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5. Sports Medicine MCQs

Practice Set 332 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 6621

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder dislocations. Preoperative CT imaging reveals 25% anterior glenoid bone loss and an engaging Hill-Sachs lesion. Which of the following is the most appropriate surgical treatment?

. Arthroscopic Bankart repair
. Arthroscopic Remplissage
. Latarjet procedure
. Open inferior capsular shift
. Putti-Platt procedure

Correct Answer & Explanation

. Latarjet procedure

Explanation

Significant glenoid bone loss (>20-25%) in a collision athlete with recurrent instability is a classic indication for a bone-block augmentation procedure, such as the Latarjet procedure (coracoid transfer). Arthroscopic soft-tissue repair alone has an unacceptably high failure rate in the setting of critical bone loss and an engaging Hill-Sachs lesion.

Question 6622

Topic: 5. Sports Medicine

An 11-year-old boy (Tanner stage 1) sustains a midsubstance ACL tear. Radiographs confirm widely open physes. The family elects for surgical management to prevent further meniscal damage. Which of the following surgical options is most appropriate?

. Transphyseal bone-patellar tendon-bone autograft
. Transphyseal hamstring autograft
. Iliotibial band extra-articular physeal-sparing reconstruction
. Primary ACL repair with internal brace
. Nonoperative management with a derotational brace

Correct Answer & Explanation

. Iliotibial band extra-articular physeal-sparing reconstruction

Explanation

In prepubescent children with significant remaining growth (Tanner stage 1 or 2, widely open physes), physeal-sparing techniques are recommended to avoid growth arrest. An iliotibial band extra-articular reconstruction (e.g., Kocher or Micheli technique) routes the graft around the physes without drilling tunnels across them. Transphyseal techniques risk premature physeal closure in this age group.

Question 6623

Topic: Shoulder & Hip Sports

A 26-year-old hockey player presents with chronic anterior groin pain exacerbated by hip flexion and internal rotation. Radiographs reveal an alpha angle of 70 degrees, a normal center-edge angle (CEA), and a negative cross-over sign. What is the primary pathomechanism of this patient's condition?

. Pincer impingement
. Cam impingement
. Ischiofemoral impingement
. Subspine impingement
. Acetabular dysplasia

Correct Answer & Explanation

. Cam impingement

Explanation

An alpha angle greater than 50-55 degrees indicates an abnormal femoral head-neck junction, characteristic of Cam impingement. Pincer impingement involves acetabular overcoverage (e.g., increased CEA or positive cross-over sign indicative of retroversion). The patient's findings isolate Cam morphology as the primary issue.

Question 6624

Topic: Knee Sports

A 19-year-old female presents with recurrent lateral patellar dislocations. Evaluation reveals a tibial tubercle-trochlear groove (TT-TG) distance of 22 mm and a Caton-Deschamps index of 1.0. The trochlea shows mild dysplasia. What is the most appropriate surgical management?

. Isolated MPFL reconstruction
. MPFL reconstruction with medializing tibial tubercle osteotomy
. MPFL reconstruction with distalizing tibial tubercle osteotomy
. Lateral retinacular release
. Trochleoplasty

Correct Answer & Explanation

. MPFL reconstruction with medializing tibial tubercle osteotomy

Explanation

An abnormal TT-TG distance >20 mm generally warrants a medializing tibial tubercle osteotomy (TTO) to correct the lateralized extensor mechanism vector. Because the patellar height is normal (Caton-Deschamps ~1.0), distalization is not needed. This should be combined with an MPFL reconstruction to restore the primary soft-tissue restraint to lateral translation.

Question 6625

Topic: Knee Sports

A 14-year-old gymnast complains of lateral elbow pain and catching. MRI of the elbow shows an osteochondritis dissecans (OCD) lesion of the capitellum with intact articular cartilage, but there is a rim of T2-hyperintense fluid behind the lesion. What is the best initial surgical management?

. Nonoperative management with rest and immobilization
. In situ arthroscopic drilling
. Arthroscopic fixation
. Osteochondral autograft transfer (OATS)
. Fragment excision and microfracture

Correct Answer & Explanation

. Arthroscopic fixation

Explanation

Fluid behind the OCD lesion on MRI indicates an unstable fragment. Because the articular cartilage is still intact, the best treatment is salvage of the native cartilage via arthroscopic internal fixation. Nonoperative management is generally reserved for stable lesions in patients with open physes. Drilling alone is for stable lesions.

Question 6626

Topic: Knee Sports

A 45-year-old female felt a 'pop' in the back of her knee while squatting. MRI demonstrates a complete posterior root tear of the medial meniscus with 4 mm of meniscal extrusion, but no significant osteoarthritis. Mechanical alignment is neutral. What is the recommended treatment?

. Arthroscopic partial meniscectomy
. Transtibial pull-out root repair
. Inside-out meniscal repair
. All-inside meniscal repair
. Nonoperative management

Correct Answer & Explanation

. Transtibial pull-out root repair

Explanation

Meniscal root tears eliminate hoop stresses, acting biomechanically similar to a total meniscectomy and leading to rapid joint degeneration. In an active patient without advanced arthritis or malalignment, anatomical repair via a transtibial pull-out technique (or suture anchor repair) is the gold standard to restore hoop tension and slow progression to osteoarthritis.

Question 6627

Topic: General Sports & Tendon

A 40-year-old water skier suffers a forced hyperflexion injury of the hip with an extended knee, resulting in a proximal hamstring avulsion. Which of the following muscles form the conjoined tendon of the proximal hamstring complex at the ischial tuberosity?

. Semimembranosus and long head of biceps femoris
. Semitendinosus and long head of biceps femoris
. Semitendinosus and semimembranosus
. Short head of biceps femoris and semimembranosus
. Adductor magnus and semimembranosus

Correct Answer & Explanation

. Semitendinosus and long head of biceps femoris

Explanation

The proximal hamstring complex attaches to the ischial tuberosity. It consists of the semitendinosus and the long head of the biceps femoris, which arise together as a conjoined tendon from the posteromedial facet of the tuberosity. The semimembranosus originates separately from the anterolateral facet.

Question 6628

Topic: Knee Sports

A 'ramp lesion' of the knee is frequently encountered during anterior cruciate ligament (ACL) reconstruction. This pathology specifically refers to a tear located in which of the following anatomic zones?

. Anterior horn of the lateral meniscus
. Posterior horn of the lateral meniscus near the meniscofemoral ligaments
. Meniscocapsular junction of the posterior horn of the medial meniscus
. Radial mid-body tear of the medial meniscus
. Anterior root of the medial meniscus

Correct Answer & Explanation

. Meniscocapsular junction of the posterior horn of the medial meniscus

Explanation

A meniscal ramp lesion is defined as a disruption of the meniscocapsular junction or the peripheral attachment of the posterior horn of the medial meniscus. It is highly associated with ACL tears and can be missed on standard anterior portal viewing, often requiring a posteromedial portal for adequate visualization and repair.

Question 6629

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. Physical examination reveals a 20-degree glenohumeral internal rotation deficit (GIRD). Which of the following MRI findings is most characteristic of 'internal impingement' in this patient?

. Anteroinferior labral tear (Bankart) with a Hill-Sachs lesion
. Posterosuperior labral fraying with an articular-sided partial supraspinatus tear
. Subcoracoid effusion with a subscapularis tendon tear
. Superior labrum anterior-posterior (SLAP) tear extending into the biceps anchor
. Thickened coracoacromial ligament with bursal-sided rotator cuff fraying

Correct Answer & Explanation

. Posterosuperior labral fraying with an articular-sided partial supraspinatus tear

Explanation

Internal impingement (posterosuperior impingement) occurs during the late cocking phase (abduction and maximal external rotation), causing the greater tuberosity to abut the posterosuperior glenoid. This pinches the posterior labrum and the articular side of the supraspinatus/infraspinatus tendons, leading to labral fraying and partial articular-sided rotator cuff tears (PASTA lesions).

Question 6630

Topic: Shoulder & Hip Sports

A 45-year-old construction worker presents with a symptomatic Type II SLAP tear. According to recent literature, compared to arthroscopic SLAP repair, primary biceps tenodesis in patients in this age demographic is associated with:

. Higher rates of postoperative stiffness
. Lower rates of return to previous level of work
. Decreased patient satisfaction
. Lower rates of revision surgery
. Higher risk of axillary nerve injury

Correct Answer & Explanation

. Lower rates of revision surgery

Explanation

In patients over 40 years old, primary biceps tenodesis for symptomatic SLAP tears yields significantly higher satisfaction, lower rates of postoperative stiffness, and lower revision rates compared to arthroscopic SLAP repair. SLAP repair in this age group has notoriously unpredictable outcomes and higher failure rates.

Question 6631

Topic: Knee Sports

During a single-bundle posterior cruciate ligament (PCL) reconstruction, the femoral tunnel is positioned to anatomically reconstruct the dominant bundle. Which specific bundle is reconstructed, and at what degree of knee flexion should the graft typically be tensioned?

. Posteromedial bundle, tensioned at 90 degrees
. Anterolateral bundle, tensioned at 90 degrees
. Posteromedial bundle, tensioned at 0 degrees (full extension)
. Anterolateral bundle, tensioned at 0 degrees
. Anteromedial bundle, tensioned at 30 degrees

Correct Answer & Explanation

. Anterolateral bundle, tensioned at 90 degrees

Explanation

The PCL consists of the larger, stronger anterolateral (AL) bundle and the smaller posteromedial (PM) bundle. Single-bundle reconstructions aim to replace the dominant AL bundle. The AL bundle is tightest in flexion; therefore, the graft is typically tensioned and fixed at 90 degrees of knee flexion.

Question 6632

Topic: Shoulder & Hip Sports

In the evaluation of anterior shoulder instability, the 'glenoid track' concept is used to determine the risk of engagement. A Hill-Sachs lesion is considered 'off-track' (and thus at high risk of engagement) if:

. The Hill-Sachs interval is less than the glenoid track
. The Hill-Sachs interval is greater than the glenoid track
. The glenoid defect is less than 15%
. The patient has an intact anterior labrum
. The Hill-Sachs lesion does not engage the anterior glenoid rim

Correct Answer & Explanation

. The Hill-Sachs interval is greater than the glenoid track

Explanation

The glenoid track is approximately 83% of the intact glenoid width minus the width of any anterior bone loss. The Hill-Sachs interval (HSI) is the width of the Hill-Sachs lesion plus the intact bone bridge medial to the rotator cuff footprint. If the HSI is greater than the glenoid track, the lesion extends outside the track during arm abduction/external rotation, making it 'off-track' and likely to engage.

Question 6633

Topic: 5. Sports Medicine

During an ACL reconstruction, the surgeon utilizes a bone-patellar tendon-bone (BPTB) autograft. Compared to hamstring autografts, BPTB grafts are historically associated with a higher incidence of which postoperative complication?

. Graft rupture
. Contralateral ACL tear
. Anterior knee pain
. Tunnel widening
. Postoperative infection

Correct Answer & Explanation

. Anterior knee pain

Explanation

BPTB autografts are associated with a significantly higher incidence of donor-site morbidity, specifically anterior knee pain and kneeling pain, compared to hamstring autografts. Rates of graft rupture and postoperative infection are largely comparable, though BPTB shows less tunnel widening.

Question 6634

Topic: Knee Sports
An MPFL reconstruction is planned for a 17-year-old female with recurrent lateral patellar dislocations. To prevent postoperative patellofemoral over-constraint, where must the femoral tunnel be positioned relative to radiographic landmarks (Schรถttle's point)?
. Anterior to the posterior femoral cortex line
. Distal to the posterior aspect of Blumensaat's line
. Proximal to the posterior aspect of Blumensaat's line
. Directly on the medial epicondyle
. Anterior and distal to the adductor tubercle

Correct Answer & Explanation

. Proximal to the posterior aspect of Blumensaat's line

Explanation

Schรถttle's point is located 1 mm anterior to the posterior femoral cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the posterior aspect of Blumensaat's line. Anatomic placement ensures the graft does not over-tension during knee flexion.

Question 6635

Topic: Knee Sports

During an anatomic posterolateral corner (PLC) reconstruction, accurate placement of the fibular collateral ligament (FCL) graft is critical. Where is the native FCL femoral attachment located relative to the popliteus sulcus?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly within the anterior half of the sulcus

Correct Answer & Explanation

. Proximal and posterior

Explanation

The native FCL femoral footprint is located 18.5 mm proximal and slightly posterior to the popliteus tendon attachment on the lateral femoral epicondyle. Non-anatomic placement can lead to graft capturing and restriction of normal knee range of motion.

Question 6636

Topic: Shoulder & Hip Sports

A 26-year-old baseball pitcher presents with posterior shoulder pain and a "dead arm" sensation during the late cocking phase of throwing. He exhibits a 25-degree glenohumeral internal rotation deficit (GIRD). What is the primary pathomechanical cause of his suspected labral pathology?

. Peel-back mechanism of the superior labrum
. Subcoracoid impingement
. Tensile failure of the middle glenohumeral ligament
. Internal impingement of the subscapularis
. Attritional tear of the coracohumeral ligament

Correct Answer & Explanation

. Peel-back mechanism of the superior labrum

Explanation

In throwing athletes, maximum external rotation in the late cocking phase causes a posterior shift of the biceps vector, creating a torsional "peel-back" force on the superior labrum. This is exacerbated by posterior capsular tightness (GIRD), driving Type II SLAP lesions.

Question 6637

Topic: Shoulder & Hip Sports

During hip arthroscopy for mixed femoroacetabular impingement (FAI), excessive bony resection of a cam lesion extending too far posterosuperiorly on the femoral head-neck junction risks injury to the terminal branches of which artery?

. Lateral circumflex femoral artery
. Medial circumflex femoral artery
. Obturator artery
. Superior gluteal artery
. Inferior gluteal artery

Correct Answer & Explanation

. Medial circumflex femoral artery

Explanation

The medial circumflex femoral artery (MCFA) provides the primary blood supply to the femoral head via the retinacular vessels, which enter the posterosuperior capsule. Overzealous resection in this area endangers these vessels and can lead to avascular necrosis (AVN).

Question 6638

Topic: Knee Sports
A 30-year-old runner with a focal 3 cmยฒ full-thickness chondral defect on the medial femoral condyle undergoes Matrix-induced autologous chondrocyte implantation (MACI). What is the primary histological goal of the repair tissue generated by MACI compared to microfracture?
. Production of predominantly Type I collagen
. Production of predominantly Type III collagen
. Production of predominantly Type II collagen
. Production of predominantly Type IX collagen
. Creation of an acellular fibrin clot

Correct Answer & Explanation

. Production of predominantly Type II collagen

Explanation

Microfracture primarily stimulates a marrow healing response resulting in fibrocartilage, which is rich in Type I collagen. Cell-based therapies like MACI aim to regenerate hyaline-like cartilage, which possesses superior biomechanical properties and is composed predominantly of Type II collagen.

Question 6639

Topic: 5. Sports Medicine

A lateral extra-articular tenodesis (LET) is performed to augment an ACL reconstruction in an athlete with a high-grade pivot shift. Biomechanically, LET or anterolateral ligament (ALL) reconstruction primarily limits which coupled motion?

. Internal rotation during extension
. External rotation during flexion
. Internal rotation during flexion
. External rotation during extension
. Anterior translation in full extension

Correct Answer & Explanation

. Internal rotation during flexion

Explanation

The anterolateral structures of the knee, including the ALL and iliotibial band, are primary restraints to internal tibial rotation at higher degrees of knee flexion. Augmenting these structures addresses residual anterolateral rotatory instability (pivot shift).

Question 6640

Topic: Shoulder & Hip Sports

A 20-year-old rugby player has recurrent anterior shoulder instability. CT shows 15% glenoid bone loss and a Hill-Sachs lesion. Based on the 'glenoid track' concept, an 'off-track' Hill-Sachs lesion is defined by which of the following?

. The medial margin of the Hill-Sachs lesion extends medial to the glenoid track
. The lateral margin of the Hill-Sachs lesion is lateral to the glenoid track
. The glenoid track is wider than the Hill-Sachs lesion
. The Hill-Sachs lesion engages only in adduction and internal rotation
. The glenoid bone loss is less than 20%

Correct Answer & Explanation

. The medial margin of the Hill-Sachs lesion extends medial to the glenoid track

Explanation

An 'off-track' Hill-Sachs lesion occurs when its medial margin lies medial to the glenoid track, meaning it will engage the anterior glenoid rim during abduction and external rotation. This usually requires a Remplissage or bone block procedure.

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