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5. Sports Medicine MCQs

Practice Set 356 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 7101

Topic: 5. Sports Medicine

A 22-year-old female collegiate soccer player undergoes anterior cruciate ligament (ACL) reconstruction. When counseling her on graft choices, she should be informed that a bone-patellar tendon-bone (BTB) autograft is associated with a statistically higher risk of which complication compared to a hamstring autograft?

. Premature osteoarthritis
. Anterior knee and kneeling pain
. Deep surgical site infection
. Postoperative arthrofibrosis
. Contralateral ACL tear

Correct Answer & Explanation

. Anterior knee and kneeling pain

Explanation

BTB autografts are associated with a higher incidence of donor site morbidity, specifically anterior knee pain and difficulty kneeling, compared to hamstring autografts. Rates of graft rupture and osteoarthritis are broadly similar between the two.

Question 7102

Topic: 5. Sports Medicine

A 19-year-old female soccer player undergoes an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BTB) autograft. At 8 months postoperatively, she reports significant localized anterior knee pain with kneeling and stairs, despite a stable knee. What is the most common cause of this specific complication?

. A localized cyclops lesion
. Postoperative arthrofibrosis
. Graft harvest site morbidity
. Graft tunnel mismatch
. Complex regional pain syndrome

Correct Answer & Explanation

. Graft harvest site morbidity

Explanation

Anterior knee pain, especially with kneeling, is the most common complication following BTB autograft harvest for ACL reconstruction. It arises directly from morbidity at the patellar tendon donor site and altered patellofemoral mechanics.

Question 7103

Topic: 5. Sports Medicine

A 6-year-old girl presents with a painless snapping sensation in her lateral knee during extension. MRI confirms a complete discoid lateral meniscus without any evidence of a meniscal tear. What is the most appropriate management?

. Observation
. Diagnostic arthroscopy and partial meniscectomy
. Arthroscopic total meniscectomy
. Arthroscopic saucerization and peripheral repair
. Open meniscal repair

Correct Answer & Explanation

. Observation

Explanation

Correct Answer: ObservationA discoid meniscus is an abnormally thickened, disc-shaped meniscus (most commonly lateral) that is prone to tearing. The Watanabe classification divides them into complete, incomplete, and Wrisberg variant (lacking posterior meniscotibial attachments, leading to hypermobility). While a Wrisberg variant can cause a "snapping knee syndrome," the standard of care for an asymptomatic or pain-free snapping discoid meniscus is observation. Surgical intervention is strictly reserved for patients who develop symptoms such as pain, locking, swelling, or a painful snap indicating a tear or significant instability. When surgery is indicated, arthroscopic saucerization (reshaping the meniscus to a normal crescent) with or without peripheral repair is the treatment of choice to preserve meniscal tissue and prevent early osteoarthritis. Total meniscectomy is avoided due to the high risk of rapid joint degeneration.

Question 7104

Topic: Knee Sports
A 10-year-old boy falls off his bicycle and sustains a closed knee injury. Radiographs show a completely displaced fracture of the tibial eminence (Meyers and McKeever Type III). What is the primary anatomic structure attached to this avulsed fragment, and what is the standard treatment?
. Anterior cruciate ligament; arthroscopic or open reduction and internal fixation
. Posterior cruciate ligament; cast in extension
. Medial meniscus; arthroscopic partial meniscectomy
. Patellar tendon; tension band wiring
. Anterior cruciate ligament; cast in 90 degrees of flexion

Correct Answer & Explanation

. Posterior cruciate ligament; cast in extension

Explanation

The tibial eminence is the distal attachment site of the anterior cruciate ligament (ACL). A completely displaced (Type III) tibial spine fracture requires arthroscopic or open reduction and internal fixation to restore ACL competence and prevent mechanical block from meniscal entrapment.

Question 7105

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two distinct functional bundles. Which of the following statements correctly describes the biomechanical role of the anteromedial (AM) bundle?

. It is tightest in extension and primarily resists rotatory loads.
. It is tightest in flexion and primarily resists anterior tibial translation.
. It is tightest in extension and primarily resists anterior tibial translation.
. It is tightest in flexion and primarily resists rotatory loads.
. It remains isometric throughout the entire range of knee motion.

Correct Answer & Explanation

. It is tightest in flexion and primarily resists anterior tibial translation.

Explanation

Correct Answer: It is tightest in flexion and primarily resists anterior tibial translation.The ACL consists of the anteromedial (AM) and posterolateral (PL) bundles, named for their tibial insertion sites. The AM bundle is tightest in knee flexion and is the primary restraint to anterior tibial translation. The PL bundle is tightest in knee extension and is the primary restraint to rotatory loads (pivot shift). Understanding this anatomy is crucial for anatomic ACL reconstruction techniques.

Question 7106

Topic: Knee Sports

The anterior cruciate ligament (ACL) is the primary restraint to anterior tibial translation. It is composed of two distinct functional bundles. Which of the following statements correctly describes the biomechanical behavior of these bundles during knee range of motion?

. The anteromedial bundle is tight in extension, while the posterolateral bundle is tight in flexion
. The anteromedial bundle is tight in flexion, while the posterolateral bundle is tight in extension
. Both bundles are equally tight throughout the entire range of motion
. The posterolateral bundle primarily resists varus stress, while the anteromedial bundle resists valgus stress
. The anteromedial bundle is the primary restraint to internal rotation in full extension

Correct Answer & Explanation

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

Explanation

Correct Answer: BThe ACL consists of the anteromedial (AM) and posterolateral (PL) bundles. Biomechanically, the AM bundle is tight in knee flexion and is the primary restraint to anterior translation at 90 degrees of flexion. The PL bundle is tight in knee extension and is the primary restraint to rotatory loads and anterior translation in near-full extension.

Question 7107

Topic: Knee Sports

The anterior cruciate ligament (ACL) is the primary restraint to anterior tibial translation. It is composed of two distinct functional bundles. Which of the following statements accurately describes the biomechanical behavior of these bundles during knee range of motion?

. The anteromedial bundle is tight in extension, while the posterolateral bundle is tight in flexion.
. The anteromedial bundle is tight in flexion, while the posterolateral bundle is tight in extension.
. Both bundles are equally tight throughout the entire range of motion.
. The posterolateral bundle primarily resists varus stress, while the anteromedial bundle resists valgus stress.
. The anteromedial bundle is the primary restraint to internal rotation in full extension.

Correct Answer & Explanation

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

Explanation

Correct Answer: BThe ACL consists of the anteromedial (AM) and posterolateral (PL) bundles, named for their tibial insertion sites. Biomechanically, the AM bundle tightens during knee flexion, providing primary restraint to anterior translation in the flexed position. Conversely, the PL bundle tightens during knee extension and is the primary restraint to rotatory loads (such as those tested during a pivot shift) when the knee is near full extension.

Question 7108

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. A 3D CT scan demonstrates a 25% anterior glenoid bone loss. Which of the following surgical interventions is most appropriate to prevent recurrent dislocation?

. Arthroscopic Bankart repair
. Latarjet procedure
. Remplissage procedure
. Open inferior capsular shift
. Putti-Platt procedure

Correct Answer & Explanation

. Latarjet procedure

Explanation

In cases of anterior shoulder instability with significant glenoid bone loss (greater than 20-25%), isolated soft tissue repairs have a high failure rate. The Latarjet procedure (coracoid transfer) is the standard of care to restore anterior stability by providing a structural bone block and a dynamic sling.

Question 7109

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, placing the femoral tunnel too anteriorly will result in which of the following postoperative biomechanical issues?

. Graft laxity in extension and tightness in flexion
. Graft tightness in extension and laxity in flexion
. Unrestricted physiological knee kinematics
. Decreased anterior translation at 30 degrees of flexion
. Premature graft rupture during pivot-shift testing

Correct Answer & Explanation

. Graft tightness in extension and laxity in flexion

Explanation

Proper femoral tunnel placement is critical in ACL reconstruction. A tunnel placed too anteriorly on the femur results in a graft that is tight in flexion and loose in extension, often leading to restricted knee flexion or eventual graft stretching.

Question 7110

Topic: Knee Sports

During an arthroscopic posterior cruciate ligament (PCL) reconstruction, the surgeon prepares the femoral footprint targeting the anterolateral bundle. Where is the anatomical insertion of this specific bundle located on the femur?

. High and deep in the medial intercondylar notch
. Low and deep in the medial intercondylar notch
. High and deep in the lateral intercondylar notch
. Low and shallow in the lateral intercondylar notch
. High and shallow in the medial intercondylar notch

Correct Answer & Explanation

. High and deep in the medial intercondylar notch

Explanation

The PCL inserts on the lateral aspect of the medial femoral condyle. The larger anterolateral bundle inserts high (superior/roof) and shallow (anterior), whereas the posteromedial bundle inserts low and deep.

Question 7111

Topic: Knee Sports

A 22-year-old female soccer player sustains a twisting knee injury. Radiographs reveal an avulsion fracture of the lateral tibial plateau (Segond fracture). This radiographic finding is most highly associated with a tear of which of the following structures?

. Posterior cruciate ligament
. Anterior cruciate ligament
. Medial collateral ligament
. Lateral meniscus
. Posterolateral corner

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

A Segond fracture is an avulsion of the anterolateral ligament complex from the lateral tibial plateau. It is considered a pathognomonic radiographic sign for an anterior cruciate ligament (ACL) tear.

Question 7112

Topic: 5. Sports Medicine

A collegiate football player sustains an acute hyperextension injury to his great toe. MRI reveals a complete tear of the plantar plate and capsuloligamentous complex with proximal migration of the sesamoids. What grade is this turf toe injury, and what is the recommended treatment?

. Grade 1; rigid carbon-fiber shoe insert
. Grade 2; immobilization in a walking boot for 2 weeks
. Grade 3; operative repair of the plantar plate
. Grade 1; immediate return to play with taping
. Grade 3; conservative management with delayed stretching

Correct Answer & Explanation

. Grade 3; operative repair of the plantar plate

Explanation

A complete tear of the plantar capsuloligamentous complex with gross instability is a Grade 3 turf toe injury. In high-level athletes, this often necessitates surgical repair to restore push-off strength.

Question 7113

Topic: 5. Sports Medicine
A professional American football player sustains a forced hyperextension injury to the first metatarsophalangeal (MTP) joint. MRI confirms a complete tear of the plantar plate with proximal retraction of the sesamoids. What is the most appropriate management?
. Taping and immediate return to play
. Stiff-soled shoe with carbon fiber insert for 6 weeks
. Surgical repair of the plantar plate and flexor hallucis brevis
. First MTP joint arthrodesis
. Sesamoidectomy

Correct Answer & Explanation

. Surgical repair of the plantar plate and flexor hallucis brevis

Explanation

A complete tear of the first MTP plantar plate with sesamoid retraction defines a Grade III turf toe injury. In high-demand professional athletes, this injury typically requires surgical repair of the plantar plate and capsuloligamentous complex to restore push-off strength.

Question 7114

Topic: 5. Sports Medicine
A professional American football player sustains a hyperextension injury to his great toe. MRI demonstrates a complete tear of the plantar plate with significant proximal retraction of the sesamoids. What is the most appropriate management?
. Stiff-soled shoe and immediate return to play
. Taping the toe in dorsiflexion
. Surgical repair of the plantar plate
. Excision of the sesamoids
. First metatarsophalangeal joint arthrodesis

Correct Answer & Explanation

. Surgical repair of the plantar plate

Explanation

A complete tear of the plantar plate with sesamoid retraction represents a high-grade (Anderson Grade III) Turf Toe injury. In elite athletes, surgical repair is indicated to restore push-off strength and prevent progressive hallux rigidus.

Question 7115

Topic: Knee Sports

In a patient with TRPS1, progressive joint deformities in the hands most often occur due to which of the following mechanisms?

. Synovial hypertrophy and pannus formation
. Premature fusion of the cone-shaped epiphyses
. Recurrent microfractures of osteopenic bone
. Deposition of monosodium urate crystals
. Ligamentous laxity and spontaneous subluxation

Correct Answer & Explanation

. Premature fusion of the cone-shaped epiphyses

Explanation

The cone-shaped epiphyses in TRPS1 frequently undergo premature fusion. This abnormal growth plate arrest leads to shortened phalanges, angular deformities like clinodactyly, and early secondary osteoarthritis.

Question 7116

Topic: 5. Sports Medicine

A patient is undergoing arthroscopy for primary synovial chondromatosis of the shoulder. During the procedure, the surgeon removes dozens of loose bodies. To minimize the rate of local recurrence of the condition, what additional intraoperative step is required?

. Biceps tenodesis
. Extensive arthroscopic or open synovectomy
. Subacromial decompression
. Thermal shrinkage of the capsule
. Intra-articular injection of methotrexate

Correct Answer & Explanation

. Extensive arthroscopic or open synovectomy

Explanation

In primary synovial chondromatosis, the underlying pathology resides in the metaplastic synovium. Removing loose bodies alone is insufficient; a thorough synovectomy must be performed to decrease the risk of local recurrence.

Question 7117

Topic: Knee Sports

During a cruciate-retaining total knee arthroplasty, the surgeon finds that the knee is well balanced and symmetric in full extension, but tight symmetrically in 90 degrees of flexion. Which of the following is the most appropriate intervention to balance the knee?

. Recut the distal femur with 2 degrees more valgus
. Recut the distal femur to remove 2 mm more bone
. Downsize the femoral component and use a thicker polyethylene insert
. Release the posterior cruciate ligament (PCL)
. Release the superficial medial collateral ligament (sMCL)

Correct Answer & Explanation

. Release the posterior cruciate ligament (PCL)

Explanation

A knee that is symmetric in extension but tight symmetrically in flexion in a cruciate-retaining implant often has a tight PCL. Releasing the PCL, increasing the posterior tibial slope, or downsizing the femoral component will increase the flexion gap without affecting the extension gap.

Question 7118

Topic: Shoulder & Hip Sports

A 55-year-old male presents with chronic right shoulder pain and weakness with overhead activities. Physical examination reveals a positive Jobe's (empty can) test and weakness in active abduction. MRI confirms a full-thickness tear of the most commonly injured rotator cuff tendon. To which anatomical structure does this specific tendon normally insert?

. Lesser tuberosity of the humerus
. Superior facet of the greater tuberosity
. Middle facet of the greater tuberosity
. Inferior facet of the greater tuberosity
. Bicipital groove

Correct Answer & Explanation

. Superior facet of the greater tuberosity

Explanation

Correct Answer: Superior facet of the greater tuberosityThe supraspinatus is the most commonly torn rotator cuff muscle. It originates from the supraspinous fossa of the scapula and inserts onto the superior facet of the greater tuberosity of the humerus. The infraspinatus inserts on the middle facet, the teres minor on the inferior facet, and the subscapularis inserts on the lesser tuberosity.

Question 7119

Topic: Shoulder & Hip Sports

A 55-year-old male carpenter presents with chronic right shoulder pain and weakness. Physical examination reveals a positive Jobe's (empty can) test and weakness in active shoulder abduction. MRI confirms a full-thickness tear of the most commonly injured rotator cuff tendon. Where does this specific tendon insert anatomically?

. Lesser tuberosity of the humerus
. Superior facet of the greater tuberosity
. Middle facet of the greater tuberosity
. Inferior facet of the greater tuberosity
. Bicipital groove

Correct Answer & Explanation

. Superior facet of the greater tuberosity

Explanation

Correct Answer: BThe supraspinatus is the most commonly torn rotator cuff muscle. It is responsible for the initiation of shoulder abduction and is tested using the Jobe's (empty can) test. Anatomically, the supraspinatus tendon inserts onto the superior facet of the greater tuberosity of the humerus. The infraspinatus inserts on the middle facet, the teres minor on the inferior facet, and the subscapularis inserts on the lesser tuberosity.

Question 7120

Topic: Shoulder & Hip Sports

A 55-year-old male presents with chronic shoulder pain and weakness with overhead activities. MRI confirms a full-thickness tear of the most commonly injured rotator cuff tendon. Which of the following describes the primary biomechanical function and insertion site of this muscle?

. Internal rotation; inserts on the lesser tuberosity
. External rotation; inserts on the inferior facet of the greater tuberosity
. Initiation of abduction; inserts on the superior facet of the greater tuberosity
. Adduction; inserts on the bicipital groove
. Depression of the humeral head; inserts on the coracoid process

Correct Answer & Explanation

. Initiation of abduction; inserts on the superior facet of the greater tuberosity

Explanation

Correct Answer: Initiation of abduction; inserts on the superior facet of the greater tuberosityThe supraspinatus is the most frequently torn rotator cuff muscle. Its primary biomechanical role is the initiation of shoulder abduction (along with stabilizing the humeral head in the glenoid). Anatomically, it originates from the supraspinous fossa and inserts onto the superior facet of the greater tuberosity of the humerus.

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