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5. Sports Medicine MCQs

Practice Set 302 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 6021

Topic: Knee Sports
A 16-year-old female presents with recurrent patellar dislocations. Imaging reveals a ruptured medial patellofemoral ligament (MPFL). If the surgeon plans a reconstruction, the anatomic femoral attachment of the MPFL (Schöttle point) should be located in relation to which osseous landmarks on a true lateral radiograph?
. Anterior to the posterior femoral cortical line and proximal to the posterior aspect of Blumensaat's line
. Posterior to the posterior femoral cortical line and proximal to the posterior aspect of Blumensaat's line
. Anterior to the posterior femoral cortical line and distal to the posterior aspect of Blumensaat's line
. Between the medial epicondyle and the adductor tubercle, directly on the posterior femoral cortical line
. At the direct center of the medial epicondyle

Correct Answer & Explanation

. Anterior to the posterior femoral cortical line and proximal to the posterior aspect of Blumensaat's line

Explanation

The Schöttle point represents the radiographic femoral origin of the MPFL. On a true lateral radiograph, it is situated 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior aspect of Blumensaat's line. Clinically, it lies in the saddle between the adductor tubercle and the medial epicondyle.

Question 6022

Topic: Knee Sports

A 55-year-old patient undergoes an arthroscopic partial meniscectomy for an isolated posterior horn tear of the medial meniscus. Intraoperatively, the tear is identified as a complete radial tear located 2 mm from the posterior bony attachment. Which of the following correctly describes the biomechanical consequence of leaving this root tear un-repaired?

. Normal hoop stresses are maintained, leading to a good long-term prognosis
. It is biomechanically equivalent to a total meniscectomy
. It causes increased stress purely on the lateral compartment
. It primarily destabilizes the anterior cruciate ligament in translation
. It causes an increase in patellofemoral contact pressures

Correct Answer & Explanation

. Normal hoop stresses are maintained, leading to a good long-term prognosis

Explanation

A complete medial meniscus posterior root tear disrupts the circumferential hoop fibers, completely un-tethering the meniscus. Biomechanical studies have shown this renders the meniscus non-functional, equating the contact pressures in the medial compartment to those seen following a total medial meniscectomy. This often leads to rapid articular cartilage wear and spontaneous osteonecrosis or insufficiency fractures if not repaired.

Question 6023

Topic: Shoulder & Hip Sports

A 60-year-old female presents with lateral hip pain that radiates down her lateral thigh. She reports pain when rising from a seated position and lying on the affected side. On exam, she has a positive Trendelenburg sign and weakness in hip abduction. Trochanteric bursitis treatments have failed. MRI reveals a full-thickness tear of the gluteus medius tendon. At which anatomic footprint does this tendon most commonly tear?

. Anterior facet of the greater trochanter
. Lateral facet of the greater trochanter
. Posterior superior facet of the greater trochanter
. Lesser trochanter
. Intertrochanteric crest

Correct Answer & Explanation

. Anterior facet of the greater trochanter

Explanation

The gluteus medius inserts primarily on the lateral and superoposterior facets of the greater trochanter. Tears of the 'rotator cuff of the hip' most commonly involve the gluteus medius at the lateral facet of the greater trochanter. The gluteus minimus inserts on the anterior facet.

Question 6024

Topic: Shoulder & Hip Sports

A 22-year-old professional baseball pitcher presents with posterior shoulder pain. On exam, he has a 25-degree deficit in glenohumeral internal rotation (GIRD) compared to his non-throwing arm, but total arc of motion is equal bilaterally. When his shoulder is placed in 90 degrees of abduction and maximal external rotation, he complains of deep posterior pain. What is the classic pathoanatomic finding on arthroscopy for 'Internal Impingement' in this population?

. Impingement of the anterior supraspinatus against the coracoacromial arch
. Impingement of the articular-sided posterior supraspinatus and anterior infraspinatus against the posterosuperior glenoid labrum
. Subcoracoid impingement of the subscapularis
. Impingement of the biceps tendon against the superior glenoid tubercle
. Impingement of the bursal-sided rotator cuff against the acromion

Correct Answer & Explanation

. Impingement of the anterior supraspinatus against the coracoacromial arch

Explanation

Internal impingement classically occurs in overhead athletes during the late cocking phase of throwing (abduction/external rotation). It involves the pathological contact (impingement) of the articular-sided fibers of the posterosuperior rotator cuff (supraspinatus and infraspinatus) against the posterosuperior glenoid labrum, often exacerbated by posterior capsular contracture (GIRD) and anterior capsular laxity.

Question 6025

Topic: Shoulder & Hip Sports

A 34-year-old recreational weightlifter presents with severe shoulder pain and inability to actively internally rotate the shoulder after a forceful extension injury. On exam, he has increased passive external rotation compared to the normal side and a positive 'lift-off' test. An MRI confirms an isolated subscapularis tendon rupture. Which accompanying pathology is most frequently associated with a complete rupture of the upper subscapularis?

. Medial dislocation of the long head of the biceps tendon
. SLAP tear
. Supraspinatus bursal-sided tear
. Coracohumeral ligament contracture
. Teres minor atrophy

Correct Answer & Explanation

. Medial dislocation of the long head of the biceps tendon

Explanation

The upper fibers of the subscapularis provide the medial stabilizing sling for the long head of the biceps tendon at the bicipital groove. A tear of the upper subscapularis often disrupts this transverse humeral ligament/medial sling complex, leading to medial subluxation or frank dislocation of the long head of the biceps tendon into the joint.

Question 6026

Topic: Shoulder & Hip Sports

A 29-year-old professional volleyball player complains of isolated, painless weakness of the throwing arm. On physical examination, she demonstrates marked weakness in active external rotation with the arm at the side, but normal internal rotation, normal abduction, and no sensory deficits. An MRI is performed. What is the most likely pathological finding?

. Paralabral cyst in the suprascapular notch
. Paralabral cyst in the spinoglenoid notch
. Quadrilateral space syndrome compressing the axillary nerve
. Thoracic outlet syndrome
. Complete tear of the supraspinatus tendon

Correct Answer & Explanation

. Paralabral cyst in the suprascapular notch

Explanation

Isolated weakness of the infraspinatus (external rotation) without supraspinatus involvement (abduction) suggests compression of the suprascapular nerve at the spinoglenoid notch. This is classically caused by a paralabral cyst associated with a posterior labral tear in overhead athletes. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 6027

Topic: Shoulder & Hip Sports

A 19-year-old dancer presents with a painful snapping sensation in her anterior hip when extending her hip from a flexed, abducted, and externally rotated position. An ultrasound demonstrates the iliopsoas tendon snapping over a bony prominence. What is the most common anatomic structure over which the iliopsoas snaps in 'Internal Snapping Hip' (Coxa Saltans Interna)?

. Greater trochanter
. Lesser trochanter
. Iliopectineal eminence or anterior femoral head
. Anterior superior iliac spine (ASIS)
. Ischial tuberosity

Correct Answer & Explanation

. Greater trochanter

Explanation

Internal snapping hip (coxa saltans interna) is caused by the iliopsoas tendon catching or snapping over the iliopectineal eminence or the anterior capsule/femoral head. External snapping hip involves the iliotibial (IT) band snapping over the greater trochanter.

Question 6028

Topic: Knee Sports

A 14-year-old male presents with non-specific knee pain. Imaging reveals Osteochondritis Dissecans (OCD) of the knee. What is the most common anatomical location for an OCD lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central weight-bearing surface of the medial femoral condyle
. Patellar articular surface
. Tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location (accounting for roughly 70-80% of cases) for an OCD lesion in the knee is the lateral aspect of the medial femoral condyle (LAME - Lateral Aspect Medial Epicondyle/Condyle). This is thought to be related to repeated impingement from the tibial spine or localized vascular insufficiency.

Question 6029

Topic: Knee Sports
A 25-year-old male sustains a dashboard injury during a motor vehicle collision. Physical examination reveals a grade III posterior sag sign. A posterior cruciate ligament (PCL) reconstruction is planned. What distinct biomechanical advantage does the tibial inlay technique offer over the traditional transtibial technique for PCL reconstruction?
. Avoids violation of the anterior tibial cortex
. Reduces the acute angle ('killer turn') at the posterior tibial aperture
. Preserves the meniscofemoral ligaments of Humphry and Wrisberg
. Allows for a purely all-inside technique without an accessory incision
. Eliminates the need for posteromedial portal placement

Correct Answer & Explanation

. Reduces the acute angle ('killer turn') at the posterior tibial aperture

Explanation

The primary biomechanical advantage of the tibial inlay technique over the transtibial technique in PCL reconstruction is the elimination of the 'killer turn.' In a transtibial reconstruction, the graft must make a sharp acute angle as it exits the posterior tibial tunnel to reach the femoral footprint. This acute angle can lead to graft abrasion, attenuation, and eventual failure over time. The tibial inlay technique involves an open posterior approach where a bone block is fixed directly to the posterior tibial footprint, avoiding this sharp turn.

Question 6030

Topic: Knee Sports

A 22-year-old collegiate soccer player is evaluated for a knee injury. The dial test demonstrates 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the uninjured contralateral side, but symmetric external rotation at 90 degrees of knee flexion. Which of the following is the most likely isolated injured structure?

. Isolated Posterolateral Corner (PLC) injury
. Isolated Posterior Cruciate Ligament (PCL) injury
. Combined PCL and PLC injury
. Isolated Anterior Cruciate Ligament (ACL) injury
. Combined ACL and PLC injury

Correct Answer & Explanation

. Isolated Posterolateral Corner (PLC) injury

Explanation

The dial test is utilized to differentiate between isolated posterolateral corner (PLC) injuries and combined PCL/PLC injuries. Increased external rotation of greater than 10 degrees (compared to the normal knee) at 30 degrees of flexion, with normal rotation at 90 degrees, indicates an isolated PLC injury. If the external rotation is increased at both 30 and 90 degrees, it suggests a combined PLC and PCL injury, as the PCL is a secondary restraint to external rotation at 90 degrees.

Question 6031

Topic: Knee Sports
A 16-year-old female presents with recurrent lateral patellar dislocations. Surgical stabilization with medial patellofemoral ligament (MPFL) reconstruction is indicated. Based on the classic anatomical layers of the medial knee described by Warren and Marshall, the native MPFL is located in which layer?
. Layer I
. Layer II
. Layer III
. Layer IV
. It is an intra-articular, extra-synovial structure

Correct Answer & Explanation

. Layer II

Explanation

According to the classic anatomical description by Warren and Marshall, the medial side of the knee is divided into three layers. Layer I is the superficial layer (sartorius fascia). Layer II contains the superficial medial collateral ligament (sMCL), medial patellofemoral ligament (MPFL), and the posterior oblique ligament (POL). Layer III is the deep layer, containing the joint capsule and deep MCL. Therefore, the MPFL is located in Layer II.

Question 6032

Topic: Shoulder & Hip Sports

A 22-year-old professional baseball pitcher presents with posterior shoulder pain. Physical examination demonstrates Glenohumeral Internal Rotation Deficit (GIRD) with internal rotation decreased by 25 degrees and the total arc of motion decreased by 15 degrees compared to the non-throwing shoulder. What is the primary pathophysiological driver of this true pathologic GIRD?

. Anterior capsular redundancy
. Posterior capsular contracture
. Humeral retrotorsion
. Subscapularis tightness
. Superior labral anterior-posterior (SLAP) tear

Correct Answer & Explanation

. Anterior capsular redundancy

Explanation

In overhead throwing athletes, a loss of internal rotation (GIRD) is common. Physiologic GIRD is characterized by a loss of internal rotation matched by an equal gain in external rotation, resulting in a symmetric total arc of motion; this is primarily due to osseous adaptation (humeral retrotorsion). However, 'pathologic GIRD' is defined by a loss of internal rotation that exceeds the gain in external rotation, resulting in a decreased total arc of motion (>5 degrees difference). This pathologic state is primarily driven by posterior capsular contracture due to repetitive eccentric loading during the deceleration phase of throwing.

Question 6033

Topic: Shoulder & Hip Sports

A 25-year-old hockey player presents with chronic groin pain exacerbated by hip flexion, adduction, and internal rotation. Radiographs reveal an alpha angle of 65 degrees. He is diagnosed with Femoroacetabular Impingement (FAI) and undergoes hip arthroscopy for cam lesion resection. A cam lesion most commonly occurs at which location on the proximal femur?

. Anterolateral head-neck junction
. Posteromedial head-neck junction
. Anterior greater trochanter
. Fovea capitis
. Intertrochanteric crest

Correct Answer & Explanation

. Anterolateral head-neck junction

Explanation

Cam-type femoroacetabular impingement (FAI) is caused by an aspherical femoral head or a decreased head-neck offset, leading to abutment against the acetabular rim. This prominent bone (cam lesion) most commonly forms at the anterolateral head-neck junction. An alpha angle > 55 degrees on a modified Dunn or frog-leg lateral radiograph is diagnostic of a cam lesion.

Question 6034

Topic: 5. Sports Medicine

A 28-year-old professional soccer player presents with chronic lower abdominal and proximal medial thigh pain unresponsive to 6 months of nonoperative management. MRI reveals a core muscle injury (athletic pubalgia). The primary pathology typically involves a disruption or imbalance at the confluence of which two structures?

. Rectus abdominis and adductor longus
. External oblique and pectineus
. Transversalis fascia and adductor brevis
. Rectus femoris and iliopsoas
. Sartorius and tensor fascia lata

Correct Answer & Explanation

. Rectus abdominis and adductor longus

Explanation

Athletic pubalgia, or 'sports hernia,' represents a core muscle injury involving the pubic aponeurosis. The primary anatomic pathology is a disruption or imbalance of the opposing forces at the pubic symphysis, specifically the insertion of the rectus abdominis (which pulls superiorly) and the origin of the adductor longus (which pulls inferiorly). Injury to the conjoint tendon of these structures leads to the classic severe lower abdominal and groin pain.

Question 6035

Topic: 5. Sports Medicine

A 45-year-old recreational overhead athlete is diagnosed with an isolated Type II Superior Labrum Anterior and Posterior (SLAP) tear. According to recent literature, what is the expected clinical advantage of primary biceps tenodesis over SLAP repair in this specific patient demographic?

. Higher rates of postoperative stiffness requiring lysis of adhesions
. Lower rates of return to pre-injury sport levels
. Lower reoperation rates and superior patient satisfaction
. Increased risk of rapidly progressive glenohumeral arthritis
. Profound loss of functional supination strength

Correct Answer & Explanation

. Higher rates of postoperative stiffness requiring lysis of adhesions

Explanation

Management of Type II SLAP tears is age-dependent. In patients over 35-40 years of age, SLAP repair is associated with higher rates of postoperative stiffness, lower satisfaction, and higher reoperation rates compared to primary biceps tenodesis. Biceps tenodesis effectively removes the pathological pull of the long head of the biceps on the labrum and provides more predictable pain relief and lower reoperation rates in older athletes.

Question 6036

Topic: Shoulder & Hip Sports

A 50-year-old female marathon runner complains of recalcitrant lateral hip pain. Physical examination demonstrates a positive Trendelenburg sign. MRI confirms a full-thickness tear of the gluteus medius tendon. During an open repair, the surgeon isolates the primary footprint of the gluteus medius. This tendon inserts onto which specific facet(s) of the greater trochanter?

. Anterior facet only
. Lateral and superoposterior facets
. Posterior facet only
. Medial and anterior facets
. Lesser trochanter

Correct Answer & Explanation

. Anterior facet only

Explanation

The gluteus medius, often referred to as the 'rotator cuff of the hip,' has a broad insertion on the greater trochanter. Its primary footprint is located on the lateral and superoposterior facets of the greater trochanter. The gluteus minimus inserts more anteriorly on the anterior facet. The gluteus maximus inserts on the gluteal tuberosity of the femur and the iliotibial band.

Question 6037

Topic: Shoulder & Hip Sports

A 19-year-old ballet dancer complains of a painful popping sensation deep in her anterior hip when she extends her hip from a flexed, abducted, and externally rotated position. Dynamic ultrasound confirms internal coxa saltans. Which anatomical structures are mechanically interacting to cause this snapping?

. Iliotibial band translating over the greater trochanter
. Gluteus maximus tendon snapping over the greater trochanter
. Iliopsoas tendon snapping over the iliopectineal eminence
. Rectus femoris snapping over the anterior inferior iliac spine
. Hamstring tendon snapping over the ischial tuberosity

Correct Answer & Explanation

. Iliotibial band translating over the greater trochanter

Explanation

Internal snapping hip (internal coxa saltans) is caused by the iliopsoas tendon snapping over the iliopectineal eminence or the femoral head, typically when the hip is moved from a flexed, abducted, externally rotated position into extension and internal rotation. External snapping hip involves the iliotibial band or gluteus maximus snapping over the greater trochanter.

Question 6038

Topic: Knee Sports

A 40-year-old male sustains a severe hyperflexion injury to his knee and is diagnosed with a posterior medial meniscal root tear. Which of the following statements best describes the in vivo biomechanical consequence of this specific injury?

. It is biomechanically equivalent to a 20% partial meniscectomy
. It increases resistance to anterior tibial translation
. It results in a complete loss of meniscal hoop stresses
. It preferentially shifts contact forces to the lateral compartment
. It decreases peak articular cartilage contact pressures

Correct Answer & Explanation

. It is biomechanically equivalent to a 20% partial meniscectomy

Explanation

A complete radial tear at the meniscal root functionally detaches the meniscus from its bony tibial anchor. This prevents the conversion of axial loads into circumferential hoop stresses, leading to a complete loss of meniscal hoop stresses. Biomechanically, a medial meniscal root tear is equivalent to a total medial meniscectomy, leading to significantly increased peak contact pressures in the medial compartment and rapid progression of osteoarthritis if left untreated.

Question 6039

Topic: Knee Sports
A 25-year-old professional basketball player presents with persistent medial knee pain. MRI reveals an isolated, unipolar, full-thickness (Outerbridge Grade IV) chondral defect on the weight-bearing surface of the medial femoral condyle, measuring 4.5 cm². The subchondral bone is completely intact without cysts or edema. He has failed nonoperative treatment. Which cartilage restoration procedure is most appropriate?
. Arthroscopic debridement and marrow stimulation (Microfracture)
. Matrix-induced autologous chondrocyte implantation (MACI)
. Osteochondral autograft transfer system (OATS)
. High tibial osteotomy alone
. Unicompartmental knee arthroplasty

Correct Answer & Explanation

. Matrix-induced autologous chondrocyte implantation (MACI)

Explanation

The treatment of focal chondral defects depends on the size of the lesion and the status of the subchondral bone. Microfracture and OATS are generally reserved for smaller lesions (< 2.0 to 2.5 cm²). For a large isolated chondral defect (4.5 cm²) with intact subchondral bone, an autologous chondrocyte implantation (such as MACI) is indicated.

Question 6040

Topic: General Sports & Tendon

A 35-year-old water skier suffers a forceful hip flexion injury with the knee extended, resulting in a 3 cm retracted avulsion of the proximal hamstring complex. During open surgical repair, the surgeon identifies the ischial tuberosity footprint. Which of the following accurately describes the anatomical footprint of the proximal hamstring complex?

. The semimembranosus originates lateral and anterior (superior) to the conjoint tendon
. The semitendinosus originates independently, lateral to the biceps femoris
. The short head of the biceps femoris originates on the medial aspect of the ischial tuberosity
. The sciatic nerve lies medial to the ischial tuberosity origin
. The conjoint tendon forms the superior-most portion of the footprint

Correct Answer & Explanation

. The semimembranosus originates lateral and anterior (superior) to the conjoint tendon

Explanation

The proximal hamstring complex originates on the ischial tuberosity. The footprint is divided into two distinct areas. The semimembranosus originates laterally and anteriorly (superiorly) and has a more crescentic footprint. The conjoint tendon, composed of the long head of the biceps femoris and the semitendinosus, originates medially and posteriorly (inferiorly). The short head of the biceps originates from the linea aspera of the femur, not the ischium. The sciatic nerve lies lateral to the ischial tuberosity.

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