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5. Sports Medicine MCQs

Practice Set 348 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 6941

Topic: Knee Sports

A 22-year-old male sustains a twisting knee injury. Examination reveals a positive Lachman test and joint-line tenderness. MRI confirms an anterior cruciate ligament (ACL) rupture and a peripheral longitudinal tear in the "red-red" zone of the posterior horn of the medial meniscus. What is the most appropriate surgical management?

. ACL reconstruction and meniscectomy
. Nonoperative management with physical therapy
. ACL reconstruction and meniscal repair
. Isolated meniscal repair
. Isolated ACL reconstruction

Correct Answer & Explanation

. ACL reconstruction and meniscal repair

Explanation

The medial meniscus tear is in the vascularized "red-red" zone, making it highly amenable to repair. Performing the repair concurrently with ACL reconstruction creates a biologically favorable environment that enhances meniscal healing.

Question 6942

Topic: 5. Sports Medicine

A 22-year-old female soccer player undergoes an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Six months postoperatively, she complains of anterior knee pain and difficulty kneeling. Which of the following is the most likely cause of her symptoms?

. Graft impingement in the intercondylar notch
. Harvest site morbidity
. Complex regional pain syndrome
. Undiagnosed cyclops lesion
. Premature return to sport causing micro-tears in the graft

Correct Answer & Explanation

. Harvest site morbidity

Explanation

Anterior knee pain and pain with kneeling are the most common specific complications of a bone-patellar tendon-bone (BPTB) autograft harvest. This harvest site morbidity is a key consideration when selecting graft types for patients whose activities require frequent kneeling.

Question 6943

Topic: 5. Sports Medicine

During an ACL reconstruction using a bone-patellar tendon-bone autograft, the surgeon places the femoral tunnel too far anteriorly. What is the most likely biomechanical consequence of this error?

. Increased graft tension in extension leading to an extension deficit
. Increased graft tension in flexion leading to a captured knee in flexion
. Laxity in both flexion and extension
. Patellar fracture during rehabilitation
. Early osteoarthritis of the medial compartment

Correct Answer & Explanation

. Increased graft tension in flexion leading to a captured knee in flexion

Explanation

An anteriorly placed femoral tunnel creates a graft that tightens excessively as the knee flexes. This limits knee flexion, causes abnormally high graft tension, and can result in a "captured knee."

Question 6944

Topic: 5. Sports Medicine

A 22-year-old athlete sustains a traumatic anterior shoulder dislocation. An MRI arthrogram reveals a bony Bankart lesion involving 25% of the anterior glenoid width. What is the most appropriate surgical management?

. Arthroscopic soft tissue Bankart repair
. Latarjet procedure (coracoid transfer)
. Remplissage procedure alone
. Humeral head allograft
. Nonoperative management with sling immobilization

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

Critical glenoid bone loss (> 20-25%) associated with recurrent anterior instability is a strong indication for a bony augmentation procedure, such as the Latarjet. Arthroscopic soft tissue repair in the setting of critical bone loss carries an unacceptably high failure rate.

Question 6945

Topic: 5. Sports Medicine

A 10-year-old girl with wide-open physes (Tanner Stage 1) sustains a complete midsubstance anterior cruciate ligament (ACL) tear. She experiences recurrent instability preventing her from participating in sports. Which surgical technique is most appropriate to stabilize the knee while minimizing the risk of growth arrest?

. Transphyseal reconstruction using a bone-patellar tendon-bone autograft
. Isolated iliotibial band physeal-sparing extra-articular tenodesis
. All-epiphyseal reconstruction using a soft tissue hamstring autograft
. Nonoperative management in a locked hinged knee brace until skeletal maturity
. Transphyseal reconstruction utilizing large 12mm drill tunnels

Correct Answer & Explanation

. All-epiphyseal reconstruction using a soft tissue hamstring autograft

Explanation

In prepubescent patients with significant growth remaining (Tanner stage 1 or 2), physeal-sparing techniques such as an all-epiphyseal reconstruction using soft tissue grafts are recommended. Bone blocks and transphyseal tunnels unacceptably increase the risk of premature physeal closure and resultant angular deformity.

Question 6946

Topic: 5. Sports Medicine

Which of the following bone graft options possesses osteoconductive, osteoinductive, and osteogenic properties?

. Demineralized bone matrix (DBM)
. Cancellous allograft
. Cortical allograft
. Iliac crest bone autograft
. Recombinant human BMP-2

Correct Answer & Explanation

. Iliac crest bone autograft

Explanation

Iliac crest bone autograft (ICBG) is the gold standard because it is the only option listed that contains living cells (osteogenic), growth factors like BMPs (osteoinductive), and a collagen/mineral scaffold (osteoconductive). Allografts and DBM lack live osteoprogenitor cells.

Question 6947

Topic: Knee Sports

When comparing structural properties of various grafts used for anterior cruciate ligament (ACL) reconstruction, which of the following grafts exhibits the highest initial ultimate tensile load prior to physiological incorporation?

. 10-mm Bone-Patellar Tendon-Bone (BPTB)
. Quadrupled Hamstring (Semitendinosus and Gracilis)
. 10-mm Quadriceps tendon with bone block
. Native intact ACL
. Doubled Semitendinosus alone

Correct Answer & Explanation

. Quadrupled Hamstring (Semitendinosus and Gracilis)

Explanation

Biomechanical studies demonstrate that the quadrupled hamstring graft has the highest ultimate tensile load (~4140 N). A 10-mm BPTB has a tensile strength of ~2977 N. A 10-mm quadriceps tendon is ~2185 N. The native, intact ACL has an ultimate tensile load of approximately 2160 N. Despite these differences in initial strength, long-term clinical stability is generally comparable.

Question 6948

Topic: Shoulder & Hip Sports

A 22-year-old male hockey player presents with groin pain exacerbated by hip flexion and internal rotation. Radiographs reveal an aspherical femoral head-neck junction with an alpha angle of 70 degrees. During hip arthroscopy for this 'cam-type' femoroacetabular impingement (FAI), where is the characteristic articular cartilage damage (chondral delamination) most likely to be found?

. Posteroinferior acetabulum
. Anterosuperior acetabulum
. Medial fovea centralis
. Anterior femoral head
. Posteromedial femoral neck

Correct Answer & Explanation

. Anterosuperior acetabulum

Explanation

Cam FAI is caused by an abnormally shaped femoral head-neck junction (alpha angle >55 degrees) engaging the acetabulum during flexion and internal rotation. This creates massive shear forces at the anterosuperior acetabular rim, classically leading to chondral delamination from the subchondral bone, peeling inward from the labro-chondral junction in the anterosuperior quadrant.

Question 6949

Topic: Knee Sports
A 25-year-old female with known Type 1 von Willebrand disease is scheduled for an elective ACL reconstruction. Which of the following is the most appropriate first-line preoperative pharmacologic intervention to optimize her hemostasis?
. Prophylactic platelet transfusion
. Administration of fresh frozen plasma (FFP)
. Recombinant Factor VIII infusion
. Administration of Desmopressin (DDAVP)
. Intravenous Vitamin K

Correct Answer & Explanation

. Administration of Desmopressin (DDAVP)

Explanation

Type 1 von Willebrand disease is a quantitative deficiency of von Willebrand factor (vWF). Desmopressin (DDAVP) is a synthetic analog of vasopressin that stimulates the release of preformed vWF and Factor VIII from the Weibel-Palade bodies of endothelial cells. It is the first-line treatment for surgical prophylaxis in patients with Type 1 vWD.

Question 6950

Topic: Knee Sports

During a posterior cruciate ligament (PCL) reconstruction, the surgeon identifies the meniscofemoral ligaments to aid in anatomic orientation. The ligament of Wrisberg passes in which relation to the PCL?

. Anterior to the PCL
. Posterior to the PCL
. Lateral to the PCL
. Medial to the PCL
. Superior to the PCL

Correct Answer & Explanation

. Posterior to the PCL

Explanation

The meniscofemoral ligaments connect the posterior horn of the lateral meniscus to the lateral aspect of the medial femoral condyle. The ligament of Wrisberg passes posterior to the PCL, while the ligament of Humphrey passes anterior to the PCL.

Question 6951

Topic: Shoulder & Hip Sports

A 13-year-old obese boy undergoes in situ single-screw fixation for a stable slipped capital femoral epiphysis (SCFE). Which of the following is the most common long-term complication associated with the residual deformity of the proximal femur in this condition?

. Avascular necrosis of the femoral head
. Chondrolysis
. Slip progression despite hardware
. Femoroacetabular impingement (FAI)
. Deep infection

Correct Answer & Explanation

. Femoroacetabular impingement (FAI)

Explanation

Following in-situ pinning of a SCFE, the uncorrected prominent anterior metaphysis frequently leads to cam-type femoroacetabular impingement (FAI). This represents the most common long-term complication and the primary cause of early-onset osteoarthritis in these patients.

Question 6952

Topic: Shoulder & Hip Sports

A 45-year-old male presents with shoulder pain and weakness following a fall. The surgeon wishes to isolate and test the subscapularis tendon. Which of the following physical examination tests is most specific for identifying a subscapularis tear?

. Jobe's test (Empty can test)
. Hornblower's sign
. Lift-off test (Gerber's test)
. Neer impingement sign
. O'Brien's active compression test

Correct Answer & Explanation

. Lift-off test (Gerber's test)

Explanation

The Lift-off test (Gerber's test) and the Belly-press test are highly specific for evaluating the integrity of the subscapularis. Jobe's test evaluates the supraspinatus, Hornblower's evaluates the teres minor, and O'Brien's evaluates the labrum/AC joint.

Question 6953

Topic: 5. Sports Medicine

Following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, the graft undergoes a biological process known as ligamentization. During which time frame is the structural strength of the healing graft at its absolute lowest point?

. 1 to 2 weeks postoperatively
. 6 to 8 weeks postoperatively
. 3 to 4 months postoperatively
. 6 to 9 months postoperatively
. 12 to 15 months postoperatively

Correct Answer & Explanation

. 6 to 8 weeks postoperatively

Explanation

The ligamentization process of an ACL autograft involves three distinct phases: early healing (necrosis), proliferation (revascularization), and maturation (remodeling). The graft's structural and mechanical strength declines initially due to avascular necrosis and reaches its nadir (weakest point) at approximately 6 to 8 weeks postoperatively, during the revascularization and cellular proliferation phase. It then gradually regains strength during the remodeling phase over the next several months.

Question 6954

Topic: Knee Sports

A 45-year-old male sustains a distal third femoral shaft fracture.

If the surgeon opts for retrograde intramedullary nailing, what is the ideal entry point?

. At the true center of the intercondylar notch, posterior to Blumensaat's line
. Anterior to Blumensaat's line and medial to the center of the notch
. In line with the medullary canal, just anterior to the origin of the posterior cruciate ligament (PCL)
. Lateral to the center of the intercondylar notch, anterior to the ACL
. Distal to the inferior pole of the patella, purely extra-articular

Correct Answer & Explanation

. In line with the medullary canal, just anterior to the origin of the posterior cruciate ligament (PCL)

Explanation

The ideal starting point for a retrograde femoral nail is intra-articular: in the center of the intercondylar notch (medial-lateral), directly in line with the anatomic axis of the femur, and just anterior to the origin of the posterior cruciate ligament (PCL). An entry point that is too anterior increases the risk of damaging the patellofemoral joint cartilage, and too posterior risks damaging the PCL or missing the diaphyseal axis.

Question 6955

Topic: 5. Sports Medicine

When performing an anatomic anterior cruciate ligament (ACL) reconstruction, understanding the native footprint is critical. In 90 degrees of knee flexion, the femoral origin of the anteromedial (AM) bundle is best described as being located:

. Proximal and deep (posterior) relative to the posterolateral (PL) bundle
. Distal and shallow (anterior) relative to the posterolateral (PL) bundle
. Central and superficial relative to the PL bundle
. Proximal and shallow (anterior) relative to the PL bundle
. Directly over the lateral intercondylar ridge

Correct Answer & Explanation

. Proximal and deep (posterior) relative to the posterolateral (PL) bundle

Explanation

The native ACL consists of the anteromedial (AM) and posterolateral (PL) bundles, named for their tibial insertion. On the femoral side, when the knee is flexed to 90 degrees (the standard position for viewing during arthroscopy), the AM bundle footprint is located high (proximal) and deep (posterior) in the notch. The PL bundle is located lower (distal) and shallower (anterior) in the notch.

Question 6956

Topic: Shoulder & Hip Sports

Biomechanical models of the rotator cuff emphasize load transmission properties. Burkhart et al. described a thick, band-like structure composed of bundled collagen fibers running perpendicular to the supraspinatus and infraspinatus tendons. This structure transmits load to the humerus and stress-shields the thinner, more avascular crescent region. What is this structure called?

. Rotator cable
. Rotator interval
. Coracohumeral ligament
. Superior glenohumeral ligament
. Transverse humeral ligament

Correct Answer & Explanation

. Rotator cable

Explanation

The 'rotator cable' is a thick, macroscopic bundle of fibers that courses perpendicular to the supraspinatus and infraspinatus tendon fibers. It acts biomechanically like a suspension bridge, transmitting forces from the muscle belly to the humerus while shielding the thinner, often avascular tissue lateral to it, known as the 'rotator crescent'. This explains why some patients with crescent tears maintain excellent function.

Question 6957

Topic: 5. Sports Medicine

Following anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone autograft, the graft undergoes a biological process termed 'ligamentization'. During which postoperative timeframe is the graft structurally at its weakest?

. 1-2 weeks
. 6-8 weeks
. 6 months
. 12 months
. 24 months

Correct Answer & Explanation

. 6-8 weeks

Explanation

The ACL graft undergoes four stages: necrosis, revascularization/proliferation, cellular repopulation, and remodeling. The graft is weakest during the revascularization and proliferation phase, typically between 6 to 8 weeks post-surgery, when necrotic tissue is being resorbed and new vascular networks are forming, drastically reducing the structural mechanical strength.

Question 6958

Topic: Knee Sports

A patient undergoes a Dial test during a knee examination. There is 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side, but symmetric external rotation at 90 degrees of flexion. This finding is most indicative of an isolated injury to which of the following structures?

. Posteromedial corner
. Anterior cruciate ligament
. Posterolateral corner
. Posterior cruciate ligament
. Medial collateral ligament

Correct Answer & Explanation

. Posterolateral corner

Explanation

The Dial test evaluates external rotation of the tibia. Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of flexion, but not at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. If increased external rotation is present at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 6959

Topic: Shoulder & Hip Sports

An 18-year-old contact athlete undergoes surgical stabilization for recurrent anterior shoulder instability. Preoperative imaging reveals 15% glenoid bone loss and a large, engaging Hill-Sachs lesion. An arthroscopic Bankart repair with a remplissage procedure is performed. Which structure is tenodesed into the humeral head defect during the remplissage?

. Infraspinatus tendon and posterior capsule
. Teres minor tendon
. Subscapularis tendon
. Supraspinatus tendon
. Long head of the biceps tendon

Correct Answer & Explanation

. Infraspinatus tendon and posterior capsule

Explanation

The remplissage procedure is an adjunctive technique used for engaging Hill-Sachs lesions to prevent the defect from engaging the anterior glenoid rim. It involves tenodesis of the infraspinatus tendon and the posterior capsule into the bony defect on the posterolateral humeral head.

Question 6960

Topic: Knee Sports

During an ACL reconstruction, a surgeon accidentally places the femoral tunnel too anteriorly relative to the native footprint. What is the most likely biomechanical consequence of this error during postoperative 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 be tight throughout the entire range of motion
. The graft will be loose throughout the entire range of motion
. The graft will impinge on the PCL during extension

Correct Answer & Explanation

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

Explanation

An anteriorly placed femoral tunnel (relative to the native footprint) causes the ACL graft to be relatively loose in extension and excessively tight in flexion. This often leads to restricted knee flexion and potential graft stretching or failure.

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