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5. Sports Medicine MCQs

Practice Set 310 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 6181

Topic: 5. Sports Medicine
A 28-year-old male has a symptomatic 3.5 cm² full-thickness chondral defect on the medial femoral condyle. He has failed conservative management. Which of the following surgical interventions is most appropriate for a defect of this size in an active patient, assuming intact menisci and normal alignment?
. Microfracture
. Osteochondral autograft transfer system (OATS)
. Matrix-induced autologous chondrocyte implantation (MACI)
. Partial medial meniscectomy
. High tibial osteotomy alone

Correct Answer & Explanation

. Matrix-induced autologous chondrocyte implantation (MACI)

Explanation

For large chondral defects (> 2 cm²) in young, active patients, cell-based therapies like MACI or osteochondral allografts are indicated. Microfracture and OATS are generally reserved for smaller lesions (< 2 cm²) due to the limited quantity of autograft available and inferior fibrocartilage properties associated with microfracture over large areas.

Question 6182

Topic: 5. Sports Medicine

A 9-year-old male (Tanner Stage I) sustains a complete ACL rupture. He has significant subjective instability. To minimize the risk of growth arrest, which of the following ACL reconstruction techniques is most appropriate?

. Transphyseal reconstruction using bone-patellar tendon-bone autograft
. Transphyseal reconstruction using soft tissue graft with suspensory fixation
. Iliotibial band extra-articular tenodesis alone
. All-epiphyseal soft tissue reconstruction
. Partial transphyseal technique (femoral physeal sparing, tibial transphyseal)

Correct Answer & Explanation

. Transphyseal reconstruction using bone-patellar tendon-bone autograft

Explanation

In very young children with significant growth remaining (Tanner stage I or II), physeal-sparing techniques are recommended to avoid growth arrest. An all-epiphyseal technique tunnels through the epiphysis entirely, completely avoiding both the femoral and tibial physes.

Question 6183

Topic: Shoulder & Hip Sports

A 23-year-old professional baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. MRI arthrogram is likely to reveal which of the following classic findings associated with internal impingement?

. Articular-sided partial tear of the infraspinatus and posterosuperior labral fraying
. Bursal-sided partial tear of the supraspinatus and subacromial bursitis
. Tear of the subscapularis and medial dislocation of the biceps tendon
. Anterosuperior labral tear (SLAP) and complete supraspinatus tear
. Bony Bankart lesion and Hill-Sachs defect

Correct Answer & Explanation

. Articular-sided partial tear of the infraspinatus and posterosuperior labral fraying

Explanation

Internal impingement occurs during hyper-abduction and external rotation (late cocking phase). The greater tuberosity impinges against the posterosuperior glenoid margin, compressing the posterosuperior rotator cuff (supraspinatus/infraspinatus junction) and the posterosuperior labrum. This leads to articular-sided partial "kissing" lesions of the cuff and labrum.

Question 6184

Topic: 5. Sports Medicine

A 14-year-old female presents with vague knee pain. Radiographs and MRI demonstrate a 1.5 cm osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. The physes are open, and MRI shows no evidence of fluid behind the lesion. What is the most appropriate initial management?

. Arthroscopic drilling of the lesion
. Bioabsorbable pin fixation
. Osteochondral autograft transfer
. Non-weight bearing and sports restriction for 3-6 months
. Fresh osteochondral allograft

Correct Answer & Explanation

. Arthroscopic drilling of the lesion

Explanation

In a skeletally immature patient with an intact, stable OCD lesion (indicated by intact articular cartilage and lack of fluid behind the lesion on T2 MRI), a trial of conservative management consisting of activity restriction and weight-bearing modification is indicated, as these have a high rate of spontaneous healing.

Question 6185

Topic: Knee Sports

A 26-year-old male sustains a dashboard injury resulting in an isolated PCL tear. He undergoes conservative treatment but continues to have posterior instability. If PCL reconstruction is performed, which bundle of the PCL is the primary restraint to posterior tibial translation at 90 degrees of knee flexion, and should be the primary focus of an anatomic single-bundle reconstruction?

. Anterolateral bundle
. Posteromedial bundle
. Anteromedial bundle
. Posterolateral bundle
. Meniscofemoral ligament of Wrisberg

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The PCL consists of the anterolateral (AL) and posteromedial (PM) bundles. The AL bundle is larger, is tight in flexion, and provides the primary restraint to posterior translation at 90 degrees of flexion. It is the bundle targeted in single-bundle PCL reconstructions. The PM bundle is tight in extension.

Question 6186

Topic: 5. Sports Medicine

A 19-year-old collegiate cross-country runner presents with a stress fracture of the femoral neck. She has a history of oligomenorrhea. As part of the female athlete triad, which underlying physiologic derangement is the primary driver of her amenorrhea and subsequent bone density loss?

. Hyperthyroidism
. Low energy availability (with or without an eating disorder)
. Primary ovarian failure
. Excessive circulating androgens
. Vitamin D deficiency

Correct Answer & Explanation

. Hyperthyroidism

Explanation

The Female Athlete Triad is fundamentally driven by low energy availability (LEA), meaning dietary energy intake is insufficient to support the energy expended during exercise. This LEA leads to hypothalamic suppression, reducing GnRH pulsatility, which causes functional hypothalamic amenorrhea and a hypoestrogenic state, ultimately culminating in reduced bone mineral density and stress fractures.

Question 6187

Topic: 5. Sports Medicine
A 25-year-old athlete sustains a dashboard injury resulting in an isolated Grade III PCL tear. He has persistent posterior instability and knee pain despite 6 months of physical therapy. You plan a single-bundle PCL reconstruction. Which of the following accurately describes the correct tunnel placement for the femoral tunnel in an anatomic single-bundle reconstruction?
. Centered in the anterolateral (AL) bundle footprint, located shallow in the notch.
. Centered in the posteromedial (PM) bundle footprint, located deep in the notch.
. Centered in the anterolateral (AL) bundle footprint, located deep in the notch.
. Centered in the posteromedial (PM) bundle footprint, located shallow in the notch.
. Placed at the isometric point high in the notch.

Correct Answer & Explanation

. Centered in the anterolateral (AL) bundle footprint, located shallow in the notch.

Explanation

The anterolateral (AL) bundle is the larger and stronger bundle of the PCL. In a single-bundle PCL reconstruction, the femoral tunnel should be centered in the AL bundle footprint, which is located relatively shallow in the notch (closer to the articular cartilage margin of the medial femoral condyle) compared to the PM bundle footprint.

Question 6188

Topic: 5. Sports Medicine

A 22-year-old collegiate baseball pitcher complains of vague anterior shoulder pain and a 'dead arm' sensation. MRI arthrogram shows a Type II SLAP tear. Nonoperative management has failed. During arthroscopy, a peel-back of the superior labrum is observed. What is the most appropriate surgical management for this patient?

. Debridement of the superior labrum.
. Arthroscopic SLAP repair using suture anchors.
. Open subpectoral biceps tenodesis.
. Arthroscopic biceps tenotomy.
. Distal clavicle excision.

Correct Answer & Explanation

. Debridement of the superior labrum.

Explanation

In a young overhead athlete (like a baseball pitcher) with a Type II SLAP tear who fails conservative treatment, arthroscopic SLAP repair is traditionally recommended to restore the labral anchor and maintain throwing mechanics. Biceps tenodesis is typically reserved for older patients (>35-40 years), revision settings, or non-overhead athletes, as tenodesis in elite overhead throwers may alter the pitching mechanics and decrease velocity.

Question 6189

Topic: Shoulder & Hip Sports

A 24-year-old rugby player has recurrent anterior shoulder instability. CT scan with 3D reconstruction reveals 25% anterior glenoid bone loss. A Latarjet procedure is planned. Which of the following accurately describes the 'sling effect' provided by the Latarjet procedure?

. The subscapularis is passed over the conjoint tendon.
. The conjoint tendon acts as a sling across the anterior and inferior capsule when the arm is abducted and externally rotated.
. The coracoacromial ligament is sutured to the subscapularis.
. The long head of the biceps provides a dynamic depressor effect.
. The pectoralis minor tendon is used to reinforce the inferior capsule.

Correct Answer & Explanation

. The subscapularis is passed over the conjoint tendon.

Explanation

The Latarjet procedure stabilizes the shoulder via three mechanisms: 1) the bone block increases the anteroposterior diameter of the glenoid (bony effect); 2) the conjoint tendon acts as a dynamic sling over the lower subscapularis and anteroinferior capsule in the abduction/external rotation position (sling effect); 3) capsular repair to the stump of the coracoacromial ligament (capsular effect).

Question 6190

Topic: Shoulder & Hip Sports

A 19-year-old female dancer complains of a painless snapping sensation over her lateral hip when she walks. Examination reveals a palpable snap over the greater trochanter when the hip is moved from flexion to extension. Which structure is most commonly implicated in this condition?

. Iliopsoas tendon
. Rectus femoris tendon
. Iliotibial band
. Gluteus medius tendon
. Ischiofemoral ligament

Correct Answer & Explanation

. Iliopsoas tendon

Explanation

External snapping hip syndrome (coxa saltans) is caused by the snapping of the iliotibial (IT) band or the anterior border of the gluteus maximus over the greater trochanter during hip flexion and extension. Internal snapping hip is caused by the iliopsoas tendon snapping over the iliopectineal eminence or femoral head.

Question 6191

Topic: Knee Sports

A 14-year-old male presents with vague knee pain and intermittent catching. Radiographs show a well-circumscribed radiolucency in the typical location for an OCD lesion of the knee. What is the most common anatomical location for an Osteochondritis Dissecans (OCD) lesion in the knee?

. Lateral aspect of the medial femoral condyle.
. Medial aspect of the medial femoral condyle.
. Central portion of the lateral femoral condyle.
. Inferior pole of the patella.
. Lateral tibial plateau.

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle.

Explanation

The most common location for an OCD lesion in the knee is the lateral aspect of the medial femoral condyle (often remembered by the acronym LAME - Lateral Aspect Medial Epicondyle/condyle), accounting for approximately 70-80% of all cases in the knee.

Question 6192

Topic: Shoulder & Hip Sports

A 25-year-old professional baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. Physical exam shows a Glenohumeral Internal Rotation Deficit (GIRD) of 25 degrees compared to the contralateral side, and a positive posterior impingement sign.

What are the hallmark arthroscopic findings of internal impingement in the thrower's shoulder?

. Anterosuperior labral tear and subscapularis tear.
. Posterosuperior labral fraying and partial articular-sided supraspinatus/infraspinatus tendon tears (PASTA).
. Anterior Bankart lesion and Hill-Sachs defect.
. Superior labral tear from anterior to posterior (SLAP) extending into the biceps tendon.
. Complete rotator cuff tear with retraction.

Correct Answer & Explanation

. Anterosuperior labral tear and subscapularis tear.

Explanation

Internal impingement occurs when the arm is in extreme abduction and external rotation (late cocking phase). The greater tuberosity impinges against the posterosuperior glenoid rim. This pinches the posterior cuff and posterosuperior labrum, leading to 'kissing lesions': partial articular-sided tears of the posterior supraspinatus/anterior infraspinatus (PASTA) and posterosuperior labral fraying.

Question 6193

Topic: 5. Sports Medicine

A 45-year-old male felt a pop in his knee while descending stairs and now cannot actively extend his knee. Radiographs reveal patella baja (infera).

Which of the following is the most likely diagnosis?

. Patellar tendon rupture
. Quadriceps tendon rupture
. Tibial tubercle avulsion fracture
. Bipartite patella
. MPFL tear

Correct Answer & Explanation

. Patellar tendon rupture

Explanation

Patella baja (abnormally low-riding patella) combined with a loss of active knee extension points to a quadriceps tendon rupture, as the intact patellar tendon tethers the patella down while the superior pull of the quadriceps is lost. Conversely, a patellar tendon rupture results in patella alta (high-riding patella) due to the unopposed pull of the quadriceps.

Question 6194

Topic: Knee Sports

A 28-year-old football player sustains a contact injury to the anteromedial aspect of his knee, forcing it into hyperextension and varus. He has a positive dial test at 30 degrees of flexion, but it is equal to the contralateral side at 90 degrees. Which structure is primarily injured?

. Posterior cruciate ligament (PCL)
. Posterolateral corner (PLC)
. Anterior cruciate ligament (ACL)
. Both PCL and PLC
. Medial collateral ligament (MCL)

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

The dial test measures external rotation of the tibia relative to the femur. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion but normal rotation at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If it is positive at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 6195

Topic: Shoulder & Hip Sports

A 55-year-old tennis player sustains a fall onto an outstretched hand. He complains of anterior shoulder pain and weakness. Physical exam reveals a positive 'bear-hug' test and increased external rotation compared to the normal side. Which tendon is primarily affected, and what structure is at risk for medial subluxation as a consequence?

. Supraspinatus tendon; long head of the biceps
. Subscapularis tendon; long head of the biceps
. Infraspinatus tendon; short head of the biceps
. Teres minor tendon; long head of the triceps
. Pectoralis major tendon; short head of the biceps

Correct Answer & Explanation

. Supraspinatus tendon; long head of the biceps

Explanation

The bear-hug test and belly-press test are specific for subscapularis tendon tears. An isolated subscapularis tear also leads to increased passive external rotation. The upper border of the subscapularis forms the medial wall of the bicipital groove. When the upper subscapularis tears, the long head of the biceps tendon can subluxate or dislocate medially out of the groove.

Question 6196

Topic: Knee Sports

A 25-year-old patient has a symptomatic 3 cm^2 focal full-thickness chondral defect on the medial femoral condyle. You are considering Matrix-induced Autologous Chondrocyte Implantation (MACI). Which of the following is an absolute contraindication for MACI?

. Body Mass Index (BMI) of 28.
. Uncorrected mechanical malalignment (varus deformity).
. Age 25 years.
. Defect size > 2 cm^2.
. Previous microfracture surgery.

Correct Answer & Explanation

. Body Mass Index (BMI) of 28.

Explanation

Uncorrected mechanical malalignment (e.g., varus alignment with a medial compartment defect) is an absolute contraindication for any advanced cartilage restoration procedure, including MACI. The uncorrected abnormal contact forces will lead to early failure of the graft. The malalignment must be corrected concurrently (e.g., High Tibial Osteotomy) or prior to the cartilage procedure.

Question 6197

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the femoral attachment is identified. Which of the following best describes the anatomic location of the MPFL origin on the femur?
. Anterior and proximal to the medial epicondyle
. Posterior and proximal to the medial epicondyle and distal to the adductor tubercle
. Anterior and distal to the adductor tubercle
. Distal to the medial epicondyle and anterior to the adductor tubercle
. Directly on the adductor tubercle

Correct Answer & Explanation

. Posterior and proximal to the medial epicondyle and distal to the adductor tubercle

Explanation

The anatomic femoral origin of the MPFL is located in a saddle-like depression between the adductor tubercle (proximal) and the medial epicondyle (distal and anterior). Schöttle's point radiographically defines this attachment, situated just anterior to the posterior cortical line and proximal to the posterior border of Blumensaat's line.

Question 6198

Topic: 5. Sports Medicine

A 22-year-old elite baseball pitcher complains of vague deep shoulder pain and decreased throwing velocity. MR arthrogram demonstrates a Type II SLAP tear. If nonoperative management fails, which of the following is the most appropriate surgical intervention?

. Biceps tenodesis
. Arthroscopic SLAP repair
. Arthroscopic debridement of the superior labrum only
. Open anterior capsulolabral repair
. Coracoclavicular ligament reconstruction

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In a young overhead athlete (e.g., <25 years) with a Type II SLAP tear who fails conservative management, arthroscopic SLAP repair is the preferred treatment, though return to previous level of play can be challenging. Older patients or non-overhead athletes typically do better with biceps tenodesis.

Question 6199

Topic: Knee Sports

When performing an ACL reconstruction, a femoral tunnel placed too anteriorly (shallow in the notch) will result in which of the following graft tension patterns?

. Tight in extension, loose in flexion
. Tight in flexion, tight in extension
. Loose in flexion, loose in extension
. Tight in flexion, loose in extension
. Isometric throughout the range of motion

Correct Answer & Explanation

. Tight in extension, loose in flexion

Explanation

A femoral tunnel placed too anteriorly (in the intercondylar notch, which is high/shallow in arthroscopic position) will cause the ACL graft to be loose in extension and excessively tight in flexion, potentially limiting range of motion. Conversely, a tunnel placed too posterior (deep) results in a graft tight in extension and loose in flexion.

Question 6200

Topic: Knee Sports
The primary static stabilizers of the posterolateral corner (PLC) of the knee include all of the following EXCEPT:
. Lateral collateral ligament (LCL)
. Popliteofibular ligament
. Popliteus tendon
. Biceps femoris tendon
. Arcuate ligament

Correct Answer & Explanation

. Biceps femoris tendon

Explanation

The primary static stabilizers of the PLC are the LCL, popliteus tendon, and popliteofibular ligament. The biceps femoris is an important dynamic stabilizer of the lateral knee, but not considered one of the primary static restraints.

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