Menu

5. Sports Medicine MCQs

Practice Set 340 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 6781

Topic: Knee Sports

The Dejour classification for trochlear dysplasia identifies four types (A, B, C, D). Which type is characterized by a 'crossover sign' but without a supratrochlear spur?

. Type A.
. Type B.
. Type C.
. Type D.
. Type E.

Correct Answer & Explanation

. Type C.

Explanation

According to Dejour's classification: Type A is a shallow trochlea. Type B has a supratrochlear spur (bump). Type C has a 'crossover sign' (the medial facet lies lateral to the lateral facet) but no supratrochlear spur. Type D is the most severe, combining both a crossover sign and a supratrochlear spur, often with a 'cliff-like' appearance. Therefore, Type C is the correct answer.

Question 6782

Topic: Knee Sports

A 14-year-old female presents with persistent patellofemoral pain after a first-time patellar dislocation treated non-operatively. MRI shows mild trochlear dysplasia, a normal TT-TG distance, no patella alta, and a healed MPFL. What is the most likely cause of her ongoing pain?

. Recurrent MPFL insufficiency.
. Unrecognized patellar maltracking without instability.
. Osteochondritis dissecans of the lateral femoral condyle.
. Infection of the patellofemoral joint.
. A primary valgus deformity of the knee.

Correct Answer & Explanation

. Unrecognized patellar maltracking without instability.

Explanation

Given that the MPFL has healed and there are no significant bony malalignments or instability, persistent pain in this scenario often points to unresolved patellar maltracking or residual patellofemoral overload. The mild trochlear dysplasia, even if not causing overt instability, can contribute to poor tracking and increased contact pressures. Osteochondritis dissecans would typically be visible on MRI. Infection would have different symptoms. Primary valgus deformity would be a bony malalignment risk factor, which is stated as not significant. Recurrent MPFL insufficiency is ruled out by a healed MPFL. Therefore, subtle maltracking or altered patellofemoral mechanics due to the mild dysplasia is the most likely culprit for persistent pain, even without overt instability.

Question 6783

Topic: Knee Sports

What is the surgical principle behind medializing a tibial tubercle osteotomy in the management of patellar instability?

. To decrease patella alta.
. To increase the leverage of the quadriceps mechanism.
. To decrease the TT-TG distance, thereby moving the patellar tendon insertion medially.
. To release tension on the lateral patellar retinaculum.
. To deepen the trochlear groove.

Correct Answer & Explanation

. To decrease the TT-TG distance, thereby moving the patellar tendon insertion medially.

Explanation

Tibial tubercle medialization osteotomy (e.g., Elmslie-Trillat or modified Fulkerson) aims to reduce the TT-TG distance. By moving the tibial tubercle medially, the line of pull of the quadriceps mechanism (via the patellar tendon) is shifted medially, bringing the patella into better alignment with the trochlear groove and reducing the lateralizing force. Distalization addresses patella alta. The procedure does not directly deepen the trochlear groove or release the lateral retinaculum.

Question 6784

Topic: Knee Sports

When assessing the TT-TG distance on an axial CT scan, which anatomical plane is used for measurement?

. Coronal plane.
. Sagittal plane.
. Transverse (axial) plane.
. Oblique plane at 45 degrees.
. Three-dimensional reconstruction, but not a specific plane.

Correct Answer & Explanation

. Transverse (axial) plane.

Explanation

The Tibial Tubercle-Trochlear Groove (TT-TG) distance is measured in the transverse (axial) plane on a CT scan or MRI. This involves superimposing an axial cut through the deepest part of the trochlear groove onto an axial cut through the center of the tibial tubercle and measuring the horizontal distance between these two points. This measures the lateralization of the tibial tubercle relative to the trochlear groove.

Question 6785

Topic: Knee Sports

A patient with recurrent patellar instability, patella alta, and a normal TT-TG distance would most appropriately be treated with which surgical procedure?

. Isolated lateral retinacular release.
. Isolated MPFL reconstruction.
. Tibial tubercle distalization osteotomy.
. Trochleoplasty.
. Tibial tubercle medialization osteotomy.

Correct Answer & Explanation

. Tibial tubercle distalization osteotomy.

Explanation

For a patient with patella alta and recurrent instability, but a normal TT-TG distance (meaning no significant lateralization of the extensor mechanism) and no mention of trochlear dysplasia, a tibial tubercle distalization osteotomy (e.g., using a Maquet or Elmslie-Trillat type osteotomy with a distal shift) is the most appropriate procedure to lower the patella and improve its engagement in the trochlear groove. Isolated lateral release is rarely sufficient. MPFL reconstruction would address the soft tissue but not the underlying patella alta. Trochleoplasty is for dysplasia. Tibial tubercle medialization is for increased TT-TG, which is normal here.

Question 6786

Topic: 5. Sports Medicine

Which type of MPFL reconstruction graft has shown promising results in terms of avoiding donor site morbidity while providing adequate strength?

. Ipsilateral hamstring autograft (semitendinosus).
. Contralateral hamstring autograft (semitendinosus).
. Quadriceps tendon autograft.
. Allograft (e.g., tibialis anterior, semitendinosus).
. Ipsilateral patellar tendon autograft.

Correct Answer & Explanation

. Allograft (e.g., tibialis anterior, semitendinosus).

Explanation

Allograft (e.g., tibialis anterior or semitendinosus allograft) for MPFL reconstruction avoids donor site morbidity associated with autograft harvest (hamstring weakness, anterior knee pain with quadriceps tendon harvest). While autografts are generally preferred for their biological integration, allografts are a viable option, especially in patients with small hamstrings, previous hamstring harvest, or for revision cases. Patellar tendon autograft is primarily for ACL reconstruction and is not typically used for MPFL. All choices except 'ipsilateral patellar tendon autograft' are valid graft sources; however, allograft is specifically chosen toavoiddonor site morbidity, hence it's the most appropriate answer to the question.

Question 6787

Topic: Knee Sports

A surgeon is considering performing a trochleoplasty for a patient with severe trochlear dysplasia and recurrent patellar instability. What is a critical intraoperative maneuver to confirm the adequacy of the trochleoplasty?

. Measuring the TT-TG distance with a ruler.
. Performing a lateral retinacular release after the trochleoplasty.
. Assessing patellar tracking and stability dynamically through a full range of motion.
. Confirming graft tension of the MPFL reconstruction.
. Performing an arthroscopic debridement of the patellofemoral joint.

Correct Answer & Explanation

. Assessing patellar tracking and stability dynamically through a full range of motion.

Explanation

After performing a trochleoplasty, it is crucial to dynamically assess patellar tracking and stability through a full range of motion (often by flexing and extending the knee while manually attempting to sublux the patella). This allows the surgeon to confirm that the newly created trochlear groove adequately contains the patella and that there is no residual apprehension or instability. The other options are either not related to the adequacy of the trochleoplasty itself, or are separate procedures/measurements.

Question 6788

Topic: Knee Sports

The medial meniscus is firmly attached to which ligament?

. Anterior Cruciate Ligament (ACL).
. Posterior Cruciate Ligament (PCL).
. Lateral Collateral Ligament (LCL).
. Medial Collateral Ligament (MCL).
. Popliteofibular ligament.

Correct Answer & Explanation

. Medial Collateral Ligament (MCL).

Explanation

The medial meniscus is firmly attached to the deep fibers of the medial collateral ligament (MCL). This attachment, along with its broader capsular attachments, makes the medial meniscus less mobile than the lateral meniscus and contributes to the higher incidence of medial meniscal tears in conjunction with MCL injuries.

Question 6789

Topic: Knee Sports

Damage to the posterior horn of the lateral meniscus is frequently associated with injury to which ligament?

. Medial collateral ligament.
. Anterior cruciate ligament.
. Posterior cruciate ligament.
. Patellar ligament.
. Oblique popliteal ligament.

Correct Answer & Explanation

. Anterior cruciate ligament.

Explanation

Tears of the lateral meniscus, particularly the posterior horn, are frequently seen in conjunction with anterior cruciate ligament (ACL) ruptures. This association is thought to be due to the rotational forces and complex kinematics during the injury event, where the lateral meniscus is compressed and sheared by the rapidly translating lateral femoral condyle.

Question 6790

Topic: Knee Sports

Which statement about meniscal regeneration or repair is most accurate regarding the role of mesenchymal stem cells (MSCs)?

. MSCs are naturally abundant within the avascular zones of the adult meniscus.
. MSCs primarily differentiate into osteoblasts to repair meniscal root attachments.
. MSCs have been shown to differentiate into fibrochondrocytes and enhance healing in vascularized regions.
. MSCs are not involved in meniscal healing due to its fibrocartilaginous nature.
. MSCs can spontaneously regenerate a full meniscus after total meniscectomy.

Correct Answer & Explanation

. MSCs have been shown to differentiate into fibrochondrocytes and enhance healing in vascularized regions.

Explanation

Mesenchymal stem cells (MSCs) hold promise for meniscal repair and regeneration. They can differentiate into fibrochondrocytes, the primary cell type of the meniscus, and produce extracellular matrix components. While not abundant in the avascular zones, exogenous MSCs (e.g., from bone marrow aspirate concentrate) or MSCs recruited to the vascularized periphery have shown potential to enhance healing in repairable tears, particularly in conjunction with other biological augmentation strategies.

Question 6791

Topic: Knee Sports

Which factor is generally considered detrimental to meniscal tear healing potential?

. Concomitant ACL reconstruction.
. Age younger than 30 years.
. Tear located in the peripheral vascular zone.
. Tear associated with minimal synovial fluid extravasation.
. Chronic, degenerative tear morphology.

Correct Answer & Explanation

. Chronic, degenerative tear morphology.

Explanation

Chronic, degenerative tears, especially those in the avascular zones, have significantly reduced healing potential. They are often characterized by compromised tissue quality, multiple tear planes, and a diminished biological response compared to acute, traumatic tears in vascularized areas. While other factors listed are generally favorable for healing, a chronic degenerative tear presents a poor biological environment for repair.

Question 6792

Topic: Knee Sports

A 'ramp lesion' refers to a specific tear pattern of which meniscal region?

. Anterior horn of the lateral meniscus.
. Mid-body of the medial meniscus.
. Posterior horn of the medial meniscus, posteromedial capsule junction.
. Lateral meniscus, discoid type.
. Anterior horn of the medial meniscus root.

Correct Answer & Explanation

. Posterior horn of the medial meniscus, posteromedial capsule junction.

Explanation

A ramp lesion is a longitudinal tear of the posterior horn of the medial meniscus that occurs at the meniscocapsular junction, often extending into the posteromedial capsule. These lesions are frequently associated with ACL ruptures and can be difficult to diagnose arthroscopically from the standard anterior portals, often requiring a posteromedial portal for visualization and repair.

Question 6793

Topic: 5. Sports Medicine

When establishing the 3-4 portal for wrist arthroscopy, the arthroscope is inserted between which two extensor compartments?

. Between the first and second compartments
. Between the second and third compartments
. Between the third and fourth compartments
. Between the fourth and fifth compartments
. Between the fifth and sixth compartments

Correct Answer & Explanation

. Between the third and fourth compartments

Explanation

The 3-4 portal is the standard viewing portal for wrist arthroscopy. It is located just distal to Lister's tubercle, between the 3rd extensor compartment (extensor pollicis longus) and the 4th extensor compartment (extensor digitorum communis and extensor indicis proprius).

Question 6794

Topic: Knee Sports

Which of the following ligaments is considered the primary static stabilizer against anterior translation of the tibia relative to the femur?

. Posterior Cruciate Ligament (PCL)
. Medial Collateral Ligament (MCL)
. Lateral Collateral Ligament (LCL)
. Anterior Cruciate Ligament (ACL)
. Posterior Oblique Ligament (POL)

Correct Answer & Explanation

. Anterior Cruciate Ligament (ACL)

Explanation

The Anterior Cruciate Ligament (ACL) is the primary static stabilizer that prevents anterior translation of the tibia on the femur, particularly in knee extension and near extension. It also resists internal rotation and hyperextension. The PCL prevents posterior translation, and the MCL and LCL primarily resist valgus and varus forces, respectively.

Question 6795

Topic: 5. Sports Medicine

Which of the following is an example of an allograft in orthopedic surgery?

. Autologous bone marrow aspirate.
. Demineralized bone matrix from a cadaver.
. Synthetic calcium phosphate cement.
. Patient's own iliac crest bone graft.
. Bone harvested from a xenograft source (e.g., bovine).

Correct Answer & Explanation

. Demineralized bone matrix from a cadaver.

Explanation

An allograft is tissue (e.g., bone) harvested from a genetically non-identical individual of the same species (i.e., from a cadaveric donor to a living human recipient). Demineralized bone matrix (DBM) from a cadaver is a common type of allograft. Autologous grafts use the patient's own tissue (autograft). Synthetic materials are non-biological. Xenografts are from a different species.

Question 6796

Topic: Shoulder & Hip Sports

A 30-year-old rugby player presents with recurrent anterior shoulder dislocations. He has a positive apprehension test and a significant Hill-Sachs lesion on MRI. On physical examination, he demonstrates hyperlaxity. Which surgical procedure is most appropriate to reduce the risk of recurrent dislocation in this patient?

. Arthroscopic Bankart repair
. Open Bankart repair
. Latarjet procedure
. Remplissage procedure
. SLAP repair

Correct Answer & Explanation

. Latarjet procedure

Explanation

In a young, active athlete involved in contact sports, with recurrent anterior shoulder instability, a significant Hill-Sachs lesion, and especially with hyperlaxity or documented glenoid bone loss, the Latarjet procedure is often the most appropriate surgical choice. The Latarjet procedure addresses glenoid bone loss and provides a sling effect (conjoint tendon transfer), significantly reducing recurrence rates in this high-risk population, where isolated soft tissue repairs (Bankart) may have higher failure rates. Remplissage is for engaging Hill-Sachs lesions without significant glenoid bone loss.

Question 6797

Topic: Shoulder & Hip Sports

A 32-year-old professional dancer complains of deep groin pain, worse with hip flexion and internal rotation. She also reports clicking and catching sensations. MRI shows a labral tear and pincer-type femoroacetabular impingement (FAI). What is the most appropriate surgical treatment to address both the labral tear and the underlying bony impingement?

. Open surgical dislocation of the hip for debridement
. Arthroscopic debridement of the labral tear only
. Arthroscopic osteochondroplasty of the acetabulum and femoral head/neck
. Hip arthroplasty
. Activity modification and NSAIDs

Correct Answer & Explanation

. Arthroscopic osteochondroplasty of the acetabulum and femoral head/neck

Explanation

For symptomatic femoroacetabular impingement (FAI), whether cam, pincer, or mixed, with an associated labral tear, the definitive surgical treatment is arthroscopic osteochondroplasty. This procedure involves reshaping the non-spherical femoral head-neck junction (for cam lesions) and/or trimming the excessive acetabular rim (for pincer lesions) to eliminate the impingement, and typically involves repairing or debriding the labral tear. This addresses both the underlying bony morphology causing the impingement and the resulting soft tissue damage. Isolated labral debridement does not address the cause, and hip arthroplasty is for end-stage arthritis.

Question 6798

Topic: 5. Sports Medicine
A 28-year-old athlete has a symptomatic focal chondral defect (Outerbridge Grade IV, 2cm diameter) on the medial femoral condyle following an osteochondral injury. Which surgical technique is best suited for treating symptomatic focal chondral defects in young, active patients, aiming for hyaline-like cartilage repair?
. Microfracture
. Autologous chondrocyte implantation (ACI)
. Osteochondral autograft transfer system (OATS)
. Debridement and lavage
. Partial knee replacement

Correct Answer & Explanation

. Autologous chondrocyte implantation (ACI)

Explanation

For symptomatic, focal, full-thickness chondral defects (Outerbridge Grade IV), especially those larger than 1.5-2 cm² in young, active patients, Autologous Chondrocyte Implantation (ACI) is a surgical technique that aims to regenerate hyaline-like cartilage. Microfracture typically leads to the formation of less durable fibrocartilage. Osteochondral Autograft Transfer System (OATS) can transfer hyaline cartilage but is limited by donor site morbidity and the size of the defect it can address. Debridement and lavage are palliative, and partial knee replacement is for arthritic changes, not isolated defects.

Question 6799

Topic: 5. Sports Medicine

When performing an ACL reconstruction in a 25-year-old high-demand athlete, which of the following graft choices is associated with the highest rate of anterior knee pain post-operatively, but also excellent outcomes in terms of graft strength and re-rupture rates?

. Autologous hamstring tendon (semitendinosus and gracilis)
. Autologous patellar tendon (bone-patellar tendon-bone)
. Autologous quadriceps tendon
. Allograft (e.g., tibialis anterior)
. Synthetic ligament

Correct Answer & Explanation

. Autologous patellar tendon (bone-patellar tendon-bone)

Explanation

The autologous patellar tendon (BTB) graft is widely considered the 'gold standard' for ACL reconstruction, especially in high-demand athletes, due to its strong bone-to-bone healing, predictable stiffness, and low re-rupture rates. However, it is also associated with the highest incidence of anterior knee pain (e.g., patellofemoral pain, patellar tendonitis, kneeling pain) and potential patellar fracture or patellar tendon rupture. Hamstring grafts have lower rates of anterior knee pain but can be associated with hamstring weakness and some loss of proprioception. Quadriceps tendon grafts offer a good compromise. Allografts carry risks of disease transmission and slower incorporation, and synthetic ligaments have largely fallen out of favor due to high failure rates and synovitis.

Question 6800

Topic: Knee Sports

A 30-year-old male sustains a bucket-handle tear of the medial meniscus. Arthroscopic examination confirms a displaced, reducible tear in the red-red zone (periphery) of the meniscus, measuring 3 cm in length, without significant chondral damage. What is the most appropriate management strategy?

. Partial meniscectomy
. Total meniscectomy
. Meniscal repair
. Microfracture
. Observation with activity modification

Correct Answer & Explanation

. Meniscal repair

Explanation

A displaced bucket-handle tear in the red-red zone (vascularized periphery) of the meniscus, especially in a young, active patient, is an ideal candidate for meniscal repair. Repair preserves meniscal tissue, which is crucial for joint load distribution and preventing osteoarthritis. Partial meniscectomy is indicated for irreparable tears or tears in the avascular zone. Total meniscectomy leads to accelerated degenerative changes. Microfracture is for chondral defects. Observation is inappropriate for a displaced, symptomatic tear.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page