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5. Sports Medicine MCQs

Practice Set 299 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 5961

Topic: Knee Sports

The posterolateral corner (PLC) of the knee is crucial for resisting varus and external rotation forces. Which three structures are considered the primary static stabilizers of the PLC?

. Iliotibial band, fibular collateral ligament, lateral meniscus
. Fibular collateral ligament, popliteus tendon, popliteofibular ligament
. Biceps femoris, lateral gastrocnemius, popliteus tendon
. Fibular collateral ligament, arcuate ligament, fabellofibular ligament
. Popliteus tendon, arcuate ligament, iliotibial band

Correct Answer & Explanation

. Iliotibial band, fibular collateral ligament, lateral meniscus

Explanation

The primary static stabilizers of the posterolateral corner are the fibular collateral ligament (FCL), the popliteus tendon, and the popliteofibular ligament.

Question 5962

Topic: Shoulder & Hip Sports

A 20-year-old football player sustains an anterior shoulder dislocation. MRI reveals an "off-track" Hill-Sachs lesion. In addition to an arthroscopic Bankart repair, which procedure is most indicated to prevent recurrent instability?

. Latarjet procedure
. Arthroscopic remplissage
. Coracoid transfer to the lesser tuberosity
. Pectoralis major transfer
. SLAP repair

Correct Answer & Explanation

. Latarjet procedure

Explanation

An "off-track" Hill-Sachs lesion engages the anterior glenoid rim during abduction and external rotation, predicting failure of isolated Bankart repair. Arthroscopic remplissage (capsulotenodesis of the infraspinatus into the defect) effectively converts it to a non-engaging, on-track lesion.

Question 5963

Topic: Shoulder & Hip Sports

When evaluating a patient with a suspected rotator cuff tear, which of the following physical examination tests is most sensitive and specific for identifying an isolated upper subscapularis tendon tear?

. Jobe's (Empty can) test
. Belly-press test
. Lift-off test
. Bear-hug test
. Hornblower's sign

Correct Answer & Explanation

. Jobe's (Empty can) test

Explanation

The Bear-hug test is highly sensitive and specific for upper subscapularis tears. In contrast, the Lift-off test is more specific to the lower portion of the subscapularis tendon.

Question 5964

Topic: Knee Sports

During posterior cruciate ligament (PCL) reconstruction, understanding the native anatomy is crucial. The PCL consists of two main bundles. Which of the following best describes their tensioning pattern during knee motion?

. Anterolateral bundle is tight in extension, posteromedial bundle is tight in flexion
. Anterolateral bundle is tight in flexion, posteromedial bundle is tight in extension
. Both bundles are maximally tight in terminal extension
. Both bundles are maximally tight at 90 degrees of flexion
. Anterolateral bundle is tight in internal rotation, posteromedial in external rotation

Correct Answer & Explanation

. Anterolateral bundle is tight in extension, posteromedial bundle is tight in flexion

Explanation

The PCL is composed of a larger anterolateral (AL) bundle and a smaller posteromedial (PM) bundle. The AL bundle is tight in flexion and is the primary restraint to posterior translation at 90 degrees, while the PM bundle is tight in extension.

Question 5965

Topic: Knee Sports

A patient presents with a suspected posterolateral corner (PLC) injury of the knee. The dial test demonstrates 15 degrees of increased external rotation compared to the contralateral knee at 30 degrees of flexion, but symmetric rotation at 90 degrees of flexion. What is the most likely injury pattern?

. Isolated PCL injury
. Combined PCL and PLC injury
. Isolated PLC injury
. Isolated ACL injury
. Combined ACL and PLC injury

Correct Answer & Explanation

. Isolated PCL injury

Explanation

A positive dial test (>10 degrees of asymmetric external rotation) isolated to 30 degrees of flexion indicates an isolated PLC injury. If the test remains positive at both 30 and 90 degrees, it suggests a combined PLC and PCL injury.

Question 5966

Topic: Knee Sports

During an anatomic anterior cruciate ligament (ACL) reconstruction, the surgeon places the femoral tunnel too anteriorly (high in the notch). Which of the following best describes the resulting graft tension pattern?

. Tight in extension and loose in flexion
. Tight in flexion and loose in extension
. Equally tight throughout the range of motion
. Equally loose throughout the range of motion
. Tight in both terminal extension and deep flexion

Correct Answer & Explanation

. Tight in extension and loose in flexion

Explanation

A femoral tunnel placed too anteriorly results in a graft that becomes tight in flexion and loose in extension. This non-anatomic placement often leads to restricted knee flexion or eventual graft stretching and failure.

Question 5967

Topic: 5. Sports Medicine

A 24-year-old athlete sustains a multiligament knee injury. Following closed reduction of the knee dislocation, the patient's Ankle-Brachial Index (ABI) is calculated to be 0.85. What is the most appropriate next step in management?

. Immediate surgical vascular exploration
. Observation and repeat ABI in 4 hours
. Magnetic Resonance Angiography (MRA)
. Computed Tomography Angiography (CTA)
. Duplex ultrasonography of the lower extremity

Correct Answer & Explanation

. Immediate surgical vascular exploration

Explanation

An ABI of less than 0.9 following a knee dislocation is indicative of potential arterial injury and mandates further advanced imaging with a CTA. Hard signs of vascular injury, such as expanding hematoma or absent pulses, would require immediate surgical exploration.

Question 5968

Topic: Shoulder & Hip Sports

Which of the following statements accurately describes the calculation of the 'Glenoid Track' in evaluating anterior shoulder instability?

. 83% of the inferior glenoid width minus the anterior glenoid bone loss
. 100% of the inferior glenoid width plus the Hill-Sachs width
. The superior-to-inferior diameter of the glenoid minus the bone loss
. 83% of the superior glenoid width minus the posterior glenoid bone loss
. The distance from the bare spot to the anterior rim multiplied by two

Correct Answer & Explanation

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

Explanation

The glenoid track is calculated as 83% of the normal inferior glenoid width subtracted by the amount of anterior glenoid bone loss. A Hill-Sachs lesion wider than this track is considered 'off-track' and carries a higher risk of engagement and recurrent dislocation.

Question 5969

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with isolated weakness in shoulder external rotation. MRI reveals a paralabral cyst located at the spinoglenoid notch. Which labral pathology is most commonly associated with this specific finding?

. Anterior Bankart tear
. Anterosuperior labral tear
. Posterior SLAP or posteroinferior labral tear
. Superior labral tear extending into the biceps root
. ALPSA lesion

Correct Answer & Explanation

. Anterior Bankart tear

Explanation

Paralabral cysts at the spinoglenoid notch typically cause isolated suprascapular nerve compression affecting only the infraspinatus. They are highly associated with posterior SLAP or posteroinferior labral tears, which allow synovial fluid to leak and form the cyst.

Question 5970

Topic: Shoulder & Hip Sports

During an interscalene nerve block for a rotator cuff repair, the patient inadvertently receives an intravascular injection of bupivacaine and subsequently develops seizures and ventricular arrhythmias. The toxic mechanism of this drug is primarily due to the blockade of which of the following cellular ion channels?

. Voltage-gated calcium channels
. Ligand-gated chloride channels
. Voltage-gated sodium channels
. ATP-sensitive potassium channels
. NMDA receptors

Correct Answer & Explanation

. Voltage-gated calcium channels

Explanation

Local anesthetics like bupivacaine act by binding to the intracellular portion of voltage-gated sodium channels, preventing sodium influx and thus inhibiting action potential propagation. Systemic toxicity (LAST) primarily affects the CNS and myocardium through this same massive sodium channel blockade.

Question 5971

Topic: 5. Sports Medicine

An orthopedic surgeon is selecting a bone graft substitute for filling a metaphyseal defect. Which of the following synthetic graft materials possesses the highest compressive strength but has the slowest rate of in vivo resorption?

. Calcium sulfate
. Demineralized bone matrix
. Calcium phosphate
. Cancellous allograft
. Cortical autograft

Correct Answer & Explanation

. Calcium sulfate

Explanation

Calcium phosphate cements have excellent compressive strength (higher than cancellous bone) but undergo very slow resorption. Conversely, calcium sulfate resorbs rapidly, often faster than the rate of new bone formation.

Question 5972

Topic: Knee Sports

During a cruciate-retaining (CR) total knee arthroplasty, the surgeon notes that the trial components demonstrate anterior lift-off of the tibial tray during deep flexion. What is the most appropriate management step to resolve this intraoperative finding?

. Downsize the femoral component
. Release the posterior cruciate ligament (PCL)
. Release the superficial medial collateral ligament
. Increase the posterior slope of the tibial cut
. Upsize the tibial polyethylene insert

Correct Answer & Explanation

. Downsize the femoral component

Explanation

Anterior lift-off of the tibial tray during deep flexion in a CR knee is a classic sign of a tight posterior cruciate ligament (PCL). Releasing or recessing the PCL will balance the flexion gap and prevent this paradoxical kinematic issue.

Question 5973

Topic: 5. Sports Medicine

A 10-year-old soccer player with widely open physes (Tanner stage 1) sustains an isolated, complete rupture of the anterior cruciate ligament. Operative reconstruction is planned using a completely physeal-sparing technique to avoid growth arrest. Which graft choice and routing strategy best describes the classic modified MacIntosh (Micheli/Kocher) technique?

. Transphyseal hamstring autograft with suspensory cortical fixation
. Bone-patellar tendon-bone autograft drilled directly through the physeal plates
. Iliotibial band autograft routed over the top of the lateral femoral condyle and under the intermeniscal ligament
. Quadriceps tendon autograft using all-inside partial tunnels
. Achilles tendon allograft through standard adult trans-tibial tunnels

Correct Answer & Explanation

. Transphyseal hamstring autograft with suspensory cortical fixation

Explanation

In prepubescent children with significant remaining growth, a completely physeal-sparing technique is indicated. The modified MacIntosh (Micheli/Kocher) technique utilizes an iliotibial band (ITB) autograft. It is left attached distally at Gerdy's tubercle, routed 'over the top' of the lateral femoral condyle (avoiding the distal femoral physis), and passed under the intermeniscal ligament or through the proximal tibial epiphysis (avoiding the proximal tibial physis).

Question 5974

Topic: Knee Sports

An 11-year-old boy complains of intermittent left knee pain after playing basketball. MRI reveals a 1.5 cm stable osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. What is the most important factor predicting successful non-operative healing of this lesion?

. The age of the patient
. The precise size of the lesion
. The location on the medial femoral condyle
. The open status of the distal femoral physis
. The presence of an effusion on examination

Correct Answer & Explanation

. The age of the patient

Explanation

The status of the physes is the most critical prognostic factor for the healing of an OCD lesion. Patients with open physes (juvenile OCD) have a significantly higher rate of spontaneous healing with non-operative management compared to those with closed physes.

Question 5975

Topic: 5. Sports Medicine
A 22-year-old athlete requires surgical intervention for chronic lateral ankle instability after failing 6 months of physical therapy. A modified Broström procedure with a Gould modification is performed. What specific structure is mobilized and advanced to augment the primary ligament repair in the Gould modification?
. Inferior extensor retinaculum
. Superior peroneal retinaculum
. Plantaris tendon
. Peroneus brevis tendon
. Extensor digitorum brevis

Correct Answer & Explanation

. Inferior extensor retinaculum

Explanation

The Gould modification of the Broström procedure involves the proximal advancement of the lateral portion of the inferior extensor retinaculum over the repaired anterior talofibular and calcaneofibular ligaments to reinforce the repair and limit inversion.

Question 5976

Topic: 5. Sports Medicine

A 30-year-old male has an osteochondral lesion of the medial talar dome measuring 1.2 cm x 1.0 cm. He has failed 6 months of conservative management. What is the most appropriate initial surgical treatment?

. Osteochondral autograft transfer (OATS)
. Arthroscopic bone marrow stimulation (microfracture)
. Autologous chondrocyte implantation (ACI)
. Fresh osteochondral allograft
. Ankle arthrodesis

Correct Answer & Explanation

. Osteochondral autograft transfer (OATS)

Explanation

Arthroscopic bone marrow stimulation (microfracture) is the recommended primary surgical treatment for osteochondral lesions of the talus that are <1.5 cm^2 in area. Procedures like OATS or ACI are reserved for larger lesions, cystic lesions, or lesions that have failed primary microfracture.

Question 5977

Topic: 5. Sports Medicine

A professional wide receiver sustains a severe hyperextension injury to his first MTP joint (Turf Toe). MRI reveals a complete rupture of the plantar plate with proximal retraction of the sesamoid apparatus. What is the most appropriate management?

. Turf toe plate and return to play as tolerated
. Short leg walking boot immobilization for 6 weeks
. Surgical repair of the plantar plate
. First MTP arthrodesis
. Complete excision of the sesamoids

Correct Answer & Explanation

. Turf toe plate and return to play as tolerated

Explanation

A Grade 3 turf toe injury, characterized by a complete tear of the plantar plate complex and proximal migration of the sesamoids, typically requires surgical repair in high-level athletes to restore the anatomic stability and push-off strength of the first MTP joint.

Question 5978

Topic: 5. Sports Medicine

A 25-year-old male athlete presents with deep ankle pain 6 months after an inversion injury. MRI reveals a 1.2 cm^2 osteochondral lesion of the medial talar dome with intact overlying cartilage. He has failed non-operative management. What is the most appropriate next step in treatment?

. Arthroscopic marrow stimulation (microfracture)
. Osteochondral autograft transfer (OATS)
. Autologous chondrocyte implantation (ACI)
. Osteochondral allograft
. Tibiotalar arthrodesis

Correct Answer & Explanation

. Arthroscopic marrow stimulation (microfracture)

Explanation

For primary osteochondral lesions of the talus (OCLT) that are < 1.5 cm^2, arthroscopic marrow stimulation (e.g., microfracture or drilling) is the gold standard surgical treatment, providing success rates typically exceeding 80%. OATS or ACI are generally reserved for larger lesions (> 1.5 cm^2), cystic lesions, or secondary lesions that have failed primary marrow stimulation.

Question 5979

Topic: 5. Sports Medicine

A professional football player sustains a hyperdorsiflexion injury to the 1st MTP joint. Clinical examination reveals absent push-off strength and a positive Lachman test of the MTP joint. MRI shows a complete disruption of the plantar plate with proximal retraction of the sesamoids. What is the most appropriate management?

. Stiff-soled shoe insert and early return to play
. Taping the toe in plantarflexion for 4 weeks
. Primary surgical repair of the plantar plate
. First MTP joint arthrodesis
. Sesamoidectomy

Correct Answer & Explanation

. Stiff-soled shoe insert and early return to play

Explanation

This represents a Grade 3 turf toe injury with complete plantar plate disruption and sesamoid retraction. In a professional athlete, primary surgical repair is indicated to restore push-off strength and joint stability.

Question 5980

Topic: 5. Sports Medicine

A 25-year-old female presents with persistent ankle pain 6 months after an inversion sprain. MRI reveals an anterolateral osteochondral lesion of the talus (OCLT) measuring 0.8 cm squared. The cartilage is intact but soft on probing during arthroscopy. What is the most appropriate surgical treatment?

. Osteochondral autograft transfer system (OATS)
. Arthroscopic marrow stimulation (microfracture)
. Fresh osteochondral allograft
. Autologous chondrocyte implantation (ACI)
. Tibiotalar arthrodesis

Correct Answer & Explanation

. Osteochondral autograft transfer system (OATS)

Explanation

For symptomatic primary OCLTs smaller than 1.5 cm squared, arthroscopic bone marrow stimulation (microfracture) is the gold standard first-line surgical treatment. Larger lesions or microfracture failures are typically treated with structural grafting.

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