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5. Sports Medicine MCQs

Practice Set 309 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 6161

Topic: 5. Sports Medicine
Figures below show the radiograph and the MRI scan obtained from a 37-year-old woman with a 2-month history of left hip pain. Which presurgical factor is most commonly associated with a poor outcome after a hip joint salvage procedure?
. Age older than 40 years
. Body mass index higher than 30
. Tönnis grade of 2 or higher
. Outerbridge grade of III or IV

Correct Answer & Explanation

. Tönnis grade of 2 or higher

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. Although age over 40 years and a body mass index higher than 30 can adversely affect clinical outcomes after joint preservation procedures such as PAO, hip arthroscopy, and femoral acetabular impingement surgery, the presence of hip arthritis on presurgical radiographs is the most commonly mentioned cause of failed hip joint preservation surgery. Tönnis grade is a radiographic measure of hip arthritis. A higher Outerbridge score is associated with more frequent poor outcomes after hip arthroscopy; however, the Outerbridge cartilage score is determined by direct visualization at the time of surgery. The Outerbridge score cannot be determined presurgically.

Question 6162

Topic: 5. Sports Medicine

Figures below show the radiographs obtained from a 19-year-old woman with a 3-year history of

progressive hip pain in the left groin with activity, which is unresponsive to activity modification and physical therapy. Examination reveals normal range of motion, with pain on anterior impingement testing. What treatment is associated with the best long-term results?

. Hip arthroscopy with labral repair
. Reverse periacetabular osteotomy
. Varus rotational osteotomy
. Open surgical dislocation with rim trimming

Correct Answer & Explanation

. Hip arthroscopy with labral repair

Explanation

This patient has symptomatic femoroacetabular impingement as well as clinical and radiographic signs of acetabular retroversion, including a cross-over sign, ischial spine sign, and posterior wall sign bilaterally. Good midterm to long-term outcomes have been reported with reverse (anteverting) Bernese periacetabular osteotomy (PAO). In patients with less retroversion, open or arthroscopic rim trimming with labral refixation have shown good short-term results, but longer-term results have yet to be fully delineated. Isolated hip arthroscopy and labral repair would not be indicated without addressing the retroversion deformity. Femoral varus rotational osteotomy plays no role in the treatment of this pathology. Open surgical dislocation with rim trimming could be considered in patients with less deformity, but some studies have shown inferior long-term results compared with reverse PAO.

Question 6163

Topic: 5. Sports Medicine

Figures 1 through 3 show the radiograph and MR arthrograms obtained from a 25-year-old woman who has

had right groin pain since joining the military 4 years ago. She has undergone treatment with NSAIDs, physical therapy, and activity modification. Examination reveals positive flexion abduction and external rotation, a positive external log roll, and increased range of motion. What is the most appropriate treatment?

. Viscosupplementation of the right hip
. Hip arthroscopy with labral repair
. Periacetabular osteotomy
. Total hip arthroplasty

Correct Answer & Explanation

. Viscosupplementation of the right hip

Explanation

This patient has symptomatic hip dysplasia that has been recalcitrant to nonsurgical management. Radiographs reveal an upsloping sourcil (acetabular index of 18) and a lateral center edge angle of 14, with posterior uncovering. The MR arthrogram shows no definitive evidence of a labral tear. Appropriate surgical management would include periacetabular osteotomy. Viscosupplementation in the hip is controversial in the treatment of osteoarthritis and plays no role in the treatment of dysplasia. Hip arthroscopy with labral repair is controversial in mild hip dysplasia, with studies demonstrating between60% and 77% good and excellent results, inferior to the results for hip arthroscopy in a femoroacetabular impingement cohort. In moderate to severe dysplasia, hip arthroscopy is not recommended. Because the acetabular cartilage is well maintained, total hip arthroplasty would not be recommended in this young and active patient.

Question 6164

Topic: Knee Sports

Injury to the popliteal artery during total knee arthroplasty (TKA) is most likely to occur when placing a

sharp retractor

. directly posterior to the posterior cruciate ligament (PCL).
. posteromedial to the PCL.
. posterolateral to the PCL.
. in the posteromedial corner of the knee.

Correct Answer & Explanation

. directly posterior to the posterior cruciate ligament (PCL).

Explanation

Vascular complications during TKA are rare but do occur. Traditionally, it was taught that the popliteal artery was situated posterior to the PCL; however, more recent anatomic dissections have demonstrated that this artery is usually located posterolateral to the PCL.

Question 6165

Topic: Knee Sports

Figures below show the radiographs, and the MRIs obtained from a 32-year-old man with worsening left

knee pain. A 3-foot hip-to-ankle radiograph shows a 13-degree varus knee deformity. The patient sustained a major left knee injury 5 years ago and a confirmed complete anterior cruciate ligament (ACL) tear. He managed this injury nonsurgically with a functional brace but experienced worsening pain. He was seen by an orthopaedic surgeon 18 months ago, and a medial meniscus tear was diagnosed; the tear was treated with an arthroscopic partial medial meniscectomy. Since then, his knee has been giving way more often, and he no longer feels safe working on a pitched roof. The patient received 6 months of formal physical therapy and was fitted for a new functional ACL brace, but he still has pain and instability. He believes he has exhausted his nonsurgical options and would like to undergo surgery. What is the most appropriate treatment at this time?


. ACL reconstruction and subsequent proximal tibial osteotomy
. ACL reconstruction alone
. Distal femoral osteotomy with simultaneous ACL reconstruction
. Proximal tibial osteotomy with subsequent ACL reconstruction

Correct Answer & Explanation

. ACL reconstruction and subsequent proximal tibial osteotomy

Explanation

Proximal tibial osteotomy is the most appropriate intervention to correct varus malalignment and to reduce stress on the ACL. In some cases, proximal tibial osteotomy alone may address both pain and instability, but if instability persists, particularly in the setting in which instability can be dangerous, subsequent ACL reconstruction can further stabilize the knee with less stress on the graft after the correction of malalignment. Varus alignment places increased stress on the native or reconstructed ACL. ACL reconstruction should be performed only at the same time as or following proximal tibial osteotomy to correct alignment in the setting of varus malalignment. It is not appropriate to perform ACL reconstruction prior to proximal tibial osteotomy in this setting. Distal femoral osteotomy is not indicated to correct varus malalignment. Varus alignment places increased stress on the native or reconstructed ACL, and ACLreconstruction alone is not indicated for this patient.

Question 6166

Topic: 5. Sports Medicine

When comparing arthroscopic lavage and knee debridement with placebo in patients with chronic

symptomatic osteoarthritis, what outcome has been demonstrated?

. Reliable and durable pain relief
. No significant benefit for chronic osteoarthritis
. Up to 75% pain relief for 2 months, then variable response
. Three-month measurable pain relief, followed by recurrence

Correct Answer & Explanation

. Reliable and durable pain relief

Explanation

Excluding a diagnosis of meniscal tear, loose body, or mechanical derangement, treating knee osteoarthritis of indeterminate cause with arthroscopic lavage and debridement has been found to provide no discernable benefit to offset the risk of surgery. The effects of arthroscopy have not been clinically significant in the vast majority of patient-oriented outcomes measures for pain and function at multipletimes between 1 week and 2 years after surgery.

Question 6167

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of the anteromedial (AM) and posterolateral (PL) functional bundles. Which of the following statements accurately describes the biomechanical relationship of these bundles during normal knee kinematics?

. The anteromedial bundle is tight in extension and controls anterior translation
. The posterolateral bundle is tight in flexion and controls internal rotation
. The anteromedial bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees
. The posterolateral bundle is tight in flexion and is the primary restraint to anterior tibial translation at 90 degrees
. Both bundles remain equally isometric throughout the entire 0-140 degree arc of motion

Correct Answer & Explanation

. The anteromedial bundle is tight in extension and controls anterior translation

Explanation

The native ACL has two distinct bundles named for their tibial insertions. Biomechanically, the anteromedial (AM) bundle is tight in flexion and is the primary restraint to anterior tibial translation when the knee is flexed (tested via Anterior Drawer test at 90 degrees). The posterolateral (PL) bundle is tight in extension and is the primary restraint to rotatory loads and anterior translation near extension (tested via Lachman test at 20-30 degrees and the Pivot Shift test). Reconstructing both functional roles is the theoretical basis behind double-bundle ACL reconstruction techniques.

Question 6168

Topic: Shoulder & Hip Sports

During an arthroscopic rotator cuff repair, a surgeon identifies a massive, retracted tear involving the entirety of the subscapularis tendon off its footprint on the lesser tuberosity. The surgeon needs to understand the innervation to mobilize the muscle safely. Which of the following peripheral nerves provide the primary motor innervation to the subscapularis?

. Suprascapular nerve
. Axillary nerve
. Upper and lower subscapular nerves
. Musculocutaneous nerve
. Thoracodorsal nerve

Correct Answer & Explanation

. Suprascapular nerve

Explanation

The subscapularis muscle originates on the subscapular fossa and inserts on the lesser tuberosity, functioning primarily as an internal rotator of the humerus. It is innervated by the upper and lower subscapular nerves, which are branches of the posterior cord of the brachial plexus. The suprascapular nerve innervates the supraspinatus and infraspinatus. The axillary nerve innervates the deltoid and teres minor. The thoracodorsal nerve innervates the latissimus dorsi. The musculocutaneous nerve innervates the anterior compartment of the arm (coracobrachialis, biceps, brachialis).

Question 6169

Topic: 5. Sports Medicine

A 45-year-old recreational athlete sustains an acute Achilles tendon rupture. When comparing non-operative management incorporating early functional rehabilitation with operative repair, which of the following statements is most accurate according to recent randomized controlled trials and meta-analyses?

. Operative repair results in a significantly higher rate of permanent functional deficit
. Non-operative management results in a significantly higher rate of deep vein thrombosis
. Operative repair carries a higher rate of soft-tissue complications, but provides equivalent re-rupture rates when early functional rehab is utilized non-operatively
. Non-operative management leads to significantly greater objective plantar flexion weakness at 2 years post-injury
. Operative repair results in a significantly lower re-rupture rate even when compared to non-operative treatment with early functional rehabilitation

Correct Answer & Explanation

. Operative repair results in a significantly higher rate of permanent functional deficit

Explanation

Recent high-level evidence (such as the Willits et al. trial) demonstrates that non-operative management with an early functional rehabilitation protocol yields re-rupture rates equivalent to operative repair. However, operative repair maintains a statistically higher risk of soft-tissue and wound healing complications.

Question 6170

Topic: 5. Sports Medicine

When selecting an autograft for an anterior cruciate ligament (ACL) reconstruction, which of the following commonly utilized grafts has the highest ultimate tensile load to failure?

. 10-mm Bone-Patellar Tendon-Bone
. Four-strand hamstring (doubled semitendinosus and gracilis)
. Quadriceps tendon with bone block
. Iliotibial band
. Central third patellar tendon (9-mm)

Correct Answer & Explanation

. 10-mm Bone-Patellar Tendon-Bone

Explanation

Biomechanical studies have demonstrated that a four-strand hamstring autograft (doubled semitendinosus and gracilis) has the highest ultimate load to failure, reaching over 4000 N. For reference, the native ACL is approximately 2160 N, and a 10-mm bone-patellar tendon-bone graft is roughly 2977 N.

Question 6171

Topic: Knee Sports

In the process of anterior cruciate ligament (ACL) reconstruction, the graft must undergo a biological process known as ligamentization. During which phase of this process does the graft exhibit its lowest mechanical strength?

. Initial necrosis phase
. Revascularization phase
. Cellular proliferation phase
. Collagen remodeling phase
. Maturation phase

Correct Answer & Explanation

. Initial necrosis phase

Explanation

The revascularization phase occurs 6 to 12 weeks postoperatively. During this time, the graft undergoes remodeling by host fibroblasts and vascular ingrowth, resulting in a transient but significant decrease in its mechanical strength.

Question 6172

Topic: 5. Sports Medicine

A 22-year-old female athlete experiences a traumatic lateral patellar dislocation. Which ligament provides the primary soft-tissue restraint to lateral patellar translation at 20 degrees of knee flexion?

. Medial patellofemoral ligament (MPFL)
. Medial patellotibial ligament
. Medial collateral ligament
. Patellomeniscal ligament
. Lateral retinaculum

Correct Answer & Explanation

. Medial patellofemoral ligament (MPFL)

Explanation

The MPFL is the primary passive restraint against lateral patellar displacement, providing 50% to 60% of the resistance, especially in early knee flexion (0 to 30 degrees) before the patella fully engages the bony stability of the trochlear groove.

Question 6173

Topic: 5. Sports Medicine

A 25-year-old athlete undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Compared to a hamstring autograft, the BPTB autograft is most commonly associated with a higher incidence of:

. Graft rupture
. Anterior knee pain
. Hamstring weakness
. Deep surgical site infection
. Intra-articular ganglion cyst formation

Correct Answer & Explanation

. Graft rupture

Explanation

Bone-patellar tendon-bone (BPTB) autografts are generally associated with a higher incidence of donor-site morbidity. This most frequently manifests as anterior knee pain and pain with kneeling.

Question 6174

Topic: 5. Sports Medicine

When selecting a bone graft or substitute for a complex nonunion, the ideal material should possess osteoinductive, osteoconductive, and osteogenic properties. Which of the following options fulfills all three criteria?

. Demineralized bone matrix (DBM)
. Cancellous allograft
. Calcium phosphate cement
. Iliac crest autograft
. Recombinant human BMP-2

Correct Answer & Explanation

. Demineralized bone matrix (DBM)

Explanation

Autogenous bone graft, such as iliac crest autograft, is the gold standard because it is the only option that is osteoconductive (provides a structural scaffold), osteoinductive (contains growth factors like BMPs), and osteogenic (contains living osteoprogenitor cells). DBM and rhBMP-2 are osteoinductive but lack intrinsic osteogenic cells.

Question 6175

Topic: Knee Sports

A 20-year-old female presents with recurrent lateral patellar instability. MRI reveals an intact MPFL but a Tibial Tubercle-Trochlear Groove (TT-TG) distance of 24 mm. Which of the following is the most appropriate surgical management?

. MPFL reconstruction alone
. Tibial tubercle medialization and MPFL reconstruction
. Lateral retinacular release alone
. Trochleoplasty
. Tibial tubercle anteriorization

Correct Answer & Explanation

. MPFL reconstruction alone

Explanation

The TT-TG distance is a crucial measurement in patellar instability. A distance > 20 mm is considered abnormal and generally an indication for tibial tubercle medialization (e.g., Fulkerson osteotomy). MPFL reconstruction alone in the setting of a TT-TG > 20 mm is associated with a significantly higher failure rate due to uncorrected excessive lateral pull.

Question 6176

Topic: Shoulder & Hip Sports

In calculating the Instability Severity Index Score (ISIS) for an 18-year-old competitive rugby player with recurrent anterior shoulder instability, which of the following factors would contribute points indicating a higher risk of recurrence after an arthroscopic Bankart repair?

. Age > 20 years
. Absence of a Hill-Sachs lesion on AP radiograph
. Participation in non-contact sports
. Loss of normal contour of the glenoid on AP radiograph
. Positive apprehension test at 45 degrees of abduction

Correct Answer & Explanation

. Age > 20 years

Explanation

The ISIS score evaluates the risk of recurrence after arthroscopic anterior shoulder stabilization. Points are awarded for: age < 20 years (2 pts), participation in competitive sports (2 pts), contact sports (1 pt), loss of inferior glenoid contour on AP radiograph (2 pts), and visible Hill-Sachs lesion on AP radiograph (2 pts). A score > 6 suggests a high risk of failure with arthroscopic repair, and Latarjet should be considered.

Question 6177

Topic: Knee Sports
A 25-year-old male sustains a knee dislocation. Exam reveals a grade III Lachman, grade III posterior drawer, and increased opening to varus stress at 0 and 30 degrees. Valgus stress is stable. According to the Schenck classification, what type of knee dislocation is this?
. KD-I
. KD-II
. KD-III M
. KD-III L
. KD-IV

Correct Answer & Explanation

. KD-III L

Explanation

The Schenck classification describes knee dislocations based on the ligaments torn. KD-I: one cruciate. KD-II: both cruciates. KD-III: both cruciates and one collateral (M for MCL, L for LCL). KD-IV: all four ligaments. This patient has ACL, PCL, and LCL tears (varus instability) with an intact MCL (stable valgus), classifying it as KD-III L.

Question 6178

Topic: Knee Sports

A 50-year-old male feels a "pop" in the back of his knee while squatting. MRI shows a medial meniscus posterior root tear. Which of the following radiographic findings is most strongly associated with chronic untreated medial meniscus posterior root tears?

. Spontaneous osteonecrosis of the knee (SONK)
. Osteochondritis dissecans of the lateral femoral condyle
. Rapidly progressive lateral compartment osteoarthritis
. Patellofemoral arthritis
. Segond fracture

Correct Answer & Explanation

. Spontaneous osteonecrosis of the knee (SONK)

Explanation

Medial meniscus root tears result in a loss of hoop stresses, effectively acting like a total meniscectomy. This drastically increases peak contact pressures in the medial compartment, predisposing the patient to subchondral insufficiency fractures, spontaneous osteonecrosis of the knee (SONK), and rapidly progressive osteoarthritis.

Question 6179

Topic: Shoulder & Hip Sports

A 45-year-old male sustains a traumatic subscapularis tear. Physical exam reveals increased passive external rotation compared to the contralateral side. Which special test is most specific for an isolated tear of the upper portion of the subscapularis tendon?

. Lift-off test
. Belly-press test
. Bear-hug test
. Hornblower's sign
. Neer impingement sign

Correct Answer & Explanation

. Lift-off test

Explanation

The Bear-hug test is highly sensitive and specific for identifying tears involving the upper portion of the subscapularis. The Lift-off test is generally more effective at evaluating the inferior portion of the subscapularis. The Belly-press test evaluates the overall subscapularis but can be compensatory.

Question 6180

Topic: 5. Sports Medicine

A 16-year-old high school female soccer player is undergoing ACL reconstruction. Which of the following graft choices is associated with the highest risk of re-rupture in this specific demographic?

. Bone-patellar tendon-bone autograft
. Hamstring autograft
. Quadriceps tendon autograft
. Allograft
. Contralateral bone-patellar tendon-bone autograft

Correct Answer & Explanation

. Bone-patellar tendon-bone autograft

Explanation

Multiple studies and registries (e.g., MOON cohort) have demonstrated that the use of allografts in young, highly active patients (especially under age 20) is associated with a significantly higher failure/re-rupture rate compared to autografts.

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