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5. Sports Medicine MCQs

Practice Set 326 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 6501

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction of the knee, surgical dissection near the fibular head places the common peroneal nerve at risk. What is the normal anatomic relationship of the common peroneal nerve as it crosses the knee joint?

. It runs posterior and medial to the biceps femoris tendon before wrapping anteriorly around the fibular neck
. It runs directly anterior to the biceps femoris tendon, deep to the iliotibial band
. It courses directly through the substance of the fibular collateral ligament
. It runs anterior to the lateral head of the gastrocnemius, crossing over the patellar tendon
. It pierces the biceps femoris muscle belly 5 cm proximal to the fibular head

Correct Answer & Explanation

. It runs posterior and medial to the biceps femoris tendon before wrapping anteriorly around the fibular neck

Explanation

The common peroneal nerve descends in the lateral aspect of the popliteal fossa, coursing posterior and medial to the tendon of the biceps femoris. It then travels distally and laterally to wrap around the neck of the fibula, deep to the peroneus longus muscle, making it highly susceptible to injury during PLC reconstruction or fibular head avulsions.

Question 6502

Topic: 5. Sports Medicine

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

. Deep vein thrombosis
. Anterior knee pain
. Graft rupture
. Infection
. Loss of knee flexion

Correct Answer & Explanation

. Anterior knee pain

Explanation

Bone-patellar tendon-bone (BPTB) autografts are historically considered the 'gold standard' for ACL reconstruction in high-demand athletes due to excellent graft incorporation (bone-to-bone healing). However, they are associated with a significantly higher rate of donor site morbidity, specifically anterior knee pain and pain with kneeling, compared to hamstring autografts.

Question 6503

Topic: Knee Sports
A 22-year-old collegiate football player sustains a combined complete anterior cruciate ligament (ACL) tear and a grade III medial collateral ligament (MCL) tear of his left knee. What is the most widely accepted treatment strategy for this injury pattern?
. Immediate simultaneous reconstruction of the ACL and MCL
. Nonoperative management of both injuries with long-term bracing
. Hinged knee brace for 4-6 weeks to allow MCL healing, followed by delayed ACL reconstruction
. ACL reconstruction within 1 week, followed by open MCL repair
. MCL reconstruction within 1 week, followed by ACL reconstruction at 6 months

Correct Answer & Explanation

. Hinged knee brace for 4-6 weeks to allow MCL healing, followed by delayed ACL reconstruction

Explanation

The gold standard treatment for a combined ACL and isolated grade III MCL injury is initial conservative management of the MCL using a hinged knee brace. This allows the MCL to heal and the patient to regain full range of motion. Delayed ACL reconstruction is then performed. Acute simultaneous reconstruction significantly increases the risk of post-operative arthrofibrosis (stiffness).

Question 6504

Topic: Knee Sports

In a patient with an acute traumatic knee injury, an MRI demonstrates a "double PCL" sign. Which of the following associated injuries is most likely to be present on further evaluation?

. ACL tear
. Medial meniscus bucket-handle tear
. Lateral meniscus radial tear
. Posterolateral corner injury
. Patellar tendon rupture

Correct Answer & Explanation

. Medial meniscus bucket-handle tear

Explanation

The "double PCL" sign on a sagittal MRI of the knee occurs when a bucket-handle tear of the medial meniscus displaces into the intercondylar notch. The displaced fragment lies anterior and parallel to the posterior cruciate ligament (PCL).

Question 6505

Topic: Shoulder & Hip Sports

In the setting of recurrent anterior shoulder instability, an engaging Hill-Sachs lesion is defined as an osseous defect that:

. Measures greater than 20% of the humeral head articular surface volume
. Is oriented parallel to the glenoid margin when the arm is abducted and externally rotated
. Engages the anterior glenoid rim when the arm is placed in abduction and external rotation
. Occurs simultaneously with an osseous Bankart lesion involving > 25% of the glenoid
. Is located on the anteromedial aspect of the humeral head, engaging in internal rotation

Correct Answer & Explanation

. Engages the anterior glenoid rim when the arm is placed in abduction and external rotation

Explanation

An engaging Hill-Sachs lesion is a posterosuperior humeral head defect that dynamically engages (levers over or drops into) the anterior glenoid rim when the shoulder is placed in a functional position of abduction and external rotation, contributing to recurrent instability.

Question 6506

Topic: Shoulder & Hip Sports

A 21-year-old rugby player presents with recurrent anterior shoulder instability. A 3D CT scan reveals 26% anterior glenoid bone loss. Which of the following procedures is the most appropriate definitive management to prevent recurrent instability?

. Arthroscopic Bankart repair with Remplissage
. Open Bankart repair with inferior capsular shift
. Coracoid process transfer (Latarjet procedure)
. Putti-Platt procedure
. Arthroscopic superior capsular reconstruction

Correct Answer & Explanation

. Coracoid process transfer (Latarjet procedure)

Explanation

In cases of anterior shoulder instability with critical glenoid bone loss (typically >20-25%), soft tissue stabilization alone has unacceptably high failure rates. The Latarjet procedure restores the bony arc and provides a dynamic sling effect via the conjoint tendon.

Question 6507

Topic: Shoulder & Hip Sports

In evaluating a patient with recurrent anterior shoulder instability, what is the defining characteristic of an "off-track" Hill-Sachs lesion?

. It occurs exclusively with an intact posterior glenoid rim.
. It requires a minimum of 30% humeral head involvement.
. Its medial margin lies medial to the glenoid track.
. Its lateral margin lies medial to the glenoid track.
. It avoids engagement with the anterior glenoid rim in abduction.

Correct Answer & Explanation

. Its medial margin lies medial to the glenoid track.

Explanation

An "off-track" Hill-Sachs lesion engages the anterior glenoid rim because its medial margin extends further medially than the width of the intact glenoid track. This biomechanical mismatch typically requires a remplissage or bone block procedure.

Question 6508

Topic: 5. Sports Medicine
An elite linebacker sustains an extreme hyperextension injury to his great toe. MRI confirms a complete tear of the plantar plate at the 1st MTP joint with proximal retraction of the sesamoid apparatus. What is the most appropriate treatment?
. Stiff-soled shoe or carbon fiber insert for 6 weeks
. Immediate taping and return to play with corticosteroid injection
. Surgical repair of the plantar plate and sesamoid apparatus
. 1st MTP joint arthrodesis
. Excision of the sesamoids with direct tendon repair

Correct Answer & Explanation

. Surgical repair of the plantar plate and sesamoid apparatus

Explanation

This is a Grade III turf toe injury (complete tear of the plantar plate/capsuloligamentous complex) with proximal retraction of the sesamoids. While Grade I and II injuries can often be managed nonoperatively with rest, taping, and stiff-soled inserts, a Grade III injury with frank instability and sesamoid retraction in a high-level athlete typically requires surgical repair to restore the windlass mechanism and push-off strength.

Question 6509

Topic: 5. Sports Medicine

A 26-year-old male presents with chronic deep ankle pain following an inversion injury 2 years ago. MRI reveals an osteochondral lesion of the medial talar dome. The lesion measures 1.8 cm^2 and is accompanied by a 12 mm deep subchondral cyst. Non-operative management has failed. According to current evidence-based algorithms, what is the most appropriate surgical intervention?

. Arthroscopic debridement and bone marrow stimulation (microfracture)
. Arthroscopic retrograde drilling of the cyst only
. Osteochondral autograft transfer system (OATS) or Autologous Chondrocyte Implantation (ACI)
. Conservative management with a patellar tendon-bearing brace for 6 additional months
. Total ankle arthroplasty

Correct Answer & Explanation

. Osteochondral autograft transfer system (OATS) or Autologous Chondrocyte Implantation (ACI)

Explanation

The treatment algorithm for osteochondral lesions of the talus (OLT) depends heavily on the size of the lesion and the presence of underlying cystic changes. Arthroscopic bone marrow stimulation (microfracture) is highly effective for primary lesions smaller than 1.5 cm^2 without massive cystic change. However, for large lesions (> 1.5 cm^2) and those with significant subchondral cysts, microfracture has a high failure rate. In these cases, structural restoration is required using an Osteochondral Autograft Transfer System (OATS) or regenerative techniques like Autologous Chondrocyte Implantation (ACI).

Question 6510

Topic: 5. Sports Medicine

A 40-year-old recreational athlete sustains an acute Achilles tendon rupture. He is evaluating his treatment options. According to recent high-quality randomized controlled trials comparing operative repair to nonoperative management with an early functional rehabilitation protocol, what is the expected outcome regarding re-rupture rates?

. Operative repair has a significantly lower re-rupture rate regardless of the rehabilitation protocol.
. Nonoperative management with early functional rehabilitation results in similar re-rupture rates to operative repair.
. Nonoperative management with prolonged cast immobilization has the lowest re-rupture rate.
. Operative repair allows for earlier weight-bearing but increases the risk of re-rupture.
. Nonoperative management has a 50% higher re-rupture rate even with early functional rehabilitation.

Correct Answer & Explanation

. Nonoperative management with early functional rehabilitation results in similar re-rupture rates to operative repair.

Explanation

Recent Level I evidence shows that when an early functional rehabilitation protocol (early weight-bearing and mobilization) is utilized, the re-rupture rates between nonoperative and operative management of Achilles tendon ruptures are statistically similar, while nonoperative treatment avoids surgical complications.

Question 6511

Topic: Shoulder & Hip Sports

During a Latarjet procedure for recurrent anterior shoulder instability, the coracoid process is transferred to the anterior glenoid neck. The 'sling effect' is considered the most significant contributor to stability in this procedure. Which of the following describes the mechanism of this dynamic sling?

. The subscapularis tendon compressing the anterior capsule
. The transferred coracoacromial ligament reinforcing the inferior glenohumeral ligament
. The conjoined tendon tensioning the inferior third of the subscapularis and anterior capsule during abduction and external rotation
. The conjoined tendon depressing the humeral head during forward elevation
. The bony block increasing the articular arc of the glenoid

Correct Answer & Explanation

. The conjoined tendon tensioning the inferior third of the subscapularis and anterior capsule during abduction and external rotation

Explanation

The primary stabilizing mechanism of the Latarjet procedure is the 'sling effect', which contributes up to 70% of the stability at the end ranges of motion. It is produced by the conjoined tendon (short head of the biceps and coracobrachialis) passing through the split in the subscapularis, which acts as a dynamic sling to tension the lower subscapularis and anterior capsule when the arm is placed in abduction and external rotation.

Question 6512

Topic: Knee Sports

A 48-year-old female presents with acute medial knee pain after a minor pivoting episode. MRI demonstrates a medial meniscus posterior root tear with 4 mm of meniscal extrusion. Which of the following best describes the biomechanical consequence of this specific injury if left untreated?

. Decreased anterior tibial translation under anterior shear loads
. Biomechanical equivalence to a total medial meniscectomy regarding peak contact pressures
. Increased tension on the anterior cruciate ligament but preserved hoop stresses
. Shift of peak contact forces to the lateral compartment
. Increased patellofemoral contact pressures during deep flexion

Correct Answer & Explanation

. Biomechanical equivalence to a total medial meniscectomy regarding peak contact pressures

Explanation

A posterior root tear of the medial meniscus completely disrupts the meniscal hoop stresses. Biomechanical studies have shown that this loss of hoop tension results in peak tibiofemoral contact pressures that are statistically equivalent to those seen after a total medial meniscectomy, drastically accelerating medial compartment arthrosis.

Question 6513

Topic: Shoulder & Hip Sports
A 23-year-old hockey player is diagnosed with Cam-type femoroacetabular impingement (FAI). Anteroposterior and Dunn view radiographs show an elevated alpha angle (>55 degrees). Where is the most common anatomic location of the Cam lesion on the proximal femur?
. Anteromedial head-neck junction
. Anterosuperior head-neck junction
. Posterosuperior head-neck junction
. Posteroinferior head-neck junction
. Directly lateral on the greater trochanteric ridge

Correct Answer & Explanation

. Anterosuperior head-neck junction

Explanation

Cam lesions are characterized by an aspherical extension of the articular surface or loss of head-neck offset. They are most commonly located at the anterosuperior portion of the femoral head-neck junction. Impingement typically occurs against the anterosuperior acetabular rim during hip flexion and internal rotation.

Question 6514

Topic: 5. Sports Medicine

A 25-year-old male is 3 months post-operative from an ACL reconstruction using a bone-patellar tendon-bone (BPTB) autograft. He complains of a new, audible 'clunk' and anterior knee pain as he reaches terminal extension. Which of the following conditions is most likely responsible for his symptoms?

. Cyclops lesion (localized anterior arthrofibrosis)
. Patellar tendon rupture
. Infrapatellar branch of the saphenous neuroma
. Graft impingement on the posterior cruciate ligament
. Chondromalacia patellae from over-tensioning

Correct Answer & Explanation

. Cyclops lesion (localized anterior arthrofibrosis)

Explanation

A Cyclops lesion is a localized nodule of fibrovascular tissue (arthrofibrosis) that typically forms anterior to the ACL graft in the intercondylar notch. It manifests with an audible or palpable 'clunk' near terminal extension and a loss of full extension. It is a classic complication post-ACL reconstruction causing mechanical block.

Question 6515

Topic: Knee Sports

A 28-year-old male sustains a severe knee injury during a rugby tackle. The dial test demonstrates 15 degrees of increased external rotation compared to the contralateral knee at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees of knee flexion. Which injury pattern does this specifically indicate?

. Isolated posterior cruciate ligament (PCL) injury
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injuries
. Combined ACL and PLC injuries
. Medial collateral ligament (MCL) and posteromedial corner injury

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

The dial test evaluates for posterolateral instability. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion, but returning to symmetry at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. If the asymmetry is present at BOTH 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 6516

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, identifying the anatomic femoral insertion is critical. According to Schöttle's radiographic landmarks on a strict lateral radiograph, where is the femoral origin of the MPFL located?
. Anterior to the posterior femoral cortical line and proximal to Blumensaat's line
. Posterior to the posterior femoral cortical line and distal to Blumensaat's line
. Anterior to the posterior femoral cortical line and distal to Blumensaat's line
. Directly on the medial epicondyle
. 1 cm distal to the adductor tubercle

Correct Answer & Explanation

. Anterior to the posterior femoral cortical line and distal to Blumensaat's line

Explanation

Schöttle's point defines the radiographic femoral origin of the MPFL on a true lateral view. It is located 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the posterior extension of Blumensaat's line.

Question 6517

Topic: Shoulder & Hip Sports

A 45-year-old bodybuilder feels a pop in his shoulder during a heavy bench press. Examination reveals increased passive external rotation and a positive belly-press test. An MRI confirms an isolated, full-thickness tear of the upper subscapularis tendon. What additional pathology is most strongly associated with this specific injury?

. Medial subluxation of the long head of the biceps tendon
. Type II SLAP tear
. Bankart lesion
. Posterior labral cyst
. Suprascapular nerve entrapment at the spinoglenoid notch

Correct Answer & Explanation

. Medial subluxation of the long head of the biceps tendon

Explanation

The upper fibers of the subscapularis tendon form the medial wall of the bicipital groove and contribute to the biceps reflection pulley. A tear of the superior subscapularis, especially when combined with a coracohumeral ligament tear, disrupts this pulley, frequently leading to medial subluxation or dislocation of the long head of the biceps tendon.

Question 6518

Topic: Knee Sports
A 22-year-old soccer player undergoes microfracture for a 1.5 cm^2 full-thickness chondral defect on the medial femoral condyle. Which of the following best describes the predominant histological composition of the reparative tissue generated by this procedure?
. Type II collagen with high proteoglycan content
. Type I collagen organized into fibrocartilage
. Type X collagen indicating endochondral ossification
. Hyaline cartilage identical to the surrounding native tissue
. Type III collagen primarily consisting of woven bone

Correct Answer & Explanation

. Type I collagen organized into fibrocartilage

Explanation

Microfracture stimulates the release of marrow elements to form a super clot over a chondral defect. The resulting reparative tissue is predominantly fibrocartilage, which is composed primarily of Type I collagen. This is mechanically inferior to the native articular hyaline cartilage, which is composed primarily of Type II collagen.

Question 6519

Topic: 5. Sports Medicine

In an overhead throwing athlete, a Type II Superior Labrum Anterior and Posterior (SLAP) tear is often symptomatic during specific phases of throwing due to the 'peel-back' mechanism. During which phase of the throwing motion does maximum peel-back force occur?

. Wind-up
. Early cocking
. Late cocking
. Acceleration
. Follow-through

Correct Answer & Explanation

. Late cocking

Explanation

The 'peel-back' mechanism is a primary cause of Type II SLAP tears in overhead athletes. During the late cocking phase, the shoulder is placed in maximum abduction and external rotation. This position causes a posterior and inferior shift in the vector of the biceps tendon, creating a torsional force that peels the superior labrum off the glenoid rim.

Question 6520

Topic: 5. Sports Medicine

A 20-year-old male with an acute ACL tear is suspected of having an associated 'ramp lesion'. Which of the following best defines a true ramp lesion of the knee?

. A radial tear of the lateral meniscus at the popliteal hiatus
. A longitudinal tear involving the meniscocapsular junction of the posterior horn of the medial meniscus
. An avulsion of the anterior root of the lateral meniscus
. A bucket-handle tear of the medial meniscus with displacement into the notch
. A chondral shear fracture of the posterolateral tibial plateau

Correct Answer & Explanation

. A longitudinal tear involving the meniscocapsular junction of the posterior horn of the medial meniscus

Explanation

A 'ramp lesion' refers specifically to a longitudinal tear at the peripheral meniscocapsular junction or the meniscotibial ligament of the posterior horn of the medial meniscus. It is highly associated with ACL tears and is often missed on standard anterior portal arthroscopy, frequently requiring evaluation via a posteromedial viewing or working portal.

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