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 6981
Topic: Knee Sports
A 25-year-old athlete sustains a knee injury. On examination, the dial test reveals 15 degrees of increased external rotation on the injured side compared to the normal side when tested at 30 degrees of knee flexion. However, at 90 degrees of knee flexion, the external rotation is symmetrical bilaterally. What is the most likely diagnosis?
Correct Answer & Explanation
. Isolated posterolateral corner (PLC) injury
Explanation
An isolated posterolateral corner (PLC) injury is indicated by increased external rotation at 30 degrees of flexion but not at 90 degrees. If external rotation asymmetry is present at both 30 and 90 degrees, a combined PLC and PCL injury is diagnosed.
Question 6982
Topic: Shoulder & Hip Sports
A 21-year-old collegiate wrestler suffers his fourth anterior shoulder dislocation. Advanced imaging reveals an anterior inferior glenoid bone defect measuring 28% of the glenoid width. Which of the following surgical procedures is considered the gold standard to restore stability in this patient?
Correct Answer & Explanation
. Latarjet procedure
Explanation
In the setting of recurrent anterior shoulder instability with critical anterior glenoid bone loss (typically greater than 20-25%), soft tissue repairs like a Bankart repair have unacceptably high failure rates. The Latarjet procedure (coracoid process transfer) is required to restore the bony architecture and provide a dynamic sling effect.
Question 6983
Topic: Knee Sports
A 28-year-old professional athlete presents with chronic posterior knee instability and functional limitations due to an isolated Grade II posterior cruciate ligament (PCL) tear, sustained 18 months ago. Non-operative management, including extensive physical therapy, has failed to restore stability or allow return to sport. Which surgical technique is generally considered the most biomechanically advantageous for PCL reconstruction in this patient?
Correct Answer & Explanation
. Single-bundle femoral inlay PCL reconstruction.
Explanation
For a chronic, symptomatic PCL deficiency in an active individual, surgical reconstruction is indicated. Among the options, the femoral inlay technique (both single and double bundle) has been shown to be biomechanically superior to the transtibial technique. The transtibial technique often creates a 'killer turn' or acute angle for the graft as it exits the tibia, which can lead to graft abrasion, lengthening, and failure. The femoral inlay technique avoids this acute turn, providing a more anatomical and biomechanically sound reconstruction. While double-bundle techniques may offer theoretical advantages in some cases, the single-bundle femoral inlay technique is a robust option that avoids the 'killer turn' and is highly effective for isolated Grade II/III tears, making it a strong choice.
Question 6984
Topic: 5. Sports Medicine
Female athletes demonstrate a higher incidence of non-contact anterior cruciate ligament (ACL) injuries compared to males. Which of the following is considered an anatomic or biomechanical risk factor for this disparity?
Correct Answer & Explanation
. Increased generalized ligamentous laxity
Explanation
Female athletes are predisposed to ACL tears due to several intrinsic risk factors, including increased generalized ligamentous laxity, increased Q angle, and a narrower intercondylar notch. Increased posterior tibial slope and hormonal fluctuations also contribute to this elevated risk.
Question 6985
Topic: 5. Sports Medicine
A 22-year-old soccer player undergoes knee arthroscopy for a longitudinal tear in the peripheral third of the medial meniscus. The surgeon decides to repair rather than resect the meniscus. From which vascular source does this specific zone of the meniscus derive its blood supply to facilitate healing?
Correct Answer & Explanation
. Medial and lateral genicular arteries
Explanation
The peripheral third of the meniscus (the red-red zone) is well-vascularized by the superior and inferior medial and lateral genicular arteries. This rich blood supply affords tears in this region a high potential for healing following surgical repair.
Question 6986
Topic: Knee Sports
A 14-year-old active male complains of poorly localized, intermittent knee pain and catching over the past six months. Radiographs reveal osteochondritis dissecans (OCD) of the knee. What is the most common anatomical location for this lesion?
Correct Answer & Explanation
. Lateral aspect of the medial femoral condyle
Explanation
The classic and most common location for osteochondritis dissecans (OCD) in the knee is the lateral aspect of the medial femoral condyle. It accounts for approximately 70-80% of all knee OCD lesions.
Question 6987
Topic: Shoulder & Hip Sports
A 22-year-old rugby player presents with recurrent anterior shoulder dislocations. A pre-operative CT scan reveals an inverted pear-shaped glenoid with 30% anterior glenoid bone loss. What is the most appropriate surgical intervention?
Correct Answer & Explanation
. Coracoid transfer (Latarjet procedure)
Explanation
In the setting of recurrent anterior shoulder instability with critical glenoid bone loss (greater than 25%), soft tissue repairs alone have a high failure rate. A bony augmentation procedure, such as the Latarjet (coracoid transfer), is required to restore glenoid width and stability.
Question 6988
Topic: Shoulder & Hip Sports
A 21-year-old collegiate rugby player with recurrent anterior shoulder instability undergoes advanced imaging. A 3D CT scan reveals 25 percent anterior glenoid bone loss. What is the most appropriate surgical management?
Correct Answer & Explanation
. Coracoid transfer to the anterior glenoid (Latarjet)
Explanation
In patients with anterior shoulder instability and significant glenoid bone loss (typically greater than 20 to 25 percent), soft tissue stabilization alone has an unacceptably high failure rate. A bony augmentation procedure, such as the Latarjet coracoid transfer, is indicated.
Question 6989
Topic: Knee Sports
A 19-year-old soccer player sustains a twisting injury to his knee. He presents with a locked knee and a large effusion. MRI reveals a complete anterior cruciate ligament (ACL) tear and a displaced bucket-handle tear of the medial meniscus. What is the recommended surgical management?
Correct Answer & Explanation
. Concurrent ACL reconstruction and medial meniscus repair
Explanation
A locked knee secondary to a displaced bucket-handle meniscal tear requires urgent surgical intervention. Concurrent ACL reconstruction and meniscal repair should be performed, as the bleeding and bone marrow elements from the ACL reconstruction create a favorable biologic environment that improves meniscal healing rates.
Question 6990
Topic: Knee Sports
The anterior cruciate ligament (ACL) is composed of two primary bundles. During knee flexion, which of the following accurately describes the tension pattern of the anteromedial (AM) and posterolateral (PL) bundles?
Correct Answer & Explanation
. AM bundle is tight, PL bundle is loose
Explanation
The ACL's two functional bundles exhibit reciprocal tension patterns. The anteromedial (AM) bundle tightens in flexion (acting as the primary restraint to anterior translation at 90 degrees), while the posterolateral (PL) bundle is tight in extension (providing rotatory stability) and becomes loose in flexion.
Question 6991
Topic: 5. Sports Medicine
Following an acute tendon rupture and surgical repair, the tissue undergoes distinct phases of healing. During the remodeling phase, what is the primary cellular event regarding collagen matrix adaptation?
Correct Answer & Explanation
. Replacement of Type III collagen with Type I collagen
Explanation
During the remodeling phase of tendon healing, the initially deposited unorganized Type III collagen is gradually replaced by stronger, longitudinally oriented Type I collagen. This process significantly increases the tensile strength of the healing tendon.
Question 6992
Topic: 5. Sports Medicine
A 22-year-old professional soccer player undergoes an anatomic single-bundle anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Based on the biology of graft incorporation, at what postoperative time frame is the graft mechanically at its weakest?
Correct Answer & Explanation
. 6-12 weeks
Explanation
An autograft ACL reconstruction goes through phases of incorporation: necrosis, revascularization, cellular repopulation, and remodeling (ligamentization). The graft undergoes significant biologic degradation during the early revascularization phase, causing it to be mechanically at its weakest roughly between 6 to 12 weeks postoperatively. This represents a critical vulnerability period where rehabilitation must balance protecting the graft with restoring range of motion.
Question 6993
Topic: Knee Sports
A 22-year-old male sustains a direct blow to the anteromedial proximal tibia while his knee is extended. A posterolateral corner (PLC) injury is suspected. Which of the following physical examination findings specifically isolates an injury to the PLC?
Correct Answer & Explanation
. Increased external rotation of the tibia at 30 degrees of knee flexion
Explanation
The dial test assesses for posterolateral corner injury. Increased external rotation at 30 degrees of flexion (but not at 90 degrees) indicates an isolated PLC injury. If it is increased at both 30 and 90 degrees, a combined PLC and PCL injury is present.
Question 6994
Topic: 5. Sports Medicine
A 25-year-old female athlete undergoes primary anterior cruciate ligament (ACL) reconstruction. Understanding the native biomechanics is crucial for anatomic tunnel placement. Which of the following statements accurately describes the biomechanical function of the native ACL bundles?
Correct Answer & Explanation
. The anteromedial bundle provides primary restraint to anterior translation during flexion.
Explanation
The native ACL consists of two main bundles. The anteromedial (AM) bundle is tightest in flexion and is the primary restraint to anterior translation in a flexed knee. The posterolateral (PL) bundle is tightest in extension and provides rotational stability.
Question 6995
Topic: Shoulder & Hip Sports
A patient sustains a high-energy motorcycle crash and suffers a traction injury to the upper trunk of the brachial plexus (Erb-Duchenne palsy). Which of the following clinical presentations is expected?
Correct Answer & Explanation
. Loss of shoulder abduction and external rotation, with the arm held in adduction and internal rotation
Explanation
An upper trunk brachial plexus injury (C5-C6), or Erb's palsy, typically results in paralysis of the deltoid, supraspinatus, infraspinatus, and biceps. This causes the limb to be held in the classic 'waiter's tip' posture: shoulder adducted and internally rotated, elbow extended, and forearm pronated.
Question 6996
Topic: Knee Sports
The anterior cruciate ligament (ACL) is composed of two primary bundles. Which of the following statements correctly describes the tensioning and primary stabilizing function of the posterolateral (PL) bundle?
Correct Answer & Explanation
. Tight in flexion and primarily controls anterior translation
Explanation
The ACL has an anteromedial (AM) and a posterolateral (PL) bundle. The AM bundle tightens in flexion and is the primary restraint to anterior tibial translation. The PL bundle tightens in extension and is the primary restraint to rotatory loads (pivot shift).
Question 6997
Topic: Knee Sports
A 45-year-old female presents with sudden onset medial knee pain after a deep squat. MRI demonstrates a posterior root tear of the medial meniscus. From a biomechanical perspective, what is the consequence of an untreated medial meniscus posterior root tear?
Correct Answer & Explanation
. It creates an environment identical to a total medial meniscectomy regarding contact pressures
Explanation
A complete radial tear at the meniscal root destroys the hoop stresses of the meniscus. Biomechanically, this results in meniscal extrusion and alters the tibiofemoral contact mechanics to a state equivalent to that of a total meniscectomy, leading to rapid progression of osteoarthritis if left untreated.
Question 6998
Topic: 5. Sports Medicine
A 25-year-old athlete sustains an articular cartilage injury in his knee. In normal hyaline cartilage, which extracellular matrix component is primarily responsible for providing compressive resilience?
Correct Answer & Explanation
. Aggrecan
Explanation
Aggrecan is the most abundant proteoglycan in articular cartilage. Its highly negatively charged glycosaminoglycan side chains attract water, providing the tissue with its characteristic compressive resilience and stiffness.
Question 6999
Topic: Knee Sports
The anterior cruciate ligament (ACL) is composed of two distinct functional bundles. Which statement best describes the primary biomechanical role of the posterolateral (PL) bundle?
Correct Answer & Explanation
. It provides primary rotatory stability in extension
Explanation
The posterolateral (PL) bundle of the ACL is tightest in extension and acts as the primary restraint to rotatory instability, which correlates with the clinical pivot shift test. In contrast, the anteromedial (AM) bundle is tightest in flexion and controls anterior translation.
Question 7000
Topic: Shoulder & Hip Sports
A 22-year-old overhead athlete presents with chronic anterior shoulder instability. MRI reveals a Bankart lesion and a significant engaging Hill-Sachs defect. The surgeon performs an arthroscopic Bankart repair with a Remplissage procedure. Which structure is tenodesed into the Hill-Sachs defect during a Remplissage?
Correct Answer & Explanation
. Infraspinatus tendon
Explanation
The Remplissage procedure (French for 'to fill') involves a capsulotenodesis where the posterior joint capsule and the infraspinatus tendon are secured into the Hill-Sachs defect on the posterolateral humeral head. This renders the bony defect extra-articular, preventing it from engaging the anterior glenoid rim during abduction and external rotation.
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