roof impingement
. Patellofemoral osteoarthritis secondary to graft tension

Correct Answer & Explanation

. Graft site morbidity at the patellar tendon harvest site

Explanation

Anterior knee pain, particularly with kneeling, is the most common specific complication associated with bone-patellar tendon-bone autografts. This is directly related to graft site morbidity and donor-site pathology rather than nerve injury, though infrapatellar saphenous nerve injury can cause isolated numbness.

Question 572

Topic: Knee Sports

The magnetic resonance imaging signs that suggest instability of an osteochondral dissecans lesion include all the following except:

. The presence of a low signal intensity line at the interface between the lesion and the underlying bone.
. Cartilaginous fractures.
. Focal cartilaginous defects.
. Cysts underlying the osteochondritis dissecans lesion.
. Fluid signal between lesion and bone

Correct Answer & Explanation

. Fluid signal between lesion and bone

Explanation

The presence of a high signal intensity line at the interface between the lesion and the underlying bone suggests instability of an osteochondritis dissecans lesion.

Question 573

Topic: 5. Sports Medicine

A 24-year-old athlete sustains a severe knee twisting injury. An MRI reveals an ACL tear and a concomitant "double PCL" sign. What additional injury does this sign indicate?

. Medial meniscus bucket-handle tear
. Lateral meniscus root tear
. PCL avulsion fracture
. Posterior capsule tear
. Tibial plateau chondral injury

Correct Answer & Explanation

. Medial meniscus bucket-handle tear

Explanation

The "double PCL" sign on a sagittal MRI is a classic indicator of a bucket-handle tear of the medial meniscus that has displaced into the intercondylar notch, lying parallel and anterior to the intact PCL.

Question 574

Topic: 5. Sports Medicine

In bone graft biology, which of the following materials is unique in possessing osteogenic, osteoinductive, and osteoconductive properties simultaneously?

. Demineralized bone matrix
. Cancellous allograft
. Iliac crest autograft
. Tricalcium phosphate
. Bone morphogenetic protein-2

Correct Answer & Explanation

. Iliac crest autograft

Explanation

Iliac crest bone graft (autograft) is considered the gold standard as it provides all three essential properties for bone healing: osteogenic (live cells), osteoinductive (growth factors), and osteoconductive (a structural scaffold).

Question 575

Topic: Knee Sports

A 45-year-old male sustains an acute twisting injury to his knee. MRI demonstrates a complete anterior cruciate ligament (ACL) tear and a medial meniscus posterior root tear with 3 mm of meniscal extrusion. What is the recommended surgical treatment?

. ACL reconstruction and partial medial meniscectomy
. ACL reconstruction and meniscal root repair
. Nonoperative management with physical therapy
. Meniscal root repair alone without ACL reconstruction
. High tibial osteotomy

Correct Answer & Explanation

. ACL reconstruction and meniscal root repair

Explanation

Medial meniscus posterior root tears result in a loss of hoop stresses, functioning biomechanically like a total meniscectomy. Transtibial pull-out repair at the time of ACL reconstruction restores joint kinematics and delays the onset of osteoarthritis.

Question 576

Topic: Shoulder & Hip Sports

A 21-year-old collegiate linebacker has a history of recurrent anterior shoulder dislocations. A 3D CT scan reveals 28% anterior glenoid bone loss and an engaging Hill-Sachs lesion. What is the most appropriate definitive surgical intervention?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with Remplissage
. Coracoid transfer (Latarjet procedure)
. Open inferior capsular shift
. Proximal humerus derotational osteotomy

Correct Answer & Explanation

. Coracoid transfer (Latarjet procedure)

Explanation

In a high-demand contact athlete with critical anterior glenoid bone loss (typically greater than 20-25%), isolated soft-tissue stabilization has an unacceptably high failure rate. A bony augmentation procedure such as the Latarjet coracoid transfer is the standard of care.

Question 577

Topic: Knee Sports

During the surgical reconstruction of a torn posterior cruciate ligament (PCL), the surgeon must accurately reproduce the native anatomy. Which of the following best describes the anatomical femoral footprint and tensioning pattern of the anterolateral (AL) bundle of the PCL?

. It attaches to the medial femoral condyle and is tightest in extension.
. It attaches to the lateral femoral condyle and is tightest in flexion.
. It attaches to the medial femoral condyle and is tightest in flexion.
. It attaches to the lateral femoral condyle and is tightest in extension.
. It attaches to the tibial plateau and is tight in all degrees of flexion.

Correct Answer & Explanation

. It attaches to the medial femoral condyle and is tightest in flexion.

Explanation

The PCL originates on the anterolateral aspect of the medial femoral condyle. The larger anterolateral (AL) bundle is tightest in knee flexion, whereas the smaller posteromedial (PM) bundle is tightest in knee extension.

Question 578

Topic: 5. Sports Medicine

During anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft, what is structurally the weakest link of the reconstruction during the first 6 weeks of graft healing?

. The intra-articular graft substance
. The tibial interference screw fixation site
. The femoral interference screw fixation site
. The patellar donor site
. The tibial tubercle donor site

Correct Answer & Explanation

. The intra-articular graft substance

Explanation

Following a BTB autograft reconstruction, the graft undergoes avascular necrosis and subsequent revascularization (ligamentization). During the first 6 to 8 weeks, the intra-articular graft substance is at its weakest point.

Question 579

Topic: 5. Sports Medicine

During the ligamentization process of a hamstring autograft used in ACL reconstruction, when is the graft mechanically at its weakest?

. Immediately postoperatively
. 6 to 8 weeks postoperatively
. 3 to 4 months postoperatively
. 6 to 9 months postoperatively
. 12 to 18 months postoperatively

Correct Answer & Explanation

. 6 to 8 weeks postoperatively

Explanation

The graft undergoes avascular necrosis and subsequent revascularization and cellular repopulation. It is mechanically at its weakest during the revascularization phase, typically around 6 to 8 weeks postoperatively.

Question 580

Topic: 5. Sports Medicine
A 13-year-old boy tears his anterior cruciate ligament (ACL) while playing flag football. What is the preferred graft material for his ACL reconstruction?
. Bone-patellar tendon-bone autograft
. Quadriceps tendon autograft
. Four-strand hamstring tendon autograft
. Four-strand hamstring tendon allograft
. Achilles tendon allograft

Correct Answer & Explanation

. Four-strand hamstring tendon autograft

Explanation

Due to the patient's age, autograft is the preferred option. Also, due to the patient's age, his growth plates are open and the surgeon is prohibited from using a graft with a bone construct due to the possible damage to the growth plate.

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