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5. Sports Medicine MCQs

Practice Set 333 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 6641

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, accurate femoral tunnel placement is crucial. Using fluoroscopy, where is the anatomic femoral origin of the MPFL located relative to Schöttle's point?
. Anterior to the posterior cortical line and proximal to the Blumensaat line
. Posterior to the posterior cortical line and distal to the Blumensaat line
. Between the medial epicondyle and adductor tubercle
. Distal to the medial collateral ligament origin
. Anterior to the Blumensaat line and proximal to the joint line

Correct Answer & Explanation

. Posterior to the posterior cortical line and distal to the Blumensaat line

Explanation

The anatomic femoral origin of the MPFL lies in the saddle between the medial epicondyle and the adductor tubercle. Radiographically, Schöttle's point is 1 mm anterior to the posterior cortical line and 2.5 mm distal to the posterior border of Blumensaat's line.

Question 6642

Topic: Shoulder & Hip Sports

A 30-year-old male hockey player undergoes hip arthroscopy for symptomatic femoroacetabular impingement (FAI). An isolated cam lesion is resected. Which anatomic landmark marks the most common location of a cam deformity on the femoral head-neck junction?

. Posteroinferior
. Anteromedial
. Anterosuperior
. Posterosuperior
. Directly medial

Correct Answer & Explanation

. Anterosuperior

Explanation

Cam lesions are most commonly located at the anterosuperior aspect of the femoral head-neck junction. Resection restores the normal concavity, preventing impingement during hip flexion and internal rotation.

Question 6643

Topic: 5. Sports Medicine

A 19-year-old gymnast requires ACL reconstruction. The surgeon considers a bone-patellar tendon-bone (BPTB) autograft. Which of the following is the most widely recognized long-term complication associated with this specific graft choice compared to hamstring autograft?

. Higher re-rupture rate
. Anterior knee pain
. Decreased terminal knee flexion
. Increased risk of deep vein thrombosis
. Medial collateral ligament attenuation

Correct Answer & Explanation

. Anterior knee pain

Explanation

BPTB autograft is known for excellent biomechanical strength but has a significantly higher incidence of donor-site morbidity, specifically anterior knee pain and pain with kneeling, compared to hamstring autografts.

Question 6644

Topic: Knee Sports

A 14-year-old male presents with knee pain. MRI reveals a 2x2 cm osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. Which MRI finding is most indicative of lesion instability requiring surgical fixation rather than non-operative management?

. Intact overlying articular cartilage
. High T2 signal rim surrounding the lesion
. Bone marrow edema in the adjacent condyle
. Lesion size greater than 1 cm
. Sclerotic margins on T1 imaging

Correct Answer & Explanation

. High T2 signal rim surrounding the lesion

Explanation

A high T2 signal rim surrounding the osteochondral fragment indicates synovial fluid tracking behind the lesion. This is the most reliable MRI sign of instability, necessitating surgical stabilization rather than conservative care.

Question 6645

Topic: Shoulder & Hip Sports

A 24-year-old professional baseball pitcher presents with vague anterior shoulder pain and a 'dead arm' sensation. Examination reveals Glenohumeral Internal Rotation Deficit (GIRD) of 25 degrees. During the late cocking phase of throwing, which mechanism is primarily responsible for a Type II SLAP tear?

. Peel-back mechanism
. Subcoracoid impingement
. Traction from the short head of the biceps
. Direct superior compression
. Internal impingement of the subscapularis

Correct Answer & Explanation

. Peel-back mechanism

Explanation

In the late cocking phase (abduction and maximal external rotation), the biceps vector shifts posteriorly. This creates a torsional 'peel-back' force on the superior labrum, leading to Type II SLAP tears in overhead athletes.

Question 6646

Topic: 5. Sports Medicine

A 26-year-old active female has a symptomatic full-thickness chondral defect on her medial femoral condyle measuring 4.5 cm^2. She has failed conservative therapy. Which of the following surgical interventions is most appropriate for a defect of this size?

. Microfracture
. Osteochondral autograft transfer (OATS)
. Matrix-induced autologous chondrocyte implantation (MACI)
. Arthroscopic debridement and lavage
. Partial medial meniscectomy

Correct Answer & Explanation

. Matrix-induced autologous chondrocyte implantation (MACI)

Explanation

MACI or osteochondral allograft transplantation are indicated for large chondral defects (>2-3 cm^2). Microfracture and OATS (autograft) are typically reserved for smaller lesions due to donor site morbidity and inferior repair tissue.

Question 6647

Topic: Knee Sports

A 45-year-old female presents with acute posterior knee pain after a deep squat. MRI reveals a complete radial tear at the posterior horn of the medial meniscus, 2 mm from its root attachment. What is the expected biomechanical consequence if this lesion is left untreated?

. Decreased peak contact pressure in the medial compartment
. Increased peak contact pressure by approximately 25%
. Loss of hoop stresses making it biomechanically equivalent to a total meniscectomy
. Medial shift of the mechanical axis by 5 degrees
. Increased tension on the anterior cruciate ligament during extension

Correct Answer & Explanation

. Loss of hoop stresses making it biomechanically equivalent to a total meniscectomy

Explanation

A medial meniscus root tear or a complete radial tear near the root disrupts the circumferential fibers. This leads to a complete loss of hoop stresses, which is biomechanically equivalent to a total meniscectomy and rapidly accelerates osteoarthritis.

Question 6648

Topic: Knee Sports

During reconstruction of the medial patellofemoral ligament (MPFL), identifying the correct femoral footprint is critical for graft isometry. According to Schottle's radiographic landmarks, where is the optimal femoral attachment located on a strictly lateral radiograph?

. Anterior to the posterior cortical line and distal to the posterior intersecting line
. Posterior to the posterior cortical line and proximal to the Blumensaat line
. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior border of the medial femoral condyle articular surface, and proximal to Blumensaat's line
. Anterior to the posterior femoral cortex line, between Blumensaat's line and the posterior intersecting line
. Posterior to the posterior cortical line, distal to Blumensaat's line

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior border of the medial femoral condyle articular surface, and proximal to Blumensaat's line

Explanation

The Schottle point is the radiographic center of the MPFL femoral footprint. It is defined as 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior border of the medial femoral condyle articular surface, and proximal to the level of Blumensaat's line.

Question 6649

Topic: Shoulder & Hip Sports

A 28-year-old male undergoes hip arthroscopy for symptomatic femoroacetabular impingement (FAI). He has a large cam lesion requiring osteochondroplasty. To minimize the risk of a postoperative iatrogenic femoral neck fracture, the maximum recommended depth of the resection should not exceed what percentage of the femoral neck diameter?

. 10%
. 20%
. 30%
. 40%
. 50%

Correct Answer & Explanation

. 30%

Explanation

Biomechanical studies have shown that resecting more than 30% of the femoral neck diameter significantly reduces load-to-failure strength. Resections should be kept below this threshold to prevent iatrogenic femoral neck fractures.

Question 6650

Topic: Knee Sports

A 25-year-old football player sustains a contact injury to his knee. Clinical examination reveals increased external rotation of the tibia at 30 degrees of knee flexion compared to the contralateral side, but equal external rotation at 90 degrees. Which structure is most likely injured?

. Posterior cruciate ligament only
. Posterolateral corner only
. Combined posterior cruciate ligament and posterolateral corner
. Anterior cruciate ligament and posterolateral corner
. Medial collateral ligament and posterior oblique ligament

Correct Answer & Explanation

. Posterolateral corner only

Explanation

A positive dial test (increased external rotation of 10 degrees or more) isolated to 30 degrees of flexion indicates an isolated posterolateral corner (PLC) injury. If it is positive at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 6651

Topic: 5. Sports Medicine

A 12-year-old gymnast is diagnosed with an osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. Her physes are wide open. MRI shows a 1.5 cm lesion with no high T2 signal behind the fragment. What is the most appropriate initial management?

. Arthroscopic drilling of the lesion
. Arthroscopic fragment excision and microfracture
. Open osteochondral autograft transfer
. Non-operative management with restricted weight-bearing and activity modification
. Bioabsorbable pin fixation

Correct Answer & Explanation

. Non-operative management with restricted weight-bearing and activity modification

Explanation

Juvenile OCD lesions (open physes) that are stable (no high T2 signal line behind the fragment on MRI) have a high rate of spontaneous healing. A trial of non-operative management, including activity modification and restricted weight-bearing, is the first-line treatment.

Question 6652

Topic: Shoulder & Hip Sports

Which of the following structures is contained within the rotator interval of the shoulder?

. Coracoacromial ligament
. Subscapularis tendon
. Supraspinatus tendon
. Coracohumeral ligament
. Middle glenohumeral ligament

Correct Answer & Explanation

. Coracohumeral ligament

Explanation

The rotator interval is a triangular anatomical space between the anterior margin of the supraspinatus and the superior margin of the subscapularis. It contains the coracohumeral ligament (CHL), superior glenohumeral ligament (SGHL), the long head of the biceps tendon, and the joint capsule.

Question 6653

Topic: Knee Sports

During a posterolateral corner (PLC) reconstruction, identifying the exact femoral footprint of the popliteus tendon is crucial. Where is the popliteus footprint located relative to the lateral collateral ligament (LCL) femoral attachment?

. Posterior and proximal
. Posterior and distal
. Anterior and proximal
. Anterior and distal
. Directly medial

Correct Answer & Explanation

. Anterior and distal

Explanation

On the lateral femoral epicondyle, the footprint for the popliteus tendon is located anterior and distal (inferior) to the origin of the lateral collateral ligament (LCL). The LCL attachment is situated posterior and proximal to the popliteus.

Question 6654

Topic: Knee Sports

During a reconstruction of the posterolateral corner of the knee, identifying the exact femoral footprints is critical. Which of the following accurately describes the relationship of the popliteus tendon insertion relative to the fibular collateral ligament (FCL) femoral attachment?

. Popliteus is proximal and posterior
. Popliteus is proximal and anterior
. Popliteus is distal and anterior
. Popliteus is distal and posterior
. Popliteus and FCL share a conjoined origin

Correct Answer & Explanation

. Popliteus is proximal and posterior

Explanation

On the lateral femoral epicondyle, the popliteus inserts at the anterior end of the popliteal sulcus. The FCL origin is proximal and posterior to the popliteus insertion. Restoring this anatomic relationship is crucial for proper biomechanical function of the reconstructed posterolateral corner.

Question 6655

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with isolated weakness in external rotation of the right shoulder. Abduction is full and symmetric to the contralateral side. Atrophy is noted in the infraspinatus fossa. An MRI reveals a paralabral cyst. Where is the cyst most likely located?

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

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Isolated weakness of the infraspinatus implies compression of the suprascapular nerve after it has already given off motor branches to the supraspinatus. This distal compression characteristically occurs at the spinoglenoid notch. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 6656

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with isolated atrophy of the infraspinatus muscle. Examination shows preserved supraspinatus strength. Magnetic resonance imaging will most likely show a paralabral cyst compressing the nerve at which specific anatomical location?

. Suprascapular notch
. Spinoglenoid notch
. Quadrangular space
. Triangular space
. Coracoid base

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch affects only its terminal branch, leading to isolated infraspinatus weakness. Compression at the more proximal suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 6657

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with isolated weakness in shoulder external rotation. Atrophy is noted over the infraspinatus fossa with a normal supraspinatus bulk. An MRI reveals a paralabral cyst. At which anatomical location is the nerve compression most likely occurring?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Coracoid process

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch results in isolated denervation of the infraspinatus muscle, presenting as external rotation weakness. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus. This condition is classically associated with posterior labral tears and resultant paralabral cysts.

Question 6658

Topic: Knee Sports

A 16-year-old female experiences recurrent lateral patellar dislocations after a traumatic first dislocation. She now presents with another acute dislocation. Which of the following structures is most commonly deficient or injured in recurrent patellar instability?

. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Medial patellofemoral ligament (MPFL)
. Lateral collateral ligament (LCL)
. Patellar tendon

Correct Answer & Explanation

. Medial patellofemoral ligament (MPFL)

Explanation

The medial patellofemoral ligament (MPFL) is the primary soft tissue stabilizer preventing lateral patellar displacement. It is almost always torn during a first-time traumatic patellar dislocation. Its deficiency is a key contributor to recurrent patellar instability. While other factors like trochlear dysplasia, patella alta, and increased Q-angle contribute, MPFL injury is paramount. The ACL, PCL, and LCL are key knee joint stabilizers but are not directly involved in patellar tracking. The patellar tendon connects the patella to the tibia.

Question 6659

Topic: 5. Sports Medicine

A 9-year-old child with Ewing's Sarcoma of the femur undergoes limb salvage surgery. What type of reconstruction would typically be considered to account for future growth?

. Arthrodesis with allograft
. Custom non-expandable endoprosthesis
. Resection with fibular autograft and no further intervention
. Expandable endoprosthesis or allograft-prosthesis composite with planned lengthening procedures
. Amputation with immediate prosthetic fitting

Correct Answer & Explanation

. Expandable endoprosthesis or allograft-prosthesis composite with planned lengthening procedures

Explanation

For growing children with limb salvage, techniques that address future growth are critical. Expandable endoprostheses (which can be lengthened externally without repeat surgery) or allograft-prosthesis composites often combined with planned lengthening procedures are utilized to manage limb length discrepancy as the child grows. Non-expandable prostheses or arthrodesis would result in significant limb length discrepancy. Fibular autografts alone for large defects are often insufficient, and amputation is generally a last resort.

Question 6660

Topic: 5. Sports Medicine

A 65-year-old male slips and falls, experiencing a sudden 'pop' above his knee. He has significant swelling and pain above the patella and is unable to actively extend his knee. A palpable gap is noted superior to the patella. What is the most likely diagnosis?

. Patellar tendon rupture.
. Quadriceps tendon rupture.
. Patella fracture.
. Meniscal tear.
. Anterior cruciate ligament (ACL) rupture.

Correct Answer & Explanation

. Quadriceps tendon rupture.

Explanation

The patient's presentation (sudden 'pop' above the knee, inability to actively extend the knee, and a palpable gap superior to the patella) is classic for a quadriceps tendon rupture. A patellar tendon rupture would present with a palpable gap inferior to the patella and a high-riding patella (patella alta). A patella fracture would typically be diagnosed on X-ray and might or might not have a palpable gap depending on the comminution and displacement. Meniscal tears and ACL ruptures typically do not cause complete inability to actively extend the knee or a palpable gap in the extensor mechanism. Quadriceps tendon ruptures often occur in older individuals with underlying degenerative changes.

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