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5. Sports Medicine MCQs

Practice Set 32 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 621

Topic: 5. Sports Medicine

During rehabilitation after anterior cruciate ligament (ACL) reconstruction using a hamstring autograft, the patient is most likely to experience a persistent deficit in which of the following functional motions compared to a bone-patellar tendon-bone autograft?

. Terminal knee extension
. Knee flexion at 90 degrees or greater
. Knee extension at 45 degrees
. Ankle plantar flexion
. Hip extension

Correct Answer & Explanation

. Knee flexion at 90 degrees or greater

Explanation

Patients with hamstring autograft ACL reconstructions often demonstrate persistent weakness in deep knee flexion (flexion at high angles) and internal tibial rotation. Conversely, bone-patellar tendon-bone autografts are more commonly associated with anterior knee pain and extension deficits.

Question 622

Topic: Shoulder & Hip Sports

When evaluating a patient after a traumatic anterior shoulder dislocation, which of the following is the single greatest risk factor for recurrent instability?

. Male gender
. High-energy mechanism of injury
. Age of the patient at the time of the initial dislocation
. Presence of a Hill-Sachs lesion involving less than 10% of the humeral head
. Immobilization duration in internal rotation after the first dislocation

Correct Answer & Explanation

. Age of the patient at the time of the initial dislocation

Explanation

The patient's age at the time of the first dislocation is the most significant prognostic factor for recurrence. Patients under 20 years old have a recurrence rate often exceeding 80%.

Question 623

Topic: Knee Sports

Which of the following best describes the biomechanical consequence of an untreated posterior medial meniscal root tear?

. Minimal change in contact pressure if the peripheral rim remains intact
. Increased contact area leading to decreased peak articular contact pressures
. Biomechanical equivalent of a total meniscectomy with significantly increased peak contact pressures
. Increased tension isolated only to the anterior cruciate ligament
. Decreased hoop stresses with no change in overall joint reaction forces

Correct Answer & Explanation

. Biomechanical equivalent of a total meniscectomy with significantly increased peak contact pressures

Explanation

A posterior meniscal root tear disrupts the ability of the meniscus to convert axial loads into hoop stresses, resulting in a biomechanical state equivalent to a total meniscectomy and leading to rapid articular degeneration.

Question 624

Topic: 5. Sports Medicine

During an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft, the surgeon must be aware of the biomechanical properties of the graft. Which of the following is true regarding a 10 mm BTB autograft compared to the native ACL?

. It has a lower ultimate failure load.
. It has approximately 168% of the ultimate tensile load of the native ACL.
. It is more prone to stretching than a hamstring autograft.
. It heals to the bone tunnels primarily via Sharpey fibers in 12 weeks.
. It possesses greater elasticity than the native ACL.

Correct Answer & Explanation

. It has approximately 168% of the ultimate tensile load of the native ACL.

Explanation

A 10 mm central third BTB autograft is biomechanically stronger and stiffer than the native ACL, possessing about 168% of the native ACL's ultimate tensile load. It heals via rapid bone-to-bone healing, typically around 6 weeks, which is faster than soft-tissue grafts.

Question 625

Topic: Shoulder & Hip Sports

A 70-year-old female presents with pseudoparalysis of the shoulder. Imaging reveals a massive, irreparable rotator cuff tear involving the supraspinatus and infraspinatus with superior migration of the humeral head, but an intact subscapularis and functioning deltoid. What is the most reliable surgical option to restore active forward elevation?

. Arthroscopic superior capsular reconstruction
. Latissimus dorsi tendon transfer
. Reverse total shoulder arthroplasty
. Anatomic total shoulder arthroplasty
. Shoulder arthrodesis

Correct Answer & Explanation

. Reverse total shoulder arthroplasty

Explanation

In an elderly patient with pseudoparalysis and a massive irreparable rotator cuff tear (rotator cuff arthropathy), reverse total shoulder arthroplasty is the most reliable procedure to restore forward elevation. It biomechanically medializes the center of rotation and increases the lever arm of the deltoid.

Question 626

Topic: 5. Sports Medicine

During an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft, the surgeon must be aware that this graft has a higher incidence of which of the following postoperative complications compared to a hamstring autograft?

. Increased graft rupture rate
. Anterior knee pain
. Hardware prominence
. Deep vein thrombosis
. Delayed graft incorporation

Correct Answer & Explanation

. Anterior knee pain

Explanation

BPTB autografts are historically associated with a higher incidence of anterior knee pain and donor site morbidity (e.g., patellar tendonitis, kneeling pain) compared to hamstring autografts. However, they demonstrate excellent fixation and incorporation rates.

Question 627

Topic: Shoulder & Hip Sports

A 22-year-old overhead athlete sustains an acute anterior shoulder dislocation. After reduction, an MRI arthrogram reveals an avulsion of the anterior-inferior labrum along with the anterior band of the inferior glenohumeral ligament (IGHL). What is the specific name of this lesion?

. SLAP lesion
. Hill-Sachs lesion
. ALPSA lesion
. Bankart lesion
. HAGL lesion

Correct Answer & Explanation

. Bankart lesion

Explanation

A classic Bankart lesion is defined as an anteroinferior detachment of the labrum and the attached inferior glenohumeral ligament from the glenoid rim. It is the essential soft-tissue lesion in recurrent anterior shoulder instability.

Question 628

Topic: 5. Sports Medicine

During an ACL reconstruction using a bone-patellar tendon-bone autograft, the surgeon notes a minor mismatch between the graft length and the tunnel length, leading to graft protrusion from the femoral tunnel. Which maneuver is best to resolve a minor (2-3 mm) mismatch?

. Rotate the graft 180 degrees
. Resect the protruding bone plug entirely
. Convert to a hamstring autograft
. Drill the femoral tunnel completely through the lateral cortex

Correct Answer & Explanation

. Rotate the graft 180 degrees

Explanation

Rotating the bone-patellar tendon-bone graft 180 degrees effectively shortens the functional length of the graft by 2 to 3 mm. This is a classic, simple technique to address minor graft-tunnel mismatch.

Question 629

Topic: Shoulder & Hip Sports

A 20-year-old male suffers a traumatic anterior shoulder dislocation. Post-reduction radiographs show a posterolateral humeral head impaction fracture. What is the eponym for this specific lesion?

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

Correct Answer & Explanation

. Hill-Sachs lesion

Explanation

A Hill-Sachs lesion is an impaction fracture of the posterolateral humeral head. It occurs when the humeral head dislocates anteriorly and forcefully impacts against the harder anterior glenoid rim.

Question 630

Topic: 5. Sports Medicine

A 22-year-old professional basketball player sustains an acute fracture of the proximal fifth metatarsal at the metaphyseal-diaphyseal junction (Zone 2). What is the most appropriate management to minimize the risk of nonunion and expedite return to play?

. Non-weight bearing in a short leg cast for 6 weeks
. Intramedullary screw fixation
. Excision of the proximal fragment and peroneus brevis advancement
. Plate and screw fixation
. Hard-soled shoe with immediate weight bearing

Correct Answer & Explanation

. Intramedullary screw fixation

Explanation

Acute Jones fractures in elite athletes are best treated with intramedullary screw fixation. This operative approach significantly decreases the time to clinical union and allows a faster, safer return to competitive sports compared to conservative management.

Question 631

Topic: Shoulder & Hip Sports

A 25-year-old male presents with recurrent anterior shoulder instability. Advanced imaging reveals 25% anterior glenoid bone loss and a large, engaging Hill-Sachs lesion. Which surgical procedure is most appropriate to prevent recurrence?

. Arthroscopic Bankart repair alone
. Latarjet procedure
. Putti-Platt procedure
. Arthroscopic SLAP repair
. Subacromial decompression

Correct Answer & Explanation

. Latarjet procedure

Explanation

Critical glenoid bone loss (>20-25%) combined with an engaging Hill-Sachs lesion is a strict contraindication to isolated soft-tissue (Bankart) repair. A bony augmentation procedure, such as the Latarjet (coracoid transfer), is required to restore stability.

Question 632

Topic: 5. Sports Medicine

A 22-year-old female soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Compared to the native ACL, what is the ultimate tensile load of a 10 mm wide BPTB graft?

. Approximately 50% of the native ACL
. Approximately equal to the native ACL
. Approximately 160% of the native ACL
. Approximately 250% of the native ACL
. Approximately 400% of the native ACL

Correct Answer & Explanation

. Approximately 160% of the native ACL

Explanation

The ultimate tensile load of a 10 mm BPTB autograft is approximately 2977 N, which is roughly 138-160% of the native ACL (which is around 2160 N). This high initial strength makes it an excellent choice for demanding athletic patients.

Question 633

Topic: 5. Sports Medicine

A 70-year-old woman who underwent a primary total knee arthroplasty 4 years ago presents with a sudden inability to actively extend her knee after a fall. Radiographs reveal a normal-appearing prosthesis but superior displacement of the patella. What is the most appropriate surgical management for this acute injury?

. Primary end-to-end repair with nonabsorbable suture
. Repair augmented with semitendinosus autograft or allograft
. Revision total knee arthroplasty with a hinged prosthesis
. Patellectomy and advancement of the quadriceps tendon
. Observation and use of a drop-lock knee brace indefinitely

Correct Answer & Explanation

. Repair augmented with semitendinosus autograft or allograft

Explanation

An acute patellar tendon rupture following a TKA necessitates surgical repair. However, primary repair alone carries a prohibitively high failure rate; therefore, augmentation with autograft, allograft (extensor mechanism allograft), or synthetic mesh is the standard of care.

Question 634

Topic: 5. Sports Medicine

A 19-year-old collegiate lacrosse player presents for treatment of acute pain along the lateral aspect of the foot. The pain developed during a preseason game 1 week ago. A radiograph is presented. The treatment that will return the athlete to playing competitively with the least likelihood of complications is:

. Open reduction and internal fixation
. Open reduction and bone grafting
. C ast immobilization and non-weight bearing
. Removable boot immobilization, weight bearing, and pool therapy
. Percutaneous screw fixation

Correct Answer & Explanation

. Percutaneous screw fixation

Explanation

To rapidly return the competitive athlete to full function, percutaneous screw fixation of an acute fracture or a stress fracture of the fifth metatarsal at thejunction of the metaphysis and diaphysis is preferred treatment. Although nonoperative treatment is associated with fracture healing, the limited function and requirement for immobilization, and possibly limited weight bearing, makes this alternative less appealing in the athlete.

Question 635

Topic: 5. Sports Medicine

A 22-year-old female soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. Which of the following is the most frequent complication specific to this graft choice compared to hamstring autografts?

. Increased anteroposterior laxity
. Anterior knee pain
. Deep vein thrombosis
. Premature graft rupture
. Septic arthritis

Correct Answer & Explanation

. Anterior knee pain

Explanation

Bone-patellar tendon-bone (BTB) autografts offer excellent bone-to-bone healing but are significantly associated with a higher incidence of anterior knee pain and kneeling pain compared to hamstring autografts.

Question 636

Topic: 5. Sports Medicine

A 40-year-old recreational athlete sustains an acute Achilles tendon rupture and opts for non-operative management. What functional protocol has been shown to result in re-rupture rates comparable to surgical repair?

. Prolonged casting in equinus for 8 weeks
. Early functional rehabilitation with controlled weight-bearing in a functional brace
. Strict non-weight-bearing in a neutral cast for 6 weeks
. Corticosteroid injections combined with physical therapy
. Non-operative management always has significantly higher re-rupture rates

Correct Answer & Explanation

. Early functional rehabilitation with controlled weight-bearing in a functional brace

Explanation

High-level evidence demonstrates that non-operative management utilizing early functional rehabilitation and functional bracing yields re-rupture rates similar to operative management, while avoiding surgical complications.

Question 637

Topic: Knee Sports

A 22-year-old soccer player sustains a twisting injury to his knee. Radiographs demonstrate an avulsion fracture of the anterolateral tibial plateau (Segond fracture). Which of the following structures is most likely injured in association with this radiographic finding?

. Posterior cruciate ligament
. Medial collateral ligament
. Anterior cruciate ligament
. Posterolateral corner
. Patellar tendon

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion of the anterolateral capsular complex from the proximal lateral tibia. It is considered a pathognomonic radiographic sign of an anterior cruciate ligament (ACL) tear.

Question 638

Topic: Knee Sports

Which of the following bundles of the anterior cruciate ligament (ACL) is the primary restraint to anterior tibial translation when the knee is in 90 degrees of flexion?

. Anteromedial bundle
. Posterolateral bundle
. Anterolateral bundle
. Posteromedial bundle
. Intermediate bundle

Correct Answer & Explanation

. Anteromedial bundle

Explanation

The anteromedial (AM) bundle of the ACL is tight in flexion and is the primary restraint to anterior translation at 90 degrees. The posterolateral (PL) bundle is tight in extension and primarily resists rotatory loads.

Question 639

Topic: 5. Sports Medicine

In the context of anterior cruciate ligament (ACL) reconstruction, which of the following graft choices possesses the highest initial ultimate tensile load?

. Native ACL
. 10-mm Bone-patellar tendon-bone autograft
. Quadrupled hamstring autograft
. Quadriceps tendon autograft without bone block
. Fascia lata autograft

Correct Answer & Explanation

. Quadrupled hamstring autograft

Explanation

A quadrupled hamstring autograft has an ultimate tensile load of approximately 4000 N, which is significantly higher than the native ACL (approx. 2160 N) and BPTB autograft (approx. 2977 N). However, long-term clinical stability remains comparable among modern graft choices.

Question 640

Topic: 5. Sports Medicine

A 22-year-old soccer player undergoes an anterior cruciate ligament reconstruction using a bone-patellar tendon-bone (BTB) autograft.

Six months postoperatively, she complains of persistent anterior knee pain when descending stairs. What is the most likely cause of her pain?

. Premature graft failure
. Development of a Cyclops lesion
. Harvest site morbidity and patellar tendinopathy
. Subacute septic arthritis
. Femoral interference screw impingement

Correct Answer & Explanation

. Harvest site morbidity and patellar tendinopathy

Explanation

Anterior knee pain is the most frequent long-term complication following BTB autograft harvest. It is typically exacerbated by activities that eccentrically load the extensor mechanism, such as descending stairs or squatting.

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