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5. Sports Medicine MCQs

Practice Set 344 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 6861

Topic: Shoulder & Hip Sports

In the preoperative evaluation of recurrent anterior shoulder instability, the 'glenoid track' concept is utilized to predict failure of isolated soft tissue stabilization. A bipolar bone loss lesion is considered 'off-track' if which of the following is true?

. The Hill-Sachs lesion is narrower than the intact glenoid articular track
. The Hill-Sachs lesion engages the anterior rim of the glenoid when the arm is positioned in abduction and external rotation
. The glenoid bone loss alone exceeds 25% of the inferior glenoid diameter
. The Hill-Sachs lesion is completely covered by the intact posterior rotator cuff footprint
. The defect primarily involves the posterior superior labrum without bony avulsion

Correct Answer & Explanation

. The Hill-Sachs lesion engages the anterior rim of the glenoid when the arm is positioned in abduction and external rotation

Explanation

An 'off-track' Hill-Sachs lesion extends medially past the medial margin of the glenoid track. Clinically and biomechanically, this means the lesion will engage the anterior rim of the glenoid in functional positions (abduction/external rotation), thereby predicting a high failure rate for an isolated Bankart repair. Such cases usually require a Remplissage procedure or a bony augmentation (e.g., Latarjet).

Question 6862

Topic: Knee Sports

A 14-year-old boy presents with vague, activity-related knee pain. MRI reveals a 1.5 cm osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. The physes are open, and the lesion shows no fluid signal behind the fragment. What is the most appropriate initial treatment?

. Transarticular drilling
. Microfracture
. Osteochondral autograft transfer (OATS)
. Non-operative management with activity restriction
. Bioabsorbable screw fixation

Correct Answer & Explanation

. Non-operative management with activity restriction

Explanation

Juvenile osteochondritis dissecans (jOCD) occurring in patients with open physes and stable lesions (no fluid behind the fragment on MRI) has a high rate of spontaneous healing. A trial of non-operative management, including activity modification and brief immobilization, is the initial standard of care.

Question 6863

Topic: 5. Sports Medicine

When performing an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft, the graft is mechanically most vulnerable to failure during which post-operative phase?

. 0 to 2 weeks
. 6 to 8 weeks
. 12 to 16 weeks
. 6 to 9 months
. 9 to 12 months

Correct Answer & Explanation

. 6 to 8 weeks

Explanation

The ACL graft undergoes a process of ligamentization (necrosis, revascularization, cellular proliferation, and remodeling). The graft is mechanically weakest during the revascularization and cellular proliferation phase, typically between 6 to 8 weeks post-operatively, as the original collagen network degrades before new structured collagen is fully synthesized.

Question 6864

Topic: Knee Sports

During anterior cruciate ligament (ACL) reconstruction, graft selection is critical. What is the approximate ultimate tensile load of the native intact human ACL?

. 500 N
. 1200 N
. 2160 N
. 4500 N
. 6000 N

Correct Answer & Explanation

. 2160 N

Explanation

The native intact human ACL has an ultimate tensile load of approximately 2160 N. By comparison, a quadrupled hamstring graft is initially stronger at time zero, exceeding 4000 N.

Question 6865

Topic: Shoulder & Hip Sports

In a patient with a massive rotator cuff tear, superior migration of the humeral head indicates disruption of the coronal plane force couple. Which two muscle groups primarily constitute this force couple?

. Subscapularis and Infraspinatus
. Deltoid and the inferior rotator cuff (infraspinatus, subscapularis, teres minor)
. Supraspinatus and Deltoid
. Pectoralis major and Latissimus dorsi
. Teres major and Coracobrachialis

Correct Answer & Explanation

. Deltoid and the inferior rotator cuff (infraspinatus, subscapularis, teres minor)

Explanation

The coronal plane force couple involves the deltoid pulling superiorly and the inferior rotator cuff (infraspinatus, subscapularis, teres minor) providing a compressive, inferiorly directed force. When the cuff fails, the deltoid acts unopposed, causing superior humeral migration.

Question 6866

Topic: Knee Sports

Understanding the biomechanics of the anterior cruciate ligament (ACL) is essential for anatomic reconstruction. The anteromedial (AM) bundle of the native ACL reaches its maximum tension in which position?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 degrees of flexion
. Internal rotation at 15 degrees

Correct Answer & Explanation

. Full extension

Explanation

The ACL is composed of two primary bundles. The anteromedial (AM) bundle is tightest in flexion (typically tested at 90 degrees with the anterior drawer), while the posterolateral (PL) bundle is tightest in extension.

Question 6867

Topic: Knee Sports

The anterior cruciate ligament (ACL) provides critical rotational and translational stability to the knee and is composed of two primary bundles. During knee flexion, how is the tension distributed between these two bundles?

. The anteromedial bundle tightens and the posterolateral bundle becomes lax
. The anteromedial bundle becomes lax and the posterolateral bundle tightens
. Both bundles tighten equally
. Both bundles become equally lax
. The anteromedial bundle remains tight in both full extension and full flexion

Correct Answer & Explanation

. The anteromedial bundle tightens and the posterolateral bundle becomes lax

Explanation

The ACL consists of the Anteromedial (AM) and Posterolateral (PL) bundles. Biomechanically, the AM bundle tightens in flexion (controlling primarily anterior translation), while the PL bundle tightens in extension (providing significant rotational stability). Therefore, during flexion, the AM bundle is tight and the PL bundle is lax.

Question 6868

Topic: 5. Sports Medicine

Which of the following bone graft materials is unique in possessing osteogenic, osteoinductive, and osteoconductive properties simultaneously?

. Demineralized bone matrix (DBM)
. Cortical allograft
. Cancellous autograft
. Calcium phosphate ceramics
. Recombinant human bone morphogenetic protein (rhBMP-2)

Correct Answer & Explanation

. Cancellous autograft

Explanation

Cancellous autograft is the 'gold standard' bone graft because it contains living bone cells (osteogenic), growth factors (osteoinductive), and a physical scaffold (osteoconductive). Allografts and synthetic substitutes lack the osteogenic component as they do not contain live cells.

Question 6869

Topic: Knee Sports

A 24-year-old football player undergoes clinical evaluation following a knee injury. The dial test demonstrates 20 degrees of increased external rotation on the injured side at 30 degrees of flexion, but symmetric external rotation at 90 degrees of flexion compared to the uninjured knee. Which structural injury does this pattern indicate?

. Combined PCL and posterolateral corner injury
. Isolated posterior cruciate ligament injury
. Isolated posterolateral corner injury
. Combined ACL and medial collateral ligament injury
. Isolated anterior cruciate ligament injury

Correct Answer & Explanation

. Isolated posterolateral corner injury

Explanation

The dial test is used to evaluate the posterolateral corner (PLC) and posterior cruciate ligament (PCL). Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion but symmetric rotation at 90 degrees indicates an isolated PLC injury. If the external rotation is increased at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.

Question 6870

Topic: Shoulder & Hip Sports

A 19-year-old collegiate wrestler undergoes MR arthrography after multiple anterior shoulder dislocations. The report describes an ALPSA lesion. How does an ALPSA lesion anatomically differ from a classic Bankart lesion?

. The anterior labrum is completely avulsed with a rupture of the anterior scapular periosteum
. The labrum is intact, but the articular cartilage is sheared off the glenoid face
. The anterior labrum is displaced medially and rotated inferiorly on the glenoid neck with an intact periosteum
. There is an avulsion of the inferior glenohumeral ligament from its humeral insertion
. It involves a bony fracture of the anteroinferior glenoid rim

Correct Answer & Explanation

. The anterior labrum is displaced medially and rotated inferiorly on the glenoid neck with an intact periosteum

Explanation

ALPSA stands for Anterior Labroligamentous Periosteal Sleeve Avulsion. Unlike a classic Bankart lesion, where the anterior labrum and periosteum are completely torn from the glenoid rim, an ALPSA lesion involves medial displacement and inferior rotation of the labroligamentous complex along the scapular neck, but the anterior periosteum remains intact (stripped but not torn). It has a higher recurrence rate if not properly mobilized during surgical repair.

Question 6871

Topic: Shoulder & Hip Sports

A 22-year-old football player undergoes arthroscopy for recurrent anterior shoulder instability. The surgeon identifies an anterior capsulolabral injury where the labrum is stripped from the glenoid, but the underlying periosteum remains intact, allowing the labrum to displace medially and inferiorly. What is the specific term for this lesion?

. Classic Bankart lesion
. Bony Bankart lesion
. Perthes lesion
. ALPSA lesion
. GLAD lesion

Correct Answer & Explanation

. ALPSA lesion

Explanation

An ALPSA (Anterior Labroligamentous Periosteal Sleeve Avulsion) lesion occurs when the anterior labrum is avulsed from the glenoid, but the anterior scapular periosteum remains intact, allowing the labrum to heal in a medially and inferiorly displaced position. A Perthes lesion also features an intact periosteum, but the labrum is not medially displaced. A classic Bankart involves complete disruption of the periosteum.

Question 6872

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, the surgeon positions the femoral tunnel too anteriorly (shallow) within the intercondylar notch. What is the expected biomechanical consequence of this malpositioned tunnel during knee range of motion?

. The graft will be tight in extension and loose in flexion
. The graft will be tight in flexion and loose in extension
. The graft will maintain perfect isometry throughout motion
. The graft will impinge on the posterior cruciate ligament
. The graft will cause an extension block only

Correct Answer & Explanation

. The graft will be tight in flexion and loose in extension

Explanation

In ACL reconstruction, placing the femoral tunnel too anteriorly (i.e., too shallow or high in the notch when viewed arthroscopically) increases the distance between the tibial and femoral attachment sites as the knee flexes. This results in a graft that is loose in extension and tightens excessively in flexion, potentially leading to a loss of knee flexion or graft stretching/failure. Placing the femoral tunnel too posterior (deep) results in the opposite: tight in extension and loose in flexion.

Question 6873

Topic: Shoulder & Hip Sports

A randomized controlled trial concludes that there is no difference in functional outcomes between two surgical techniques for rotator cuff repair. The authors report that the study was appropriately powered at 0.80. Statistical power is best defined as the probability of which of the following?

. Rejecting the null hypothesis when it is true
. Rejecting the null hypothesis when it is false
. Accepting the null hypothesis when it is false
. Accepting the null hypothesis when it is true
. Concluding the study results are due entirely to chance

Correct Answer & Explanation

. Rejecting the null hypothesis when it is false

Explanation

Statistical power (1 - Beta) is the probability of correctly rejecting the null hypothesis when a true difference actually exists (when the null hypothesis is false). A power of 0.80 means there is an 80% chance of detecting a significant difference if one truly exists.

Question 6874

Topic: 5. Sports Medicine

When comparing graft choices for anterior cruciate ligament (ACL) reconstruction, which of the following grafts has the highest initial ultimate tensile load?

. Native ACL
. 10-mm Bone-Patellar Tendon-Bone (BPTB) autograft
. Quadrupled hamstring autograft
. Quadriceps tendon autograft
. Fascia lata autograft

Correct Answer & Explanation

. Quadrupled hamstring autograft

Explanation

A quadrupled hamstring (semitendinosus and gracilis) autograft has the highest initial ultimate tensile load (approximately 4,000 to 4,300 N), which is substantially greater than a 10-mm BPTB graft (approx. 2,900 N), quadriceps tendon (approx. 2,300 N), and the native ACL (approx. 2,160 N). However, clinical stability outcomes are roughly comparable.

Question 6875

Topic: 5. Sports Medicine
A 14-year-old boy is scheduled for an osteochondral autograft transfer system (OATS) procedure for an OCD lesion of the medial femoral condyle. The graft being transferred consists of normal hyaline articular cartilage. What is the predominant type of collagen found in the extracellular matrix of this tissue?
. Type I
. Type II
. Type III
. Type IX
. Type X

Correct Answer & Explanation

. Type II

Explanation

Hyaline articular cartilage is primarily composed of water (65-80%) and an extracellular matrix of collagen and proteoglycans. Type II collagen makes up 90-95% of the collagen in articular cartilage. Type I collagen is predominant in bone, tendon, meniscus, and annulus fibrosus. Type X is associated with the calcified cartilage zone and hypertrophic chondrocytes in the growth plate.

Question 6876

Topic: Shoulder & Hip Sports

An overhead throwing athlete is diagnosed with a Type II SLAP tear. During arthroscopic repair, the surgeon evaluates the biceps anchor. The typical anatomy of a Type II SLAP tear involves detachment of the superior labrum and the origin of the long head of the biceps. Which structural variation must the surgeon be careful not to mistake for a pathologic labral tear during this procedure?

. Buford complex
. Bankart lesion
. Hill-Sachs lesion
. ALPSA lesion
. HAGL lesion

Correct Answer & Explanation

. Buford complex

Explanation

A Buford complex is a normal anatomical variant consisting of a cord-like middle glenohumeral ligament (MGHL) and an absent anterosuperior labrum. It is present in roughly 1.5% to 3% of shoulders. If a surgeon incorrectly identifies the absent anterosuperior labrum as a tear and repairs the cord-like MGHL to the glenoid, it will cause severe restriction in external rotation.

Question 6877

Topic: 5. Sports Medicine

When performing an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft, drilling the femoral tunnel too anteriorly (shallow) will most likely result in which of the following postoperative complications?

. Loss of terminal extension
. Loss of deep flexion
. Anterior knee pain during kneeling
. Early graft failure due to posterior cruciate ligament (PCL) impingement
. Patellar fracture

Correct Answer & Explanation

. Loss of deep flexion

Explanation

If the femoral tunnel is placed too anteriorly (non-isometric placement), the graft will tighten excessively during knee flexion, limiting deep flexion and potentially leading to early graft failure due to high tension. Placing the femoral tunnel too posteriorly or the tibial tunnel too anteriorly can cause roof impingement and a loss of terminal extension.

Question 6878

Topic: Knee Sports

During the physical examination of a patient's knee, the pivot-shift test is utilized to assess rotatory instability. Which specific bundle of the anterior cruciate ligament (ACL) is primarily responsible for resisting internal rotation and is assessed during this maneuver?

. Anteromedial (AM) bundle
. Posterolateral (PL) bundle
. Posteromedial (PM) bundle
. Anterolateral (AL) bundle
. Ligament of Wrisberg

Correct Answer & Explanation

. Posterolateral (PL) bundle

Explanation

The ACL is composed of two primary bundles: the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle is tight in flexion and primarily controls anterior-posterior translation. The PL bundle is tight in extension and primarily controls rotatory stability (resists internal rotation). The pivot-shift test examines rotatory instability near full extension, thus specifically testing the integrity of the PL bundle.

Question 6879

Topic: 5. Sports Medicine

A 55-year-old female undergoes knee arthroscopy for a complete radial tear at the bony attachment of the posterior horn of the medial meniscus (root tear). If left untreated, this injury alters the biomechanics of the knee compartment in a manner most equivalent to which of the following?

. A 50% partial meniscectomy
. Anterior cruciate ligament deficiency
. Total meniscectomy
. Chondral delamination injury
. Posterior cruciate ligament deficiency

Correct Answer & Explanation

. Total meniscectomy

Explanation

A medial meniscus posterior root tear results in complete loss of meniscal hoop stresses, allowing the meniscus to extrude peripherally under axial load. Biomechanical studies demonstrate that a complete root tear drastically increases peak articular contact pressures, functionally equating to the biomechanical state of a total meniscectomy.

Question 6880

Topic: Shoulder & Hip Sports

A 22-year-old collegiate baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. Magnetic resonance imaging reveals a partial articular-sided tear of the supraspinatus and posterosuperior labral fraying. These findings are the hallmark of which of the following conditions?

. Subacromial impingement syndrome
. Internal impingement
. Adhesive capsulitis
. Coracoid impingement
. Parsonage-Turner syndrome

Correct Answer & Explanation

. Internal impingement

Explanation

Internal impingement occurs in overhead throwing athletes during the late cocking phase (abduction and maximal external rotation). The articular surface of the supraspinatus/infraspinatus footprint impinges physically against the posterosuperior glenoid and labrum, leading to articular-sided cuff tears and labral pathology.

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