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5. Sports Medicine MCQs

Practice Set 308 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 6141

Topic: 5. Sports Medicine

An 8-year-old boy presents with an intermittent snapping sensation and catching in the lateral aspect of his left knee. MRI demonstrates a classic complete discoid lateral meniscus. During arthroscopy, the meniscus is found to be hypermobile and translates completely anteriorly with knee extension. Which of the following anatomical variants explains this specific hypermobility?

. Absence of the anterior horn meniscotibial ligament
. Wrisberg variant, lacking the posterior meniscotibial (coronary) ligament
. Tear of the anterior cruciate ligament
. Pathologic hypertrophy of the meniscofemoral ligament of Humphrey
. Anomalous insertion of the popliteus tendon into the meniscus

Correct Answer & Explanation

. Absence of the anterior horn meniscotibial ligament

Explanation

The Wrisberg variant of a discoid meniscus is characterized by an absence of the normal posterior meniscotibial (coronary) ligament attachments. The posterior horn is only tethered by the meniscofemoral ligament of Wrisberg. This lack of posterior capsular attachment allows the meniscus to displace anteriorly into the joint during knee extension, leading to the classic 'snapping knee' syndrome. Treatment requires saucerization and secure stabilization/repair of the posterior horn.

Question 6142

Topic: 5. Sports Medicine

A 10-year-old boy (Tanner stage 1) sustains a midsubstance ACL tear while playing soccer. Following recurrent episodes of instability despite bracing and physical therapy, surgical reconstruction is planned. To minimize the risk of iatrogenic growth arrest, which of the following techniques is most appropriate?

. Transphyseal reconstruction using an 11mm bone-patellar tendon-bone autograft
. Iliotibial band extra-articular tenodesis alone (MacIntosh procedure)
. All-epiphyseal reconstruction using a soft tissue autograft
. Primary repair of the ACL with suture augmentation
. Transphyseal reconstruction utilizing an Achilles tendon allograft with a large bone block

Correct Answer & Explanation

. Transphyseal reconstruction using an 11mm bone-patellar tendon-bone autograft

Explanation

In a skeletally immature patient with significant growth remaining (Tanner stage 1 or 2), techniques that avoid drilling across the physes with bone blocks are preferred to prevent growth arrest (leg length discrepancy or angular deformity). An all-epiphyseal reconstruction using a soft tissue graft (like hamstrings) avoids violating the distal femoral and proximal tibial physes. Bone-patellar tendon-bone grafts are contraindicated due to the high risk of physeal damage from the bone plugs.

Question 6143

Topic: Knee Sports

A newborn is evaluated for a congenital lower extremity deformity. Examination reveals a shortened right leg, anteromedial bowing of the tibia, absence of the lateral two rays of the foot, and a dimple over the anterior aspect of the tibia. What intra-articular knee anomaly is most frequently associated with this diagnosis?

. Absent or hypoplastic posterior cruciate ligament (PCL)
. Absent or hypoplastic anterior cruciate ligament (ACL)
. Habitual patellar dislocation
. Meniscal agenesis
. Discoid lateral meniscus

Correct Answer & Explanation

. Absent or hypoplastic posterior cruciate ligament (PCL)

Explanation

The clinical description is classic for fibular hemimelia. It is the most common congenital long bone deficiency. It is characterized by anteromedial tibial bowing, equinovalgus foot, absent lateral rays, and a shortened limb. In the knee, there is a very high association with an absent or hypoplastic anterior cruciate ligament (ACL), leading to anteroposterior instability, though patients often adapt well functionally without reconstruction.

Question 6144

Topic: 5. Sports Medicine

A 7-year-old girl presents with a prominent snapping sensation and pain in her lateral knee when squatting. Examination reveals a palpable clunk on knee flexion and extension. MRI confirms a complete, symptomatic discoid lateral meniscus with a peripheral tear. What is the most appropriate surgical treatment?

. Complete total meniscectomy
. Partial meniscectomy (saucerization) with peripheral repair
. Non-operative management with a hinged knee brace and NSAIDs
. Meniscal allograft transplantation
. Lateral release and observation

Correct Answer & Explanation

. Complete total meniscectomy

Explanation

Symptomatic discoid menisci, especially those with an associated peripheral tear (Wrisberg variant or standard tear), are best treated with partial meniscectomy (saucerization) to reshape the meniscus to a more normal crescentic form, combined with repair of the peripheral tear. Total meniscectomy is avoided in children due to the extremely high risk of early, severe compartment osteoarthritis.

Question 6145

Topic: Knee Sports

A 9-year-old boy presents with an asymptomatic snapping sensation in his right knee, which his mother notes occurs predominantly when he extends his knee. He has no history of trauma, pain, or swelling. Which of the following anatomic variations is most likely responsible for this symptomatic presentation?

. Absence of the anterior meniscofemoral ligament of Humphrey
. Absence of the posterior meniscotibial attachments of the lateral meniscus
. Abnormal attachment of the medial meniscus to the anterior cruciate ligament
. Bifurcate morphology of the medial meniscus
. Hypertrophy of the transverse intermeniscal ligament

Correct Answer & Explanation

. Absence of the anterior meniscofemoral ligament of Humphrey

Explanation

The patient has the Wrisberg variant of a discoid lateral meniscus. This variant is characterized by the absence of the normal posterior meniscotibial capsular attachments; its only posterior attachment is the meniscofemoral ligament of Wrisberg. This instability allows the meniscus to subluxate anteriorly during knee extension, producing a palpable or audible 'snap' or 'clunk'.

Question 6146

Topic: Knee Sports

A 10-year-old boy presents with a painful, swollen knee after falling off his bicycle. Radiographs reveal a displaced, completely elevated fracture of the anterior tibial spine (Meyers and McKeever Type 3). Which of the following structures is most commonly entrapped, blocking anatomic closed reduction?

. Anterior cruciate ligament
. Transverse intermeniscal ligament
. Anterior horn of the medial meniscus
. Posterior cruciate ligament
. Patellar tendon

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

In Meyers and McKeever Type 3 tibial eminence (spine) fractures, the anterior horn of the medial meniscus is the most common structure that becomes entrapped under the avulsed fragment, blocking anatomic reduction. The intermeniscal ligament can also be involved. This entrapment necessitates arthroscopic or open reduction.

Question 6147

Topic: 5. Sports Medicine

A 9-year-old boy presents with knee pain. Radiographs and an MRI reveal a stable osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. There is no fluid behind the lesion. What is the most appropriate initial management?

. Arthroscopic drilling of the lesion to promote bleeding
. Bioabsorbable pin fixation of the fragment
. Activity modification and protected weight-bearing
. Osteochondral autograft transfer (OATS)
. Autologous chondrocyte implantation (ACI)

Correct Answer & Explanation

. Arthroscopic drilling of the lesion to promote bleeding

Explanation

In a skeletally immature patient with a stable OCD lesion (intact articular cartilage, no fluid behind the lesion on MRI), initial management is non-operative. Activity modification and protected weight-bearing yield a high rate of spontaneous healing.

Question 6148

Topic: Knee Sports

In anterior cruciate ligament (ACL) reconstruction, placing the femoral tunnel too anteriorly (shallow) will result in which of the following kinematic abnormalities?

. Tight in extension and loose in flexion
. Tight in flexion and loose in extension
. Tight in both flexion and extension
. Loose in both flexion and extension
. Impingement in the intercondylar notch in extension

Correct Answer & Explanation

. Tight in extension and loose in flexion

Explanation

An anteriorly placed femoral tunnel (too shallow or anterior to the anatomic footprint) results in the graft being tight in flexion and loose in extension, often limiting full flexion. A posteriorly placed femoral tunnel results in a graft that is tight in extension and loose in flexion. Notch impingement in extension is typically caused by an excessively anterior tibial tunnel.

Question 6149

Topic: Shoulder & Hip Sports

A 20-year-old male undergoes arthroscopic stabilization for recurrent anterior shoulder instability. During the procedure, an anterior-inferior labral tear is identified along with an avulsed piece of the anterior-inferior glenoid rim. What is the eponymous name for this bony avulsion?

. Hill-Sachs lesion
. Bony Bankart lesion
. ALPSA lesion
. GLAD lesion
. HAGL lesion

Correct Answer & Explanation

. Hill-Sachs lesion

Explanation

A bony Bankart lesion is a fracture of the anterior-inferior glenoid rim associated with an anterior shoulder dislocation. A soft tissue Bankart is detachment of the anterior-inferior labrum alone. A Hill-Sachs lesion is a chondral impaction fracture of the posterosuperior humeral head. ALPSA is an anterior labroligamentous periosteal sleeve avulsion. HAGL is a humeral avulsion of the glenohumeral ligament.

Question 6150

Topic: Shoulder & Hip Sports

During arthroscopic repair of a Type II SLAP lesion, a suture anchor is placed at the 11 o'clock position in a right shoulder. Postoperatively, the patient complains of severe pain and weakness with external rotation. An EMG shows denervation of the infraspinatus with a normal supraspinatus. Which structure was most likely injured by errant drill or anchor placement?

. Axillary nerve
. Suprascapular nerve at the suprascapular notch
. Suprascapular nerve at the spinoglenoid notch
. Musculocutaneous nerve
. Spinal accessory nerve

Correct Answer & Explanation

. Axillary nerve

Explanation

Suture anchors placed in the posterosuperior quadrant of the glenoid (10 to 12 o'clock in right shoulder, but commonly cited as 11 o'clock) place the suprascapular nerve at risk as it wraps around the spinoglenoid notch (approximately 1.5 - 2 cm medial to the glenoid rim). Injury at the spinoglenoid notch spares the supraspinatus but denervates the infraspinatus, leading to isolated external rotation weakness.

Question 6151

Topic: Shoulder & Hip Sports

When evaluating a patient with rotator cuff pathology, which of the following best describes a 'massive' rotator cuff tear according to the traditional Cofield classification?

. A tear involving two or more complete tendons
. A tear dimension greater than 3 cm
. A tear dimension greater than 5 cm
. Retraction of the tendon to the glenoid rim
. Fatty infiltration of Goutallier grade 3 or higher

Correct Answer & Explanation

. A tear involving two or more complete tendons

Explanation

According to the Cofield classification of rotator cuff tears, a small tear is < 1 cm, a medium tear is 1-3 cm, a large tear is 3-5 cm, and a massive tear is > 5 cm. While Gerber defines a massive tear as involving two or more complete tendons, the Cofield system relies exclusively on the anterior-to-posterior dimension of the tear being greater than 5 cm.

Question 6152

Topic: Shoulder & Hip Sports

A 22-year-old athlete presents with a recurrent anterior shoulder dislocation. An MRI shows an anterior labral tear and a distinct impaction fracture on the posterolateral aspect of the humeral head. Which of the following best describes this bony defect?

. Reverse Hill-Sachs lesion
. Bankart lesion
. Hill-Sachs lesion
. ALPSA lesion
. GLAD lesion

Correct Answer & Explanation

. Reverse Hill-Sachs lesion

Explanation

An anterior shoulder dislocation can result in the posterolateral aspect of the humeral head impacting forcefully against the hard anterior glenoid rim, causing an impaction fracture known as a Hill-Sachs lesion. A reverse Hill-Sachs lesion is an anteromedial impaction fracture seen with posterior dislocations. A Bankart lesion is an avulsion of the anterior-inferior labrum from the glenoid.

Question 6153

Topic: Knee Sports

A 24-year-old professional soccer player undergoes anterior cruciate ligament (ACL) reconstruction using an autologous bone-patellar tendon-bone graft. The graft must undergo a process of "ligamentization" to restore function. At what postoperative time frame is the structural graft mechanically at its weakest due to the revascularization and necrosis phase?

. 1 to 2 weeks
. 6 to 8 weeks
. 12 to 16 weeks
. 6 to 8 months
. 12 to 18 months

Correct Answer & Explanation

. 1 to 2 weeks

Explanation

The "ligamentization" of a free tendon graft involves stages of necrosis, revascularization, cellular proliferation, and remodeling. The graft is generally at its weakest biomechanical point around 6 to 8 weeks postoperatively, which must be considered when designing rehabilitation protocols to prevent premature failure.

Question 6154

Topic: Knee Sports

A 22-year-old soccer player sustains a twisting injury to his knee. Radiographs reveal an avulsion fracture of the lateral tibial plateau (Segond fracture). This radiographic finding is virtually pathognomonic for an injury to which of the following structures?

. Posterior cruciate ligament (PCL)
. Medial collateral ligament (MCL)
. Anterior cruciate ligament (ACL)
. Lateral collateral ligament (LCL)
. Popliteus tendon

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

A Segond fracture is an avulsion fracture of the anterolateral proximal tibia. It represents an avulsion of the anterolateral ligament (ALL) or lateral capsular attachment and is highly specific for an anterior cruciate ligament (ACL) tear.

Question 6155

Topic: 5. Sports Medicine

Following a zone II flexor tendon repair of the index finger, a structured early active motion rehabilitation protocol is initiated. What is the primary biomechanical advantage of an early active mobilization protocol compared to immobilization?

. Increases the ultimate tensile strength of the repair at 1 week postoperatively
. Promotes intrinsic tendon healing and decreases adhesion formation
. Accelerates the inflammatory phase of tendon healing
. Prevents joint contractures but increases the rate of tendon rupture
. Decreases the need for a core suture of high caliber

Correct Answer & Explanation

. Increases the ultimate tensile strength of the repair at 1 week postoperatively

Explanation

Early active mobilization protocols after flexor tendon repair promote intrinsic tendon healing over extrinsic healing. This approach significantly reduces the formation of peritendinous adhesions and improves functional glide without excessively increasing the rupture rate.

Question 6156

Topic: Knee Sports

During anterior cruciate ligament (ACL) reconstruction, improper placement of the femoral tunnel can lead to graft failure or loss of motion. Placing the femoral tunnel too anteriorly (shallow) within the intercondylar notch results in which of the following graft tension patterns?

. Tight in extension and loose in flexion
. Loose in extension and tight in flexion
. Tight in both extension and flexion
. Loose in both extension and flexion
. Isometric throughout the entire range of motion

Correct Answer & Explanation

. Tight in extension and loose in flexion

Explanation

Femoral tunnel malposition is the most common cause of technical failure in ACL reconstruction. A femoral tunnel placed too anteriorly (shallow) will result in a graft that is loose in extension and pathologically tight in flexion, limiting terminal knee flexion.

Question 6157

Topic: 5. Sports Medicine
Figure 1 shows the radiograph and Figure 2 shows the MRI scan obtained from a 37-year-old woman with a 2-month history of left hip pain. Which combination of a single symptom and examination finding is most likely in this scenario?
. Pain during sitting; flexion abduction and external rotation of the hip
. Groin pain; pain with internal rotation and adduction while supine with the hip and knee flexed 90°
. Clicking; abductor lurch
. Buttock pain; pain with hip extension, adduction, and external rotation while prone

Correct Answer & Explanation

. Groin pain; pain with internal rotation and adduction while supine with the hip and knee flexed 90°

Explanation

MRI reveals an anterior labral tear, and the radiograph shows minimal arthritis with possible dysplasia. The most common location of pain in patients with a labral tear is the groin, and the most common physical finding is a positive impingement test result. Pain during sitting, clicking, and buttock pain are frequently described by patients with a labral tear, but these symptoms are less common than groin pain. A positive posterior impingement test finding is more common in patients with a posterior labral tear.

Question 6158

Topic: 5. Sports Medicine

Figures below show the radiographs, MRI, and MR arthrogram obtained from a 25-year-old collegiate

soccer player who has new-onset left groin pain. He played competitive soccer from a young age and has competed or practiced 5 to 6 times per week since the age of 10. He denies any specific hip injury that necessitated treatment, but his trainer contends that he had a groin pull. He reports groin pain with passive flexion and internal rotation of the left hip, and his hip has less internal rotation than his asymptomatic right hip. He is otherwise healthy. What is the primary cause of a cam deformity?


. A genetic problem
. Repetitive activities involving an open proximal femoral physis
. Early closure of the proximal femoral physis
. Hip dysplasia

Correct Answer & Explanation

. A genetic problem

Explanation

Multiple studies have confirmed that cam or pincer anatomy is commonly present in asymptomatic hips. According to a large systematic review, cam deformities are present in approximately one-third of asymptomatic hips in young adults, and the proportion is higher than 50% in the subgroup of athletes. Ganz and associates proposed that femoral acetabular impingement is the root cause of osteoarthritis in most nontraumatic, nondysplastic hips, and functional improvement with surgical correction of the deformity has been demonstrated. Despite the link between cam deformity and hip osteoarthritis, a corresponding link between the correction of the deformity and prevention of osteoarthritis has never been proven. The results of cam deformity correction, typically including repair of the degenerative labral tear, are much poorer when substantial joint space loss is present. A typical joint space cutoff of 2 mm or less is used to recommend against hip preservation surgery.

Question 6159

Topic: 5. Sports Medicine

Figures below show the radiographs, MRI, and MR arthrogram obtained from a 25-year-old collegiate

soccer player who has new-onset left groin pain. He played competitive soccer from a young age and has competed or practiced 5 to 6 times per week since the age of 10. He denies any specific hip injury that necessitated treatment, but his trainer contends that he had a groin pull. He reports groin pain with passive flexion and internal rotation of the left hip, and his hip has less internal rotation than his asymptomatic right hip. He is otherwise healthy.When counseling patients who have a cam deformity, the orthopaedic surgeon should note that


. osteoarthritis of the hip is likely to occur later in life.
. correction prevents later development of osteoarthritis.
. most acetabular tears are symptomatic, and surgical treatment will be necessary.
. this is an inherited deformity.

Correct Answer & Explanation

. osteoarthritis of the hip is likely to occur later in life.

Explanation

Multiple studies have confirmed that cam or pincer anatomy is commonly present in asymptomatic hips. According to a large systematic review, cam deformities are present in approximately one-third of asymptomatic hips in young adults, and the proportion is higher than 50% in the subgroup of athletes. Ganz and associates proposed that femoral acetabular impingement is the root cause of osteoarthritis in most nontraumatic, nondysplastic hips, and functional improvement with surgical correction of the deformity has been demonstrated. Despite the link between cam deformity and hip osteoarthritis, a corresponding link between the correction of the deformity and prevention of osteoarthritis has never been proven. The results of cam deformity correction, typically including repair of the degenerative labral tear, are much poorer when substantial joint space loss is present. A typical joint space cutoff of 2 mm or less is used to recommend against hip preservation surgery.

Question 6160

Topic: 5. Sports Medicine

Figures 1 through 5 show the radiographs, MRI, and MR arthrogram obtained from a 25-year-old

collegiate soccer player who has new-onset left groin pain. He played competitive soccer from a young age and has competed or practiced 5 to 6 times per week since the age of 10. He denies any specific hip injury that necessitated treatment, but his trainer contends that he had a groin pull. He reports groin pain

with passive flexion and internal rotation of the left hip, and his hip has less internal rotation than his asymptomatic right hip. He is otherwise healthy. Approximately what percentage of asymptomatic

athletes have cam deformities of the hip?

. 5%
. 10%
. 25%
. At least 50%

Correct Answer & Explanation

. 5%

Explanation

Multiple studies have confirmed that cam or pincer anatomy is commonly present in asymptomatic hips. According to a large systematic review, cam deformities are present in approximately one-third of asymptomatic hips in young adults, and the proportion is higher than 50% in the subgroup of athletes. Ganz and associates proposed that femoral acetabular impingement is the root cause of osteoarthritis in most nontraumatic, nondysplastic hips, and functional improvement with surgical correction of the deformity has been demonstrated. Despite the link between cam deformity and hip osteoarthritis, a corresponding link between the correction of the deformity and prevention of osteoarthritis has never been proven. The results of cam deformity correction, typically including repair of the degenerative labral tear, are much poorer when substantial joint space loss is present. A typical joint space cutoff of 2 mm or less is used to recommend against hip preservation surgery.

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