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 6921
Topic: 5. Sports Medicine
Following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, the graft undergoes a process of 'ligamentization'. During which phase is the graft mechanically at its weakest?
Correct Answer & Explanation
. Early remodeling phase (6-12 weeks)
Explanation
The remodeling phase (often termed the necrotic or revascularization phase initially, transitioning to remodeling) occurs roughly 6 to 12 weeks post-operatively. During this time, the graft undergoes necrosis and revascularization, resulting in the lowest mechanical strength before fibroblasts lay down new collagen and maturation occurs.
Question 6922
Topic: Shoulder & Hip Sports
A 22-year-old rugby player has suffered multiple anterior shoulder dislocations. Pre-operative advanced imaging demonstrates 25% anterior glenoid bone loss. Which of the following surgical procedures is most appropriate to minimize recurrence?
Correct Answer & Explanation
. Latarjet procedure
Explanation
Significant anterior glenoid bone loss (> 20-25%) in the setting of recurrent anterior instability is a contraindication to an isolated soft-tissue repair (Bankart). The Latarjet procedure (coracoid transfer) is the standard of care to restore the osseous arc and provide a sling effect from the conjoined tendon.
Question 6923
Topic: Knee Sports
A 40-year-old male sustains a posterior medial meniscus root tear. Biomechanically, this injury is most equivalent to which of the following?
Correct Answer & Explanation
. A total meniscectomy
Explanation
A posterior meniscus root tear completely disrupts the hoop stresses of the meniscus, rendering it biomechanically equivalent to a total meniscectomy. This drastically increases peak contact pressures in the compartment, leading to rapid osteoarthritis.
Question 6924
Topic: 5. Sports Medicine
When performing an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft, which of the following is the most commonly reported long-term complication compared to hamstring autografts?
Correct Answer & Explanation
. Increased anterior knee pain and pain with kneeling
Explanation
Bone-patellar tendon-bone (BPTB) autografts are associated with a significantly higher incidence of donor site morbidity compared to hamstring grafts. This is most frequently manifested as anterior knee pain and discomfort with kneeling.
Question 6925
Topic: 5. Sports Medicine
When evaluating graft choices for anterior cruciate ligament (ACL) reconstruction, how do the biomechanical properties of a 10mm bone-patellar tendon-bone (BPTB) autograft compare to those of the native intact ACL?
Correct Answer & Explanation
. BPTB has a higher ultimate load to failure and higher stiffness
Explanation
A 10mm bone-patellar tendon-bone (BPTB) autograft is biomechanically stronger and stiffer than the native ACL. The native ACL has an ultimate load to failure of approximately 2160 N and a stiffness of 242 N/mm. A 10mm BPTB graft has an ultimate load to failure of approximately 2977 N and a stiffness of 620 N/mm. Therefore, it has both higher ultimate load to failure and higher stiffness than the native ACL.
Question 6926
Topic: Shoulder & Hip Sports
A 50-year-old male sustains a traumatic anterior shoulder dislocation. After reduction, he continues to have severe anterior shoulder pain and significant weakness in internal rotation. Examination demonstrates a positive lift-off test. Given this specific injury pattern, which adjacent structure is at the highest risk for subluxation or instability?
Correct Answer & Explanation
. Long head of the biceps tendon
Explanation
The patient has a traumatic subscapularis tear, indicated by weakness in internal rotation and a positive lift-off test. The subscapularis tendon insertion forms the medial wall of the bicipital groove and, together with the coracohumeral ligament, creates the biceps pulley. A tear of the upper border of the subscapularis profoundly destabilizes this pulley system, allowing the long head of the biceps tendon (LHBT) to subluxate or dislocate medially.
Question 6927
Topic: 5. Sports Medicine
Following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft, at what time point postoperative is the graft substance structurally at its weakest mechanics due to remodeling?
Correct Answer & Explanation
. 6 to 12 weeks
Explanation
The autograft undergoes a process of necrosis, revascularization, and remodeling (ligamentization). During the 6-12 week postoperative window, the graft substance undergoes significant cellular repopulation and collagen remodeling, making it mechanically at its weakest point and most vulnerable to elongation or rupture.
Question 6928
Topic: Shoulder & Hip Sports
A 22-year-old baseball pitcher presents with vague anterior shoulder pain. An MRI arthrogram reveals a SLAP tear. Which type of SLAP lesion involves detachment of both the superior labrum and the origin of the long head of the biceps tendon from the supraglenoid tubercle?
Correct Answer & Explanation
. Type II
Explanation
Type II SLAP tears are characterized by the detachment of the superior labrum and the long head of the biceps anchor from the supraglenoid tubercle. Type I is degenerative fraying; Type III is a bucket-handle tear with an intact biceps anchor; Type IV is a bucket-handle tear extending into the biceps tendon.
Question 6929
Topic: Knee Sports
During reconstruction of the anterior cruciate ligament (ACL), the surgeon must be aware of the native ligament's vascular supply to optimize graft incorporation. The primary blood supply to the native ACL arises from which vessel?
Correct Answer & Explanation
. Middle genicular artery
Explanation
The primary blood supply to the ACL is the middle genicular artery, which branches from the popliteal artery and pierces the posterior joint capsule to supply the cruciate ligaments.
Question 6930
Topic: Knee Sports
Articular cartilage is primarily composed of water, collagen, and proteoglycans. Which type of collagen constitutes the vast majority of the collagenous framework in normal, healthy adult hyaline articular cartilage?
Correct Answer & Explanation
. Type II
Explanation
Type II collagen accounts for 90-95% of the collagen in healthy hyaline articular cartilage, providing its necessary tensile strength. Fibrocartilage, which often forms after microfracture procedures, is predominantly composed of Type I collagen.
Question 6931
Topic: Knee Sports
A 25-year-old skier presents with acute knee swelling after a twisting fall. Plain radiographs reveal an avulsion fracture of the lateral tibial plateau (Segond fracture). This radiographic finding is pathognomonic for an injury to which of the following structures?
Correct Answer & Explanation
. Anterior cruciate ligament
Explanation
A Segond fracture is an avulsion fracture of the anterolateral proximal tibia, representing an avulsion of the anterolateral ligament (ALL) or lateral capsular attachment. It is highly pathognomonic for an anterior cruciate ligament (ACL) tear.
Question 6932
Topic: Shoulder & Hip Sports
A 20-year-old athlete undergoes arthroscopic evaluation for recurrent anterior shoulder instability. An 'engaging' Hill-Sachs lesion is identified. What is the most appropriate concurrent procedure to perform alongside an arthroscopic Bankart repair?
Correct Answer & Explanation
. Remplissage procedure
Explanation
An engaging Hill-Sachs lesion can lever the humeral head out of the glenoid during external rotation and abduction. The Remplissage procedure, which involves tenodesis of the infraspinatus and capsule into the defect, converts an intra-articular defect into an extra-articular one, preventing engagement.
Question 6933
Topic: Knee Sports
In a posterior-stabilized total knee arthroplasty, the posterior cruciate ligament is sacrificed. What design feature is primarily responsible for substituting the function of the PCL to achieve physiologic femoral rollback during deep flexion?
Correct Answer & Explanation
. The interaction between the femoral cam and the tibial polyethylene post
Explanation
In a posterior-stabilized (PS) total knee arthroplasty, the PCL is excised. To replicate the PCL's normal function of causing posterior translation (rollback) of the femur on the tibia during flexion, a cam mechanism on the femoral component engages with a central post on the tibial polyethylene insert. This engagement mechanically forces the femur to roll back as the knee flexes past a certain point, optimizing the extensor mechanism moment arm and improving maximum flexion.
Question 6934
Topic: 5. Sports Medicine
Which of the following commonly utilized grafts for anterior cruciate ligament (ACL) reconstruction demonstrates the highest ultimate load to failure in biomechanical testing compared to the native ACL?
Correct Answer & Explanation
. Quadrupled hamstring autograft
Explanation
Biomechanical studies have shown that the native ACL has an ultimate load to failure of approximately 2160 N. A quadrupled hamstring graft (double-stranded semitendinosus and gracilis) is the strongest of the standard autografts, with an ultimate load to failure exceeding 4000 N. A 10 mm BPTB graft fails at roughly 2977 N, and a central quadriceps tendon graft at ~2350 N.
Question 6935
Topic: 5. Sports Medicine
A 22-year-old athlete sustains a non-contact pivoting injury to the knee, resulting in an acute anterior cruciate ligament (ACL) rupture. Which of the following is the most commonly associated meniscal injury in the acute setting?
Correct Answer & Explanation
. Lateral meniscus posterior horn tear
Explanation
In acute ACL ruptures, the lateral meniscus is most commonly torn (specifically the posterior horn) due to the pivot-shift mechanism of injury and the collision of the lateral femoral condyle against the posterolateral tibial plateau. In contrast, chronic ACL deficiency most commonly leads to tears of the posterior horn of the medial meniscus, as it acts as the primary secondary restraint to anterior tibial translation over time.
Question 6936
Topic: Shoulder & Hip Sports
The Instability Severity Index Score (ISIS) is used to predict the risk of recurrent anterior shoulder instability following arthroscopic Bankart repair. Which of the following is NOT a parameter evaluated in the ISIS?
Correct Answer & Explanation
. Presence of an isolated SLAP tear on MRI
Explanation
The ISIS predicts the risk of recurrent anterior shoulder instability. Parameters include age <20 (2 pts), competitive sports (2 pts), contact/forced overhead sports (1 pt), Hill-Sachs lesion on AP radiograph (2 pts), and glenoid bone loss on AP radiograph (2 pts). A score >6 historically suggested an unacceptably high failure rate for arthroscopic repair, prompting consideration for a Latarjet procedure. A SLAP tear is not a component of the score.
Question 6937
Topic: Knee Sports
Biomechanical studies have demonstrated that a complete posterior root avulsion of the medial meniscus disrupts the circumferential hoop stresses of the knee. This specific injury leads to medial compartment contact pressures most equivalent to which of the following states?
Correct Answer & Explanation
. A total medial meniscectomy
Explanation
A complete radial tear or root avulsion of the posterior horn of the medial meniscus breaks the continuity of the meniscal ring, completely abolishing its ability to convert axial loads into circumferential hoop stresses. Biomechanically, this results in medial compartment peak contact pressures and kinematics that are completely equivalent to a total meniscectomy, leading to rapid, progressive osteoarthritis if left untreated.
Question 6938
Topic: Knee Sports
A 28-year-old competitive athlete sustains a high-energy knee injury resulting in a knee dislocation with rupture of the ACL, PCL, and posterolateral corner (PLC). Neurovascular examination reveals intact distal pulses and sensation. After emergent reduction, the knee remains grossly unstable. What is the most appropriate surgical management strategy and timing for this patient?
Correct Answer & Explanation
. Single-stage reconstruction of all ruptured ligaments once swelling subsides (2-3 weeks post-injury)
Explanation
For multi-ligament knee dislocations without vascular compromise, the current consensus typically favors a single-stage, comprehensive reconstruction of all ruptured ligaments. The optimal timing is generally delayed until acute swelling and inflammation have subsided, typically 2-3 weeks post-injury. This allows for better tissue handling, reduced arthrofibrosis risk, and improved surgical outcomes. Acute repair of multiple ligaments often fails due to poor tissue quality and high tension. Staged reconstruction is an option but can be more complex and prolong recovery; single-stage is preferred for efficiency. Non-operative management is usually reserved for very low-demand patients or those with severe comorbidities and is generally not recommended for athletes with significant instability. Arthroscopic debridement alone does not address gross instability.
Question 6939
Topic: Shoulder & Hip Sports
A 22-year-old rugby player has recurrent anterior shoulder instability. CT arthrogram demonstrates 25% anterior glenoid bone loss and an engaging Hill-Sachs lesion. Which of the following surgical procedures is most appropriate?
Correct Answer & Explanation
. Latarjet procedure
Explanation
Glenoid bone loss greater than 20-25% in a contact athlete is an absolute indication for a bony augmentation procedure like the Latarjet. Soft tissue repairs alone have an unacceptably high failure rate in this scenario.
Question 6940
Topic: 5. Sports Medicine
A 19-year-old female soccer player undergoes ACL reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Which of the following complications is most specific to this graft choice compared to a hamstring autograft?
Correct Answer & Explanation
. Patellar fracture
Explanation
Patellar fracture is a recognized, specific complication of the BPTB autograft due to the harvest of the bone block from the patella. Hamstring grafts have a higher association with saphenous nerve neuropathy.
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