Menu

5. Sports Medicine MCQs

Practice Set 294 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 5861

Topic: Shoulder & Hip Sports

A 22-year-old male athlete presents with recurrent anterior shoulder dislocations. Pre-operative imaging and 3D CT reconstruction indicate an engaging Hill-Sachs lesion and a 26% anterior glenoid bone loss. What is the most appropriate definitive surgical management?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with Remplissage
. Coracoid transfer procedure (Latarjet)
. Open inferior capsular shift
. Putti-Platt procedure

Correct Answer & Explanation

. Coracoid transfer procedure (Latarjet)

Explanation

In the setting of recurrent anterior shoulder instability with significant anterior glenoid bone loss (>20-25%), soft tissue stabilization alone (Bankart repair) is associated with an unacceptably high failure rate. Bony augmentation is required. The Latarjet procedure (transfer of the coracoid process with the attached conjoint tendon to the anterior glenoid) provides a 'triple blocking' effect (bone, sling, and capsule) and is the gold standard for significant glenoid bone loss.

Question 5862

Topic: Knee Sports

A 35-year-old male sustains a high-energy traumatic knee dislocation. On examination in the trauma bay, the knee is locked in a slightly flexed position, and there is a distinct transverse furrow or 'puckering' of the skin over the medial joint line (the 'dimple sign'). An attempted closed reduction is unsuccessful. What anatomic structure is primarily responsible for blocking the reduction?

. Medial meniscus
. Medial capsule and retinaculum
. Semitendinosus tendon
. Anterior cruciate ligament stump
. Patellar tendon

Correct Answer & Explanation

. Medial capsule and retinaculum

Explanation

The 'dimple sign' represents a posterolateral knee dislocation in which the medial femoral condyle buttonholes through the anterior medial capsule and retinaculum. The intact capsule prevents the condyle from returning to its anatomical position, rendering the dislocation irreducible by closed means. It requires immediate open reduction. Applying excessive force during closed reduction attempts can cause skin necrosis or further soft tissue damage.

Question 5863

Topic: Knee Sports

A 16-year-old female dancer experiences a primary lateral patellar dislocation. Which of the following ligamentous structures is most likely to be injured and represents the primary soft-tissue restraint to lateral patellar translation at 20 degrees of knee flexion?

. Medial patellotibial ligament
. Medial patellomeniscal ligament
. Medial patellofemoral ligament
. Vastus medialis obliquus
. Lateral retinaculum

Correct Answer & Explanation

. Medial patellofemoral ligament

Explanation

The medial patellofemoral ligament (MPFL) is the primary static stabilizer against lateral patellar translation, providing 50-60% of the restraining force, particularly in early flexion (0-30 degrees) before the patella engages fully in the trochlear groove. It is torn in nearly 100% of acute lateral patellar dislocations, typically avulsing from its femoral attachment (near the adductor tubercle) or its patellar attachment.

Question 5864

Topic: Shoulder & Hip Sports

A 24-year-old male manual laborer presents with recurrent anterior shoulder instability. A 3D CT scan reveals 28% glenoid bone loss and a large, engaging Hill-Sachs lesion. Which of the following surgical procedures is the most appropriate definitive management?

. Arthroscopic Bankart repair alone
. Open Bankart repair with inferior capsular shift
. Arthroscopic remplissage with Bankart repair
. Coracoid transfer (Latarjet procedure)
. Subscapularis advancement (Putti-Platt procedure)

Correct Answer & Explanation

. Coracoid transfer (Latarjet procedure)

Explanation

Critical glenoid bone loss in anterior shoulder instability is generally accepted to be >20-25%. Soft tissue procedures (Bankart repair, with or without remplissage) have a high failure rate when significant glenoid bone loss is present. The Latarjet procedure (transfer of the coracoid process to the anterior glenoid) provides both a bony block and a dynamic sling effect (via the conjoined tendon) and is the gold standard for instability with >25% glenoid bone loss.

Question 5865

Topic: Knee Sports
A 16-year-old female sustains a first-time lateral patellar dislocation, which reduces spontaneously. Subsequent MRI evaluates the medial patellofemoral ligament (MPFL). Where is the most common anatomic location of an MPFL tear in the setting of acute patellar dislocation?
. Tibial tubercle
. Patellar insertion
. Mid-substance
. Femoral origin
. Fibular head

Correct Answer & Explanation

. Femoral origin

Explanation

The Medial Patellofemoral Ligament (MPFL) is the primary restraint to lateral patellar translation at 0-30 degrees of flexion. In an acute lateral patellar dislocation, the MPFL tears in >90% of cases. The most common location of the tear is at its femoral origin (near Schöttle's point, situated between the medial epicondyle and adductor tubercle).

Question 5866

Topic: Shoulder & Hip Sports

A 22-year-old male athlete presents with recurrent anterior shoulder dislocations. A 3D CT scan reveals 25% anterior glenoid bone loss and an engaging Hill-Sachs lesion, indicating an 'off-track' lesion. What is the gold standard surgical intervention to restore stability in this patient?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with remplissage
. Latarjet procedure
. Putti-Platt procedure
. Humeral head osteochondral allograft

Correct Answer & Explanation

. Latarjet procedure

Explanation

For anterior shoulder instability with critical glenoid bone loss (greater than 20-25%), isolated soft tissue repairs have unacceptably high failure rates. The Latarjet procedure (coracoid transfer) is the standard of care.

Question 5867

Topic: Shoulder & Hip Sports

A 40-year-old male experiences a first-time seizure and subsequently complains of shoulder pain. Radiographs demonstrate a posterior shoulder dislocation with an anteromedial humeral head impression fracture (reverse Hill-Sachs lesion) involving 25% of the articular surface. What is the most appropriate surgical management?

. Closed reduction and sling immobilization
. Open reduction and subscapularis transfer (McLaughlin procedure)
. Latarjet procedure
. Total shoulder arthroplasty
. Hemiarthroplasty

Correct Answer & Explanation

. Open reduction and subscapularis transfer (McLaughlin procedure)

Explanation

A reverse Hill-Sachs lesion involving 20-40% of the articular surface is commonly managed with the McLaughlin procedure (transfer of the subscapularis into the defect) or its modification (lesser tuberosity transfer). This prevents the defect from engaging the posterior glenoid rim.

Question 5868

Topic: Knee Sports

A 26-year-old soccer player sustains a knee injury. Physical exam reveals a positive posterior drawer test and increased external rotation at both 30 and 90 degrees of knee flexion during the Dial test compared to the contralateral side. What combined injury pattern is present?

. ACL and MCL
. PCL and MCL
. PCL and Posterolateral Corner (PLC)
. ACL and PLC
. Isolated PLC

Correct Answer & Explanation

. PCL and Posterolateral Corner (PLC)

Explanation

The Dial test evaluates posterolateral instability. Asymmetry of greater than 10 degrees of external rotation at both 30 and 90 degrees of knee flexion indicates a combined injury to both the PCL and the Posterolateral Corner (PLC).

Question 5869

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. The anteromedial (AM) bundle is tightest in which position of the knee?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 degrees of flexion
. 120 degrees of flexion

Correct Answer & Explanation

. 90 degrees of flexion

Explanation

The ACL's anteromedial (AM) bundle is tightest in flexion and primarily controls anterior translation in this position, assessed clinically via the anterior drawer test at 90 degrees. The posterolateral (PL) bundle is tightest in extension and provides rotatory stability, tested via the Lachman test at 20-30 degrees.

Question 5870

Topic: Shoulder & Hip Sports

A Bankart lesion is classically described as an avulsion of the anteroinferior labrum and attached capsule from the glenoid rim. What is the associated bony injury resulting from impaction of the humeral head against the anterior glenoid rim?

. Reverse Hill-Sachs lesion
. ALPSA lesion
. GLAD lesion
. Hill-Sachs lesion
. HAGL lesion

Correct Answer & Explanation

. Hill-Sachs lesion

Explanation

A Hill-Sachs lesion is an osteochondral impaction fracture of the posterosuperior aspect of the humeral head. It occurs when the humeral head dislocates anteriorly and impacts forcefully against the hard cortical bone of the anterior glenoid rim.

Question 5871

Topic: Knee Sports

Anatomical reconstruction of the anterior cruciate ligament (ACL) aims to restore the function of its two distinct bundles. Which of the following best describes the native biomechanics of the anteromedial (AM) and posterolateral (PL) bundles?

. AM bundle is tight in flexion and primarily controls anterior translation; PL bundle is tight in extension and primarily controls rotatory stability
. AM bundle is tight in extension and primarily controls anterior translation; PL bundle is tight in flexion and primarily controls rotatory stability
. AM bundle controls posterior translation in extension; PL bundle controls anterior translation in flexion
. Both bundles are maximally tight in full extension to prevent hyperextension
. Both bundles act isometrically throughout the entire arc of knee motion

Correct Answer & Explanation

. AM bundle is tight in flexion and primarily controls anterior translation; PL bundle is tight in extension and primarily controls rotatory stability

Explanation

The ACL consists of two main bundles named for their tibial insertion: the Anteromedial (AM) and Posterolateral (PL) bundles. Biomechanically, the AM bundle is tightest in knee flexion and provides primary restraint against anterior tibial translation. The PL bundle is tightest in full extension and provides primary restraint against rotatory loads (e.g., pivot shift). Understanding this is crucial for anatomic tunnel placement.

Question 5872

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. Which of the following best describes the isolated biomechanical function of the posterolateral (PL) bundle?

. It provides the primary restraint to anterior tibial translation in 90 degrees of knee flexion
. It is tightest in extension and provides primary rotational stability to the knee
. It is the primary restraint to valgus stress when the knee is fully extended
. It is tightest in full flexion and provides primary varus stability
. It acts synergistically with the posterior cruciate ligament to prevent posterior translation

Correct Answer & Explanation

. It is tightest in extension and provides primary rotational stability to the knee

Explanation

The posterolateral (PL) bundle of the ACL is tightest in knee extension and acts as the primary restraint to rotatory loads. Conversely, the anteromedial (AM) bundle is tightest in flexion.

Question 5873

Topic: Knee Sports

During anterior cruciate ligament (ACL) reconstruction, understanding the function of the two primary bundles is critical. The posterolateral (PL) bundle of the ACL is primarily responsible for which of the following biomechanical functions?

. Resisting anterior tibial translation at 90 degrees of flexion.
. Resisting rotatory loads near full extension.
. Resisting posterior tibial translation at 30 degrees of flexion.
. Resisting valgus stress at 90 degrees of flexion.
. Resisting varus stress in full extension.

Correct Answer & Explanation

. Resisting anterior tibial translation at 90 degrees of flexion.

Explanation

The ACL is composed of the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees of knee flexion. The PL bundle is tight in extension and is the primary restraint to rotatory loads (and anterior translation) when the knee is near full extension.

Question 5874

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with insidious onset of shoulder weakness. Examination reveals isolated weakness in external rotation with the arm at the side, but full strength in shoulder abduction. Atrophy is noted over the posterior scapula below the spine. Entrapment of the suprascapular nerve at which of the following anatomical locations best explains this specific deficit?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Subcoracoid space

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve innervates both the supraspinatus (abduction) and infraspinatus (external rotation). If the nerve is entrapped at the suprascapular notch, both muscles are affected. If it is entrapped more distally at the spinoglenoid notch (commonly by a paralabral cyst in overhead athletes), it causes isolated denervation and weakness of the infraspinatus, sparing the supraspinatus.

Question 5875

Topic: 5. Sports Medicine

A 22-year-old soccer player undergoes an anterior cruciate ligament (ACL) reconstruction. The surgeon debates between a Bone-Patellar Tendon-Bone (BPTB) autograft and a quadrupled hamstring autograft. Regarding the biomechanical properties at 'time zero' (implantation), which of the following statements is true?

. BPTB has a higher ultimate tensile load than the native ACL.
. A quadrupled hamstring graft has a lower ultimate tensile load than BPTB.
. The native ACL has the highest ultimate tensile load of all three options.
. A quadrupled hamstring graft has a higher ultimate tensile load than both BPTB and the native ACL.
. Both grafts are structurally weaker than the native ACL at time zero.

Correct Answer & Explanation

. A quadrupled hamstring graft has a higher ultimate tensile load than both BPTB and the native ACL.

Explanation

At time zero, a quadrupled hamstring graft has the highest ultimate tensile load (approx. 4000 N), which is higher than both the native ACL (approx. 2160 N) and the central third BPTB graft (approx. 2977 N). However, clinical stability also depends heavily on graft fixation and biologic incorporation over time.

Question 5876

Topic: Shoulder & Hip Sports

A 13-year-old obese male undergoes in-situ percutaneous pinning for a stable Slipped Capital Femoral Epiphysis (SCFE). Over the next 5 years, he develops progressively worsening anterior hip pain and a decrease in hip internal rotation. What is the most common long-term mechanical complication of an unreduced SCFE pinned in-situ?

. Chondrolysis
. Avascular necrosis of the femoral head
. Subtrochanteric fracture
. Cam-type femoroacetabular impingement (FAI)
. Pincer-type femoroacetabular impingement (FAI)

Correct Answer & Explanation

. Cam-type femoroacetabular impingement (FAI)

Explanation

In-situ pinning of a SCFE arrests slip progression but leaves a residual proximal femoral deformity (the metaphysis remains prominent anteriorly and superiorly). This abnormal morphology frequently results in cam-type femoroacetabular impingement (FAI), causing labral damage and early-onset hip osteoarthritis.

Question 5877

Topic: 5. Sports Medicine
A 24-year-old collegiate baseball pitcher complains of anterior shoulder pain and a 'dead arm' sensation. MRI arthrogram demonstrates a Type II SLAP (Superior Labrum Anterior Posterior) lesion. Based on Snyder's classification, which of the following accurately describes a Type II SLAP lesion?
. Degenerative fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and the biceps anchor from the superior glenoid
. Bucket-handle tear of the superior labrum with an intact biceps anchor
. Bucket-handle tear of the superior labrum extending into the long head of the biceps tendon
. Anterior-inferior labral avulsion extending superiorly to involve the coracohumeral ligament

Correct Answer & Explanation

. Detachment of the superior labrum and the biceps anchor from the superior glenoid

Explanation

In Snyder's classification of SLAP tears: Type I is degenerative fraying. Type II involves detachment of the superior labrum and the biceps anchor from the superior glenoid (the most common type requiring repair in young athletes). Type III is a bucket-handle tear with an intact anchor. Type IV is a bucket-handle tear that extends into the biceps tendon.

Question 5878

Topic: Shoulder & Hip Sports

When calculating the 'glenoid track' to evaluate a patient with recurrent anterior shoulder instability and an engaging Hill-Sachs lesion, which of the following formulas is used to determine the width of the glenoid track?

. 83% of the intact glenoid width minus the anterior bone loss
. 100% of the intact glenoid width minus the anterior bone loss
. 83% of the intact glenoid width plus the anterior bone loss
. The Hill-Sachs interval divided by the intact glenoid width
. 50% of the intact glenoid width minus the Hill-Sachs depth

Correct Answer & Explanation

. 83% of the intact glenoid width minus the anterior bone loss

Explanation

The glenoid track width is calculated as 83% of the inferior true intact glenoid width minus the width of the anterior glenoid bone defect. If the Hill-Sachs Interval (HSI) is greater than the glenoid track width, the lesion is considered 'off-track' and is at high risk of engaging over the anterior glenoid rim.

Question 5879

Topic: 5. Sports Medicine

During the early stages of flexor tendon healing in Zone II of the hand, the tendon utilizes both intrinsic and extrinsic mechanisms for repair. Which of the following is the primary clinical disadvantage of healing that relies predominantly on extrinsic mechanisms?

. Delayed restoration of structural tensile strength
. Increased risk of spontaneous tendon rupture
. Formation of dense peritendinous adhesions
. Excessive synovial fluid leakage from the sheath
. Central necrosis of the tendon core

Correct Answer & Explanation

. Formation of dense peritendinous adhesions

Explanation

Extrinsic tendon healing relies on cellular infiltration and capillary ingrowth from the surrounding sheath and tissues. While it provides rapid biological healing, its primary disadvantage is the formation of dense peritendinous adhesions that restrict tendon excursion and normal gliding. Intrinsic healing is preferred to optimize functional outcomes.

Question 5880

Topic: 5. Sports Medicine

Following an ACL reconstruction using a bone-patellar tendon-bone autograft, the graft undergoes 'ligamentization'. During which post-operative time frame is the graft biomechanically at its weakest due to ongoing revascularization and cellular repopulation?

. 1 to 2 weeks
. 6 to 12 weeks
. 6 to 9 months
. 12 to 18 months
. 2 to 3 years

Correct Answer & Explanation

. 6 to 12 weeks

Explanation

The ligamentization process includes initial necrosis, revascularization/cellular repopulation (remodeling), and maturation. Biomechanically, the graft is at its weakest during the early remodeling phase, typically around 6 to 12 weeks post-operatively, making it highly susceptible to rupture if exposed to excessive stress or premature return to sport.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page