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 7021
Topic: Knee Sports
A 22-year-old female soccer player sustains a non-contact pivoting injury to her right knee. MRI confirms a complete anterior cruciate ligament tear alongside a displaced bucket-handle tear of the medial meniscus. What is the primary vascular supply to the peripheral third (red-red zone) of the menisci?
Correct Answer & Explanation
. Inferior and superior medial/lateral genicular arteries
Explanation
The peripheral 10-30% of the menisci is vascularized by a capillary plexus originating from the superior and inferior branches of the medial and lateral genicular arteries. The middle genicular artery primarily supplies the cruciate ligaments.
Question 7022
Topic: Knee Sports
A 24-year-old collegiate football player sustains a multi-ligament knee injury. During the surgical reconstruction of the posterolateral corner (PLC), the surgeon must be careful to protect a peripheral nerve that courses around the fibular neck. Which of the following clinical findings would result from an iatrogenic transection of this nerve?
Correct Answer & Explanation
. Inability to actively dorsiflex the ankle
Explanation
The common peroneal nerve courses around the fibular neck and is at high risk during PLC reconstruction. Injury results in a foot drop due to weakness in ankle dorsiflexion and loss of sensation over the first dorsal web space.
Question 7023
Topic: Knee Sports
A 45-year-old male presents with chronic anterior knee pain, worse with climbing stairs and prolonged sitting. Physical examination reveals patellar grind tenderness, pain with patellar compression, and a positive J-sign. Imaging shows lateral patellar tilt and increased tibial tubercle-trochlear groove (TTTG) distance of 18mm. He has failed conservative management. Which of the following surgical interventions is most appropriate?
Given the increased TTTG distance (normal < 15mm) indicating significant lateralization of the extensor mechanism, a tibial tubercle anteromedialization (Fulkerson osteotomy) is the most appropriate surgical intervention. This procedure moves the patellar tendon insertion medially and anteriorly, decreasing the Q-angle and patellofemoral contact pressures, thereby addressing both patellar maltracking and chondromalacia. MPFL reconstruction is primarily for recurrent patellar instability due to medial restraint insufficiency, though it can be combined with osteotomy for severe cases. Lateral retinacular release alone is often insufficient for significant maltracking. Trochleoplasty is reserved for severe trochlear dysplasia, and total knee arthroplasty is excessive for isolated patellofemoral pain in a 45-year-old.
Question 7024
Topic: Knee Sports
What is the primary function of the meniscofemoral ligaments (ligament of Wrisberg and ligament of Humphry)?
Correct Answer & Explanation
. Connect the lateral meniscus to the posterior cruciate ligament (PCL) and medial femoral condyle.
Explanation
The meniscofemoral ligaments (MFLs) are typically two ligaments: the anterior meniscofemoral ligament (ligament of Humphry) and the posterior meniscofemoral ligament (ligament of Wrisberg). Both arise from the posterior horn of the lateral meniscus and insert onto the medial femoral condyle, specifically joining the posterior cruciate ligament (PCL). Their primary function is to stabilize the posterior horn of the lateral meniscus, particularly in relation to the PCL, and to a lesser extent, contribute to PCL function. They do not primarily stabilize the patella, reinforce the ACL, or provide varus stability.
Question 7025
Topic: Knee Sports
What is the primary mechanical function of the ACL?
Correct Answer & Explanation
. Preventing anterior translation of the tibia on the femur.
Explanation
The primary mechanical function of the anterior cruciate ligament (ACL) is to prevent anterior translation of the tibia on the femur. It also plays a significant role in limiting internal rotation of the tibia and to a lesser extent, hyperextension. The posterior cruciate ligament (PCL) prevents posterior translation. The medial collateral ligament (MCL) resists valgus stress, and the lateral collateral ligament (LCL) resists varus stress. While the ACL contributes to rotational stability, its primary role is sagittal plane stability against anterior tibial translation.
Question 7026
Topic: Shoulder & Hip Sports
What is the typical characteristic finding on physical examination for a patient with a complete rupture of the pectoralis major tendon?
Correct Answer & Explanation
. Asymmetry of the anterior axillary fold and weakness in adduction/internal rotation.
Explanation
A complete rupture of the pectoralis major tendon typically presents with an asymmetry of the anterior axillary fold (loss of contour on the affected side) and significant weakness in shoulder adduction and internal rotation. A 'Popeye' deformity is characteristic of a biceps brachii rupture. Loss of external rotation is more common with rotator cuff injuries. Inability to abduct past 90 degrees points to rotator cuff or deltoid dysfunction. Deltoid atrophy suggests axillary nerve injury. Therefore, the combination of a visibly flattened axillary fold and functional weakness in its primary actions are key indicators of a pectoralis major rupture.
Question 7027
Topic: 5. Sports Medicine
A 21-year-old collegiate pitcher undergoes shoulder arthroscopy for chronic pain. The image shows a Type I SLAP lesion. Which of the following best describes the pathologic anatomy of a Type I SLAP lesion?
Correct Answer & Explanation
. Fraying and degeneration of the superior labrum with an intact biceps anchor.
Explanation
A Type I SLAP lesion is characterized by fraying and degeneration of the superior labrum, but the biceps anchor remains firmly attached to the glenoid. Treatment typically involves simple debridement. Type II involves detachment of the superior labrum and biceps anchor. Type III is a bucket-handle tear of the labrum with an intact biceps anchor. Type IV is a bucket-handle tear extending into the biceps tendon.
Question 7028
Topic: Knee Sports
The MRI scans shown demonstrate a lipohemarthrosis in the knee. Which of the following is the most common underlying etiology for this specific MRI finding?
Correct Answer & Explanation
. Intra-articular fracture
Explanation
Correct Answer: CLipohemarthrosis is characterized by the layering of fat and blood within a joint cavity. The most common cause is an intra-articular fracture, which allows marrow fat to escape into the joint space. On MRI, it typically shows a superior layer of fat, a central layer of serum, and an inferior layer of red blood cells. While an ACL tear causes a hemarthrosis, it does not typically cause a lipohemarthrosis unless accompanied by an osteochondral fracture.
Question 7029
Topic: 5. Sports Medicine
A patient presents to the emergency department with acute knee swelling following a high-energy trauma. T1-weighted MRI is obtained and shown. The distinct layering effect seen in the suprapatellar pouch is most strongly associated with which of the following underlying injuries?
Correct Answer & Explanation
. Intra-articular fracture
Explanation
Correct Answer: Intra-articular fractureThe MRI scan demonstrates a lipohemarthrosis, characterized by the layering of fat, serum, and red blood cells in the joint space. The superior layer contains fat (high signal intensity on T1), the middle layer contains serum, and the dependent layer contains red blood cells. The presence of a lipohemarthrosis is highly indicative of an intra-articular fracture, which allows marrow fat to escape into the joint cavity. While ligamentous and meniscal injuries can cause a hemarthrosis, they do not typically introduce marrow fat into the joint unless accompanied by an osteochondral defect or fracture.
Question 7030
Topic: Shoulder & Hip Sports
A 25-year-old man presents with right shoulder pain. An arthroscopic view from the posterior portal viewing the articular surface of the supraspinatus is shown. The lesion is identified as a partial articular-sided supraspinatus tendon avulsion (PASTA). If this lesion involves greater than 50% of the tendon thickness, which of the following is an accepted surgical management strategy?
Correct Answer & Explanation
. Transtendon arthroscopic repair
Explanation
Correct Answer: Transtendon arthroscopic repairThe images demonstrate a PASTA lesion (Partial Articular-Sided Tendon Avulsion). When a PASTA lesion involves greater than 50% of the tendon footprint thickness, surgical repair is generally indicated. An accepted and common technique is a transtendon arthroscopic repair, which allows the surgeon to secure the articular-sided tear down to the footprint without taking down the intact bursal-sided tissue. This preserves the intact lateral fibers of the rotator cuff while restoring the medial footprint anatomy.
Question 7031
Topic: 5. Sports Medicine
A 21-year-old collegiate pitcher presents with shoulder pain. Arthroscopy reveals fraying of the superior labrum with an intact biceps anchor, as shown in the provided image. Which of the following is the most appropriate management for this specific lesion?
Correct Answer & Explanation
. Arthroscopic debridement
Explanation
Correct Answer: Arthroscopic debridementThe image and description correspond to a Type I SLAP lesion (fraying of the superior labrum with an intact biceps anchor). The appropriate treatment is simple debridement. Biceps tenodesis or release is not indicated because the biceps tendon and anchor are intact. There is no indication for labral repair or capsulorrhaphy.
Question 7032
Topic: 5. Sports Medicine
A 23-year-old competitive overhead athlete undergoes shoulder arthroscopy. The intraoperative finding is shown in the provided image. Which of the following treatments is most appropriate to allow return to competitive overhead sports?
Correct Answer & Explanation
. Arthroscopic labral repair
Explanation
Correct Answer: Arthroscopic labral repairThe image shows a Type II SLAP tear (detachment of the superior labrum and biceps anchor). In a young, competitive overhead athlete, arthroscopic labral repair is the treatment of choice to restore anatomy and function. Labral debridement leads to predictably poor results in this demographic, while biceps tenodesis or tenotomy is generally reserved for older patients or those who are not competitive overhead athletes.
Question 7033
Topic: 5. Sports Medicine
A patient presents with acute knee swelling following trauma. MRI scans (T1 and T2-weighted) are shown. The layering effect seen within the joint space is most strongly associated with which of the following underlying injuries?
Correct Answer & Explanation
. Intra-articular fracture
Explanation
Correct Answer: Intra-articular fractureThe MRI shows lipohemarthrosis, characterized by layering of fat (superior, high signal on T1), serum (central, low signal), and red blood cells (inferior, low signal). This finding is highly indicative of an intra-articular fracture, which allows marrow fat to escape into the joint space.
Question 7034
Topic: Shoulder & Hip Sports
A 25-year-old man presents with right shoulder pain. MRI and arthroscopic images are provided. The pathology shown is best described as:
Correct Answer & Explanation
. A partial articular-sided supraspinatus tendon avulsion
Explanation
Correct Answer: A partial articular-sided supraspinatus tendon avulsionThe images demonstrate a partial articular surface supraspinatus tear (PASTA lesion). The arthroscopic view from the posterior portal shows the articular surface of the supraspinatus with partial tearing. These tears are a common source of shoulder pain and are often amenable to transtendon arthroscopic repair without detachment of the intact bursal surface.
Question 7035
Topic: 5. Sports Medicine
A 21-year-old overhead athlete presents with chronic shoulder pain that has not improved with rest and physical therapy. Arthroscopy reveals fraying of the superior labrum without detachment of the biceps anchor, as seen in the provided image. Which of the following is the most appropriate management for this specific lesion?
Correct Answer & Explanation
. Arthroscopic debridement
Explanation
Correct Answer: BThe image demonstrates a Type I superior labrum anterior and posterior (SLAP) lesion, characterized by fraying and degeneration of the superior labrum with an intact biceps anchor. The appropriate treatment for a Type I SLAP lesion is simple arthroscopic debridement. Biceps tenodesis or tenotomy is not indicated because the biceps anchor is stable. Suture anchor repair is reserved for Type II or Type IV SLAP lesions where the biceps anchor is detached.
Question 7036
Topic: 5. Sports Medicine
A 23-year-old competitive baseball pitcher undergoes shoulder arthroscopy for refractory pain. The intraoperative finding is shown in the image. Which of the following treatments provides the most predictable return to competitive throwing for this patient?
Correct Answer & Explanation
. Arthroscopic labral repair
Explanation
Correct Answer: CThe image shows a classic Type II SLAP tear, where the superior labrum and biceps anchor are detached from the superior glenoid. In a young, competitive overhead athlete, arthroscopic labral repair yields the highest satisfaction and best chance for return to overhead sports. Labral debridement alone leads to predictably poor results in this demographic. Biceps tenodesis or tenotomy may be considered in older patients or non-overhead athletes with Type II SLAP tears.
Question 7037
Topic: Shoulder & Hip Sports
A 25-year-old man presents with right shoulder pain. MRI and arthroscopic images are provided. The arthroscopic view from the posterior portal demonstrates a partial articular-sided supraspinatus tendon avulsion (PASTA). Which of the following is an accepted surgical management strategy for this lesion if it involves greater than 50% of the tendon thickness?
Correct Answer & Explanation
. Transtendon arthroscopic repair without detachment of the intact bursal surface
Explanation
Correct Answer: AThe images show a partial articular surface supraspinatus tear (PASTA lesion). When these tears involve greater than 50% of the tendon thickness, surgical repair is often indicated. A common and effective technique is a transtendon arthroscopic repair, which secures the articular-sided avulsion while preserving the intact bursal surface of the tendon. Acromioplasty alone does not address the structural tendon defect.
Question 7038
Topic: 5. Sports Medicine
A 35-year-old skier sustains a twisting injury to the knee. An MRI is obtained, and a T1-weighted sagittal image is shown. The layering effect seen in the suprapatellar pouch is most strongly associated with which of the following underlying injuries?
Correct Answer & Explanation
. Intra-articular fracture
Explanation
Correct Answer: CThe MRI demonstrates lipohemarthrosis, characterized by a distinct layering effect in the suprapatellar pouch. Fat (which has high signal intensity on T1-weighted images) layers superiorly, serum layers centrally, and red blood cells layer inferiorly. This finding is highly indicative of an intra-articular fracture, which allows marrow fat to escape into the joint space.
Question 7039
Topic: 5. Sports Medicine
A 22-year-old collegiate volleyball player experiences deep shoulder pain and a 'dead arm' sensation during serving. An arthroscopic image is shown. Which of the following treatments provides the best chance for return to pre-injury level of play?
Correct Answer & Explanation
. Arthroscopic SLAP repair with suture anchors
Explanation
Correct Answer: DThe image shows a Type II SLAP lesion, characterized by detachment of the superior labrum and biceps anchor from the superior glenoid. In a young, competitive overhead athlete, arthroscopic repair of the SLAP lesion using suture anchors is the treatment of choice to restore the stabilizing function of the biceps anchor and allow return to sports. Tenodesis or tenotomy is generally reserved for older patients or those with chronic, degenerative changes.
Question 7040
Topic: Shoulder & Hip Sports
A 45-year-old man sustained a distal radius fracture treated with cast immobilization. He subsequently developed severe shoulder stiffness. After 6 months of physical therapy, his forward elevation is 130 degrees, but external rotation at the side is limited to 5 degrees. Which of the following structures is most likely contracted and requires arthroscopic release?
Correct Answer & Explanation
. Rotator cuff interval (coracohumeral and superior glenohumeral ligaments)
Explanation
Correct Answer: CIsolated or disproportionate loss of external rotation with the arm at the side is the clinical hallmark of a contracted rotator cuff interval, which includes the coracohumeral ligament and the superior glenohumeral ligament. Arthroscopic release of the rotator cuff interval is the treatment of choice when conservative management fails to restore external rotation.
Test Yourself
Switch to an interactive, timed exam simulation to truly master this topic.