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5. Sports Medicine MCQs

Practice Set 351 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 7001

Topic: Knee Sports

The 'Dial test' is utilized to evaluate posterolateral corner (PLC) instability of the knee. Increased external rotation of the tibia at 30 degrees of flexion, but normal external rotation at 90 degrees of flexion, indicates an isolated injury to which of the following structures?

. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Posterolateral corner (PLC) alone
. Combined PLC and PCL
. Medial collateral ligament (MCL)

Correct Answer & Explanation

. Posterolateral corner (PLC) alone

Explanation

A positive Dial test (>10 degrees of asymmetry in external rotation compared to the contralateral knee) at 30 degrees of flexion with a normal test at 90 degrees indicates an isolated injury to the posterolateral corner (PLC). If the test is positive at both 30 degrees and 90 degrees, it suggests a combined injury to the PLC and the PCL.

Question 7002

Topic: 5. Sports Medicine

After an anterior cruciate ligament (ACL) reconstruction using an autograft, during which post-operative time frame is the graft biomechanically at its weakest point?

. 0 to 2 weeks
. 6 to 12 weeks
. 16 to 24 weeks
. 6 to 9 months
. 12 to 18 months

Correct Answer & Explanation

. 6 to 12 weeks

Explanation

The ACL autograft goes through a process of 'ligamentization' involving necrosis, revascularization, and remodeling. It is biomechanically weakest during the revascularization phase, typically between 6 to 12 weeks post-operatively.

Question 7003

Topic: 5. Sports Medicine

When comparing bone-patellar tendon-bone (BPTB) autograft to multiple-strand hamstring autograft for ACL reconstruction, the BPTB graft is most uniquely and consistently associated with which of the following postoperative morbidities?

. Increased incidence of postoperative deep vein thrombosis
. Anterior knee pain and risk of patellar fracture
. Greater pathological laxity over a 5-year period
. Higher risk of graft failure in female athletes
. Increased incidence of painful saphenous nerve neuroma

Correct Answer & Explanation

. Anterior knee pain and risk of patellar fracture

Explanation

BPTB autografts utilize a central third of the patellar tendon with bone plugs from the patella and tibial tubercle. The most distinct donor-site morbidities associated with this graft choice are anterior knee pain, kneeling pain, and a rare but devastating risk of postoperative patellar fracture. Hamstring grafts are more associated with saphenous nerve injury and slight increases in terminal laxity.

Question 7004

Topic: 5. Sports Medicine

During an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft, the surgeon must be cautious. Which of the following is the most common donor site morbidity associated with this specific graft choice?

. Saphenous nerve injury
. Anterior knee pain
. Patellar fracture
. Quadriceps tendon rupture
. Deep vein thrombosis

Correct Answer & Explanation

. Anterior knee pain

Explanation

Anterior knee pain, especially with kneeling, is the most common donor site complication following a bone-patellar tendon-bone (BTB) autograft for ACL reconstruction. Patellar fracture and patellar tendon rupture are severe but less common.

Question 7005

Topic: Knee Sports

In a posterior-stabilized (PS) total knee arthroplasty, the interaction between the cam on the femoral component and the post on the tibial polyethylene insert is designed to substitute for the function of which native structure?

. Anterior cruciate ligament
. Poster cruciate ligament
. Medial collateral ligament
. Lateral collateral ligament
. Posterior oblique ligament

Correct Answer & Explanation

. Poster cruciate ligament

Explanation

In a posterior-stabilized (PS) TKA design, the posterior cruciate ligament (PCL) is sacrificed. The cam-and-post mechanism engages during knee flexion to enforce femoral rollback, effectively substituting for the function of the resected PCL.

Question 7006

Topic: Shoulder & Hip Sports

During a Latarjet procedure for recurrent anterior shoulder instability with 30% glenoid bone loss, the coracoid process is transferred to the anterior glenoid. Which structure attached to the transferred coracoid provides a dynamic "sling" effect?

. Pectoralis minor
. Short head of the biceps and coracobrachialis
. Long head of the triceps
. Subscapularis
. Coracoacromial ligament

Correct Answer & Explanation

. Short head of the biceps and coracobrachialis

Explanation

The Latarjet procedure transfers the coracoid process with the attached conjoined tendon (short head of the biceps and coracobrachialis). This tendon acts as a dynamic sling across the inferior subscapularis and anterior-inferior capsule when the arm is abducted and externally rotated.

Question 7007

Topic: Shoulder & Hip Sports

A 28-year-old overhead athlete presents with posterior shoulder pain and isolated weakness in external rotation. An MRI shows a paralabral cyst. Where is the cyst most likely located to produce these specific clinical findings?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Rotator interval

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Isolated external rotation weakness indicates isolated infraspinatus denervation. The suprascapular nerve innervates the supraspinatus and then passes through the spinoglenoid notch to innervate the infraspinatus. Compression at the spinoglenoid notch affects only the infraspinatus, whereas compression at the suprascapular notch affects both the supraspinatus and infraspinatus.

Question 7008

Topic: Knee Sports

During a physical examination of a knee, a posterior drawer test is performed. The posterior cruciate ligament (PCL) is the primary restraint to posterior tibial translation. Which bundle of the PCL is the tightest in 90 degrees of knee flexion?

. Posteromedial bundle
. Anterolateral bundle
. Anteromedial bundle
. Posterolateral bundle
. Ligament of Wrisberg

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The PCL consists of two main functional bundles: the anterolateral (AL) and posteromedial (PM) bundles. The AL bundle is the larger of the two and is tightest in knee flexion (which is why the posterior drawer is tested at 90 degrees). The PM bundle is tightest in knee extension.

Question 7009

Topic: Knee Sports

During an anatomical single-bundle ACL reconstruction, the surgeon must properly place the femoral tunnel. The center of the native ACL footprint is positioned anatomically in relation to which two osseous landmarks on the medial aspect of the lateral femoral condyle?

. Lateral intercondylar ridge and lateral bifurcate ridge
. Medial intercondylar ridge and lateral epicondyle
. Gerdy's tubercle and the fibular head
. Adductor tubercle and medial epicondyle
. Anterior horn of the lateral meniscus and PCL insertion

Correct Answer & Explanation

. Lateral intercondylar ridge and lateral bifurcate ridge

Explanation

The lateral intercondylar ridge (resident's ridge) represents the anterior margin of the ACL footprint, and the lateral bifurcate ridge separates the anteromedial and posterolateral bundle footprints.

Question 7010

Topic: Knee Sports

The anterior cruciate ligament (ACL) provides crucial stability to the knee and is composed of two primary bundles. Which of the following statements correctly describes their varying tension during knee motion?

. The anteromedial bundle is tight in extension, and the posterolateral bundle is tight in flexion.
. The anteromedial bundle is tight in flexion, and the posterolateral bundle is tight in extension.
. Both bundles maintain equal and constant tension throughout the entire range of motion.
. The anterolateral bundle primarily controls external rotation in full extension.
. The posteromedial bundle is the primary restraint to posterior translation.

Correct Answer & Explanation

. The anteromedial bundle is tight in flexion, and the posterolateral bundle is tight in extension.

Explanation

The ACL has two distinct functional bundles based on their tibial insertions. The anteromedial (AM) bundle is the primary restraint to anterior translation and is tightest in flexion, while the posterolateral (PL) bundle provides rotational stability and is tightest in extension.

Question 7011

Topic: 5. Sports Medicine

In anterior cruciate ligament (ACL) reconstruction, bone-patellar tendon-bone (BTB) autografts are frequently utilized. Compared to the native ACL, what is the ultimate tensile load of a 10-mm wide BTB graft at the exact time of implantation?

. Approximately 50% of the native ACL
. Equal to the native ACL
. Approximately 135% to 140% of the native ACL
. Approximately 250% of the native ACL
. Approximately 300% of the native ACL

Correct Answer & Explanation

. Approximately 135% to 140% of the native ACL

Explanation

A 10-mm BTB graft has an ultimate tensile load of approximately 2977 N, which is about 138% of the native ACL (roughly 2160 N). However, this mechanical strength drops significantly during the necrotic and revascularization remodeling phases.

Question 7012

Topic: Shoulder & Hip Sports

The "peel-back" mechanism in overhead-throwing athletes primarily contributes to the pathogenesis of which of the following shoulder lesions?

. Anterior Bankart lesion
. Type II SLAP tear
. Posterior labral tear
. Subscapularis tendon tear
. Coracoclavicular ligament rupture

Correct Answer & Explanation

. Type II SLAP tear

Explanation

The "peel-back" mechanism occurs during the late cocking phase of throwing (maximum abduction and external rotation). This shifts the biceps vector posteriorly, generating a torsional force that peels the superior labrum off the glenoid rim, creating a Type II SLAP tear.

Question 7013

Topic: 5. Sports Medicine

A 40-year-old recreational athlete sustains an acute Achilles tendon rupture. Non-operative management is chosen using an early functional rehabilitation protocol. Compared to surgical repair, which of the following statements regarding non-operative management is most accurate based on recent high-level evidence?

. Significantly higher rate of deep infection
. Equivalent re-rupture rate when combined with early functional rehabilitation
. Decreased rate of sural nerve injury but a substantially higher DVT rate
. Significantly lower plantarflexion strength at 1 year post-injury
. A 50% lower return to sport rate

Correct Answer & Explanation

. Equivalent re-rupture rate when combined with early functional rehabilitation

Explanation

Recent meta-analyses demonstrate that when using an early functional rehabilitation protocol, the re-rupture rates between operative and non-operative management of acute Achilles tendon ruptures are statistically equivalent. However, operative management carries a higher risk of soft-tissue complications and nerve injury.

Question 7014

Topic: Knee Sports

The Anterior Cruciate Ligament (ACL) is composed of two primary bundles. Which of the following accurately describes the tension pattern and primary function of the anteromedial (AM) bundle?

. It is tight in extension and provides primary restraint to anterior tibial translation in extension
. It is tight in flexion and provides primary restraint to anterior tibial translation in flexion
. It is tight in extension and provides primary restraint to internal rotation
. It is tight in flexion and provides primary restraint to internal rotation
. It exhibits constant tension throughout the entire arc of motion

Correct Answer & Explanation

. It is tight in flexion and provides primary restraint to anterior tibial translation in flexion

Explanation

The ACL consists of the Anteromedial (AM) and Posterolateral (PL) bundles. The AM bundle is tight in flexion and acts 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 loads.

Question 7015

Topic: 5. Sports Medicine
A 22-year-old pitcher is diagnosed with a SLAP (Superior Labrum Anterior Posterior) tear. Arthroscopy reveals a superior labral tear with a detached biceps anchor, but the remaining labrum is intact without a bucket-handle component. According to the Snyder classification, what type of SLAP lesion is this?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

According to the Snyder classification of SLAP tears: Type I is fraying of the superior labrum with an intact biceps anchor. Type II is a detachment of the superior labrum and biceps anchor from the superior glenoid. Type III is a bucket-handle tear of the superior labrum with an intact biceps anchor. Type IV is a bucket-handle tear that extends into the biceps tendon.

Question 7016

Topic: Shoulder & Hip Sports

A 21-year-old athlete sustains recurrent anterior shoulder dislocations. Preoperative imaging reveals an "engaging" Hill-Sachs lesion. What specific biomechanical criterion defines this lesion as "engaging"?

. It involves greater than 20% of the humeral head
. It parallels the glenoid face in internal rotation
. It aligns parallel to the anterior glenoid rim when the shoulder is in abduction and external rotation
. It is associated with a concomitant bony Bankart lesion
. It extends completely into the bicipital groove

Correct Answer & Explanation

. It aligns parallel to the anterior glenoid rim when the shoulder is in abduction and external rotation

Explanation

An "engaging" Hill-Sachs lesion is one whose long axis becomes parallel to the anterior rim of the glenoid when the shoulder is placed in functional abduction and external rotation. This alignment allows the defect to drop over the rim and lever the head out of joint.

Question 7017

Topic: Knee Sports

During reconstruction of the anterior cruciate ligament (ACL), placing the femoral tunnel too far anteriorly will result in which of the following kinematic abnormalities?

. Tightness in extension and laxity in flexion
. Tightness in flexion and laxity in extension
. Equal laxity throughout the full range of motion
. Restriction of both flexion and extension
. Increased external rotation of the tibia in extension

Correct Answer & Explanation

. Tightness in flexion and laxity in extension

Explanation

An anteriorly placed femoral tunnel in ACL reconstruction causes the graft to be overly tight in knee flexion and loose in extension. This error often results in restricted terminal knee flexion or graft stretching over time.

Question 7018

Topic: Knee Sports

A 14-year-old male presents with vague anterior knee pain and intermittent catching. Radiographs reveal an osteochondral lesion consistent with osteochondritis dissecans (OCD). Based on the most common location for this pathology, which specific anatomical site is most likely affected?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central weight-bearing portion of the medial femoral condyle
. Inferior pole of the patella
. Anterior aspect of the lateral tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

Correct Answer: A. Lateral aspect of the medial femoral condyleOsteochondritis dissecans (OCD) of the knee most commonly affects the lateral aspect of the medial femoral condyle (accounting for approximately 70-80% of cases). It is thought to result from repetitive microtrauma leading to subchondral bone ischemia and subsequent fragmentation of the overlying articular cartilage and bone. The classic radiographic finding is a crescent-shaped radiolucency. The lateral femoral condyle is the second most common site.

Question 7019

Topic: 5. Sports Medicine

A 24-year-old female soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. The surgeon aims to anatomically reconstruct the anteromedial (AM) and posterolateral (PL) bundles. Which of the following best describes the biomechanical function and tensioning pattern of the native ACL bundles?

. The AM bundle is tight in extension and controls rotatory stability.
. The PL bundle is tight in flexion and controls anterior translation.
. The AM bundle is tight in flexion and primarily controls anterior translation.
. The PL bundle is tight in flexion and primarily controls rotatory stability.
. Both bundles are equally tensioned throughout the entire range of motion.

Correct Answer & Explanation

. The AM bundle is tight in flexion and primarily controls anterior translation.

Explanation

Correct Answer: CThe anterior cruciate ligament (ACL) consists of two distinct functional bundles named for their tibial insertion sites: the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle is tightest in flexion and is the primary restraint to anterior tibial translation. The PL bundle is tightest in extension and is the primary restraint to rotatory loads, which is clinically evaluated by the pivot shift test.

Question 7020

Topic: Shoulder & Hip Sports

A 45-year-old male undergoes an open reduction and internal fixation of a proximal humerus fracture via a deltopectoral approach. Postoperatively, he has profound weakness in shoulder abduction and numbness over the lateral aspect of the shoulder. The injured nerve exits the axilla through a specific anatomic space. What are the borders of this space?

. Teres minor (superior), teres major (inferior), long head of triceps (medial), surgical neck of humerus (lateral).
. Teres minor (superior), teres major (inferior), long head of triceps (lateral), surgical neck of humerus (medial).
. Teres major (superior), latissimus dorsi (inferior), long head of triceps (medial), humerus (lateral).
. Subscapularis (superior), teres major (inferior), short head of biceps (medial), coracobrachialis (lateral).
. Teres minor (superior), teres major (inferior), long head of triceps (medial), long head of biceps (lateral).

Correct Answer & Explanation

. Teres minor (superior), teres major (inferior), long head of triceps (medial), surgical neck of humerus (lateral).

Explanation

Correct Answer: AThe patient has an iatrogenic axillary nerve injury. The axillary nerve and the posterior circumflex humeral artery exit the axilla posteriorly through the quadrilateral space. The borders of the quadrilateral space are: superiorly the teres minor (viewed posteriorly) or subscapularis (viewed anteriorly), inferiorly the teres major, medially the long head of the triceps, and laterally the surgical neck of the humerus.

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