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 6261
Topic: Shoulder & Hip Sports
Internal impingement is characterized by which of the following anatomic lesions?
Correct Answer & Explanation
. Articular-sided rotator cuff tear
Explanation
Internal impingement is characterized by articular-sided partial-thickness rotator cuff tears and superior glenoid labral tears. The capsule is characterized by laxity anteriorly and tightness posteriorly.
Question 6262
Topic: 5. Sports Medicine
Which of the following most accurately approximates the estimated risk of a musculoskeletal allograft containing the human immunodeficiency virus (HIV) despite adequate screening?
Correct Answer & Explanation
. 1 in 1,600,000
Explanation
The calculated risk of a musculoskeletal allograft containing HIV despite adequate screening has been estimated to be approximately 1 in 1.6 million. This estimate is based on the risk of HIV in the population, projected population estimates, and current methods of donor screening.
Question 6263
Topic: Shoulder & Hip Sports
A 22-year-old patient has had severe groin pain for many months and is unable to engage in any physical activity. The radiograph of the pelvis shows minimal arthritis. The lateral radiograph of the hip is shown in Figure 33a. An MR-arthrogram is shown in Figure 33b. What is the most appropriate treatment at this stage?
Correct Answer & Explanation
. Femoroacetabular osteoplasty and labral repair
Explanation
The patient has femoroacetabular impingement. The prominence on the femoral neck has resulted in a labral tear and detachment. Labral debridement without addressing the underlying anatomic abnormality is likely to result in a suboptimal outcome. The most appropriate treatment, when indicated, is shaving down of the femoral neck to remove the bony prominence and attachment of the labrum.
Question 6264
Topic: Shoulder & Hip Sports
Figures 1 through 3 are the MRI scans of a 56-year-old woman in good health who reports a 6-month history of shoulder pain and external rotation weakness. Her radiographs are unremarkable. What is the diagnosis?
Correct Answer & Explanation
. Rotator cuff tear
Explanation
31The images reveal T2-weighted MRI sequences with edema isolated to the infraspinatus. In the absence of a tear in the infraspinatus tendon, the edema is most likely due to compression of the suprascapular nerve in the spinoglenoid notch. As this pathology persists, progressive muscle atrophy and fatty infiltration can result. Compression of the suprascapular nerve in the suprascapular notch would have resulted in edema and weakness in both the supra- and infraspinatus muscles. Compression is commonly caused by cysts from the joint secondary to labral tears. A rotator cuff tear of the infraspinatus is not identified on these images, and there is no history of trauma provided. There is no evidence of an anteroinferior labral tear, nor would this be expected to result in external rotation weakness or MRI abnormality of the infraspinatus. Quadrilateral space syndrome results in compression of the axillary nerve, which supplies the teres minor.Correcr
Question 6265
Topic: 5. Sports Medicine
Emergent management of acute tooth displacement (luxation) includes:
Correct Answer & Explanation
. immediate repositioning or replantation of the tooth.
Explanation
Immediate repositioning or replantation of the tooth is the standard of care. Avulsed teeth must be replanted immediately to enhance viability of the periodontal ligament cells on the root. With the tooth in place, the athlete should bite down on a towel to maintain stability. The athlete should be taken emergently to a dentistโs office or emergency room. The avulsed tooth should not be handled by the root or scrubbed to remove debris. If immediate replantation is not possible, the tooth should be transported in saline solution, milk, or saliva on gauze.
Question 6266
Topic: 5. Sports Medicine
Recommendations for sports activity should include
Correct Answer & Explanation
. full participation without restrictions.
Explanation
- avoidance of contact or collision sports.
Question 6267
Topic: Shoulder & Hip Sports
What is the most likely predictor of postsurgical pain following a coracoid transfer procedure for recurrent shoulder instability?
Correct Answer & Explanation
. Pain before surgery
Explanation
Recurrent glenohumeral instability with anteroinferior glenoid bone loss is best treated with a coracoid transfer. In studies of coracoid transfers for recurrent instability and anterior glenoid deficiency, patients who reported pain before surgery were 20 times more likely to have pain after surgery that compromised the functional outcome. Optimal graft placement correlated with better functional outcomes and less progression of arthrosis, but not with pain. Consequently, poor graft position, arthritis progression, and prior surgical treatment are not as consistently predictive of pain after surgery.
Question 6268
Topic: 5. Sports Medicine
A 24-year-old female soccer player has recurrent instability following noncontact injury to the right knee 2 years after anterior cruciate reconstruction using hamstring autograft. Physical examination reveals positive Lachman and pivot shift. Radiographs reveal well-preserved joint spaces with 13ยฐ of posterior tibial slope. MRI scan reveals failure of graft with small tear of the lateral meniscus. What is the most appropriate treatment?
Correct Answer & Explanation
. Revision anterior cruciate ligament (ACL) reconstruction using patellar tendon autograft and lateral meniscal repair
Explanation
Increased tibial slope (>12ยฐ) may be a risk factor for noncontact ACL injury and subsequent failure of repair, and corrective proximal tibial osteotomy may be indicated combined with primary or revision ACL reconstruction. The indications for proximal tibial valgus osteotomy are generally isolated medial compartment degeneration in a knee with varus malalignment in a young, active individual. Factors associated with early failure include increased age (>55 years), increased BMI (10% greater than normal), preoperative flexion<120ยฐ and under- or overcorrection. Inflammatory arthritis, including gout, would be a relative contraindication.
Question 6269
Topic: 5. Sports Medicine
A 16-year-old female elite soccer player is scheduled to undergo an anterior cruciate ligament (ACL) reconstruction. During the preoperative discussion regarding graft choices, you inform her of the risks associated with different graft types. Which of the following graft options is associated with the highest rate of clinical failure and graft rupture in her specific demographic?
Correct Answer & Explanation
. Bone-patellar tendon-bone (BTB) autograft
Explanation
Extensive literature, including large registry data (e.g., MOON cohort), demonstrates that allografts have a significantly higher failure rate compared to autografts when used in young, active patients (especially those under 25 years of age returning to cutting/pivoting sports). The higher failure rate is attributed to delayed graft incorporation, potential deleterious effects of the sterilization process, and slower biological remodeling.
Question 6270
Topic: Shoulder & Hip Sports
A 30-year-old male sustains a traumatic posterior shoulder dislocation during a seizure. Upon successful closed reduction in the emergency department, an MRI is obtained which reveals a reverse Hill-Sachs lesion. Which of the following best describes the precise anatomic location of this bony defect?
Correct Answer & Explanation
. Posterolateral aspect of the humeral head
Explanation
A reverse Hill-Sachs lesion is an impaction fracture of the anteromedial aspect of the humeral head. It occurs during a posterior shoulder dislocation when the anterior aspect of the humeral head impacts against the hard posterior rim of the glenoid. In contrast, a classic Hill-Sachs lesion occurs during an anterior dislocation and is located on the posterolateral aspect of the humeral head.
Question 6271
Topic: Knee Sports
During an anterior cruciate ligament (ACL) reconstruction, a surgeon places the femoral tunnel excessively anterior (shallow) in the intercondylar notch. What biomechanical consequence will this have on the graft during knee range of motion?
Correct Answer & Explanation
. The graft will be overly tight in extension and tight in flexion
Explanation
In ACL reconstruction, femoral tunnel malposition is the most common cause of graft failure. If the femoral tunnel is placed too anteriorly (i.e., shallow, away from the anatomical footprint and closer to the anterior cortex), the distance between the femoral and tibial tunnels increases as the knee flexes. This results in a graft that is excessively tight in flexion (limiting knee flexion or risking graft rupture) and lax in extension.
Question 6272
Topic: Knee Sports
During an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft, which component represents the weakest link of the graft construct during the first 6 weeks postoperatively?
Correct Answer & Explanation
. The graft midsubstance
Explanation
In the early postoperative period (first 6-8 weeks) following ACL reconstruction, the weakest link in the construct is typically the fixation site. For a BTB graft, the tibial interference screw interface is the weakest point due to the lower bone mineral density in the proximal tibia compared to the distal femur.
Question 6273
Topic: Shoulder & Hip Sports
A 21-year-old football player undergoes an MRI for recurrent anterior shoulder instability. The MRI reveals an avulsion of the anterior labrum where the labrum and the intact periosteum are stripped and displaced medially along the glenoid neck. What is the specific eponym for this pathology?
Correct Answer & Explanation
. Bankart lesion
Explanation
An ALPSA (Anterior Labroligamentous Periosteal Sleeve Avulsion) lesion involves the anterior labrum being stripped from the glenoid rim along with an intact periosteal sleeve, displacing medially. In contrast, a classic Bankart lesion involves a torn periosteum.
Question 6274
Topic: 5. Sports Medicine
A 22-year-old athlete undergoes an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Postoperatively, he lacks 15 degrees of terminal extension but can flex to 140 degrees. What is the most likely intraoperative technical error causing this complication?
Correct Answer & Explanation
. Femoral tunnel placed too far anteriorly
Explanation
An anteriorly placed tibial tunnel can cause roof impingement, leading to a loss of full knee extension. Conversely, a femoral tunnel placed too anteriorly typically results in a graft that is tight in flexion.
Question 6275
Topic: 5. Sports Medicine
A 25-year-old female athlete is 6 months post-anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. She complains of a mechanical block to terminal knee extension and an audible clunk. MRI shows a focal fibrovascular nodule anterior to the tibial insertion of the graft. What is the most likely diagnosis?
Correct Answer & Explanation
. Generalized arthrofibrosis
Explanation
A cyclops lesion is a localized form of anterior arthrofibrosis that typically presents with a mechanical block to terminal knee extension after ACL reconstruction. Treatment consists of arthroscopic excision.
Question 6276
Topic: Shoulder & Hip Sports
A 22-year-old male requires arthroscopic stabilization for recurrent anterior shoulder instability. Advanced imaging calculates his glenoid bone loss at 10%, but identifies an 'off-track' Hill-Sachs lesion. Which of the following procedures is indicated in addition to an arthroscopic Bankart repair to prevent engagement of the defect?
Correct Answer & Explanation
. Latarjet procedure
Explanation
An 'off-track' Hill-Sachs lesion will engage the anterior glenoid rim during abduction and external rotation, causing failure of an isolated Bankart repair. A Remplissage procedure (tenodesis of the infraspinatus into the humeral defect) makes the defect extra-articular, preventing engagement.
Question 6277
Topic: 5. Sports Medicine
A 24-year-old elite soccer player is scheduled for anterior cruciate ligament (ACL) reconstruction. When counseling the patient on using a bone-patellar tendon-bone (BTB) autograft versus a hamstring autograft, which complication is significantly more common with the BTB graft?
Correct Answer & Explanation
. Higher overall graft rupture rate
Explanation
Bone-patellar tendon-bone (BTB) autografts are highly associated with donor site morbidity, particularly anterior knee pain, patellar tendinitis, and a small risk of patellar fracture. Hamstring grafts carry a higher risk of saphenous nerve irritation and hamstring weakness.
Question 6278
Topic: General Sports & Tendon
A 45-year-old male sustains an acute, complete avulsion of the proximal hamstring origin (all three tendons) with 4 cm of retraction. If this is treated non-operatively, which long-term complication is he at highest risk for developing?
Correct Answer & Explanation
. Quadriceps functional weakness
Explanation
Complete, retracted proximal hamstring avulsions treated without surgical repair frequently result in persistent weakness, cramping, and loss of power. Additionally, scarring of the retracted stump around the sciatic nerve can cause chronic neuropathic pain.
Question 6279
Topic: 5. Sports Medicine
A 22-year-old athlete presents with chronic anterior knee pain and catching. MRI reveals an osteochondritis dissecans (OCD) lesion. What is the most common anatomical location for this pathology in the knee?
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. This classic location accounts for approximately 70% of all knee OCD lesions.
Question 6280
Topic: Knee Sports
During an anterior cruciate ligament (ACL) reconstruction, the femoral tunnel is inadvertently placed too far anteriorly. What is the most likely biomechanical consequence of this technical error?
Correct Answer & Explanation
. Loss of terminal extension
Explanation
An anteriorly placed femoral tunnel in ACL reconstruction results in a graft that tightens excessively as the knee flexes. This restricts deep knee flexion and increases the risk of premature graft failure or rupture.
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