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5. Sports Medicine MCQs

Practice Set 324 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 6461

Topic: 5. Sports Medicine

A 13-year-old male soccer player presents with vague knee pain. MRI shows a 1.5 cm osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. A high-signal T2 line is visible behind the lesion. Radiographs confirm wide open physes. What is the most appropriate management?

. Strict non-weight bearing and cylinder cast for 6 weeks
. Arthroscopic microfracture of the lesion bed
. Arthroscopic in situ drilling and fixation of the lesion
. Osteochondral allograft transplantation
. Observation and unrestricted return to play

Correct Answer & Explanation

. Strict non-weight bearing and cylinder cast for 6 weeks

Explanation

A high-signal T2 line behind an OCD lesion indicates synovial fluid tracking behind the fragment, denoting instability. Despite the open physes, unstable lesions require surgical stabilization (drilling and fixation) to prevent loose body formation.

Question 6462

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. She is most at risk for which of the following complications postoperatively compared to the use of a hamstring autograft?

. Anterior knee pain and pain with kneeling
. Decreased knee flexion strength at deep flexion angles
. Higher overall graft rupture rate
. Greater postoperative knee laxity
. Increased risk of deep vein thrombosis

Correct Answer & Explanation

. Anterior knee pain and pain with kneeling

Explanation

BTB autograft is associated with a significantly higher incidence of anterior knee pain and kneeling pain (donor site morbidity) compared to hamstring autograft. Hamstring grafts are associated with decreased deep flexion strength. Both grafts have comparable ultimate clinical failure rates when correctly tensioned and fixed.

Question 6463

Topic: Shoulder & Hip Sports

A 20-year-old male sustains an anterior shoulder dislocation during a tackle. Following reduction, an MRI arthrogram reveals an avulsion of the anterior inferior labrum along with the anterior band of the inferior glenohumeral ligament (IGHL) directly off the glenoid rim. This specific lesion is termed a:

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

Correct Answer & Explanation

. SLAP tear

Explanation

A Bankart lesion is an avulsion of the anterior-inferior labrum and the attached inferior glenohumeral ligament (IGHL) complex from the anterior glenoid rim. It is the most common pathologic lesion (essential lesion) in traumatic anterior shoulder instability. An ALPSA lesion is similar but the labroligamentous complex is displaced medially and inferiorly along the scapular neck.

Question 6464

Topic: 5. Sports Medicine

When selecting an autograft for an anterior cruciate ligament (ACL) reconstruction, which of the following provides the highest initial ultimate tensile load compared to the native ACL?

. 10mm Bone-Patellar Tendon-Bone
. Quadrupled Hamstring
. Quadriceps tendon (10mm)
. Single strand Gracilis
. Single strand Semitendinosus

Correct Answer & Explanation

. 10mm Bone-Patellar Tendon-Bone

Explanation

A quadrupled hamstring graft has an initial ultimate tensile load of approximately 4000-4100 N, which is significantly higher than the native ACL (~2160 N) and a 10mm BPTB graft (~2977 N). However, graft healing, incorporation, and fixation strength also play critical roles in long-term clinical outcomes.

Question 6465

Topic: Knee Sports

A 22-year-old soccer player sustains a twisting knee injury. Radiographs reveal a small avulsion fracture of the lateral tibial plateau. This radiographic finding is pathognomonic for an injury to which of the following structures?

. Medial collateral ligament
. Posterior cruciate ligament
. Anterior cruciate ligament
. Lateral meniscus
. Posterolateral corner

Correct Answer & Explanation

. Medial collateral ligament

Explanation

A Segond fracture is an avulsion fracture of the lateral tibial plateau at the insertion of the anterolateral ligament (ALL) and lateral capsular ligament. It is highly associated (pathognomonic) with an anterior cruciate ligament (ACL) tear.

Question 6466

Topic: Shoulder & Hip Sports

During the preoperative planning for a patient with recurrent anterior shoulder instability, the 'glenoid track' concept is utilized. An 'off-track' Hill-Sachs lesion without critical glenoid bone loss is best managed by which of the following soft-tissue procedures in addition to an arthroscopic Bankart repair?

. Coracoid transfer (Latarjet procedure)
. Remplissage procedure
. Superior labrum anterior-posterior (SLAP) repair
. Rotator interval closure
. Subscapularis advancement

Correct Answer & Explanation

. Coracoid transfer (Latarjet procedure)

Explanation

An 'off-track' Hill-Sachs lesion is one that engages the anterior glenoid rim during shoulder abduction and external rotation. When glenoid bone loss is subcritical, adding a Remplissage (insetting the infraspinatus tendon and posterior capsule into the Hill-Sachs defect) to the Bankart repair effectively converts the lesion to an 'on-track' lesion, preventing engagement.

Question 6467

Topic: 5. Sports Medicine

Which of the following bone graft options possesses osteogenic, osteoinductive, and osteoconductive properties?

. Demineralized bone matrix (DBM)
. Cancellous allograft
. Autogenous iliac crest bone graft
. Ceramic bone void filler
. Recombinant human BMP-2

Correct Answer & Explanation

. Demineralized bone matrix (DBM)

Explanation

Autogenous bone graft is the only option that contains live cells (osteogenic), growth factors (osteoinductive), and a structural scaffold (osteoconductive). Allografts lack osteogenic properties due to processing.

Question 6468

Topic: Shoulder & Hip Sports

A 55-year-old female presents with an anterior shoulder dislocation and an associated greater tuberosity fracture. Following closed reduction, radiographs demonstrate the greater tuberosity is displaced superiorly by 8 mm. What is the most appropriate management?

. Sling immobilization for 3 weeks followed by physical therapy
. Open reduction and internal fixation of the greater tuberosity
. Arthroscopic Bankart repair only
. Total shoulder arthroplasty
. Reverse total shoulder arthroplasty

Correct Answer & Explanation

. Sling immobilization for 3 weeks followed by physical therapy

Explanation

In active patients, greater tuberosity displacement of more than 5 mm after reduction of an anterior shoulder dislocation is generally an indication for surgical fixation. This prevents subacromial impingement and restores rotator cuff function.

Question 6469

Topic: 5. Sports Medicine

A 22-year-old collegiate soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Compared to hamstring autograft, the BPTB graft is associated with a higher incidence of which of the following?

. Graft rupture
. Anterior knee pain
. Deep infection
. Saphenous nerve injury
. Delayed graft incorporation

Correct Answer & Explanation

. Graft rupture

Explanation

Bone-patellar tendon-bone (BPTB) autografts have excellent clinical outcomes but are consistently associated with a higher incidence of donor-site morbidity, specifically anterior knee pain and pain with kneeling, compared to hamstring autografts.

Question 6470

Topic: 5. Sports Medicine

A 25-year-old athlete undergoes arthroscopic repair of a medial meniscus tear. Which of the following best describes the vascularity of the meniscus and its potential for healing?

. The entire meniscus is avascular and relies on synovial fluid for nutrition
. The inner one-third is highly vascularized by the middle geniculate artery
. The peripheral 10-30% is vascularized by the medial and lateral geniculate arteries
. Blood supply enters centrally from the intercondylar notch and flows peripherally
. Vascularity increases with age, improving healing potential in older patients

Correct Answer & Explanation

. The entire meniscus is avascular and relies on synovial fluid for nutrition

Explanation

The adult meniscus has a limited blood supply, with only the peripheral 10-30% (the red-red zone) being vascularized by branches of the medial, lateral, and middle geniculate arteries. Tears in this peripheral zone have the best healing capacity following repair.

Question 6471

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction of the knee, anatomical placement of the fibular collateral ligament (LCL) graft on the femur is critical to avoid graft isometry mismatch. What is the native anatomical relationship of the LCL origin on the lateral femoral condyle relative to the popliteus tendon origin?

. LCL origin is proximal and posterior to the popliteus origin
. LCL origin is distal and anterior to the popliteus origin
. LCL origin is proximal and anterior to the popliteus origin
. LCL origin is distal and posterior to the popliteus origin
. They share a conjoined origin at the lateral epicondyle

Correct Answer & Explanation

. LCL origin is proximal and posterior to the popliteus origin

Explanation

Anatomical studies (such as those by LaPrade et al.) have established that the native femoral attachment of the fibular collateral ligament (LCL) is located proximal and posterior to the popliteus tendon attachment on the lateral femoral condyle. The LCL origin is slightly proximal and posterior to the lateral epicondyle, while the popliteus originates anterior and distal to the LCL in the popliteal sulcus.

Question 6472

Topic: Knee Sports

In reconstructing the posterolateral corner (PLC) of the knee, precise anatomical placement of the popliteus tendon graft is crucial. What is the correct anatomical footprint of the popliteus tendon on the lateral femur relative to the lateral collateral ligament (LCL) origin?

. Anterior and superior to the LCL origin
. Anterior and inferior to the LCL origin
. Posterior and superior to the LCL origin
. Posterior and inferior to the LCL origin
. Directly medial to the LCL origin

Correct Answer & Explanation

. Anterior and superior to the LCL origin

Explanation

The popliteus tendon inserts on the lateral femoral condyle anterior and inferior to the origin of the lateral collateral ligament (LCL). Understanding this relationship is critical for anatomical PLC reconstructions.

Question 6473

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player is diagnosed with a paralabral cyst at the spinoglenoid notch compressing the passing nerve. What is the expected clinical physical examination finding?

. Supraspinatus weakness only
. Infraspinatus weakness only
. Combined supraspinatus and infraspinatus weakness
. Teres minor weakness only
. Deltoid and teres minor weakness

Correct Answer & Explanation

. Supraspinatus weakness only

Explanation

The suprascapular nerve innervates the supraspinatus and then passes through the spinoglenoid notch to innervate the infraspinatus. Entrapment at the spinoglenoid notch (often due to posterior labral cysts) causes isolated infraspinatus weakness. Entrapment at the suprascapular notch affects both.

Question 6474

Topic: Shoulder & Hip Sports

A posterior approach to the shoulder exposes the quadrilateral space, which contains the axillary nerve and posterior circumflex humeral artery. What are the correct anatomical borders of the quadrilateral space?

. Superior: Teres minor; Inferior: Teres major; Medial: Long head of triceps; Lateral: Humeral shaft
. Superior: Teres major; Inferior: Teres minor; Medial: Lateral head of triceps; Lateral: Humeral shaft
. Superior: Teres minor; Inferior: Teres major; Medial: Humeral shaft; Lateral: Long head of triceps
. Superior: Infraspinatus; Inferior: Teres minor; Medial: Long head of triceps; Lateral: Humeral shaft
. Superior: Subscapularis; Inferior: Teres major; Medial: Short head of biceps; Lateral: Humeral shaft

Correct Answer & Explanation

. Superior: Teres minor; Inferior: Teres major; Medial: Long head of triceps; Lateral: Humeral shaft

Explanation

The quadrilateral space is bounded superiorly by the teres minor, inferiorly by the teres major, medially by the long head of the triceps, and laterally by the surgical neck of the humerus. It transmits the axillary nerve and posterior circumflex humeral vessels.

Question 6475

Topic: Knee Sports

The posterior horn of the lateral meniscus is stabilized by the meniscofemoral ligaments. What is the correct anatomical course of the ligament of Wrisberg in relation to the posterior cruciate ligament (PCL)?

. It courses anterior to the PCL
. It courses posterior to the PCL
. It courses superior to the ACL
. It courses inferior to the popliteus tendon
. It runs longitudinally through the central substance of the PCL

Correct Answer & Explanation

. It courses anterior to the PCL

Explanation

The meniscofemoral ligaments connect the posterior horn of the lateral meniscus to the medial femoral condyle. The ligament of Humphrey passes anterior to the PCL, whereas the ligament of Wrisberg passes posterior to the PCL. A helpful mnemonic is alphabetical: Humphrey is Anterior, Wrisberg is Posterior.

Question 6476

Topic: Knee Sports

The popliteofibular ligament is a crucial component of the posterolateral corner (PLC) of the knee, acting as a primary restraint to external rotation. From its origin at the popliteus musculotendinous junction, where does it anatomically insert?

. Anterior aspect of the fibular head
. Lateral epicondyle of the femur
. Posteromedial aspect of the fibular styloid
. Gerdy's tubercle
. Lateral rim of the lateral meniscus

Correct Answer & Explanation

. Anterior aspect of the fibular head

Explanation

The popliteofibular ligament (PFL) is a key structure in the posterolateral corner of the knee. It arises from the popliteus tendon at its musculotendinous junction and courses inferiorly and laterally to insert on the posteromedial aspect of the fibular styloid process. It plays a major role in resisting external tibial rotation and varus opening.

Question 6477

Topic: Shoulder & Hip Sports

The suprascapular nerve provides motor innervation to the infraspinatus muscle. At the spinoglenoid notch, the nerve is at risk of compression from a paralabral cyst. Which ligament forms the roof of the spinoglenoid notch?

. Superior transverse scapular ligament
. Coracoclavicular ligament
. Inferior transverse scapular (spinoglenoid) ligament
. Coracoacromial ligament
. Coracohumeral ligament

Correct Answer & Explanation

. Superior transverse scapular ligament

Explanation

The suprascapular nerve passes through the suprascapular notch (under the superior transverse scapular ligament) to innervate the supraspinatus, and then travels through the spinoglenoid notch to innervate the infraspinatus. The roof of the spinoglenoid notch is formed by the inferior transverse scapular ligament (also known as the spinoglenoid ligament).

Question 6478

Topic: Knee Sports

The lateral meniscus of the knee is more mobile and less prone to injury than the medial meniscus. Which of the following anatomical features is unique to the lateral meniscus compared to the medial meniscus?

. It is firmly attached to the lateral collateral ligament
. It receives direct tendinous attachment from the semimembranosus
. It lacks vascular supply in its peripheral third
. It has attachments to the meniscofemoral ligaments (Humphrey and Wrisberg)
. It is C-shaped with widely separated anterior and posterior horns

Correct Answer & Explanation

. It is firmly attached to the lateral collateral ligament

Explanation

The lateral meniscus is more circular (O-shaped) and has more closely approximated horns. Unlike the medial meniscus, which is firmly attached to the deep MCL, the lateral meniscus has no attachment to the LCL (separated by the popliteus tendon). Unique to the lateral meniscus are the meniscofemoral ligaments of Humphrey (anterior to PCL) and Wrisberg (posterior to PCL), which attach its posterior horn to the medial femoral condyle.

Question 6479

Topic: Shoulder & Hip Sports

The rotator interval is a distinct anatomical and capsular space in the shoulder. What structures form its superior and inferior borders, respectively?

. Supraspinatus and Infraspinatus
. Subscapularis and Teres minor
. Supraspinatus and Subscapularis
. Coracohumeral ligament and Glenohumeral ligaments
. Biceps tendon and Coracoacromial ligament

Correct Answer & Explanation

. Supraspinatus and Infraspinatus

Explanation

The rotator interval is a triangular space in the anterosuperior aspect of the shoulder capsule. It is bordered superiorly by the anterior margin of the supraspinatus tendon and inferiorly by the superior margin of the subscapularis tendon. It contains the long head of the biceps tendon and the coracohumeral ligament.

Question 6480

Topic: Shoulder & Hip Sports

When performing a Latarjet procedure, the conjoined tendon is retracted medially. To prevent injury to the musculocutaneous nerve, the surgeon must remember that it typically enters the coracobrachialis at what approximate distance distal to the coracoid process?

. 1 to 2 cm
. 3 to 8 cm
. 10 to 12 cm
. It does not enter the coracobrachialis
. It enters proximal to the coracoid

Correct Answer & Explanation

. 1 to 2 cm

Explanation

The musculocutaneous nerve enters the coracobrachialis muscle approximately 3 to 8 cm (typically around 5 cm) distal to the tip of the coracoid process. Vigorous medial retraction of the conjoined tendon can cause a stretch neurapraxia.

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