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5. Sports Medicine MCQs

Practice Set 298 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 5941

Topic: Shoulder & Hip Sports
A baseball pitcher complains of deep shoulder pain during the cocking phase of throwing. MRI arthrogram suggests a Type II SLAP tear. What is the defining 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 that extends into the biceps tendon
. An anteroinferior labral tear extending superiorly

Correct Answer & Explanation

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

Explanation

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

Question 5942

Topic: Knee Sports

In a patient undergoing posterior cruciate ligament (PCL) reconstruction using a tibial inlay technique, the patient is placed in the prone position. The approach to the posterior knee involves dissecting between which two structures to access the PCL footprint?

. Medial head of gastrocnemius and semimembranosus
. Lateral head of gastrocnemius and biceps femoris
. Popliteal artery and tibial nerve
. Semitendinosus and gracilis
. Plantaris and popliteus

Correct Answer & Explanation

. Medial head of gastrocnemius and semimembranosus

Explanation

The posteromedial approach to the knee for a tibial inlay PCL reconstruction utilizes the interval between the medial head of the gastrocnemius (which is retracted laterally to protect the neurovascular bundle) and the semimembranosus (retracted medially). This exposes the posterior joint capsule and the tibial footprint of the PCL.

Question 5943

Topic: Knee Sports

During an anatomic single-bundle anterior cruciate ligament (ACL) reconstruction, the surgeon aims to place the femoral tunnel within the native footprint.

Which of the following osseous landmarks designates the anterior border of the native ACL femoral footprint?

. Medial intercondylar ridge
. Lateral intercondylar ridge (Resident's ridge)
. Lateral bifurcate ridge
. Blumensaat's line
. Posterior articular margin

Correct Answer & Explanation

. Medial intercondylar ridge

Explanation

The lateral intercondylar ridge, also known as Resident's ridge, marks the anterior margin of the ACL footprint on the medial aspect of the lateral femoral condyle. The lateral bifurcate ridge separates the anteromedial and posterolateral bundles.

Question 5944

Topic: Knee Sports

The posterior cruciate ligament (PCL) consists of two main functional bundles. Which of the following statements best describes the biomechanics and relative size of the anterolateral (AL) bundle?

. It is smaller than the posteromedial bundle and is maximally tight in extension.
. It is larger than the posteromedial bundle and is maximally tight in extension.
. It is smaller than the posteromedial bundle and is maximally tight in flexion.
. It is larger than the posteromedial bundle and is maximally tight in flexion.
. It is equal in size to the posteromedial bundle and acts exclusively as a secondary restraint.

Correct Answer & Explanation

. It is smaller than the posteromedial bundle and is maximally tight in extension.

Explanation

The anterolateral (AL) bundle is the larger and stiffer of the two PCL bundles. It is maximally tight in knee flexion, whereas the smaller posteromedial (PM) bundle is tight in extension.

Question 5945

Topic: Knee Sports
A 22-year-old female complains of medial knee pain and an inability to flex her knee past 70 degrees following a medial patellofemoral ligament (MPFL) reconstruction. Which of the following surgical errors is the most likely cause of this complication?
. Femoral tunnel placed too distal and posterior
. Femoral tunnel placed too proximal and anterior
. Patellar fixation placed too superiorly
. Over-tensioning of the graft in 90 degrees of flexion
. Failure to repair the lateral retinaculum

Correct Answer & Explanation

. Femoral tunnel placed too proximal and anterior

Explanation

Placement of the femoral tunnel too proximal and anterior to the anatomic Schöttle's point causes the MPFL graft to become excessively tight in flexion. This leads to restricted knee flexion and elevated medial compartment pressures.

Question 5946

Topic: Shoulder & Hip Sports

A 24-year-old rugby player undergoes a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss.

What is the primary dynamic stabilizing mechanism of this procedure?

. The osseous block increasing the anteroposterior diameter of the glenoid
. The capsular repair to the coracoacromial ligament stump
. The sling effect of the conjoint tendon across the anterior-inferior capsule when the arm is abducted and externally rotated
. The tensioning of the subscapularis muscle belly
. The creation of a functional tenodesis of the long head of the biceps

Correct Answer & Explanation

. The osseous block increasing the anteroposterior diameter of the glenoid

Explanation

While the Latarjet provides an osseous block (static), its primary dynamic stabilizing effect is the 'sling effect'. The conjoint tendon tensions across the anterior-inferior capsule during abduction and external rotation, preventing anterior translation.

Question 5947

Topic: Knee Sports

A patient presents with a suspected multiligamentous knee injury following a motorcycle collision. The Dial test demonstrates 15 degrees of increased external rotation at 30 degrees of flexion compared to the contralateral side, but symmetric external rotation at 90 degrees. This finding is most consistent with an isolated injury to which of the following?

. Posterolateral corner (PLC)
. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Combined PLC and PCL
. Medial collateral ligament (MCL)

Correct Answer & Explanation

. Posterolateral corner (PLC)

Explanation

A positive Dial test (increased external rotation of >10 degrees) at 30 degrees of flexion that reduces at 90 degrees indicates an isolated injury to the posterolateral corner (PLC). If the test is positive at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 5948

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with insidious onset of posterior shoulder pain and isolated weakness in external rotation. MRI reveals a paralabral cyst compressing a nerve at the spinoglenoid notch. Which muscle(s) will most likely exhibit denervation changes on EMG?

. Supraspinatus only
. Infraspinatus only
. Supraspinatus and Infraspinatus
. Teres minor
. Subscapularis

Correct Answer & Explanation

. Supraspinatus only

Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch. Compression at the spinoglenoid notch isolatedly affects the nerve branches to the infraspinatus, causing isolated external rotation weakness.

Question 5949

Topic: Knee Sports

Which of the following descriptions best defines a 'ramp lesion' in the setting of an acute ACL rupture?

. A radial tear of the lateral meniscus mid-body
. A horizontal cleavage tear of the anterior horn of the medial meniscus
. A disruption of the meniscocapsular attachment of the posterior horn of the medial meniscus
. An avulsion of the posterior root of the lateral meniscus
. A bucket-handle tear of the lateral meniscus

Correct Answer & Explanation

. A radial tear of the lateral meniscus mid-body

Explanation

A ramp lesion is a hidden longitudinal tear or disruption of the meniscocapsular junction at the posterior horn of the medial meniscus. It is highly associated with ACL tears and is best visualized arthroscopically via a posteromedial portal.

Question 5950

Topic: Shoulder & Hip Sports

A 25-year-old hockey player presents with chronic groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate an alpha angle of 65 degrees. What is the primary pathomorphologic mechanism of cartilage damage in this condition?

. Contrecoup injury to the posteroinferior labrum
. Delamination of the anterosuperior acetabular cartilage due to a shear force from the femoral neck
. Direct crushing of the anterior labrum between the femoral head and pincer lesion
. Attrition of the ligamentum teres leading to microinstability
. Posterior subluxation of the femoral head causing posterior labral tears

Correct Answer & Explanation

. Contrecoup injury to the posteroinferior labrum

Explanation

An alpha angle >55 degrees is diagnostic of Cam impingement. The non-spherical femoral head exerts severe shear forces on the acetabular rim during flexion, classically causing anterosuperior chondral delamination from the subchondral bone.

Question 5951

Topic: 5. Sports Medicine

In the overhead throwing athlete, a Type II Superior Labrum Anterior to Posterior (SLAP) tear is most commonly generated during which phase of the throwing motion due to the 'peel-back' mechanism?

. Wind-up
. Early cocking
. Late cocking
. Acceleration
. Follow-through

Correct Answer & Explanation

. Wind-up

Explanation

The 'peel-back' mechanism occurs during the late cocking phase of throwing when the shoulder is in maximal abduction and external rotation. This position causes the biceps vector to shift posteriorly, twisting the superior labrum off the glenoid.

Question 5952

Topic: 5. Sports Medicine

A 22-year-old athlete has a symptomatic 3.5 square centimeter full-thickness chondral defect on the weight-bearing surface of the medial femoral condyle. He has normal limb alignment and an intact meniscus. What is the most appropriate, evidence-based surgical intervention?

. Arthroscopic microfracture
. Osteochondral autograft transfer system (OATS)
. Matrix-induced autologous chondrocyte implantation (MACI)
. Fresh osteochondral allograft transplantation
. High tibial osteotomy

Correct Answer & Explanation

. Arthroscopic microfracture

Explanation

For contained, large (>2 cm^2) full-thickness chondral defects in patients with normal alignment, MACI or osteochondral allograft are preferred. Microfracture and OATS are generally reserved for smaller defects (<2 cm^2) due to inferior outcomes and donor site morbidity.

Question 5953

Topic: Knee Sports

Which of the following locations is the classic and most common site for osteochondritis dissecans (OCD) lesions within the knee joint?

. Medial aspect of the medial femoral condyle
. Lateral aspect of the medial femoral condyle
. Central weight-bearing dome of the lateral femoral condyle
. Inferior pole of the patella
. Lateral aspect of the lateral femoral condyle

Correct Answer & Explanation

. Medial aspect of the medial femoral condyle

Explanation

The classic location for an OCD lesion of the knee is the lateral aspect of the medial femoral condyle. This accounts for roughly 70-80% of all knee OCD lesions.

Question 5954

Topic: Knee Sports
A trauma patient presents with a Schenck KD III-L multiligament knee injury (disruption of the ACL, PCL, and posterolateral corner). What is the approximate incidence of common peroneal nerve injury associated with this specific injury pattern?
. < 1%
. 5%
. 25%
. 60%
. 90%

Correct Answer & Explanation

. 25%

Explanation

Multiligament knee injuries involving the posterolateral corner (KD III-L or KD IV) carry the highest risk of common peroneal nerve injury. The reported incidence generally ranges from 16% to 30% (averaging around 25%).

Question 5955

Topic: Shoulder & Hip Sports

A 21-year-old baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. Arthroscopy reveals 'kissing lesions' consisting of fraying of the articular-sided posterior supraspinatus and posterosuperior labrum. This internal impingement pathology is classically associated with which glenohumeral physical exam finding?

. Glenohumeral internal rotation deficit (GIRD)
. Positive belly-press test
. Positive Hornblower's sign
. Increased anterior translation on load and shift test
. Glenohumeral external rotation deficit

Correct Answer & Explanation

. Glenohumeral internal rotation deficit (GIRD)

Explanation

Internal impingement in overhead throwers occurs when the articular side of the rotator cuff impinges against the posterosuperior glenoid. It is classically driven by acquired contracture of the posterior capsule, presenting clinically as Glenohumeral Internal Rotation Deficit (GIRD).

Question 5956

Topic: 5. Sports Medicine

A 24-year-old athlete undergoes an isolated anterior cruciate ligament reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Compared to a hamstring autograft, which of the following is a statistically higher risk postoperatively?

. Graft rupture
. Contralateral ACL tear
. Deep infection
. Anterior knee pain
. Hardware failure

Correct Answer & Explanation

. Graft rupture

Explanation

Bone-patellar tendon-bone (BPTB) autografts are associated with a higher incidence of donor-site morbidity. Specifically, patients experience higher rates of anterior knee pain and kneeling pain compared to those receiving hamstring autografts.

Question 5957

Topic: Knee Sports

When evaluating the posterior cruciate ligament (PCL), it is structurally divided into anterolateral (AL) and posteromedial (PM) bundles. Which of the following best describes their biomechanical behavior?

. Both bundles are tightest in full extension.
. 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 maintain constant tension throughout the arc of motion.
. The PM bundle provides the primary restraint to posterior translation at 90 degrees of flexion.

Correct Answer & Explanation

. Both bundles are tightest in full extension.

Explanation

The larger AL bundle is tightest in flexion and is the primary restraint to posterior translation at 90 degrees. The smaller PM bundle is tightest in full extension.

Question 5958

Topic: Shoulder & Hip Sports

A 19-year-old collegiate wrestler requires a Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. The "sling effect" provided by this procedure is primarily dependent on which of the following structures?

. Coracoacromial ligament
. Pectoralis minor tendon
. Conjoint tendon
. Subscapularis tendon
. Long head of the biceps tendon

Correct Answer & Explanation

. Coracoacromial ligament

Explanation

The Latarjet procedure provides stability via a triple blocking effect. The dynamic "sling effect" of the conjoint tendon across the inferior subscapularis when the arm is abducted and externally rotated is a critical component.

Question 5959

Topic: Shoulder & Hip Sports

In the surgical management of Femoroacetabular Impingement (FAI), a cam lesion is typically addressed. This lesion causes cartilage damage primarily through which of the following mechanisms?

. Chondral delamination on the anterosuperior acetabulum via shear forces
. Global pincer-type compression of the labrum
. Impaction of the fovea capitis against the transverse acetabular ligament
. Hypertrophy of the ligamentum teres
. Avulsion of the rectus femoris origin

Correct Answer & Explanation

. Chondral delamination on the anterosuperior acetabulum via shear forces

Explanation

A cam lesion results from decreased femoral head-neck offset. As it enters the joint in flexion, it creates shear forces that lead to classic outside-in chondral delamination and labral tears at the anterosuperior acetabulum.

Question 5960

Topic: Knee Sports

A patient with recurrent patellar instability is evaluated. Advanced imaging reveals a tibial tubercle to trochlear groove (TT-TG) distance of 24 mm. Which of the following surgical interventions is most appropriate to normalize the extensor mechanism alignment?

. Isolated Medial Patellofemoral Ligament (MPFL) reconstruction
. Lateral retinacular release
. Anteromedialization of the tibial tubercle (Fulkerson osteotomy)
. Distalization of the tibial tubercle
. Trochleoplasty

Correct Answer & Explanation

. Isolated Medial Patellofemoral Ligament (MPFL) reconstruction

Explanation

A TT-TG distance greater than 20 mm is a classic indication for an anteromedial tibial tubercle osteotomy (Fulkerson procedure). This effectively centralizes the patella and decreases lateral translation forces.

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