Menu

5. Sports Medicine MCQs

Practice Set 35 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 681

Topic: 5. Sports Medicine

A 10-year-old male with wide-open physes sustains a mid-substance ACL tear. The family opts for surgical intervention. Which of the following surgical techniques is most appropriate to minimize the risk of growth arrest?

. Standard transphyseal bone-patellar tendon-bone autograft
. All-epiphyseal or iliotibial band extra-articular reconstruction
. Transphyseal hamstring autograft with an 11 mm tunnel
. Primary repair of the ACL with suture anchors
. Non-operative management with a hinged knee brace until skeletal maturity

Correct Answer & Explanation

. All-epiphyseal or iliotibial band extra-articular reconstruction

Explanation

In prepubescent patients with significant remaining growth (Tanner stages 1 and 2), physeal-sparing techniques such as an all-epiphyseal reconstruction or an iliotibial band extra-articular tenodesis (e.g., Micheli or Kocher technique) are recommended to avoid crossing the physes and causing growth arrest.

Question 682

Topic: 5. Sports Medicine

A 16-year-old athlete undergoes an arthroscopic partial meniscectomy for a symptomatic discoid lateral meniscus. The surgeon notes that the posterior horn lacks meniscotibial attachments and is hypermobile. Which variant of a discoid meniscus does this represent?

. Incomplete Watanabe
. Complete Watanabe
. Wrisberg variant
. Ligament of Humphry variant
. Complex multidirectional variant

Correct Answer & Explanation

. Wrisberg variant

Explanation

The Wrisberg variant of a discoid meniscus is characterized by the absence of the posterior meniscotibial (coronary) ligaments. The meniscus is attached only by the meniscofemoral ligament of Wrisberg, leading to hypermobility and the classic "snapping knee" syndrome.

Question 683

Topic: Knee Sports

During acute ACL reconstruction, the surgeon evaluates the menisci. A peripheral longitudinal tear at the meniscocapsular junction of the posterior horn of the medial meniscus is suspected but not clearly visualized from the standard anterolateral viewing portal. What is the best step to evaluate this lesion?

. Obtain a stat intraoperative MRI
. Establish a posteromedial portal and view with a 30- or 70-degree arthroscope
. Perform a medial arthrotomy
. Probe the anterior horn forcefully to subluxate the meniscus
. Assume the meniscus is intact and proceed with ACL reconstruction

Correct Answer & Explanation

. Establish a posteromedial portal and view with a 30- or 70-degree arthroscope

Explanation

Ramp lesions are tears at the meniscocapsular junction of the posterior horn of the medial meniscus, highly associated with ACL tears. They are frequently "blind spots" from the anterior viewing portals and require a posteromedial portal or a trans-notch view for accurate diagnosis and repair.

Question 684

Topic: 5. Sports Medicine

A 25-year-old male is 3 weeks post-operative from an ACL reconstruction with bone-patellar tendon-bone autograft. He presents with worsening knee pain, swelling, erythema, and a fever of 101.5°F. Joint aspiration yields a leukocyte count of 65,000 cells/mm3 with 90% neutrophils. What is the most appropriate initial management?

. Intravenous antibiotics and immediate graft removal
. Oral antibiotics and observation for 48 hours
. Arthroscopic irrigation and debridement with retention of the graft
. Open arthrotomy, graft removal, and placement of an antibiotic spacer
. Serial aspirations in the clinic every 3 days

Correct Answer & Explanation

. Arthroscopic irrigation and debridement with retention of the graft

Explanation

In the setting of acute septic arthritis following ACL reconstruction, the standard of care is urgent arthroscopic irrigation and debridement. The ACL graft should be retained as long as its fixation is secure and the tissue is not grossly necrotic.

Question 685

Topic: Knee Sports

Which of the following blood vessels provides the primary arterial supply to the peripheral 10-30% of the medial and lateral menisci?

. Middle genicular artery
. Medial and lateral inferior genicular arteries
. Descending genicular artery
. Popliteal artery branches directly
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Medial and lateral inferior genicular arteries

Explanation

The peripheral blood supply to the menisci (the red-red zone) is provided by the perimeniscal capillary plexus, which arises predominantly from the medial and lateral inferior genicular arteries. The middle genicular artery supplies the ACL, PCL, and the synovial fold.

Question 686

Topic: 5. Sports Medicine

When counseling a patient on graft choices for primary ACL reconstruction, you discuss the morbidity of bone-patellar tendon-bone (BTB) autograft compared to hamstring autograft. Which of the following is significantly more common with BTB autograft?

. Higher risk of graft rupture
. Increased residual laxity on instrumented testing
. Anterior knee pain and kneeling pain
. Saphenous nerve injury
. Deep vein thrombosis

Correct Answer & Explanation

. Anterior knee pain and kneeling pain

Explanation

Bone-patellar tendon-bone (BTB) autografts are associated with a higher incidence of donor site morbidity, specifically anterior knee pain and pain with kneeling, compared to hamstring autografts. Rates of graft rupture and residual laxity are generally comparable or slightly favor BTB in some high-level athletes.

Question 687

Topic: Knee Sports

A surgeon is performing an ACL reconstruction using an anteromedial portal technique for femoral tunnel drilling. To minimize the risk of a critically short femoral tunnel or posterior wall blowout, at what degree of knee flexion should the knee ideally be positioned during drilling?

. 0 degrees (full extension)
. 30 degrees
. 60 degrees
. 90 degrees
. 120 degrees or greater

Correct Answer & Explanation

. 120 degrees or greater

Explanation

When using an independent anteromedial portal to drill the femoral tunnel, the knee must be hyperflexed (typically 120 degrees or more) to ensure adequate tunnel length and avoid posterior cortical blowout of the lateral femoral condyle.

Question 688

Topic: 5. Sports Medicine

A patient presents with a laceration isolated to the flexor digitorum profundus (FDP) tendon in Zone I of the index finger. If primary repair is performed utilizing an early active mobilization protocol, what complication is statistically most common?

. Infection
. Tendon rupture
. Distal interphalangeal joint flexion contracture
. Quadriga effect
. Complex regional pain syndrome

Correct Answer & Explanation

. Distal interphalangeal joint flexion contracture

Explanation

Following Zone I FDP repairs, flexion contractures of the distal interphalangeal (DIP) joint and adhesion formation are the most common complications. Despite early active motion protocols aiming to reduce this, stiffness and contracture remain more common than acute tendon rupture.

Question 689

Topic: 5. Sports Medicine

A 16-year-old female gymnast is undergoing ACL reconstruction. If a bone-patellar tendon-bone allograft is chosen instead of a bone-patellar tendon-bone autograft, what is the most likely biomechanical or clinical consequence?

. A significantly higher rate of graft rupture
. Decreased risk of contralateral ACL tear
. Increased incidence of long-term anterior knee pain
. Increased risk of postoperative arthrofibrosis
. No statistically significant difference in rupture rates

Correct Answer & Explanation

. A significantly higher rate of graft rupture

Explanation

In young, highly active patients (under 25 years old), the use of allograft for ACL reconstruction is associated with a significantly higher failure/rupture rate compared to autograft. Autografts are the preferred choice in this demographic to minimize retear rates.

Question 690

Topic: Knee Sports

During an ACL reconstruction, the surgeon evaluates the native footprints. The native anterior cruciate ligament consists of two distinct bundles. The anteromedial (AM) bundle is best described by which of the following kinematic characteristics?

. It is tightest in extension and serves as the primary restraint to rotation
. It is tightest in flexion and serves as the primary restraint to anterior tibial translation
. It is tightest in mid-flexion and serves as a secondary restraint to varus stress
. It is tightest in extension and serves as the primary restraint to anterior tibial translation
. It remains isometric throughout the entire arc of motion

Correct Answer & Explanation

. It is tightest in extension and serves as the primary restraint to anterior tibial translation

Explanation

The ACL is composed of the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle is tightest in flexion and provides the primary restraint to anterior tibial translation, whereas the PL bundle is tightest in extension and provides primary rotational stability.

Question 691

Topic: 5. Sports Medicine

A 24-year-old male presents 4 months after an uncomplicated hamstring autograft ACL reconstruction complaining of a painful inability to fully extend his knee. Clinical examination reveals a palpable clunk at terminal extension. What is the most likely etiology of his limited extension?

. Formation of a fibrovascular nodule anterior to the graft
. Generalized arthrofibrosis from delayed mobilization
. Graft placement too posterior on the femoral footprint
. Unrecognized acute posterolateral corner injury
. Acquired patella baja

Correct Answer & Explanation

. Formation of a fibrovascular nodule anterior to the graft

Explanation

The patient's presentation is classic for a 'Cyclops lesion', a localized fibrovascular nodule that forms anterior to the ACL graft. It typically causes loss of terminal extension and a palpable or audible clunk as it impinges in the intercondylar notch.

Question 692

Topic: 5. Sports Medicine

A 9-year-old boy (Tanner stage 1) with widely open physes sustains a complete ACL tear. He experiences recurrent giving-way episodes despite bracing and physical therapy. If surgical reconstruction is selected, which technique is most appropriate to minimize the risk of iatrogenic growth arrest?

. Standard transphyseal bone-patellar tendon-bone autograft
. All-epiphyseal (physeal-sparing) ACL reconstruction
. Partial transphyseal reconstruction traversing only the femoral physis
. Over-the-top femoral routing with standard transphyseal tibial drilling
. Primary end-to-end repair without augmentation

Correct Answer & Explanation

. All-epiphyseal (physeal-sparing) ACL reconstruction

Explanation

In young patients with significant remaining growth (Tanner stages 1 and 2), drilling across the physes can lead to premature closure and angular deformity. An all-epiphyseal, physeal-sparing reconstruction using a soft tissue graft is the recommended surgical approach to avoid growth arrest.

Question 693

Topic: Knee Sports

During an arthroscopic ACL reconstruction, the surgeon probes the posterior aspect of the medial compartment and identifies a 'ramp lesion'. This pathology represents a tear involving which of the following specific structures?

. The meniscofemoral ligaments of Humphry and Wrisberg
. The meniscotibial (coronary) ligament at the posterior horn of the medial meniscus
. The anterior root insertion of the lateral meniscus
. The transverse intermeniscal ligament
. The popliteomeniscal fascicles

Correct Answer & Explanation

. The meniscotibial (coronary) ligament at the posterior horn of the medial meniscus

Explanation

A 'ramp lesion' is a peripheral longitudinal tear of the posterior horn of the medial meniscus located at the meniscocapsular junction. It specifically involves a disruption of the meniscotibial (coronary) ligament and is highly associated with ACL ruptures.

Question 694

Topic: 5. Sports Medicine

Following a multi-strand Zone II flexor tendon repair, modern postoperative rehabilitation often employs early active motion protocols. What is the primary physiological and clinical advantage of early active mobilization over prolonged strict immobilization?

. Decreased overall rate of tendon rupture
. Increased intrinsic tendon healing and reduction of restrictive adhesion formation
. Accelerated revascularization exclusively from the vincula brevia
. Elimination of the need for an epitendinous repair
. Prevention of digital nerve traction injuries

Correct Answer & Explanation

. Increased intrinsic tendon healing and reduction of restrictive adhesion formation

Explanation

Early active mobilization promotes tendon excursion, which minimizes the formation of restrictive peritendinous adhesions. It also stimulates intrinsic cellular activity within the tendon, enhancing the tensile strength of the healing site.

Question 695

Topic: Shoulder & Hip Sports

A 45-year-old active male presents with the displaced proximal humerus fracture shown in the radiographs. The fracture involves the surgical neck and a displaced greater tuberosity. The surgeon plans for ORIF with a locking plate. Which of the following specific fracture characteristics, visible in the provided image, is a key consideration influencing the decision for surgical fixation in an active patient?

. A. The presence of a comminuted humeral head.
. B. The degree of valgus impaction of the humeral head.
. C. The significant displacement of the greater tuberosity.
. D. The presence of an isolated lesser tuberosity fracture.
. E. The absence of any articular surface involvement.

Correct Answer & Explanation

. C. The significant displacement of the greater tuberosity.

Explanation

Correct Answer: CThe radiographs clearly show significant displacement of the greater tuberosity fragment. In an active patient, a displaced greater tuberosity fracture is a strong indication for surgical fixation. The greater tuberosity is the insertion site for the supraspinatus, infraspinatus, and teres minor (rotator cuff muscles). Significant displacement can lead to rotator cuff dysfunction, impingement, and poor functional outcomes if not anatomically reduced and fixed. The case emphasizes achieving the "best functional outcome" for an active patient, which necessitates addressing such displacement.Option A (The presence of a comminuted humeral head):While comminution can influence treatment, the primary visible displacement driving the surgical decision for a three-part fracture in this context is the tuberosity. The head itself is not described as severely comminuted in the case.Option B (The degree of valgus impaction of the humeral head):Valgus impaction can be a stable pattern, sometimes managed non-operatively, especially if the head is well-aligned. The image shows displacement, not necessarily stable valgus impaction.Option D (The presence of an isolated lesser tuberosity fracture):The image shows a displaced greater tuberosity, not an isolated lesser tuberosity fracture. Isolated lesser tuberosity fractures are less common and often associated with posterior dislocations.Option E (The absence of any articular surface involvement):While the articular surface may not be severely comminuted, the displacement of the head relative to the shaft and the tuberosity implies significant disruption that, if left unaddressed, could lead to articular incongruity and pain. However, the most striking and functionally significant displacement for an active patient is the greater tuberosity.

Question 696

Topic: Shoulder & Hip Sports

A 25-year-old male sustains a first-time anterior shoulder dislocation during a rugby match. After successful closed reduction in the emergency department, he is neurovascularly intact. He is a highly active individual and desires to return to competitive sports. What is the most appropriate initial management strategy?

. Immediate surgical stabilization (arthroscopic Bankart repair)
. Sling immobilization for 3 weeks followed by a gradual rehabilitation program
. Corticosteroid injection into the glenohumeral joint to reduce inflammation
. Aggressive range of motion and strengthening exercises initiated immediately
. MRI of the shoulder to confirm labral tear and then observe

Correct Answer & Explanation

. Sling immobilization for 3 weeks followed by a gradual rehabilitation program

Explanation

Correct Answer: BFor a first-time anterior shoulder dislocation in a young, active patient, initial management typically involves a period of sling immobilization (usually 2-3 weeks) to allow for initial soft tissue healing, followed by a structured rehabilitation program. While young, active patients have a higher risk of recurrent dislocation, immediate surgical stabilization is generally not indicated for a first-time dislocation unless there are specific indications such as a large bony Bankart lesion, significant Hill-Sachs lesion, or concomitant rotator cuff tear in an older patient. The goal of initial non-operative management is to restore range of motion and strength while minimizing the risk of recurrence. Corticosteroid injections are not indicated for acute dislocations. Aggressive immediate range of motion can hinder soft tissue healing. An MRI is often performed after initial stabilization to assess for associated injuries (e.g., Bankart lesion, Hill-Sachs lesion, rotator cuff tears) which will guide long-term management and surgical decision-making, but it is not the immediate next step after reduction and neurovascular assessment.

Question 697

Topic: Shoulder & Hip Sports

A 45-year-old male presents with acute onset of right shoulder pain and weakness after attempting to lift a heavy object. On examination, he has significant weakness in external rotation and abduction. Deltoid function is intact. Radiographs are normal. Which of the following is the most likely diagnosis?

. Subscapularis tear
. Infraspinatus tear
. Supraspinatus tear
. Axillary nerve palsy
. Long head of biceps rupture

Correct Answer & Explanation

. Infraspinatus tear

Explanation

Correct Answer: BThe patient presents with acute shoulder pain and weakness, specifically in external rotation and abduction. While the supraspinatus initiates abduction, the infraspinatus is the primary external rotator. Given the intact deltoid (ruling out axillary nerve palsy) and significant weakness in external rotation, a tear of the infraspinatus is the most likely diagnosis. Subscapularis tears primarily affect internal rotation, and long head of biceps rupture typically presents with a 'Popeye' deformity and weakness in elbow flexion/supination, not primarily shoulder abduction/external rotation.

Question 698

Topic: Knee Sports

Which of the following describes the most common mechanism of injury for an anterior cruciate ligament (ACL) rupture?

. Direct blow to the anterior tibia with the knee in flexion
. Hyperextension injury with a varus force
. Non-contact deceleration with a rotational (valgus and external rotation) force
. Posteriorly directed force to the proximal tibia with the knee flexed
. Landing from a jump with the knee in full extension

Correct Answer & Explanation

. Non-contact deceleration with a rotational (valgus and external rotation) force

Explanation

Correct Answer: CThe most common mechanism for ACL rupture is a non-contact injury involving deceleration, cutting, or pivoting maneuvers, typically with the knee in slight flexion, valgus, and external rotation of the tibia on the femur. This creates significant tension on the ACL. A direct blow to the anterior tibia (dashboard injury) can cause a posterior cruciate ligament (PCL) injury. Hyperextension with varus force might stress the posterolateral corner, while a direct posterior force to the tibia causes PCL injury. Landing in full extension is less common than dynamic valgus loading for ACL rupture.

Question 699

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, the surgeon inadvertently places the femoral tunnel too anteriorly. What is the most likely clinical consequence?

. Laxity in extension and tightness in flexion
. Tightness in extension and laxity in flexion
. Increased rotational laxity only
. Graft impingement in the intercondylar notch during extension
. Premature osteoarthritis of the patellofemoral joint

Correct Answer & Explanation

. Tightness in extension and laxity in flexion

Explanation

An anteriorly placed femoral tunnel in ACL reconstruction results in increased distance between the attachments in flexion, causing the graft to be tight in flexion and loose in extension. A properly placed tunnel should maintain relatively isometric tension throughout motion.

Question 700

Topic: Shoulder & Hip Sports

A 22-year-old football player sustains a recurrent anterior shoulder dislocation. Imaging demonstrates a glenoid bone loss of 25% and an engaging Hill-Sachs lesion. Which of the following is the most appropriate surgical management?

. Arthroscopic Bankart repair
. Arthroscopic Bankart repair with remplissage
. Latarjet procedure
. Open capsular shift
. Glenoid resurfacing with distal tibial allograft

Correct Answer & Explanation

. Latarjet procedure

Explanation

The Latarjet procedure (coracoid transfer) is indicated for anterior shoulder instability with critical glenoid bone loss (typically >20-25%). Arthroscopic Bankart repair has an unacceptably high failure rate when glenoid bone loss exceeds this threshold.

Test Yourself

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

On this Page