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5. Sports Medicine MCQs

Practice Set 295 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 5881

Topic: 5. Sports Medicine
A 24-year-old professional baseball pitcher presents with vague anterior shoulder pain, a "dead arm" sensation, and clicking during the late cocking phase of throwing. MRI arthrogram reveals a tear of the superior labrum with detachment of the biceps anchor from the superior glenoid tubercle. According to the Snyder classification, what type of SLAP lesion is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

A Snyder Type II SLAP lesion involves detachment of the superior labrum and the origin of the long head of the biceps tendon from the glenoid. It is the most common type of SLAP tear and frequently causes "dead arm" syndrome in overhead athletes.

Question 5882

Topic: 5. Sports Medicine

A 22-year-old athlete is recovering from an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. During which phase of graft healing is the structural integrity of the graft at its weakest point, making it highly susceptible to rupture?

. Immediate postoperative phase (0-2 weeks)
. Necrosis phase (2-4 weeks)
. Revascularization and proliferation phase (6-12 weeks)
. Ligamentization phase (4-6 months)
. Remodeling phase (6-12 months)

Correct Answer & Explanation

. Revascularization and proliferation phase (6-12 weeks)

Explanation

The revascularization phase occurs typically between 6 to 12 weeks postoperatively. During this time, the graft undergoes remodeling and cell repopulation, which transiently decreases its mechanical strength and represents the weakest point of the graft.

Question 5883

Topic: Shoulder & Hip Sports

A 24-year-old rugby player with recurrent anterior shoulder instability is undergoing preoperative evaluation. The 'glenoid track' concept is used to determine his risk of recurrent postoperative dislocation. An 'off-track' Hill-Sachs lesion is best managed by arthroscopic Bankart repair with which concurrent procedure?

. Latarjet coracoid transfer
. Arthroscopic remplissage
. Superior labrum anterior to posterior (SLAP) repair
. Subscapularis peel and advancement
. Proximal biceps tenodesis

Correct Answer & Explanation

. Arthroscopic remplissage

Explanation

An 'off-track' Hill-Sachs lesion indicates that the humeral head defect engages the anterior glenoid rim during abduction and external rotation. To prevent this engagement and recurrent dislocation, a remplissage (filling the defect with the infraspinatus tendon) is performed concurrently with a Bankart repair.

Question 5884

Topic: Knee Sports

During normal knee flexion, the femoral contact point translates posteriorly on the tibial plateau, a phenomenon known as femoral rollback. Which ligament is the primary driver of this kinematic movement?

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

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

The Posterior Cruciate Ligament (PCL) tightens during deep knee flexion, drawing the femoral condyles posteriorly on the tibia. This femoral rollback improves the extensor mechanism lever arm and prevents posterior impingement to maximize flexion.

Question 5885

Topic: Knee Sports

The anterior cruciate ligament (ACL) consists of two distinct functional bundles. Which of the following statements correctly describes the primary tension patterns of these bundles during knee range of motion?

. The anteromedial bundle is tight in extension and lax in flexion.
. The posterolateral bundle is tight in flexion and lax in extension.
. The anteromedial bundle is tight in flexion, and the posterolateral bundle is tight in extension.
. Both bundles are equally tight throughout the entire range of motion.
. Both bundles are maximally lax at 90 degrees of flexion.

Correct Answer & Explanation

. The anteromedial bundle is tight in flexion, and the posterolateral bundle is tight in extension.

Explanation

The ACL consists of the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle is tight in flexion and primarily controls anterior translation. The PL bundle is tight in extension and provides significant rotational stability. Reconstructive techniques often aim to address both functional requirements.

Question 5886

Topic: Knee Sports

During the physical examination of a patient with a suspected anterior cruciate ligament (ACL) tear, a pivot shift test is performed. Which specific biomechanical function of the ACL is this test primarily designed to assess?

. Anterior translation in high degrees of knee flexion, controlled by the anteromedial bundle.
. Rotational stability, which is primarily provided by the posterolateral bundle in near-extension.
. Varus-valgus stability at 30 degrees of flexion.
. Posterior tibial translation during active quadriceps contraction.
. Anterior translation in internal rotation, controlled by the medial collateral ligament.

Correct Answer & Explanation

. Rotational stability, which is primarily provided by the posterolateral bundle in near-extension.

Explanation

The pivot shift test assesses the dynamic rotational stability of the knee, which is primarily controlled by the posterolateral (PL) bundle of the ACL. The PL bundle is tightest in extension and near-extension, which is the position where the pivot shift phenomenon occurs.

Question 5887

Topic: Shoulder & Hip Sports

In the evaluation of anterior shoulder instability, the concept of the 'glenoid track' is used to determine surgical management. A Hill-Sachs lesion is designated as 'off-track' when which of the following conditions is met?

. The medial margin of the Hill-Sachs lesion remains lateral to the medial margin of the glenoid track.
. The medial margin of the Hill-Sachs lesion extends medially beyond the medial margin of the glenoid track.
. The defect involves greater than 10% of the humeral head articular surface.
. The glenoid bone loss is less than 5% without any bipolar lesion.
. The Hill-Sachs lesion only engages during internal rotation and adduction.

Correct Answer & Explanation

. The medial margin of the Hill-Sachs lesion extends medially beyond the medial margin of the glenoid track.

Explanation

A Hill-Sachs lesion is 'off-track' if its medial margin extends further medially than the medial margin of the glenoid track (calculated as 83% of the glenoid width, minus any anterior bone loss). Off-track lesions will engage the anterior glenoid rim during abduction/external rotation, leading to instability, and typically require a Remplissage procedure or bone block in addition to a Bankart repair.

Question 5888

Topic: Knee Sports

A 45-year-old female sustains a posterior medial meniscus root tear. Biomechanically, this injury is most equivalent to which of the following?

. Anterior cruciate ligament tear
. Total meniscectomy
. Partial meniscectomy
. Medial collateral ligament sprain
. Posterior cruciate ligament tear

Correct Answer & Explanation

. Total meniscectomy

Explanation

A posterior meniscal root tear disrupts the hoop stresses of the meniscus, leading to extrusion. Biomechanically, it alters contact pressures in the compartment to a degree equivalent to a total meniscectomy.

Question 5889

Topic: Knee Sports

In bone-patellar tendon-bone (BTB) ACL reconstruction, which phase of graft healing is characterized by peak fibroblast proliferation and the beginning of collagen remodeling, but marks the weakest point of the graft?

. Necrosis phase
. Revascularization phase
. Proliferation phase
. Ligamentization phase
. Maturation phase

Correct Answer & Explanation

. Revascularization phase

Explanation

The revascularization phase (typically 6-12 weeks post-op) involves robust biologic activity and vessel ingrowth but paradoxically represents the biomechanically weakest period for the graft before complete ligamentization occurs.

Question 5890

Topic: Knee Sports

A 28-year-old male sustains a dashboard injury in a motor vehicle collision. Examination reveals a positive posterior drawer test. The dial test shows a 15-degree increase in external rotation at both 30 degrees and 90 degrees of flexion compared to the contralateral normal knee. Which of the following structures are most likely injured?

. Posterior cruciate ligament only
. Posterior cruciate ligament and posterolateral corner
. Anterior cruciate ligament and posteromedial corner
. Posterior cruciate ligament and medial collateral ligament
. Posterolateral corner only

Correct Answer & Explanation

. Posterior cruciate ligament and posterolateral corner

Explanation

The Dial test evaluates for injuries to the posterolateral corner (PLC) and posterior cruciate ligament (PCL). An asymmetric increase of >10 degrees of external rotation at 30 degrees of flexion indicates a PLC injury. If the asymmetry persists or increases at 90 degrees, it indicates a combined PCL and PLC injury.

Question 5891

Topic: Shoulder & Hip Sports
A 24-year-old elite baseball pitcher complains of vague, deep shoulder pain and decreased throwing velocity. He has a positive active compression test (O'Brien's). MR arthrogram reveals a Type II SLAP tear. What is the defining anatomical feature of a Type II SLAP tear?
. Fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and biceps anchor from the superior glenoid
. A bucket-handle tear of the superior labrum with an intact biceps anchor
. A bucket-handle tear of the superior labrum extending into the biceps tendon
. An anteroinferior labral tear extending superiorly to the biceps anchor

Correct Answer & Explanation

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

Explanation

According to Snyder's classification: Type I is fraying of the superior labrum with an intact biceps anchor. Type II is detachment of the superior labrum and biceps anchor. Type III is a bucket-handle tear of the labrum with an intact biceps anchor. Type IV is a bucket-handle tear extending into the biceps tendon.

Question 5892

Topic: Knee Sports

When designing a posterior-stabilized (PS) total knee arthroplasty implant, the interaction between the femoral cam and the tibial post is engineered to replicate the function of which native structure?

. Medial collateral ligament
. Lateral collateral ligament
. Anterior cruciate ligament
. Posterior cruciate ligament
. Popliteus tendon

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

In a posterior-stabilized (PS) TKA, the posterior cruciate ligament (PCL) is sacrificed. The implant substitutes for the PCL's function (preventing excessive posterior translation of the tibia and inducing femoral rollback during flexion) via the interaction between a cam on the femoral component and a vertical post on the polyethylene tibial insert.

Question 5893

Topic: 5. Sports Medicine
A 24-year-old overhead athlete undergoes shoulder arthroscopy. The surgeon identifies a bucket-handle tear of the superior labrum that extends into the long head of the biceps tendon. According to the Snyder classification, what type of SLAP lesion is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

According to the Snyder classification: Type I is fraying of the superior labrum; Type II is detachment of the superior labrum and biceps anchor from the glenoid; Type III is a bucket-handle tear of the labrum with an intact biceps anchor; Type IV is a bucket-handle tear of the labrum that extends into the long head of the biceps tendon.

Question 5894

Topic: 5. Sports Medicine

A 24-year-old athlete undergoes an osteochondral autograft transfer for a femoral condyle defect. Which zone of articular cartilage is primarily responsible for resisting sheer stress and contains the highest concentration of collagen?

. Superficial (tangential) zone
. Middle (transitional) zone
. Deep (radial) zone
. Tidemark
. Calcified cartilage zone

Correct Answer & Explanation

. Superficial (tangential) zone

Explanation

The superficial (tangential) zone of articular cartilage has the highest concentration of Type II collagen fibers arranged parallel to the joint surface. This configuration allows it to primarily resist shear stress. The deep zone primarily resists compressive forces.

Question 5895

Topic: Shoulder & Hip Sports

A 55-year-old laborer undergoes an arthroscopic massive rotator cuff repair. Six months postoperatively, MRI reveals a retear. Which of the following preoperative MRI findings is most strongly associated with structural failure of rotator cuff healing?

. Age under 60
. Acromioclavicular osteoarthritis
. Goutallier grade 3 or higher fatty infiltration
. Type II acromion
. Subacromial bursitis

Correct Answer & Explanation

. Goutallier grade 3 or higher fatty infiltration

Explanation

Advanced fatty infiltration (Goutallier grade 3 or 4) and muscle atrophy are irreversible changes. They are strongly predictive of poor clinical outcomes and structural failure after rotator cuff repair.

Question 5896

Topic: 5. Sports Medicine

Following anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, the graft undergoes ligamentization. During which phase is the graft structurally and mechanically at its weakest?

. Early healing phase (0-4 weeks)
. Proliferation and revascularization phase (4-12 weeks)
. Maturation phase (3-6 months)
. Remodeling phase (6-12 months)
. Incorporation phase (>12 months)

Correct Answer & Explanation

. Proliferation and revascularization phase (4-12 weeks)

Explanation

The graft is mechanically weakest during the proliferation/revascularization phase (typically 4-12 weeks post-op) due to cellular necrosis and the early ingrowth of new blood vessels and fibroblasts.

Question 5897

Topic: 5. Sports Medicine

A 24-year-old athlete undergoes an anterior cruciate ligament (ACL) reconstruction. Postoperatively, she demonstrates an inability to achieve terminal knee flexion, and physical examination reveals increasing graft tension as the knee moves from extension to flexion. What is the most likely technical error made during the surgery?

. Femoral tunnel placed too far anteriorly
. Femoral tunnel placed too far posteriorly
. Tibial tunnel placed too far posteriorly
. Tibial tunnel placed too medially
. Tibial tunnel placed too laterally

Correct Answer & Explanation

. Femoral tunnel placed too far anteriorly

Explanation

A femoral tunnel placed too far anteriorly (anterior to Blumensaat's line) causes the ACL graft to be tight in flexion and loose in extension. This error restricts knee flexion, can lead to graft stretching or failure, and causes a 'captured knee' feeling.

Question 5898

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, the surgeon drills the femoral tunnel too vertically (high and anterior in the intercondylar notch). Which of the following clinical findings is most likely to result from this non-anatomic tunnel placement?

. Residual rotational instability demonstrated by a positive pivot shift test
. Loss of terminal knee flexion
. Severe anterior knee pain during activity
. Medial joint line tenderness from meniscal impingement
. Premature graft rupture from intercondylar roof impingement

Correct Answer & Explanation

. Residual rotational instability demonstrated by a positive pivot shift test

Explanation

A vertically placed femoral tunnel (common with older transtibial drilling techniques) effectively restores anterior-posterior stability (resulting in a negative Lachman test) but fails to adequately restore rotational stability. This leaves the patient with a persistent positive pivot shift test. Roof impingement with loss of extension is typically due to an anterior tibial tunnel placement.

Question 5899

Topic: 5. Sports Medicine

Following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, the tissue undergoes a biological process termed 'ligamentization'. During which specific post-operative phase is the graft mechanically at its weakest?

. Initial necrosis phase (0-4 weeks)
. Early remodeling and revascularization phase (6-12 weeks)
. Late remodeling phase (6-9 months)
. Maturation phase (1-2 years)
. Immediate postoperative phase (0-2 weeks)

Correct Answer & Explanation

. Early remodeling and revascularization phase (6-12 weeks)

Explanation

The ACL graft is mechanically weakest during the early remodeling or revascularization phase, which typically occurs between 6 and 12 weeks postoperatively. During this vulnerable time, the initial graft undergoes cellular necrosis, repopulation, and profound collagen remodeling.

Question 5900

Topic: Knee Sports

A patient presents with a knee dislocation and a suspected posterolateral corner (PLC) injury. The dial test is performed. Which of the following findings is diagnostic of an isolated PLC injury without an associated PCL tear?

. Increased external rotation at both 30 and 90 degrees of flexion
. Increased external rotation at 30 degrees but normal at 90 degrees of flexion
. Increased external rotation at 90 degrees but normal at 30 degrees of flexion
. Increased internal rotation at 30 degrees of flexion
. Increased valgus laxity at 30 degrees of flexion

Correct Answer & Explanation

. Increased external rotation at 30 degrees but normal at 90 degrees of flexion

Explanation

The dial test shows increased external rotation of greater than 10 degrees compared to the contralateral side at 30 degrees of flexion in isolated PLC injuries. If external rotation is increased at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

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