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5. Sports Medicine MCQs

Practice Set 329 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 6561

Topic: 5. Sports Medicine

You are performing a double-bundle posterior cruciate ligament (PCL) reconstruction using an Achilles tendon allograft. To accurately recreate native knee biomechanics, how should the anterolateral (AL) and posteromedial (PM) bundles be tensioned during graft fixation?

. AL bundle tensioned in full extension; PM bundle tensioned in 90 degrees of flexion
. AL bundle tensioned in 90 degrees of flexion; PM bundle tensioned in full extension
. Both bundles tensioned in full extension
. Both bundles tensioned in 90 degrees of flexion
. AL bundle tensioned in 30 degrees of flexion; PM bundle tensioned in 120 degrees of flexion

Correct Answer & Explanation

. AL bundle tensioned in 90 degrees of flexion; PM bundle tensioned in full extension

Explanation

The native anterolateral (AL) bundle is taut in flexion, whereas the posteromedial (PM) bundle is taut in extension. Therefore, during double-bundle reconstruction, the AL bundle is fixed at 90 degrees of flexion and the PM bundle is fixed in near full extension.

Question 6562

Topic: Knee Sports

During an acute anterior cruciate ligament (ACL) reconstruction in a 25-year-old athlete, a peripheral tear of the posterior horn of the medial meniscus at the meniscocapsular junction (Ramp lesion) is identified. What is the primary biomechanical consequence of leaving this lesion unrepaired?

. Increased posterior tibial translation at 90 degrees of flexion
. Increased anterior tibial translation and rotatory instability
. Increased valgus laxity in full extension
. Decreased contact pressure in the medial compartment
. Increased risk of posterior cruciate ligament (PCL) failure

Correct Answer & Explanation

. Increased anterior tibial translation and rotatory instability

Explanation

Ramp lesions disrupt the posterior medial meniscocapsular attachments, which act as important secondary restraints to anterior tibial translation. Failure to repair them during ACL reconstruction leads to significantly increased anterior tibial translation and persistent pivot-shift kinematics.

Question 6563

Topic: Knee Sports
A 35-year-old male sustains a traumatic knee dislocation resulting in ACL, PCL, and posterolateral corner (PLC) tears (Schenck KD III-L). He has normal distal pulses (ABI > 0.9) but exhibits a dense, complete foot drop. What is the most appropriate management regarding his peroneal nerve injury during his planned multiligament knee reconstruction at 3 weeks post-injury?
. Immediate sural nerve grafting prior to ligament reconstruction
. Primary end-to-end nerve repair concurrent with ligament reconstruction
. Nerve exploration and neurolysis during the PLC reconstruction
. Delayed nerve exploration at 6 months only if no spontaneous recovery occurs
. Tibial nerve to deep peroneal nerve transfer during the index procedure

Correct Answer & Explanation

. Nerve exploration and neurolysis during the PLC reconstruction

Explanation

In a multiligament knee injury with concomitant peroneal nerve palsy, exploration and neurolysis are indicated at the time of the PLC reconstruction to assess the zone of injury and prevent local tethering. Definitive repair, grafting, or nerve transfers are typically delayed if function fails to return after several months.

Question 6564

Topic: 5. Sports Medicine
A 21-year-old basketball player presents with a 4.5 cm² full-thickness chondral defect on the weight-bearing surface of the medial femoral condyle. He has failed conservative management and requires surgical intervention. Which of the following procedures is most appropriate to provide hyaline-like cartilage for a defect of this magnitude?
. Arthroscopic microfracture
. Osteochondral autograft transfer system (OATS)
. Autologous chondrocyte implantation (ACI)
. Particulated juvenile articular cartilage allograft
. High tibial osteotomy without cartilage restoration

Correct Answer & Explanation

. Autologous chondrocyte implantation (ACI)

Explanation

Autologous chondrocyte implantation (ACI) is indicated for large (> 2-3 cm²), symptomatic full-thickness chondral defects in young, active patients, and it has been proven to regenerate hyaline-like cartilage. Microfracture and OATS are generally reserved for smaller defects (< 2 cm²).

Question 6565

Topic: Knee Sports

A resident is performing a single-bundle anterior cruciate ligament (ACL) reconstruction. If the femoral tunnel is erroneously placed too far anteriorly (shallow) within the intercondylar notch, what abnormal graft tensioning pattern will result?

. Tight in flexion, loose in extension
. Loose in flexion, tight in extension
. Tight in both flexion and extension
. Loose in both flexion and extension
. Symmetrically tensioned throughout the arc of motion

Correct Answer & Explanation

. Tight in flexion, loose in extension

Explanation

Proper femoral tunnel placement is critical for isometric graft tension. A femoral tunnel placed too far anteriorly (anterior to the anatomic footprint) will result in an ACL graft that is excessively tight in flexion (often restricting flexion or stretching the graft) and loose in extension.

Question 6566

Topic: Knee Sports

A 45-year-old male sustains a complete avulsion of the posterior root of the medial meniscus. Biomechanical studies indicate that the resulting contact pressures in the medial compartment of the knee are most functionally equivalent to which of the following conditions?

. An intact medial meniscus
. A 25% partial meniscectomy
. A 50% partial meniscectomy
. A bucket-handle tear
. A total medial meniscectomy

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

The meniscal roots are essential for anchoring the meniscus and converting axial loads into circumferential hoop stresses. Complete avulsion of the posterior medial meniscal root eliminates these hoop stresses and leads to meniscal extrusion, rendering the joint biomechanically equivalent to having undergone a total meniscectomy.

Question 6567

Topic: Knee Sports
You are performing a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. To place the femoral tunnel anatomically, you use Schöttle's point on a strictly lateral fluoroscopic view. Where is this point located relative to key radiographic landmarks?
. Anterior to the posterior femoral cortex extension line and proximal to Blumensaat's line
. Anterior to the posterior femoral cortex extension line and distal to Blumensaat's line
. Posterior to the posterior femoral cortex extension line and proximal to Blumensaat's line
. Posterior to the posterior femoral cortex extension line and distal to Blumensaat's line
. Directly on the anterior femoral cortex, distal to Blumensaat's line

Correct Answer & Explanation

. Anterior to the posterior femoral cortex extension line and proximal to Blumensaat's line

Explanation

Schöttle's point represents the anatomic femoral origin of the MPFL. On a strict lateral radiograph, it is located approximately 1 mm anterior to a line extending from the posterior femoral cortex, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line.

Question 6568

Topic: Shoulder & Hip Sports

A 24-year-old professional hockey player presents with deep anterior groin pain exacerbated by hip flexion and internal rotation. An AP pelvis radiograph demonstrates a 'crossover sign', where the anterior wall of the acetabulum crosses lateral to the posterior wall before reaching the lateral edge of the sourcil. This radiographic finding is pathognomonic for which condition?

. Cam-type femoroacetabular impingement
. Acetabular retroversion
. Coxa profunda
. Protrusio acetabuli
. Developmental dysplasia of the hip (DDH)

Correct Answer & Explanation

. Acetabular retroversion

Explanation

The crossover sign is the classic radiographic indicator of cranial or global acetabular retroversion, a common cause of pincer-type femoroacetabular impingement (FAI). Normally, the anterior wall line remains medial to the posterior wall line throughout its course.

Question 6569

Topic: Knee Sports

A 28-year-old male sustains a multi-ligamentous knee injury. Physical examination includes a dial test, which reveals 15 degrees of asymmetric increased external rotation of the tibia at 30 degrees of knee flexion compared to the uninjured side. However, external rotation is symmetric at 90 degrees of flexion. This pattern isolates injury to which structure(s)?

. Posterolateral corner (PLC) and posterior cruciate ligament (PCL)
. Posterolateral corner (PLC) only
. Posterior cruciate ligament (PCL) only
. Anterior cruciate ligament (ACL) and PLC
. Medial collateral ligament (MCL) and PCL

Correct Answer & Explanation

. Posterolateral corner (PLC) and posterior cruciate ligament (PCL)

Explanation

The dial test assesses for posterolateral instability. Asymmetric external rotation of >10 degrees at 30 degrees of flexion only indicates an isolated posterolateral corner (PLC) injury. If the asymmetry is present at both 30 degrees and 90 degrees of flexion, it signifies a combined PLC and PCL injury.

Question 6570

Topic: Shoulder & Hip Sports

A 24-year-old professional volleyball player presents with progressive, painless weakness in his dominant shoulder. Physical examination reveals isolated atrophy of the infraspinatus muscle with normal bulk of the supraspinatus. External rotation strength is 3/5. Compression of a nerve is suspected. At what specific anatomic location is the entrapment most likely occurring?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Spiral groove

Correct Answer & Explanation

. Spinoglenoid notch

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 a paralabral cyst in overhead athletes) causes isolated infraspinatus atrophy and weakness. Entrapment at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 6571

Topic: 5. Sports Medicine
A 22-year-old collegiate baseball pitcher presents with deep, vague shoulder pain and clicking during the throwing motion. He has a positive O'Brien's active compression test. Diagnostic arthroscopy demonstrates a detachment of the superior labrum and the origin of the long head of the biceps tendon from the glenoid. Which SLAP tear classification type does this represent?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

A Type II SLAP (Superior Labrum Anterior and Posterior) tear involves detachment of the superior labrum and the biceps anchor from the superior glenoid tubercle. Type I is fraying of an intact labrum. Type III is a bucket-handle tear with an intact biceps anchor. Type IV is a bucket-handle tear that extends into the biceps tendon.

Question 6572

Topic: Shoulder & Hip Sports

A 60-year-old male has an asymptomatic, full-thickness supraspinatus tear discovered incidentally on an MRI taken for neck pain. What is the most likely natural history of this rotator cuff tear if managed non-operatively?

. Spontaneous healing of the tendon tear
. Progression in tear size and eventual development of symptoms
. Rapid progression to cuff tear arthropathy within 12 months
. Development of classic adhesive capsulitis
. Regression of existing fatty infiltration in the muscle belly

Correct Answer & Explanation

. Progression in tear size and eventual development of symptoms

Explanation

Asymptomatic rotator cuff tears frequently enlarge over time. Studies have shown that up to 50% will become symptomatic within 2-3 years, and the progression of tear size correlates strongly with the onset of pain and dysfunction. Spontaneous healing of full-thickness tears does not occur, and fatty infiltration is generally irreversible.

Question 6573

Topic: Shoulder & Hip Sports

A 22-year-old elite tennis player presents with posterior shoulder pain during the late cocking phase of serving. Physical examination reveals glenohumeral internal rotation deficit (GIRD). The diagnosis of internal impingement is suspected. Which structures are most likely impinging on one another?

. Subscapularis tendon and the middle glenohumeral ligament
. Undersurface of the supraspinatus/infraspinatus tendons and the posterosuperior glenoid labrum
. Long head of the biceps tendon and the superior labrum
. Coracoacromial arch and the bursal surface of the supraspinatus tendon
. Infraspinatus muscle belly and the spinoglenoid notch

Correct Answer & Explanation

. Undersurface of the supraspinatus/infraspinatus tendons and the posterosuperior glenoid labrum

Explanation

Internal impingement typically occurs in overhead athletes during maximal abduction and external rotation (late cocking phase). It is caused by the impingement of the articular (undersurface) side of the posterosuperior rotator cuff (supraspinatus and infraspinatus) against the posterosuperior glenoid labrum.

Question 6574

Topic: Shoulder & Hip Sports

A 55-year-old male slips on ice and falls on an outstretched hand. He presents with pain and weakness during internal rotation. A tear of the upper border of the subscapularis tendon is suspected. Which physical examination test is most sensitive and specific for evaluating an upper subscapularis tear?

. Neer impingement sign
. Lift-off test
. Bear hug test
. Speed's test
. Hornblower's sign

Correct Answer & Explanation

. Bear hug test

Explanation

The bear hug test and the belly-press test are highly sensitive and specific for evaluating tears of the upper portion of the subscapularis. The lift-off test requires full internal rotation and is more indicative of a complete or lower subscapularis tear. Hornblower's sign evaluates the teres minor.

Question 6575

Topic: Shoulder & Hip Sports

A 40-year-old male is brought to the emergency department after a generalized tonic-clonic seizure. His right shoulder is locked in internal rotation and adduction, and he has a mechanical block to external rotation. An AP radiograph shows a 'lightbulb' appearance of the humeral head. Which associated skeletal defect is most commonly present in this specific type of dislocation?

. Bankart lesion
. Reverse Hill-Sachs lesion
. Greater tuberosity fracture
. Anterior labroligamentous periosteal sleeve avulsion (ALPSA)
. Coracoid process fracture

Correct Answer & Explanation

. Reverse Hill-Sachs lesion

Explanation

The clinical presentation (locked in internal rotation after a seizure) and the radiographic 'lightbulb' sign (due to fixed internal rotation) are classic for a posterior shoulder dislocation. This injury is strongly associated with a reverse Hill-Sachs lesion, which is an impaction fracture of the anteromedial aspect of the humeral head against the posterior glenoid rim.

Question 6576

Topic: Shoulder & Hip Sports

During an open Latarjet procedure for severe anterior shoulder instability with significant glenoid bone loss, the coracoid process is osteotomized and transferred to the anterior glenoid neck. Which specific anatomical structure remains attached to the transferred coracoid process to provide a dynamic 'sling effect'?

. Pectoralis minor
. Conjoint tendon (short head of biceps and coracobrachialis)
. Coracoacromial ligament
. Long head of biceps
. Subscapularis tendon

Correct Answer & Explanation

. Conjoint tendon (short head of biceps and coracobrachialis)

Explanation

The Latarjet procedure involves transferring the coracoid process, along with its attached conjoint tendon (short head of the biceps and coracobrachialis), through a split in the subscapularis muscle to the anterior glenoid. The tension of the conjoint tendon across the anterior-inferior capsule provides a dynamic 'sling' that prevents anterior translation of the humeral head.

Question 6577

Topic: 5. Sports Medicine

A 28-year-old volleyball player presents with insidious onset of vague posterior shoulder pain and isolated weakness in external rotation. Shoulder abduction strength is normal. MRI arthrogram is most likely to show a paralabral cyst in which of the following locations?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Isolated weakness in external rotation with normal abduction suggests compression of the suprascapular nerve at the spinoglenoid notch. At this level, the nerve has already given off its motor branches to the supraspinatus muscle. Spinoglenoid cysts are highly associated with posterosuperior labral tears in overhead athletes.

Question 6578

Topic: Shoulder & Hip Sports

A 35-year-old male presents with posterior shoulder pain and paresthesias over the lateral deltoid. MRI reveals severe teres minor atrophy. Compression in the quadrilateral space is suspected. Which of the following boundaries forms the superior border of this anatomical space?

. Teres major
. Long head of the triceps
. Humeral shaft
. Teres minor
. Subscapularis

Correct Answer & Explanation

. Teres minor

Explanation

The quadrilateral space is bordered by the teres minor (superiorly), teres major (inferiorly), long head of the triceps (medially), and the humeral shaft (laterally). It contains the axillary nerve and posterior humeral circumflex artery. Teres minor atrophy is a classic MRI finding in quadrilateral space syndrome.

Question 6579

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. Physical examination reveals glenohumeral internal rotation deficit (GIRD). Which of the following pathophysiologic mechanisms best explains 'internal impingement' in this patient?

. Impingement of the supraspinatus tendon against the coracoacromial arch
. Contact between the undersurface of the posterosuperior rotator cuff and the posterosuperior glenoid labrum
. Subcoracoid impingement of the subscapularis tendon
. Entrapment of the long head of the biceps brachii in the bicipital groove
. Fraying of the anteroinferior labrum due to obligate anterior translation

Correct Answer & Explanation

. Contact between the undersurface of the posterosuperior rotator cuff and the posterosuperior glenoid labrum

Explanation

Internal impingement occurs in overhead athletes when the shoulder is in maximum abduction and external rotation (late cocking phase). This position causes the undersurface of the posterosuperior rotator cuff to impinge against the posterosuperior glenoid labrum, often exacerbated by GIRD and posterior capsular contracture.

Question 6580

Topic: Shoulder & Hip Sports

During a Latarjet procedure for anterior shoulder instability, the coracoid process is osteotomized and transferred to the anterior glenoid. Which nerve is most at risk of injury when mobilizing the conjoint tendon and retracting it medially?

. Axillary nerve
. Suprascapular nerve
. Radial nerve
. Musculocutaneous nerve
. Median nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve enters the deep surface of the coracobrachialis muscle approximately 5 to 8 cm distal to the tip of the coracoid process. Aggressive medial retraction of the conjoint tendon during a Latarjet procedure can stretch this nerve, resulting in neuropraxia or permanent injury.

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