Menu

5. Sports Medicine MCQs

Practice Set 296 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 5901

Topic: 5. Sports Medicine

A 35-year-old recreational athlete sustains an acute Achilles tendon rupture. Nonoperative management with early functional rehabilitation is chosen. Compared to surgical repair, which of the following is the most established outcome difference for nonoperative management?

. Higher rate of deep vein thrombosis
. Higher rate of sural nerve injury
. Higher rate of tendon rerupture
. Lower rate of return to play
. Significantly decreased plantarflexion strength

Correct Answer & Explanation

. Higher rate of tendon rerupture

Explanation

While early functional rehabilitation has vastly improved outcomes for nonoperative treatment, surgical repair is still associated with a slightly lower tendon rerupture rate. However, surgery carries a higher risk of wound complications and infections.

Question 5902

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, the surgeon places the femoral tunnel too far anteriorly. What is the most likely biomechanical consequence of this tunnel malposition?

. The graft will be loose in flexion and normal in extension
. The graft will be tight in flexion and loose in extension
. The graft will lack rotational stability only
. The graft will anatomically impinge on the PCL
. The graft will stretch out during normal straight-line gait

Correct Answer & Explanation

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

Explanation

An anteriorly placed femoral tunnel in ACL reconstruction results in a graft that is tight in flexion and loose in extension. This can lead to restricted knee flexion and eventual graft stretching or failure.

Question 5903

Topic: 5. Sports Medicine

A 55-year-old female with poorly controlled rheumatoid arthritis presents to the clinic having acutely lost the ability to actively flex the interphalangeal joint of her thumb. Passive flexion remains intact. Which of the following bony prominences is most likely responsible for this spontaneous tendon rupture?

. Lister's tubercle
. Hook of the hamate
. Volar osteophyte of the scaphoid
. Trapezial ridge
. Distal radioulnar joint

Correct Answer & Explanation

. Volar osteophyte of the scaphoid

Explanation

Mannerfelt syndrome (or Mannerfelt-Norman lesion) refers to an attritional rupture of the flexor pollicis longus (FPL) tendon in patients with rheumatoid arthritis. This rupture is classically caused by friction over a sharp volar osteophyte of the scaphoid that pierces through the volar wrist capsule.

Question 5904

Topic: Knee Sports

In a posterior-stabilized (PS) total knee arthroplasty design, what is the primary biomechanical function of the cam-and-post mechanism?

. To substitute for the anterior cruciate ligament
. To prevent varus/valgus instability
. To induce femoral rollback during knee flexion
. To limit knee hyperextension
. To improve medial collateral ligament tension

Correct Answer & Explanation

. To induce femoral rollback during knee flexion

Explanation

In a posterior-stabilized (PS) knee, the posterior cruciate ligament (PCL) is sacrificed. The PCL's native role includes causing the femur to roll posteriorly on the tibia during deep flexion. The cam on the femoral component engages the post on the tibial insert, mechanically forcing the femur to translate posteriorly (femoral rollback), which clears the posterior tibia and improves maximum flexion.

Question 5905

Topic: 5. Sports Medicine

A 69-year-old woman sustains a chronic, recurrent patellar tendon rupture 2 years following a primary TKA. Previous primary repair with cerclage wire augmentation failed. Her knee is well-aligned and components are radiographically well-fixed. She has an extension lag of 45 degrees. Which of the following reconstruction techniques offers the best long-term outcome for this salvage situation?

. Direct end-to-end repair with non-absorbable sutures
. Hamstring autograft reconstruction
. Extensor mechanism allograft reconstruction or synthetic mesh reconstruction
. Revision to a hinged knee arthroplasty
. Arthrodesis of the knee

Correct Answer & Explanation

. Extensor mechanism allograft reconstruction or synthetic mesh reconstruction

Explanation

Chronic or recurrent disruption of the extensor mechanism after TKA is a devastating complication. Primary repair has a very high failure rate and is generally contraindicated for chronic ruptures. The standard of care for a salvage reconstruction with well-fixed components is either a full extensor mechanism allograft (tibial tubercle, patellar tendon, patella, and quadriceps tendon) or a synthetic mesh reconstruction (e.g., Marlex mesh). Both require prolonged postoperative immobilization in extension.

Question 5906

Topic: 5. Sports Medicine

In the treatment of a chronic patellar tendon rupture following Total Knee Arthroplasty (TKA) using a full extensor mechanism allograft, which of the following intraoperative technical steps is most critical to prevent the most common mode of failure (extensor lag)?

. Tensioning the graft with the knee in 30 degrees of flexion
. Tensioning the allograft tightly in full extension
. Reaming the tibia deeply to accommodate a longer bone block plug
. Preserving the native patella and suturing the allograft over it
. Retaining the native tibial tubercle and performing an overlay graft

Correct Answer & Explanation

. Tensioning the allograft tightly in full extension

Explanation

The most common mode of failure for an extensor mechanism allograft after TKA is stretching out of the graft, leading to a persistent extensor lag. To mitigate this, the allograft must be tensioned tightly with the knee in full extension (0 degrees). Postoperatively, the knee is immobilized in full extension for an extended period (typically 6-8 weeks) before allowing graduated flexion.

Question 5907

Topic: 5. Sports Medicine

A patient presents with an infected TKA and massive extensor mechanism necrosis requiring radical resection. After eradicating the infection, reconstruction of the extensor mechanism is planned. Which of the following is considered the most durable and reliable material for massive full-thickness extensor mechanism defects?

. Whole extensor mechanism allograft (tibial bone block-tendon-patella-quad tendon)
. Primary end-to-end repair with non-absorbable sutures
. Gastrocnemius rotational flap
. Synthetic Dacron mesh alone
. Hamstring autograft

Correct Answer & Explanation

. Whole extensor mechanism allograft (tibial bone block-tendon-patella-quad tendon)

Explanation

Massive defects of the extensor mechanism (especially in revision TKA) cannot be closed primarily. A fresh-frozen complete extensor mechanism allograft is the gold standard for restoring continuity, tightly sutured proximally to the host quadriceps and fixed distally via a bone block in the tibial tubercle. Synthetic mesh is an alternative but historically allografts are standard.

Question 5908

Topic: Knee Sports

What is the primary function of the "screw-home" mechanism in the normal human knee during terminal extension?

. Internal rotation of the tibia to unlock the joint
. Translation of the patella medially
. Tensioning of the posterior cruciate ligament (PCL)
. External rotation of the tibia on the femur to lock the knee in stable extension
. Relaxation of the medial collateral ligament

Correct Answer & Explanation

. External rotation of the tibia on the femur to lock the knee in stable extension

Explanation

Because the medial femoral condyle is larger and longer than the lateral condyle, the tibia must externally rotate a few degrees during the final 10-15 degrees of terminal extension. This "locks" the joint in a highly stable position for prolonged standing, reducing muscular energy requirements.

Question 5909

Topic: Knee Sports

A 22-year-old athlete sustains a non-contact knee injury with a reported 'pop'. Initial radiographs reveal a small avulsion fracture of the lateral aspect of the proximal tibial plateau. This radiographic finding (Segond fracture) is virtually pathognomonic for an injury to which of the following structures?

. Posterior cruciate ligament
. Lateral collateral ligament
. Anterior cruciate ligament
. Medial meniscus
. Posterolateral corner

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion fracture of the anterolateral tibial plateau, specifically involving the insertion of the anterolateral ligament (ALL) or lateral capsular ligament. It is highly specific (pathognomonic) for a tear of the anterior cruciate ligament (ACL).

Question 5910

Topic: Shoulder & Hip Sports

In evaluating a patient with recurrent anterior shoulder instability, the concept of the "glenoid track" is utilized to determine the risk of an engaging Hill-Sachs lesion. The glenoid track width is calculated based on which of the following?

. 83% of the intact glenoid width minus the anterior glenoid bone loss
. The full width of the intact glenoid minus the anterior glenoid bone loss
. 83% of the Hill-Sachs lesion width
. The diameter of the humeral head minus the Hill-Sachs depth
. 75% of the intact glenoid width

Correct Answer & Explanation

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

Explanation

The glenoid track is approximately 83% of the width of the intact inferior glenoid. To calculate the patient's specific track, the width of the anterior glenoid bone defect is subtracted from this value.

Question 5911

Topic: 5. Sports Medicine

Following Anterior Cruciate Ligament (ACL) reconstruction using a Bone-Patellar Tendon-Bone (BPTB) autograft, the graft undergoes a process of "ligamentization". During which phase of this process is the graft mechanically at its weakest?

. Implantation phase (0-2 weeks)
. Early remodeling phase (6-12 weeks)
. Late remodeling phase (6-9 months)
. Maturation phase (1-2 years)
. The graft strength remains constant throughout healing

Correct Answer & Explanation

. Implantation phase (0-2 weeks)

Explanation

The graft undergoes a phase of revascularization and necrosis known as the early remodeling or proliferation phase, typically around 6 to 12 weeks post-operatively. During this time, the structural properties decrease significantly, making the graft mechanically at its weakest.

Question 5912

Topic: 5. Sports Medicine

Which of the following autografts used for anterior cruciate ligament (ACL) reconstruction possesses the highest initial ultimate tensile load compared to the native ACL?

. Bone-patellar tendon-bone (10 mm)
. Quadrupled hamstring tendon
. Quadriceps tendon (10 mm)
. Iliotibial band
. Gracilis tendon alone

Correct Answer & Explanation

. Bone-patellar tendon-bone (10 mm)

Explanation

A quadrupled hamstring autograft has an initial ultimate tensile load exceeding 4000 N. This is the highest among common graft choices and significantly stronger than the native ACL, which has an ultimate tensile load of approximately 2160 N.

Question 5913

Topic: 5. Sports Medicine

A 25-year-old overhead athlete is diagnosed with a Type II SLAP lesion following an MRI arthrogram. According to the Snyder classification, which of the following accurately describes a Type II SLAP tear?

. Degenerative fraying of the superior labrum with an intact biceps anchor
. Detachment of the superior labrum and 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 with detachment of the biceps anchor
. Anteroinferior labral tear extending into the superior labrum

Correct Answer & Explanation

. Degenerative fraying of the superior labrum with an intact biceps anchor

Explanation

A Type II SLAP tear involves the detachment of both the superior labrum and the origin of the long head of the biceps tendon from the supraglenoid tubercle. It is the most common variant requiring surgical repair in overhead athletes.

Question 5914

Topic: Shoulder & Hip Sports

A 35-year-old volleyball player presents with isolated weakness in external rotation of the shoulder but normal abduction strength. An MRI shows a paralabral ganglion cyst causing nerve compression. Where is the cyst most likely located?

. Quadrangular space
. Suprascapular notch
. Spinoglenoid notch
. Triangular interval
. Cubital tunnel

Correct Answer & Explanation

. Quadrangular space

Explanation

Isolated weakness of external rotation (infraspinatus) with preserved abduction (supraspinatus) implies compression of the suprascapular nerve after it has innervated the supraspinatus. This occurs at the spinoglenoid notch. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 5915

Topic: Knee Sports

During anterior cruciate ligament (ACL) reconstruction, understanding the functional bundles is key to restoring normal knee kinematics. Which statement correctly describes the tension patterns of the native ACL bundles?

. The anteromedial bundle is tight in extension and the posterolateral bundle is tight in flexion.
. The anteromedial bundle is tight in flexion and the posterolateral bundle is tight in extension.
. Both bundles are tightest at 90 degrees of flexion.
. The posterolateral bundle restricts anterior translation most effectively at 90 degrees of flexion.
. The anteromedial bundle provides the main restraint to internal rotation in full extension.

Correct Answer & Explanation

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

Explanation

The ACL consists of two main bundles named for their tibial insertion: anteromedial (AM) and posterolateral (PL). The AM bundle tightens in flexion, providing the primary restraint to anterior translation at 90 degrees of flexion. The PL bundle is tight in extension, providing rotational stability and limiting anterior translation near full extension.

Question 5916

Topic: Shoulder & Hip Sports

The rotator interval is a capsular space in the shoulder that is often implicated in glenohumeral instability and adhesive capsulitis. What are the correct boundaries of the rotator interval?

. Supraspinatus superiorly, subscapularis inferiorly, and the base of the coracoid medially.
. Teres minor superiorly, subscapularis inferiorly, and the glenoid medially.
. Infraspinatus superiorly, supraspinatus inferiorly, and the acromion medially.
. Long head of biceps superiorly, short head of biceps inferiorly, and the transverse humeral ligament laterally.
. Subscapularis superiorly, pectoralis major inferiorly, and the conjoined tendon medially.

Correct Answer & Explanation

. Supraspinatus superiorly, subscapularis inferiorly, and the base of the coracoid medially.

Explanation

The rotator interval is bounded superiorly by the anterior margin of the supraspinatus tendon, inferiorly by the superior margin of the subscapularis tendon, laterally by the transverse humeral ligament, and medially by the base of the coracoid process. It contains the long head of the biceps tendon, the coracohumeral ligament, and the superior glenohumeral ligament.

Question 5917

Topic: Knee Sports

The posterior cruciate ligament (PCL) is the primary restraint to posterior tibial translation. Which of the following accurately describes its functional bundle anatomy and biomechanics?

. The anterolateral bundle is tight in flexion; the posteromedial bundle is tight in extension.
. The anterolateral bundle is tight in extension; the posteromedial bundle is tight in flexion.
. Both bundles are tightest in full extension.
. The bundles run strictly parallel without crossing each other in any degree of flexion.
. The anteromedial bundle is tight in flexion; the posterolateral bundle is tight in extension.

Correct Answer & Explanation

. The anterolateral bundle is tight in flexion; the posteromedial bundle is tight in extension.

Explanation

The PCL consists of the larger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. The AL bundle is tight in flexion, whereas the PM bundle is tight in extension. This is conceptually the reverse of the ACL bundles, where the AM is tight in flexion and PL in extension.

Question 5918

Topic: Shoulder & Hip Sports

During closed reduction of a proximal humerus fracture, a patient sustains an iatrogenic injury to the axillary nerve. Which of the following muscles would most likely demonstrate denervation on electromyography?

. Supraspinatus and Infraspinatus
. Teres major and Subscapularis
. Deltoid and Teres minor
. Pectoralis major and Deltoid
. Latissimus dorsi and Teres major

Correct Answer & Explanation

. Supraspinatus and Infraspinatus

Explanation

The axillary nerve is derived from the posterior cord of the brachial plexus (C5-C6). It provides motor innervation to the deltoid and the teres minor muscles, and provides sensation to the lateral aspect of the shoulder via the superior lateral brachial cutaneous nerve.

Question 5919

Topic: Knee Sports
Anatomic reconstruction of the medial patellofemoral ligament (MPFL) requires precise femoral tunnel placement. Where is the normal anatomical footprint of the MPFL on the femur located in relation to palpable osseous landmarks?
. Proximal to the adductor tubercle
. Distal to the adductor tubercle and proximal to the medial epicondyle
. Distal to the medial epicondyle
. Anterior to the adductor tubercle
. Directly on the medial joint line

Correct Answer & Explanation

. Distal to the adductor tubercle and proximal to the medial epicondyle

Explanation

The femoral footprint of the MPFL is located in a saddle-like depression. It is situated distal to the adductor tubercle, and proximal and slightly posterior to the medial epicondyle. Accurate identification of this site (radiographically approximated by Schöttle's point) is crucial for a successful MPFL reconstruction to ensure isometric graft behavior.

Question 5920

Topic: 5. Sports Medicine

When harvesting hamstring autografts for ACL reconstruction, the surgeon must identify the pes anserinus. From anterior to posterior, what is the correct arrangement of the tendons at their insertion on the proximal medial tibia?

. Sartorius, Gracilis, Semitendinosus
. Gracilis, Sartorius, Semitendinosus
. Semitendinosus, Gracilis, Sartorius
. Sartorius, Semitendinosus, Gracilis
. Semitendinosus, Sartorius, Gracilis

Correct Answer & Explanation

. Sartorius, Gracilis, Semitendinosus

Explanation

The correct anterior-to-posterior orientation of the pes anserinus insertion is Sartorius, Gracilis, and Semitendinosus. A useful mnemonic is 'Say Grace before Tea'.

Test Yourself

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

On this Page