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5. Sports Medicine MCQs

Practice Set 349 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 6961

Topic: Shoulder & Hip Sports

In the setting of anterior shoulder instability, a 'bony Bankart' lesion is identified on CT scan. What percentage of glenoid bone loss is generally considered the critical threshold at which an arthroscopic soft-tissue repair has an unacceptably high failure rate, thereby necessitating a bony augmentation procedure?

. 5-10%
. 10-15%
. 20-25%
. 35-40%
. 50-60%

Correct Answer & Explanation

. 20-25%

Explanation

Critical glenoid bone loss in anterior shoulder instability is classically cited as 20% to 25% of the inferior glenoid width. Defect sizes above this threshold result in a biomechanically unstable joint (the 'inverted pear' glenoid) and have unacceptably high failure rates with arthroscopic Bankart repair alone.

Question 6962

Topic: Knee Sports

During a posterior cruciate ligament (PCL) reconstruction, the surgeon is tensioning the anterolateral (AL) bundle of the graft. In a normal knee, the anterolateral bundle of the PCL is under maximum tension in which of the following positions?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 degrees of flexion
. 120 degrees of flexion

Correct Answer & Explanation

. 90 degrees of flexion

Explanation

The PCL consists of two main bundles: the anterolateral (AL) bundle and the posteromedial (PM) bundle. The AL bundle is larger, stiffer, and is tightest in 90 degrees of flexion. The PM bundle is tightest in extension. Single-bundle PCL reconstructions typically attempt to recreate the AL bundle and are therefore tensioned and fixed at 90 degrees of knee flexion.

Question 6963

Topic: Knee Sports

In the kinematics of the native knee joint, 'femoral rollback' allows for increased knee flexion by preventing early posterior impingement of the femur on the posterior tibia. This rollback mechanism is primarily driven by the intact:

. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Medial collateral ligament (MCL)
. Lateral collateral ligament (LCL)
. Popliteofibular ligament

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

Femoral rollback is the posterior translation of the femoral condyles on the tibial plateau as the knee flexes. This is primarily driven by the tension in the posterior cruciate ligament (PCL). In total knee arthroplasty, posterior stabilized (PS) designs use a cam and post mechanism to artificially recreate this rollback when the PCL is sacrificed.

Question 6964

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two distinct bundles. Which of the following best describes the function of the posterolateral (PL) bundle?

. It is tightest in full flexion and controls anterior translation.
. It is tightest in extension and primarily controls rotatory stability.
. It is the primary restraint to valgus stress.
. It inserts onto the medial meniscus.
. It is tightest in 90 degrees of flexion and controls internal rotation.

Correct Answer & Explanation

. It is tightest in extension and primarily controls rotatory stability.

Explanation

The PL bundle is tight in extension and provides primary rotatory stability to the knee. In contrast, the anteromedial (AM) bundle is tightest in flexion and serves as the primary restraint against anterior tibial translation.

Question 6965

Topic: Shoulder & Hip Sports

A 40-year-old male presents with a locked shoulder after a generalized tonic-clonic seizure. The arm is internally rotated, and external rotation is mechanically blocked. An axillary radiograph confirms a posterior glenohumeral dislocation. What impaction fracture is typically associated with this injury?

. Hill-Sachs lesion
. Reverse Hill-Sachs lesion
. Bankart lesion
. Bony Bankart lesion
. Coracoid fracture

Correct Answer & Explanation

. Reverse Hill-Sachs lesion

Explanation

A reverse Hill-Sachs lesion is an impaction fracture of the anteromedial humeral head. It occurs when the humeral head becomes engaged on the posterior glenoid rim during a posterior shoulder dislocation.

Question 6966

Topic: 5. Sports Medicine

A 35-year-old female undergoes an ACL reconstruction using a bone-patellar tendon-bone autograft. Postoperatively, she lacks terminal extension. An MRI demonstrates a nodular mass of fibrous tissue anterior to the tibial tunnel in the intercondylar notch. What is this lesion called?

. Mucoid degeneration
. Ganglion cyst
. Cyclops lesion
. Chondrocalcinosis
. Pigmented villonodular synovitis (PVNS)

Correct Answer & Explanation

. Cyclops lesion

Explanation

A Cyclops lesion is a localized anterior arthrofibrosis complication following ACL reconstruction. It physically blocks terminal knee extension and typically requires arthroscopic excision if symptomatic.

Question 6967

Topic: 5. Sports Medicine

During the ligamentization process of a bone-patellar tendon-bone autograft used for ACL reconstruction, the graft is mechanically at its weakest at approximately what time postoperatively?

. 1 to 2 weeks
. 6 to 12 weeks
. 6 to 9 months
. 12 to 18 months
. Immediately after implantation

Correct Answer & Explanation

. 6 to 12 weeks

Explanation

The graft undergoes an ischemic necrosis and revascularization phase, becoming mechanically weakest between 6 to 12 weeks postoperatively. During this proliferative phase, aggressive rehabilitation must be carefully managed to prevent graft failure.

Question 6968

Topic: Shoulder & Hip Sports

A patient sustains a massive rotator cuff tear involving the supraspinatus and infraspinatus. Atrophy and fatty infiltration of the infraspinatus muscle are most directly associated with retraction of the tendon beyond which anatomical landmark?

. Acromioclavicular joint
. Glenoid rim
. Coracoid process
. Spine of the scapula
. Greater tuberosity

Correct Answer & Explanation

. Glenoid rim

Explanation

Retraction of the supraspinatus/infraspinatus tendons to the level of the glenoid rim places excessive traction on the suprascapular nerve as it passes through the spinoglenoid notch. This traction neuropathy can lead to irreversible fatty infiltration and muscle atrophy.

Question 6969

Topic: 5. Sports Medicine

Following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, at what postoperative time frame is the graft biomechanically at its weakest point due to the 'ligamentization' process?

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

Correct Answer & Explanation

. 6 to 8 weeks

Explanation

The healing ACL graft undergoes a process of 'ligamentization' involving necrosis, revascularization, and cellular proliferation. The graft is biomechanically at its weakest during the revascularization phase, typically occurring between 6 and 8 weeks (sometimes extended up to 12 weeks) postoperatively.

Question 6970

Topic: 5. Sports Medicine

Which of the following accurately describes the incorporation process of a massive cortical bone allograft compared to an autograft?

. Faster rate of complete incorporation
. Highly immunogenic response leading to rapid rejection
. Incorporation via creeping substitution that remains incomplete
. Osteoinductive potential comparable to autograft
. Immediate revascularization via host vessels

Correct Answer & Explanation

. Incorporation via creeping substitution that remains incomplete

Explanation

Cortical allografts incorporate primarily via creeping substitution, a process of simultaneous bone resorption and formation. Unlike autografts, this process is significantly slower and often remains incomplete, leaving a mixture of necrotic and viable bone.

Question 6971

Topic: Knee Sports

Biomechanical studies of the anterior cruciate ligament (ACL) demonstrate distinct functional roles for the anteromedial (AM) and posterolateral (PL) bundles. Which of the following statements is true regarding their biomechanics?

. The AM bundle is tight in extension and primarily controls rotatory stability.
. The PL bundle is tight in flexion and primarily controls anterior translation.
. The AM bundle is tight in flexion and the PL bundle is tight in extension.
. Both bundles maintain equal tension throughout the entire arc of motion.
. The PL bundle is the primary restraint to varus stress in full extension.

Correct Answer & Explanation

. The AM bundle is tight in flexion and the PL bundle is tight in extension.

Explanation

The AM bundle is tight in flexion and serves as the primary restraint to anterior tibial translation at 90 degrees of flexion. The PL bundle is tight in extension and is the primary restraint to rotatory instability.

Question 6972

Topic: Knee Sports

Regarding the functional anatomy of the anterior cruciate ligament (ACL), the anteromedial (AM) and posterolateral (PL) bundles exhibit distinct tension patterns during knee motion. Which statement is most accurate?

. The AM bundle is tight in extension and loose in flexion
. The PL bundle is tight in flexion and loose in extension
. The AM bundle is tight in flexion and the PL bundle is tight in extension
. Both bundles exhibit maximum tension at 45 degrees of flexion
. The PL bundle controls anterior translation primarily at 90 degrees of flexion

Correct Answer & Explanation

. The AM bundle is tight in flexion and the PL bundle is tight in extension

Explanation

The anteromedial (AM) bundle of the ACL is primarily tight in flexion, controlling anterior tibial translation at 90 degrees. The posterolateral (PL) bundle is tight in extension, providing primary rotational stability in early flexion.

Question 6973

Topic: 5. Sports Medicine

When comparing a bone-patellar tendon-bone (BPTB) autograft to a quadrupled hamstring autograft for ACL reconstruction, the BPTB graft is most closely associated with which of the following post-operative outcomes?

. Increased incidence of anterior knee pain
. Higher graft failure rate in young females
. Increased widening of the femoral and tibial tunnels
. Increased deep infection rate
. Greater loss of terminal knee flexion

Correct Answer & Explanation

. Increased incidence of anterior knee pain

Explanation

BPTB autografts are historically associated with an increased incidence of anterior knee pain and kneeling pain due to the harvest of the central third of the patellar tendon and the creation of bone defects in the patella and tibial tubercle. Hamstring grafts are associated with increased tunnel widening and potential loss of deep hamstring strength, but less anterior knee pain.

Question 6974

Topic: Shoulder & Hip Sports

A 60-year-old male presents with shoulder pain and weakness. On physical examination, the patient has a positive 'horn blower's' sign. This finding is most specific for pathology involving which of the following muscles?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Teres major

Correct Answer & Explanation

. Teres minor

Explanation

The horn blower's sign evaluates for teres minor weakness or a massive rotator cuff tear involving the teres minor. It is positive when the patient is unable to maintain external rotation with the arm abducted to 90 degrees, causing the arm to fall into internal rotation, often forcing the patient to elevate their arm to bring their hand to their mouth.

Question 6975

Topic: Shoulder & Hip Sports

A 22-year-old male rugby player presents with recurrent anterior shoulder dislocations. A pre-operative 3D CT scan demonstrates 25% anterior glenoid bone loss. Which of the following is the most appropriate surgical treatment?

. Arthroscopic Bankart repair
. Open Bankart repair
. Coracoid process transfer (Latarjet procedure)
. Arthroscopic remplissage alone
. Putti-Platt procedure

Correct Answer & Explanation

. Coracoid process transfer (Latarjet procedure)

Explanation

Anterior glenoid bone loss greater than 20-25% in a contact athlete (referred to as a critical bone defect) is a contraindication to an isolated arthroscopic or open soft-tissue Bankart repair due to unacceptably high recurrence rates. A bony augmentation procedure, most commonly the Latarjet procedure (transfer of the coracoid process with the attached conjoined tendon to the anterior glenoid), is the gold standard for restoring stability in this scenario.

Question 6976

Topic: Knee Sports

A 50-year-old female felt a sudden 'pop' in the back of her knee while squatting. MRI reveals a complete tear of the medial meniscus posterior root. If left untreated, this injury results in a biomechanical state most equivalent to which of the following?

. Loss of anterior tibial translation restraint equivalent to an ACL tear
. Complete loss of hoop stresses, equivalent to a total meniscectomy
. Increased lateral compartment contact pressures
. Shift of the mechanical axis into valgus
. Decreased contact area with paradoxically decreased contact pressures

Correct Answer & Explanation

. Complete loss of hoop stresses, equivalent to a total meniscectomy

Explanation

The meniscal roots anchor the meniscus to the tibia, converting axial loads into circumferential 'hoop stresses.' A complete root tear disrupts this mechanism, allowing the meniscus to extrude. Biomechanically, this results in a complete loss of hoop stresses, significantly reducing contact area and increasing peak contact pressures in the medial compartment, functioning identically to a total meniscectomy.

Question 6977

Topic: 5. Sports Medicine

When compared to a quadrupled hamstring autograft, which of the following is considered a primary biological advantage of using a bone-patellar tendon-bone (BPTB) autograft in anterior cruciate ligament (ACL) reconstruction?

. Lower incidence of anterior knee pain and kneeling pain
. Higher ultimate tensile strength at time zero
. Faster and more rigid graft incorporation at the tunnel sites
. Decreased risk of contralateral ACL rupture
. Complete preservation of knee extension strength without deficits

Correct Answer & Explanation

. Faster and more rigid graft incorporation at the tunnel sites

Explanation

The major biological advantage of a BPTB autograft is bone-to-bone healing at the tunnel sites, which occurs much faster (approximately 6 weeks) and provides more rigid initial fixation than the soft tissue-to-bone healing (Sharpey's fibers) required for hamstring autografts (which takes 8-12 weeks). BPTB grafts have a higher incidence of anterior knee pain. At time zero, a quadrupled hamstring graft is actually stronger (approx 4000 N) than a 10mm BPTB graft (approx 2900 N).

Question 6978

Topic: Knee Sports

A 22-year-old football player sustains a non-contact pivoting knee injury. Radiographs reveal an avulsion fracture of the lateral tibial plateau (Segond fracture). This radiographic finding is virtually pathognomonic for an injury to which of the following structures?

. Posterior cruciate ligament
. Anterior cruciate ligament
. Medial collateral ligament
. Posterolateral corner complex
. Popliteus tendon

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

The Segond fracture is an avulsion of the anterolateral capsular attachments (often involving the anterolateral ligament) from the lateral tibial plateau. Its presence on an AP radiograph is highly specific and virtually pathognomonic for an anterior cruciate ligament (ACL) tear.

Question 6979

Topic: 5. Sports Medicine

Following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, the graft undergoes 'ligamentization'. During which phase is the graft mechanically at its weakest?

. Early necrosis phase (0-4 weeks)
. Revascularization/proliferation phase (6-12 weeks)
. Early remodeling phase (3-6 months)
. Late remodeling phase (6-12 months)
. Maturation phase (1-2 years)

Correct Answer & Explanation

. Revascularization/proliferation phase (6-12 weeks)

Explanation

The revascularization and cellular proliferation phase (typically 6-12 weeks post-op) is characterized by significant enzymatic degradation and collagen turnover. This renders the graft mechanically at its weakest point and highly susceptible to elongation or rupture.

Question 6980

Topic: Shoulder & Hip Sports

During preoperative planning for a patient with recurrent anterior shoulder instability, the concept of the 'glenoid track' is evaluated. A Hill-Sachs lesion is considered 'off-track' if it:

. Is located entirely within the medial margin of the glenoid track
. Extends medial to the medial margin of the glenoid track
. Involves less than 15% of the humeral head articular surface
. Is associated with a bony Bankart lesion less than 10% of the glenoid width
. Does not engage the anterior glenoid rim with the arm in adduction

Correct Answer & Explanation

. Extends medial to the medial margin of the glenoid track

Explanation

An 'off-track' Hill-Sachs lesion extends medial to the medial margin of the glenoid track. This makes it an engaging lesion during abduction and external rotation, which often requires a concurrent Remplissage procedure in addition to Bankart repair.

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