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5. Sports Medicine MCQs

Practice Set 355 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 7081

Topic: 5. Sports Medicine

A 22-year-old collegiate football player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. Which of the following is the most commonly reported complication specific to this graft choice compared to a hamstring autograft?

. Increased rate of graft rupture
. Anterior knee pain
. Loss of deep knee flexion
. Saphenous nerve injury
. Hardware failure

Correct Answer & Explanation

. Anterior knee pain

Explanation

BTB autograft is associated with a higher incidence of anterior knee pain and pain with kneeling compared to hamstring autografts. Graft rupture rates are generally equivalent or slightly lower in BTB grafts.

Question 7082

Topic: 5. Sports Medicine

An 18-year-old female soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Which of the following is a recognized disadvantage of this graft choice compared to a hamstring autograft?

. Higher overall graft re-rupture rate
. Increased incidence of anterior knee pain
. Slower biologic graft incorporation into the tunnels
. Significantly lower return to sport rates
. Increased postoperative knee laxity on Lachman testing

Correct Answer & Explanation

. Increased incidence of anterior knee pain

Explanation

A major disadvantage of the BPTB autograft is an increased risk of donor-site morbidity, specifically anterior knee pain and patellar tendinitis. However, BPTB grafts offer excellent stability and fast bone-to-bone healing.

Question 7083

Topic: Shoulder & Hip Sports

A 22-year-old collegiate football player presents with recurrent anterior shoulder dislocations. Advanced imaging demonstrates a bony Bankart lesion with 25% anterior glenoid bone loss. Which surgical procedure is most appropriate to prevent further instability?

. Arthroscopic soft-tissue Bankart repair
. Arthroscopic SLAP repair
. Latarjet procedure (coracoid transfer)
. Remplissage procedure alone
. Proximal humerus derotational osteotomy

Correct Answer & Explanation

. Latarjet procedure (coracoid transfer)

Explanation

The Latarjet procedure (transfer of the coracoid process to the anterior glenoid) is indicated for patients with recurrent anterior shoulder instability and significant anterior glenoid bone loss (typically greater than 20-25%).

Question 7084

Topic: 5. Sports Medicine

A 9-year-old boy (Tanner stage 1) sustains a complete anterior cruciate ligament (ACL) tear. He experiences recurrent episodes of instability despite bracing and physical therapy. What is the most appropriate surgical management?

. Transphyseal reconstruction using a bone-patellar tendon-bone autograft
. Transphyseal reconstruction using a soft-tissue hamstring autograft
. Physeal-sparing all-epiphyseal reconstruction
. Extra-articular tenodesis alone
. Nonoperative management until skeletal maturity is reached

Correct Answer & Explanation

. Physeal-sparing all-epiphyseal reconstruction

Explanation

In a Tanner stage 1 patient with significant remaining growth, a physeal-sparing all-epiphyseal or extra-articular ACL reconstruction is indicated to prevent growth arrest. Transphyseal techniques in this age group risk significant physeal damage and subsequent limb deformity.

Question 7085

Topic: 5. Sports Medicine

A 35-year-old female undergoes arthroscopic management for primary synovial chondromatosis of the hip. To minimize the risk of recurrence, which procedure must be performed alongside loose body removal?

. Core decompression
. Labral reconstruction
. Extensive synovectomy
. Femoral head resurfacing
. Osteochondral autograft transfer

Correct Answer & Explanation

. Extensive synovectomy

Explanation

Primary synovial chondromatosis is a metaplastic condition of the synovium. Therefore, loose body removal combined with an extensive synovectomy is required to significantly reduce the risk of disease recurrence.

Question 7086

Topic: 5. Sports Medicine

Which of the following bone grafting materials is most prone to failure due to complete resorption when used for filling a defect after curettage of a fibrous dysplasia lesion?

. Cancellous autograft
. Cortical allograft strut
. Vascularized fibular graft
. Polymethylmethacrylate (PMMA)
. Demineralized bone matrix

Correct Answer & Explanation

. Cancellous autograft

Explanation

Cancellous autograft is universally recognized to have a high failure rate in fibrous dysplasia because the host's dysplastic bone forming process rapidly resorbs the autograft and replaces it with weak, dysplastic woven bone. Structural allografts or synthetic substitutes are preferred if grafting is necessary.

Question 7087

Topic: Shoulder & Hip Sports

In the Woodward procedure for surgical correction of Sprengel's deformity, the scapula is mobilized and translated inferiorly. Which muscular origins are detached from the spinous processes to facilitate this maneuver?

. Latissimus dorsi and serratus anterior
. Trapezius and rhomboids
. Levator scapulae and pectoralis minor
. Supraspinatus and infraspinatus
. Deltoid and teres major

Correct Answer & Explanation

. Trapezius and rhomboids

Explanation

The Woodward procedure involves detaching the origins of the trapezius and rhomboid major and minor muscles from the spinous processes. The scapula is moved inferiorly, and the muscles are reattached at a lower level.

Question 7088

Topic: Shoulder & Hip Sports

A 14-year-old girl with an acute-on-chronic slipped capital femoral epiphysis (SCFE) undergoes an urgent modified Dunn procedure (surgical dislocation and anatomic reduction). What is the primary advantage of the modified Dunn procedure over traditional closed reduction and percutaneous pinning?

. It eliminates the risk of avascular necrosis (AVN)
. It guarantees immediate full weight-bearing postoperatively
. It allows for direct visualization and preservation of the retinacular vessels while restoring proximal femoral anatomy
. It completely prevents the future development of femoroacetabular impingement (FAI) in all cases
. It avoids the need to open the joint capsule, reducing infection risk

Correct Answer & Explanation

. It allows for direct visualization and preservation of the retinacular vessels while restoring proximal femoral anatomy

Explanation

The modified Dunn procedure utilizes a surgical hip dislocation approach to carefully develop a retinacular flap, protecting the blood supply to the epiphysis. It allows for anatomic reduction, mitigating the cam deformity and FAI associated with in-situ pinning of severe slips.

Question 7089

Topic: 5. Sports Medicine

A 25-year-old soccer player presents with persistent anterolateral ankle pain 6 months after an inversion injury. MRI reveals a 1.2 cm x 1.0 cm osteochondral lesion of the anterolateral talar dome with an intact cartilage cap and no subchondral cysts. Non-operative management has failed. What is the most appropriate next step?

. Osteochondral autograft transfer (OATS)
. Arthroscopic bone marrow stimulation (microfracture)
. Fresh osteochondral allograft transplantation
. Autologous chondrocyte implantation (ACI)
. Ankle arthrodesis

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

Arthroscopic bone marrow stimulation (microfracture) is the primary surgical treatment for symptomatic, small-to-medium (<1.5 cm squared) talar osteochondral lesions without large cysts. OATS is typically reserved for lesions >1.5 cm squared or revision cases.

Question 7090

Topic: 5. Sports Medicine

A 22-year-old elite track athlete complains of vague dorsal midfoot pain that worsens with sprinting. Plain radiographs are negative, but an MRI demonstrates a stress fracture involving the central third of the navicular body without displacement. What is the most appropriate initial management?

. Walking boot with weight-bearing as tolerated for 6 weeks
. Strict non-weight-bearing in a short leg cast for 6 to 8 weeks
. Immediate percutaneous screw fixation
. Open reduction and internal fixation with bone grafting
. Pulsed electromagnetic field therapy and return to play in 2 weeks

Correct Answer & Explanation

. Strict non-weight-bearing in a short leg cast for 6 to 8 weeks

Explanation

Non-displaced navicular stress fractures are at high risk for nonunion due to the watershed vascular supply of the central third of the bone. Strict non-weight-bearing in a short leg cast for 6-8 weeks is the standard initial treatment to ensure predictable healing.

Question 7091

Topic: 5. Sports Medicine

A 9-year-old Tanner stage I male sustains a mid-substance anterior cruciate ligament (ACL) tear. Non-operative management has failed due to recurrent instability. When planning surgical reconstruction, which technique minimizes the risk of growth arrest and angular deformity?

. Transphyseal reconstruction with an 8mm bone-patellar tendon-bone autograft
. Iliotibial band extra-articular tenodesis combined with an all-epiphyseal reconstruction
. Standard adult-type transphyseal hamstring reconstruction with interference screw fixation across the physis
. Primary repair of the ACL with suture augmentation
. Wait until skeletal maturity before performing any surgical intervention

Correct Answer & Explanation

. Iliotibial band extra-articular tenodesis combined with an all-epiphyseal reconstruction

Explanation

Correct Answer: Iliotibial band extra-articular tenodesis combined with an all-epiphyseal reconstructionIn a skeletally immature patient with significant growth remaining (Tanner stage I or II), physeal-sparing techniques are recommended to avoid iatrogenic physeal injury, growth arrest, and angular deformity. An all-epiphyseal reconstruction, often combined with an IT band extra-articular tenodesis (such as the MacIntosh or Lemaire procedure), provides stability while respecting the open physes.

Question 7092

Topic: 5. Sports Medicine

A 9-year-old boy with wide-open physes sustains a complete, mid-substance anterior cruciate ligament (ACL) tear with objective instability. To minimize the risk of growth arrest while restoring stability, which of the following surgical techniques is most appropriate?

. Transphyseal reconstruction with bone-patellar tendon-bone autograft
. Primary end-to-end repair of the torn ligament fibers
. All-epiphyseal intra-articular reconstruction
. Conservative management with a functional brace until skeletal maturity
. High tibial osteotomy to alter the posterior tibial slope

Correct Answer & Explanation

. All-epiphyseal intra-articular reconstruction

Explanation

For prepubescent patients with significant remaining growth (Tanner stage 1 or 2), physeal-sparing techniques like the all-epiphyseal reconstruction or the iliotibial band extra-articular tenodesis (MacIntosh/Micheli) are recommended to avoid crossing the physes and causing growth arrest.

Question 7093

Topic: Knee Sports
An 11-year-old boy sustains a Meyers and McKeever Type III fracture of the tibial eminence during a bicycle fall. Which ligamentous structure is directly involved in this avulsion injury?
. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Medial collateral ligament (MCL)
. Lateral collateral ligament (LCL)
. Patellar tendon

Correct Answer & Explanation

. Anterior cruciate ligament (ACL)

Explanation

A tibial eminence fracture in the pediatric population is a bony avulsion of the anterior cruciate ligament (ACL) insertion. A Type III fracture is completely displaced and requires surgical reduction and internal fixation.

Question 7094

Topic: Knee Sports

A 12-year-old male with open physes presents with knee pain. MRI reveals an intact, stable osteochondritis dissecans (OCD) lesion. What is the most common anatomical location for this lesion?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central portion of the trochlea
. Inferior pole of the patella
. Medial aspect of the medial femoral condyle

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The lateral aspect of the medial femoral condyle is the classic and most common location for osteochondritis dissecans (OCD) lesions in the knee. Stable lesions in patients with open physes generally heal with conservative activity modification.

Question 7095

Topic: 5. Sports Medicine

An 8-year-old girl is brought in for an audible, painless snapping in the lateral aspect of her right knee. She has no history of trauma, and her physical exam is otherwise completely normal. What is the most appropriate management for her condition?

. Diagnostic arthroscopy
. Total lateral meniscectomy
. Observation
. Partial meniscectomy with meniscal repair
. Knee immobilization in a cylinder cast

Correct Answer & Explanation

. Observation

Explanation

The clinical presentation is classic for an asymptomatic snapping discoid lateral meniscus. Observation is the standard of care, as prophylactic meniscectomy in asymptomatic patients accelerates early joint degeneration and osteoarthritis.

Question 7096

Topic: Shoulder & Hip Sports

A patient presents with profound weakness in external rotation and isolated atrophy of the infraspinous fossa, as seen in the clinical photograph. The supraspinous fossa has normal muscle bulk. Entrapment of the suprascapular nerve is most likely occurring at which of the following anatomic locations?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Spiral groove

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Correct Answer: BCompression of the suprascapular nerve by a ganglion cyst is a well-documented cause of pain and weakness in the shoulder. Isolated involvement of the infraspinatus indicates that the area of entrapment is at the spinoglenoid notch and not the suprascapular notch. The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus.

Question 7097

Topic: Shoulder & Hip Sports

A 32-year-old volleyball player presents with profound weakness in external rotation of the shoulder. Examination reveals isolated atrophy of the infraspinous fossa, with normal supraspinatus muscle bulk. An MRI is shown. The compressive lesion responsible for this presentation is most likely located at which of the following anatomic sites?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Spiral groove

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Correct Answer: BThe patient has isolated infraspinatus atrophy and weakness in external rotation, which indicates compression of the suprascapular nerve after it has innervated the supraspinatus. This occurs at the spinoglenoid notch. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus muscles. The MRI shows a paralabral ganglion cyst, which is commonly associated with labral tears.

Question 7098

Topic: 5. Sports Medicine

A 24-year-old professional football player underwent a two-level anterior cervical diskectomy and fusion (ACDF) 9 months ago. His current radiograph is shown. He is asymptomatic with full range of motion and a normal neurologic exam. Which of the following findings would be an absolute contraindication to his return to collision sports?

. A solid fusion at the two operated levels.
. Persistent neurologic deficit.
. Asymptomatic adjacent segment degeneration.
. Loss of 5 degrees of terminal cervical extension.
. Presence of the anterior cervical plate.

Correct Answer & Explanation

. Persistent neurologic deficit.

Explanation

Correct Answer: BPatients with one- or two-level anterior cervical diskectomies and fusions that have healed fully can return to play. Any loss of motion, persistent neurologic deficit, or significant adjacent segment degeneration may preclude a player from returning. The presence of hardware or a solid fusion is expected and does not contraindicate return to play.

Question 7099

Topic: Shoulder & Hip Sports

A patient presents with profound weakness in external rotation and atrophy of the infraspinous fossa, as shown in the clinical photograph. The supraspinous fossa has normal muscle bulk. This specific pattern of isolated infraspinatus involvement indicates nerve entrapment at which of the following anatomic locations?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Spiral groove

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Correct Answer: BCompression of the suprascapular nerve by a ganglion cyst is a well-documented cause of pain and weakness in the shoulder. Isolated involvement of the infraspinatus indicates that the area of entrapment is at the spinoglenoid notch and not the suprascapular notch. Entrapment at the suprascapular notch would affect both the supraspinatus and infraspinatus muscles.

Question 7100

Topic: 5. Sports Medicine

A 24-year-old professional football player underwent a two-level anterior cervical diskectomy and fusion (ACDF) 9 months ago. His current radiograph is shown. He is asymptomatic with a normal neurologic examination and full range of motion. Which of the following findings would be an absolute contraindication to his return to play?

. A solid fusion on CT scan.
. Persistent neurologic deficit.
. Full, painless range of motion.
. Absence of adjacent segment degeneration.
. The presence of the anterior cervical plate.

Correct Answer & Explanation

. Persistent neurologic deficit.

Explanation

Correct Answer: BPatients with one- or two-level anterior cervical diskectomies and fusions that have healed fully can return to play. Any loss of motion, persistent neurologic deficit, or significant adjacent segment degeneration may preclude a player from returning. The presence of instrumentation or a solid fusion are not contraindications to return to play.

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