Menu

5. Sports Medicine MCQs

Practice Set 303 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 6041

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. He exhibits increased external rotation and decreased internal rotation (GIRD) compared to the contralateral side. What is the primary pathophysiologic mechanism of this condition?

. Impingement of the supraspinatus against the coracoacromial arch
. Contact of the articular surface of the rotator cuff with the posterosuperior glenoid
. Traction injury to the long head of the biceps during deceleration
. Contracture of the anterior capsule causing posterior translation
. Subcoracoid impingement of the subscapularis tendon

Correct Answer & Explanation

. Impingement of the supraspinatus against the coracoacromial arch

Explanation

This patient has internal impingement, common in overhead athletes. It occurs during extreme abduction and external rotation (late cocking phase), leading to pathologic contact between the articular surface of the posterior rotator cuff (supraspinatus/infraspinatus) and the posterosuperior glenoid and labrum.

Question 6042

Topic: 5. Sports Medicine

A 21-year-old athlete undergoes an anatomic posterolateral corner (PLC) reconstruction. The fibular collateral ligament (FCL) graft is being secured on the femur. What are the correct anatomic landmarks for the femoral footprint of the FCL?

. Posterior and proximal to the popliteus insertion
. Anterior and distal to the popliteus insertion
. Directly centered on the lateral epicondyle
. Posterior and distal to the popliteus insertion
. Anterior and proximal to the popliteus insertion

Correct Answer & Explanation

. Posterior and proximal to the popliteus insertion

Explanation

On the lateral femoral condyle, the anatomic footprint of the fibular collateral ligament (FCL) is situated approximately 18.5 mm proximal and posterior to the popliteus tendon insertion.

Question 6043

Topic: Shoulder & Hip Sports
A 35-year-old weightlifter feels a "pop" in his anterior shoulder during a heavy bench press. He now has increased passive external rotation and profound weakness in internal rotation. He tests positive on the bear hug test. Which of the following associated injuries is most likely present given this pathology?
. Bony Bankart lesion
. Biceps pulley lesion with medial subluxation of the long head of the biceps
. Superior labrum anterior to posterior (SLAP) type II tear
. Teres minor tear
. Posterior capsular avulsion (POLPSA)

Correct Answer & Explanation

. Biceps pulley lesion with medial subluxation of the long head of the biceps

Explanation

Acute subscapularis tears, particularly traumatic ruptures in younger patients, are highly associated with damage to the biceps pulley (superior glenohumeral ligament and coracohumeral ligament). This leads to medial subluxation or dislocation of the long head of the biceps tendon out of the bicipital groove.

Question 6044

Topic: 5. Sports Medicine

A 19-year-old soccer player has a symptomatic 2.5 cm^2 full-thickness chondral defect on the weight-bearing surface of the medial femoral condyle. He has failed conservative management. What is the most appropriate surgical treatment that provides hyaline-like cartilage repair for a defect of this size?

. Microfracture
. Osteochondral autograft transfer (OATS)
. Autologous chondrocyte implantation (ACI)
. Osteochondral allograft transplantation
. Debridement and subchondral drilling

Correct Answer & Explanation

. Microfracture

Explanation

For a 2.5 cm^2 defect (>2 cm^2), microfracture is relatively contraindicated (fails to provide durable hyaline-like cartilage) and OATS carries high donor site morbidity. Autologous chondrocyte implantation (ACI) provides hyaline-like cartilage and is the standard of care for symptomatic defects between 2 and 10 cm^2 in young patients.

Question 6045

Topic: Shoulder & Hip Sports

A 28-year-old professional volleyball player presents with vague posterior shoulder pain and weakness in external rotation. Examination reveals isolated atrophy of the infraspinatus muscle.

Where is the most likely site of neural compression?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Thoracic outlet

Correct Answer & Explanation

. Suprascapular notch

Explanation

The suprascapular nerve innervates both the supraspinatus and infraspinatus. Compression at the suprascapular notch affects both muscles. Compression further distal at the spinoglenoid notch (often due to a paralabral cyst associated with a posterior labral tear) selectively denervates the infraspinatus, sparing the supraspinatus.

Question 6046

Topic: Knee Sports

A 14-year-old male presents with knee pain and catching. Radiographs demonstrate a classical osteochondritis dissecans (OCD) lesion.

What is the most common anatomical location for this lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central trochlea
. Inferior pole of the patella
. Weight-bearing surface of the medial tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for osteochondritis dissecans (OCD) of the knee is the lateral aspect of the medial femoral condyle (accounting for 70-80% of all knee OCD lesions), classically remembered by the mnemonic LAME (Lateral Aspect Medial Epicondyle/condyle).

Question 6047

Topic: Knee Sports

During an arthroscopic posterior cruciate ligament (PCL) reconstruction using a single-bundle technique, the tibial tunnel is prepared.

Which of the following describes the correct anatomic trajectory of the PCL tibial guide pin to optimize footprint coverage while avoiding neurovascular injury?

. Just proximal to the "killer turn" on the anterior tibia
. 7 mm anterior to the posterior tibial cortex, in the distal aspect of the PCL facet
. Directly through the posterior horn of the medial meniscus
. Medial to the medial tibial spine
. Directly adjacent to the popliteal artery

Correct Answer & Explanation

. Just proximal to the "killer turn" on the anterior tibia

Explanation

The anatomic tibial footprint of the PCL is located in the posterior aspect of the tibia (PCL facet). The guide pin should be placed approximately 7 mm anterior to the posterior tibial cortex. This ensures a complete cortical rim remains for tunnel integrity and minimizes the risk of posterior pin penetration injuring the popliteal neurovascular bundle.

Question 6048

Topic: Shoulder & Hip Sports

A 60-year-old male undergoes arthroscopic rotator cuff repair.

To optimize tendon-to-bone healing, the surgeon decorticates the greater trochanter footprint. What is the primary histological mechanism of healing at the tendon-bone interface following this repair?

. Primary bone healing with direct remodeling
. Formation of a native four-zone transitional structure
. Fibrovascular scar tissue formation
. Direct regeneration of Sharpey's fibers without scar
. Intramembranous ossification of the distal tendon

Correct Answer & Explanation

. Primary bone healing with direct remodeling

Explanation

Following surgical rotator cuff repair, the healing process does not reliably regenerate the native four-zone transitional anatomy (tendon, uncalcified fibrocartilage, calcified fibrocartilage, bone). Instead, it heals primarily by fibrovascular scar tissue formation, which is structurally and biomechanically weaker than the native insertion.

Question 6049

Topic: Knee Sports

A 16-year-old female dancer experiences her first episode of acute lateral patellar dislocation. Radiographs show no osteochondral loose bodies. MRI confirms an isolated full-thickness tear of the medial patellofemoral ligament (MPFL).

What is the most common site of MPFL injury in an acute lateral patellar dislocation?

. Patellar insertion
. Mid-substance of the ligament
. Femoral origin
. Tibial insertion
. Junction with the vastus medialis obliquus (VMO)

Correct Answer & Explanation

. Patellar insertion

Explanation

In the setting of an acute primary lateral patellar dislocation, the medial patellofemoral ligament (MPFL) most commonly tears at its femoral origin, which is located in the saddle region between the adductor tubercle and the medial epicondyle.

Question 6050

Topic: 5. Sports Medicine

A 20-year-old female ballet dancer presents with a palpable and audible "snap" over her deep anterior groin when she extends her hip from a flexed, abducted, and externally rotated position.

Dynamic ultrasound evaluation demonstrates a tendon snapping over a bony prominence. What is the most likely diagnosis?

. External coxa saltans
. Internal coxa saltans
. Intra-articular snapping hip
. Sports hernia
. Osteitis pubis

Correct Answer & Explanation

. External coxa saltans

Explanation

Internal coxa saltans (snapping hip syndrome) is caused by the iliopsoas tendon snapping over the iliopectineal eminence or the anterior femoral head during extension of the hip from a flexed, abducted, and externally rotated position. External coxa saltans involves the IT band snapping over the greater trochanter.

Question 6051

Topic: Knee Sports

A 45-year-old male feels a pop in his posterior knee while squatting. MRI shows a medial meniscus posterior root tear. What is the primary biomechanical consequence of leaving this specific lesion untreated?

. Decreased contact area and increased peak contact pressures, equivalent to a total meniscectomy.
. Increased anterior translation of the tibia, equivalent to an anterior cruciate ligament tear.
. Increased valgus laxity, secondary to medial collateral ligament attenuation.
. Decreased peak contact pressures, leading to disuse osteopenia of the medial compartment.
. No significant biomechanical change, as the anterior root remains intact.

Correct Answer & Explanation

. Decreased contact area and increased peak contact pressures, equivalent to a total meniscectomy.

Explanation

A posterior root tear of the medial meniscus disrupts hoop stresses, leading to meniscal extrusion. Biomechanically, this failure is equivalent to a total meniscectomy, causing significantly increased peak contact pressures and rapid articular cartilage degeneration.

Question 6052

Topic: Knee Sports

During an arthroscopic anterior cruciate ligament (ACL) reconstruction, the femoral tunnel is inadvertently placed too anteriorly within the intercondylar notch. What is the most likely clinical consequence during postoperative rehabilitation?

. Excessive anterior knee laxity in deep flexion.
. Loss of full knee flexion due to graft tensioning.
. Loss of full knee extension due to impingement.
. Persistent anterior knee pain resembling patellar tendinopathy.
. Development of a postoperative patellar clunk syndrome.

Correct Answer & Explanation

. Excessive anterior knee laxity in deep flexion.

Explanation

An anteriorly placed femoral tunnel causes the ACL graft to tighten excessively as the knee transitions into flexion. This over-tensioning captures the joint, leading to a restricted arc of motion and a significant loss of full knee flexion.

Question 6053

Topic: Knee Sports

A 25-year-old football player presents with an acute knee injury. The Dial test demonstrates 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side, but symmetric external rotation at 90 degrees of flexion. What is the most likely injury pattern?

. Isolated Posterior Cruciate Ligament (PCL) injury.
. Isolated Posterolateral Corner (PLC) injury.
. Combined PCL and PLC injury.
. Isolated Medial Collateral Ligament (MCL) injury.
. Combined ACL and PLC injury.

Correct Answer & Explanation

. Isolated Posterior Cruciate Ligament (PCL) injury.

Explanation

Increased external tibial rotation at 30 degrees of flexion, which normalizes at 90 degrees, is the hallmark of an isolated posterolateral corner (PLC) injury. If external rotation is increased at both 30 and 90 degrees, it strongly suggests a combined PLC and PCL injury.

Question 6054

Topic: Shoulder & Hip Sports

A 22-year-old rugby player suffers recurrent anterior shoulder instability. 3D CT reconstruction demonstrates 12% anterior glenoid bone loss and a deep, engaging Hill-Sachs lesion. Which of the following is the most appropriate surgical management?

. Isolated arthroscopic Bankart repair.
. Latarjet procedure with coracoid transfer.
. Arthroscopic Bankart repair combined with a Remplissage procedure.
. Open anterior capsular shift without osseous intervention.
. Iliac crest bone grafting to the anterior glenoid.

Correct Answer & Explanation

. Isolated arthroscopic Bankart repair.

Explanation

An engaging Hill-Sachs lesion combined with subcritical glenoid bone loss (<20-25%) is optimally managed with an arthroscopic Bankart repair and a Remplissage procedure. Remplissage prevents engagement by tenodesing the infraspinatus and posterior capsule into the Hill-Sachs defect.

Question 6055

Topic: Knee Sports
When performing a medial patellofemoral ligament (MPFL) reconstruction, accurate placement of the femoral attachment is critical to prevent graft anisometry. Based on Schรถttle's anatomic landmarks, where is the correct femoral footprint of the MPFL located?
. Distal to the medial epicondyle.
. Proximal to the adductor tubercle.
. In the saddle-like depression between the adductor tubercle and the medial epicondyle.
. Anterior to the medial collateral ligament origin on the femoral condyle.
. On the medial aspect of the patellar tendon insertion.

Correct Answer & Explanation

. In the saddle-like depression between the adductor tubercle and the medial epicondyle.

Explanation

The native MPFL femoral footprint is anatomically located in the saddle-like groove between the adductor tubercle (proximally) and the medial epicondyle (distally). Non-anatomic placement, particularly too proximal, leads to graft tightening in knee flexion and patellofemoral overload.

Question 6056

Topic: Shoulder & Hip Sports

A 28-year-old semi-professional baseball pitcher presents with recurrent anterior glenohumeral instability despite dedicated rehabilitation. He has suffered 5 dislocations in the past 18 months. An axial CT scan reveals a glenoid bone loss of approximately 28% and an engaging Hill-Sachs lesion. The image provided shows a representative axial CT view of a shoulder with bone loss.

What is the most appropriate surgical management for this patient?

. Arthroscopic Bankart repair with Remplissage
. Open Bankart repair with suture anchors
. Latarjet procedure
. Thermal capsulorrhaphy and labral repair
. Non-operative management with continued physical therapy and activity modification

Correct Answer & Explanation

. Arthroscopic Bankart repair with Remplissage

Explanation

The Latarjet procedure is indicated for recurrent anterior glenohumeral instability in patients with significant glenoid bone loss (typically >20-25%) or an engaging Hill-Sachs lesion, especially in high-demand athletes. This procedure addresses both the glenoid bone defect and the humeral head defect, providing a robust bony block to prevent recurrence. Arthroscopic or open Bankart repairs alone are insufficient for significant bone loss. Remplissage addresses the Hill-Sachs but doesn't restore glenoid bone. Thermal capsulorrhaphy is rarely used due to high failure rates and concerns for chondrolysis.

Question 6057

Topic: Shoulder & Hip Sports

A 45-year-old heavy laborer presents with an irreparable massive rotator cuff tear involving the supraspinatus and infraspinatus. The subscapularis and teres minor are intact, and he lacks active external rotation. Which of the following is the most appropriate surgical option?

. Reverse total shoulder arthroplasty
. Latissimus dorsi tendon transfer
. Pectoralis major tendon transfer
. Lower trapezius tendon transfer
. Arthroscopic superior capsule reconstruction

Correct Answer & Explanation

. Reverse total shoulder arthroplasty

Explanation

Latissimus dorsi transfer is indicated for younger, active patients with irreparable posterosuperior cuff tears (supraspinatus and infraspinatus) and an intact subscapularis. Pectoralis major transfers are reserved for subscapularis tears, while reverse TSA is generally for older, lower-demand patients or those with arthropathy.

Question 6058

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player complains of vague posterior shoulder pain. On examination, he has full active abduction but marked weakness in external rotation. MRI reveals a paralabral cyst at the spinoglenoid notch. Which muscle(s) will show denervation changes on EMG?

. Supraspinatus only
. Infraspinatus only
. Both supraspinatus and infraspinatus
. Teres minor only
. Deltoid and teres minor

Correct Answer & Explanation

. Supraspinatus only

Explanation

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

Question 6059

Topic: Shoulder & Hip Sports

A 35-year-old male presents to the ER after a generalized seizure. His arm is locked in internal rotation and he cannot passively externally rotate past 0 degrees. An AP radiograph shows a symmetric, rounded humeral head ('lightbulb sign').

CT imaging is obtained. What specific osseous defect is most likely to be present on the humeral head?

. Posterosuperior defect (Hill-Sachs lesion)
. Anteroinferior glenoid fracture (Bony Bankart)
. Posterior glenoid rim fracture
. Anteromedial defect (Reverse Hill-Sachs lesion)
. Lesser tuberosity avulsion

Correct Answer & Explanation

. Posterosuperior defect (Hill-Sachs lesion)

Explanation

Posterior shoulder dislocations are classically associated with a 'Reverse Hill-Sachs' lesion, which is an impaction fracture on the anteromedial aspect of the humeral head caused by the posterior glenoid rim.

Question 6060

Topic: Shoulder & Hip Sports

A 45-year-old heavy laborer presents with deep shoulder pain and mechanical catching. MRI arthrogram reveals a Type II SLAP tear. Given his age and occupational demands, current literature suggests which surgical intervention provides the most reliable return to work and pain relief?

. Debridement of the labrum only
. Anatomic arthroscopic SLAP repair with suture anchors
. Open capsular shift
. Biceps tenodesis
. Coracoid transfer (Latarjet)

Correct Answer & Explanation

. Debridement of the labrum only

Explanation

Recent literature demonstrates that patients over the age of 40, especially laborers, have higher complication rates and stiffness with SLAP repairs. Biceps tenodesis provides superior, reliable outcomes in this demographic.

Test Yourself

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

On this Page