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5. Sports Medicine MCQs

Practice Set 320 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 6381

Topic: Shoulder & Hip Sports

In the evaluation of recurrent anterior shoulder instability, the 'glenoid track' concept is utilized to determine if a Hill-Sachs lesion is engaging. By definition, a Hill-Sachs lesion is considered 'off-track' (engaging) if its medial margin extends medial to the glenoid track. In a patient with an intact anterior glenoid rim (no bony Bankart), the width of the glenoid track is calculated as approximately what percentage of the native anterior-posterior glenoid width?

. 63%
. 73%
. 83%
. 93%
. 100%

Correct Answer & Explanation

. 63%

Explanation

The glenoid track is defined as the contact zone between the glenoid and the humeral head when the arm is in abduction and external rotation. In a normal shoulder without anterior bone loss, the width of the glenoid track is approximately 83% of the anterior-posterior width of the native glenoid. If there is an anterior glenoid bone defect, the track width is reduced by the width of that defect (83% of native width minus the defect width).

Question 6382

Topic: 5. Sports Medicine

A 22-year-old collegiate soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. Which of the following is the most commonly reported long-term complication specific to this graft choice?

. Patellar tendon rupture
. Patellar fracture
. Anterior knee pain
. Graft rupture
. Arthrofibrosis

Correct Answer & Explanation

. Patellar tendon rupture

Explanation

Anterior knee pain (donor site morbidity) is the most common complication following BTB autograft ACL reconstruction. Patellar fracture and tendon rupture are severe but rare complications.

Question 6383

Topic: 5. Sports Medicine

During arthroscopy, articular cartilage is evaluated. The superficial zone of articular cartilage is primarily designed to resist shear forces. Which of the following best describes the collagen fiber orientation and chondrocyte morphology in this superficial zone?

. Parallel to the joint surface with flattened chondrocytes
. Perpendicular to the joint surface with spherical chondrocytes
. Randomly oriented with hypertrophic chondrocytes
. Oblique to the joint surface with columnar chondrocytes
. Arranged in a radial pattern with sparse chondrocytes

Correct Answer & Explanation

. Parallel to the joint surface with flattened chondrocytes

Explanation

In the superficial zone of articular cartilage, collagen fibers are oriented parallel to the joint surface to resist shear forces. The chondrocytes in this layer are flattened and elongated.

Question 6384

Topic: 5. Sports Medicine

A 25-year-old athlete undergoes an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. Compared to a hamstring autograft, which of the following is an established complication more frequently associated with BTB autografts?

. Higher rate of graft rupture
. Greater loss of hamstring strength
. Increased anterior knee pain
. Higher risk of deep vein thrombosis
. Slower graft incorporation

Correct Answer & Explanation

. Higher rate of graft rupture

Explanation

Bone-patellar tendon-bone (BTB) autografts are associated with a higher incidence of anterior knee pain and kneeling pain compared to hamstring autografts. Both grafts offer excellent long-term stability and comparable rupture rates.

Question 6385

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes an anterior stabilization procedure for recurrent shoulder dislocations. Preoperative CT reveals a 25% loss of the anterior glenoid rim. Which of the following procedures is most appropriate to restore glenohumeral stability?

. Arthroscopic Bankart repair
. Latarjet procedure
. Remplissage procedure
. Putti-Platt procedure
. Superior labrum anterior to posterior (SLAP) repair

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

An anterior glenoid bone loss of greater than 20-25% is an absolute indication for a bony augmentation procedure, such as the Latarjet procedure. Soft tissue repairs alone have an unacceptably high failure rate in the setting of critical bone loss.

Question 6386

Topic: Shoulder & Hip Sports

A 22-year-old male athlete presents with recurrent anterior shoulder dislocations. An MRI reveals an engaging Hill-Sachs lesion and anterior glenoid bone loss of 25%. What is the most appropriate surgical management for this patient to prevent recurrence?

. Arthroscopic Bankart repair
. Arthroscopic remplissage alone
. Latarjet procedure
. Open capsular shift
. Biceps tenodesis

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

A Latarjet procedure (coracoid transfer) is indicated for patients with recurrent anterior shoulder instability and significant glenoid bone loss (>20-25%). Soft tissue stabilization alone has unacceptably high failure rates in the setting of critical bone loss.

Question 6387

Topic: Knee Sports

A 32-year-old skier sustains a Schatzker Type II tibial plateau fracture (split-depression of the lateral plateau). Which associated intra-articular injury is most commonly encountered and must be addressed during surgical management?

. Medial meniscus tear
. Lateral meniscus tear
. Anterior cruciate ligament (ACL) rupture
. Posterior cruciate ligament (PCL) rupture
. Osteochondral defect of the medial femoral condyle

Correct Answer & Explanation

. Medial meniscus tear

Explanation

Schatzker Type II fractures involve the lateral tibial plateau. There is a very high incidence (up to 50%) of associated lateral meniscal tears. The meniscus frequently becomes incarcerated within the depressed articular fragments, requiring meticulous extraction, elevation of the joint surface, and meniscal repair during ORIF.

Question 6388

Topic: Shoulder & Hip Sports

A 45-year-old sustains a traumatic anterior shoulder dislocation. Post-reduction imaging shows an anterior glenoid bone loss of 30% and an engaging Hill-Sachs lesion. What is the most appropriate definitive surgical management to prevent recurrent instability?

. Arthroscopic Bankart repair with multiple suture anchors
. Open inferior capsular shift
. Arthroscopic Remplissage procedure alone
. Latarjet procedure (coracoid process transfer)
. Glenohumeral arthrodesis

Correct Answer & Explanation

. Arthroscopic Bankart repair with multiple suture anchors

Explanation

In the setting of anterior shoulder instability with critical glenoid bone loss (>20-25%), soft tissue repairs like the Bankart procedure have a high failure rate. A bony augmentation procedure, such as the Latarjet, is indicated.

Question 6389

Topic: 5. Sports Medicine

When comparing operative to nonoperative management of acute Achilles tendon ruptures utilizing an early functional rehabilitation protocol, current evidence indicates which of the following regarding clinical outcomes?

. Operative treatment has a significantly lower rate of re-rupture.
. Nonoperative treatment is associated with a significantly higher rate of deep vein thrombosis.
. There is no clinically significant difference in re-rupture rates.
. Nonoperative treatment reliably provides greater plantarflexion strength at 1 year.
. Operative treatment decreases the overall time required to return to sports.

Correct Answer & Explanation

. Operative treatment has a significantly lower rate of re-rupture.

Explanation

Recent high-quality randomized controlled trials and meta-analyses have demonstrated that when an early functional rehabilitation protocol (early weight-bearing and mobilization) is utilized, there is no significant difference in the re-rupture rates between operative and nonoperative management of acute Achilles tendon ruptures. Operative management does, however, carry higher risks of wound complications and sural nerve injury.

Question 6390

Topic: 5. Sports Medicine

A 26-year-old male has persistent deep ankle pain 8 months after a severe inversion sprain. MRI demonstrates a 1.2 cm x 1.0 cm osteochondral lesion of the medial talar dome with intact overlying cartilage. He has failed exhaustive conservative management. What is the most appropriate first-line surgical intervention?

. Arthroscopic bone marrow stimulation (microfracture)
. Osteochondral autograft transfer system (OATS)
. Fresh osteochondral allograft transplantation
. Tibiotalar arthrodesis
. Autologous chondrocyte implantation (ACI)

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

For primary, symptomatic osteochondral lesions of the talus (OLT) that are relatively small (< 1.5 cm^2 or < 15 mm in diameter) and have failed conservative management, arthroscopic debridement and bone marrow stimulation (microfracture) is the gold standard first-line surgical treatment. OATS or allografts are reserved for larger lesions (> 1.5 cm^2), cystic lesions, or revision surgery.

Question 6391

Topic: 5. Sports Medicine

A 21-year-old collegiate basketball player sustains an acute Zone 2 fracture of the proximal fifth metatarsal (Jones fracture). He wishes to return to play as soon as safely possible. What is the recommended treatment to minimize the risk of nonunion and allow early return to sports?

. Non-weight bearing in a short leg cast for 6 weeks
. Weight-bearing as tolerated in a stiff-soled shoe
. Intramedullary screw fixation
. Excision of the proximal fragment and peroneus brevis advancement
. Open reduction and plating

Correct Answer & Explanation

. Non-weight bearing in a short leg cast for 6 weeks

Explanation

Zone 2 (Jones) fractures occur at the metaphyseal-diaphyseal junction and are prone to nonunion due to a watershed blood supply. While nonoperative management can be used in the general population, elite athletes have an unacceptably high risk of delayed union/nonunion and prolonged return to play. Intramedullary screw fixation is the gold standard for high-level athletes to ensure early and reliable return to sport.

Question 6392

Topic: 5. Sports Medicine
A 28-year-old professional football player suffers a hyperextension injury to his great toe. Physical examination reveals marked tenderness over the plantar aspect of the first MTP joint and weakness of active plantarflexion of the hallux. An MRI demonstrates a complete rupture of the plantar plate with proximal retraction of the sesamoids. What is the most appropriate treatment?
. Taping and immediate return to play
. Stiff-soled shoe for 2 weeks followed by physical therapy
. Cast immobilization for 8 weeks
. Surgical repair of the plantar plate and sesamoid complex
. First MTP joint arthrodesis

Correct Answer & Explanation

. Surgical repair of the plantar plate and sesamoid complex

Explanation

This is a Grade III turf toe injury (complete tear of the plantar plate/capsuloligamentous complex) with proximal sesamoid migration. In a high-demand professional athlete, surgical repair is indicated to restore the push-off strength and anatomy of the first MTP joint, preventing chronic instability, weakness, and hallux rigidus.

Question 6393

Topic: 5. Sports Medicine
A professional football player sustains a severe forced hyperextension injury to his first metatarsophalangeal (MTP) joint. MRI confirms a complete tear of the plantar plate with significant retraction of the sesamoids proximal to the MTP joint line. Which of the following is the most appropriate management strategy to optimize his return to elite play?
. Stiff-soled shoe and return to play as tolerated
. Short leg walking cast for 6 weeks
. Surgical repair of the plantar plate and capsuloligamentous complex
. Excision of both the medial and lateral sesamoids
. Primary arthrodesis of the first MTP joint

Correct Answer & Explanation

. Surgical repair of the plantar plate and capsuloligamentous complex

Explanation

This represents a Grade III turf toe injury (complete tear of the plantar plate capsule-ligamentous complex). In high-demand athletes, especially when accompanied by sesamoid retraction, frank joint instability, or a massive tear of the capsular structures, surgical repair is indicated to restore functional push-off strength and joint stability.

Question 6394

Topic: 5. Sports Medicine

A 28-year-old male undergoes ankle arthroscopy for a symptomatic osteochondral lesion of the medial talar dome. The lesion measures 120 square millimeters. What is the most appropriate surgical treatment?

. Arthroscopic debridement and bone marrow stimulation (microfracture)
. Osteochondral autograft transfer (OATS)
. Fresh osteochondral allograft transplantation
. Retrograde drilling alone
. Total ankle arthroplasty

Correct Answer & Explanation

. Arthroscopic debridement and bone marrow stimulation (microfracture)

Explanation

Arthroscopic bone marrow stimulation (microfracture) is highly successful and remains the first-line treatment for primary osteochondral lesions of the talus smaller than 150 square millimeters. Larger or cystic lesions may require an autograft or allograft transfer.

Question 6395

Topic: 5. Sports Medicine

A 25-year-old football player sustains a hyperdorsiflexion injury to his great toe. Exam reveals profound ecchymosis, swelling, and gross instability of the first metatarsophalangeal joint with absent push-off strength. MRI confirms a complete tear of the plantar plate and sesamoid complex. What is the most appropriate treatment?

. Stiff-soled shoe and early return to play
. Taping and weight-bearing as tolerated
. Corticosteroid injection and physical therapy
. Surgical repair of the plantar plate and sesamoid complex
. First MTP joint arthrodesis

Correct Answer & Explanation

. Stiff-soled shoe and early return to play

Explanation

A Grade 3 turf toe injury involves a complete tear of the plantar plate complex with gross instability. In high-level competitive athletes, surgical repair is indicated to restore push-off strength and joint stability.

Question 6396

Topic: 5. Sports Medicine
A 24-year-old professional American football player sustains a hyperextension injury to his first metatarsophalangeal (MTP) joint. Clinical exam reveals marked swelling, ecchymosis, and frank instability of the first MTP joint with proximal migration of the sesamoids on radiographs. What is the most appropriate management?
. Rigid orthosis and return to play as tolerated
. Taping the hallux into plantarflexion for 6 weeks
. Operative repair of the plantar plate
. First MTP joint arthrodesis
. Excision of the sesamoids

Correct Answer & Explanation

. Operative repair of the plantar plate

Explanation

This is a Grade III turf toe injury characterized by a complete tear of the plantar plate and sesamoid complex with frank instability. In a competitive athlete, operative repair of the plantar plate and stabilization of the sesamoids is indicated.

Question 6397

Topic: Shoulder & Hip Sports

A 24-year-old athlete sustains a traction injury to the neck and shoulder. Clinical examination reveals profound weakness in shoulder abduction initiation and external rotation, with isolated atrophy of the supraspinatus and infraspinatus. Sensation over the lateral deltoid is intact. From which specific component of the brachial plexus does the affected nerve originate?

. Lateral cord
. Posterior cord
. Medial cord
. Upper trunk
. Lower trunk

Correct Answer & Explanation

. Lateral cord

Explanation

The patient exhibits a suprascapular nerve palsy, innervating the supraspinatus (abduction initiation) and infraspinatus (external rotation). Sensation over the lateral deltoid is intact, distinguishing it from an axillary nerve injury. The suprascapular nerve originates directly from the Upper Trunk (C5, C6) of the brachial plexus.

Question 6398

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, the surgeon evaluates the femoral footprint. The ACL consists of two functional bundles. Which of the following statements accurately describes the biomechanical role of the ACL bundles?

. The anteromedial (AM) bundle is tight in extension and controls rotational stability
. The posterolateral (PL) bundle is tight in flexion and controls anterior translation
. The anteromedial (AM) bundle is tight in flexion and is the primary restraint to anterior translation
. The posterolateral (PL) bundle primarily limits valgus stress in extension
. Both bundles are equally tensioned throughout the entire range of motion

Correct Answer & Explanation

. The anteromedial (AM) bundle is tight in extension and controls rotational stability

Explanation

The anteromedial (AM) bundle of the ACL is tight in flexion and is the primary restraint to anterior tibial translation. The posterolateral (PL) bundle is tight in extension and primarily controls rotational stability.

Question 6399

Topic: Shoulder & Hip Sports

A 25-year-old elite volleyball player complains of vague posterior shoulder pain and weakness. Physical examination reveals isolated weakness in external rotation with the arm at the side, but normal forward elevation and internal rotation. MRI reveals a paralabral cyst. Where is the cyst most likely located to produce this specific deficit?

. Suprascapular notch
. Quadrilateral space
. Spinoglenoid notch
. Triangular interval
. Subcoracoid space

Correct Answer & Explanation

. Suprascapular notch

Explanation

Entrapment of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus muscle, leading to isolated external rotation weakness. Entrapment at the more proximal suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 6400

Topic: 5. Sports Medicine

Following anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, the graft undergoes a process of 'ligamentization'. During this biological remodeling process, at what postoperative time frame is the graft biomechanically at its weakest?

. 1-2 weeks
. 3-4 weeks
. 6-8 weeks
. 12-16 weeks
. 6 months

Correct Answer & Explanation

. 1-2 weeks

Explanation

The ACL graft is biomechanically weakest during the 'proliferation' or revascularization phase, which typically occurs around 6 to 8 weeks postoperatively. During this time, the graft tissue is undergoing significant necrosis and subsequent cellular repopulation.

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