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5. Sports Medicine MCQs

Practice Set 47 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 921

Topic: Knee Sports

The case describes a posterior approach to the knee for a PCL avulsion fracture, as seen in the images.

Beyond PCL avulsion fixation, which of the following is NOT a recognized indication for a posterior approach to the knee as discussed in the case?

. A. Removal of popliteal cysts
. B. Repair of posterior vascular injuries
. C. Open reduction and internal fixation of posterior tibial plateau shear fractures
. D. Arthroscopic meniscectomy of a lateral meniscal tear
. E. Posterior inlay PCL reconstructions

Correct Answer & Explanation

. D. Arthroscopic meniscectomy of a lateral meniscal tear

Explanation

Correct Answer: DThe candidate lists several indications for the posterior approach: 'The indications include removal of popliteal cysts and neoplasms, posterior synovectomy, open reduction and internal fixation of posterior tibial plateau shear fractures, fixation of bone avulsions associated with a posterior cruciate ligament (PCL) injury, repair of posterior vascular injuries, and more recently, posterior inlay PCL reconstructions.'Option D (Arthroscopic meniscectomy of a lateral meniscal tear)is incorrect because arthroscopic meniscectomy is typically performed through standard anteromedial and anterolateral portals, not a posterior open approach. While posterior portals can be used for posterior horn meniscal pathology, the question specifies an 'open posterior approach' and 'arthroscopic meniscectomy,' which are distinct.Options A, B, C, and Eare all explicitly mentioned as indications for a posterior approach in the provided text.

Question 922

Topic: Knee Sports

Following successful fixation of the PCL avulsion, the same rugby player later sustains an ACL injury to his contralateral knee, requiring single-bundle ACL reconstruction.

For a single-bundle ACL reconstruction in a right knee, what is the optimal femoral tunnel placement, aiming for the footprint of the posterolateral bundle?

. A. 12 o'clock position
. B. 3 o'clock position
. C. 10 to 10:30 o'clock position
. D. 7 to 7:30 o'clock position
. E. 1:30 to 2 o'clock position

Correct Answer & Explanation

. C. 10 to 10:30 o'clock position

Explanation

Correct Answer: CThe candidate states: 'For the femoral tunnel the isometric point lies at about 10 to 10.30 o’clock for right knee and 1.30 to 2 for left knee.' The question specifically asks for a right knee.Option A (12 o'clock position)is generally too anterior and can lead to impingement and restricted flexion.Option B (3 o'clock position)is too anterior and lateral for a right knee, leading to similar issues as 12 o'clock.Option D (7 to 7:30 o'clock position)would be too posterior for a right knee, leading to excessive tightening in extension.Option E (1:30 to 2 o'clock position)is the optimal placement for a left knee, not a right knee, as stated in the text.

Question 923

Topic: Knee Sports

During an ACL reconstruction, a surgeon inadvertently places the femoral tunnel too anteriorly, near the 'resident's ridge,' as described in the case.

What is the most likely clinical consequence of this technical error?

. A. Excessive tightening of the graft when the knee is extended
. B. Increased incidence of patellar fracture
. C. Restriction of knee flexion and potential graft elongation
. D. Increased risk of saphenous nerve injury
. E. Faster graft incorporation due to improved blood supply

Correct Answer & Explanation

. C. Restriction of knee flexion and potential graft elongation

Explanation

Correct Answer: CThe candidate explicitly states: 'The most common mistake is to place femoral tunnel too anterior or ‘resident’s ridge’. This restricts flexion of the knee and may result in elongation of graft.' This directly answers the question.Option A (Excessive tightening of the graft when the knee is extended)is incorrect. This consequence is associated with a femoral tunnel placed too posteriorly, not too anteriorly.Option B (Increased incidence of patellar fracture)is incorrect. Patellar fracture is a potential donor site morbidity associated with BPTB grafts, not a complication of femoral tunnel malpositioning.Option D (Increased risk of saphenous nerve injury)is incorrect. Saphenous nerve injury is a potential donor site morbidity associated with hamstring graft harvest, not a complication of femoral tunnel malpositioning.Option E (Faster graft incorporation due to improved blood supply)is incorrect. Femoral tunnel placement does not directly influence graft incorporation speed in this manner, and an anterior placement is a technical error, not an advantage.

Question 924

Topic: 5. Sports Medicine

When considering graft options for ACL reconstruction, the case discusses both hamstring and bone-patellar tendon-bone (BPTB) autografts.

Which of the following is a distinct advantage of using a BPTB autograft compared to a hamstring autograft, as highlighted in the case?

. A. Less donor site morbidity, including reduced anterior knee pain
. B. Faster healing due to bone-to-bone incorporation
. C. Smaller incision required for harvest
. D. Reduced risk of hamstring weakness
. E. Lower incidence of early osteoarthritis

Correct Answer & Explanation

. B. Faster healing due to bone-to-bone incorporation

Explanation

Correct Answer: BThe candidate states: 'The BPTB graft has the advantage of being easy to harvest, rigid fixation and faster integration as it uses bone to bone healing.' This directly identifies 'faster integration as it uses bone to bone healing' as an advantage.Option A (Less donor site morbidity, including reduced anterior knee pain)is incorrect. The case states BPTB has 'donor site morbidity which includes anterior knee pain in 30–50%,' while hamstring has 'less donor site morbidity.'Option C (Smaller incision required for harvest)is incorrect. The case states hamstring 'can be harvested from a small incision,' implying BPTB may require a larger incision or at least not a smaller one.Option D (Reduced risk of hamstring weakness)is incorrect. Hamstring weakness is a potential complication of hamstring graft harvest, so BPTB would inherently have a reduced risk of this specific complication, but the question asks for a distinct advantage of BPTB, and the text focuses on bone-to-bone healing as a key advantage.Option E (Lower incidence of early osteoarthritis)is incorrect. The case states, 'Most studies show arthroscopic reconstruction with either graft results in similar functional outcome but increased morbidity in BPTB in form of early OA,' indicating BPTB may have a higher, not lower, incidence of early OA.

Question 925

Topic: 5. Sports Medicine

A 30-year-old recreational athlete undergoes ACL reconstruction using a hamstring autograft.

Based on the case discussion, which of the following is a recognized donor site morbidity specifically associated with hamstring graft harvest?

. A. Patellar fracture
. B. Anterior knee pain (30-50% incidence)
. C. Patella baja
. D. Saphenous nerve injury
. E. Patellar tendonitis

Correct Answer & Explanation

. D. Saphenous nerve injury

Explanation

Correct Answer: DThe candidate discusses hamstring graft disadvantages: 'However it has slow healing because of tendon to bone incorporation which takes 8 to 12 weeks. It can also result in hamstring weakness and saphenous nerve injury.' This directly identifies saphenous nerve injury as a specific morbidity.Options A, B, C, and Eare all listed as donor site morbidities associated with the Bone-Patellar Tendon-Bone (BPTB) graft, not the hamstring graft.

Question 926

Topic: 5. Sports Medicine

The case highlights the importance of proper technique in ACL reconstruction, whether for a PCL avulsion patient or a new ACL injury.

According to the discussion, which of the following is a fundamental principle of ACL reconstruction?

. A. Placement of tunnels in the most anterior position to maximize graft tension
. B. Exclusive use of allografts to minimize donor site morbidity
. C. Placement of tunnels anatomically and isometrically with adequate graft tensioning
. D. Delayed rehabilitation to allow for complete graft maturation (6 months minimum immobilization)
. E. Routine notchplasty in all cases to prevent impingement

Correct Answer & Explanation

. C. Placement of tunnels anatomically and isometrically with adequate graft tensioning

Explanation

Correct Answer: CThe candidate states: 'The principles of ACL reconstruction are placement of tunnel anatomically and isometrically, using biologically active grafts which are adequately tensioned to allow early rehabilitation.' This directly encompasses anatomical and isometric tunnel placement with adequate graft tensioning.Option A (Placement of tunnels in the most anterior position to maximize graft tension)is incorrect. The case specifically warns against placing the femoral tunnel too anteriorly ('resident’s ridge') as it 'restricts flexion of the knee and may result in elongation of graft.'Option B (Exclusive use of allografts to minimize donor site morbidity)is incorrect. The discussion focuses on autografts (hamstring and BPTB) and does not advocate for exclusive allograft use, nor is it a fundamental principle of the procedure itself, but rather a graft choice consideration.Option D (Delayed rehabilitation to allow for complete graft maturation)is incorrect. The principles include 'to allow early rehabilitation,' directly contradicting this option.Option E (Routine notchplasty in all cases to prevent impingement)is incorrect. The case states, 'Careful assessment of notch should be done prior to graft insertion... The presence of impingement with correct placement of tunnels necessitates notchplasty,' implying it is not routine but rather indicated when impingement is present with correct tunnel placement.

Question 927

Topic: Knee Sports

During an ACL reconstruction, after careful assessment and correct placement of the femoral and tibial tunnels, the surgeon identifies impingement on the lateral femoral condyle.

According to the case discussion, what is the appropriate next step to address this issue?

. A. Reposition the femoral tunnel more anteriorly to avoid impingement
. B. Reposition the tibial tunnel more posteriorly to avoid impingement
. C. Perform a notchplasty of the anterior portion of the lateral femoral condyle
. D. Switch to a smaller diameter graft to reduce impingement
. E. Proceed with graft insertion, as minor impingement is clinically insignificant

Correct Answer & Explanation

. C. Perform a notchplasty of the anterior portion of the lateral femoral condyle

Explanation

Correct Answer: CThe candidate states: 'Careful assessment of notch should be done prior to graft insertion using a pin to ensure no impingement on lateral femoral condyle. The presence of impingement with correct placement of tunnels necessitates notchplasty of the anterior portion of lateral femoral condyle.' This directly indicates notchplasty as the solution when impingement occurs despite correct tunnel placement.Option A (Reposition the femoral tunnel more anteriorly)is incorrect. The case explicitly states that the impingement is occurring 'with correct placement of tunnels.' Repositioning the femoral tunnel anteriorly is a common mistake that leads to other complications like restricted flexion and graft elongation, and would not be the solution if the current placement is already correct.Option B (Reposition the tibial tunnel more posteriorly)is incorrect. Similar to option A, the tunnels are assumed to be correctly placed. Altering tibial tunnel placement could lead to other issues of non-isometricity or impingement elsewhere.Option D (Switch to a smaller diameter graft)is incorrect. Graft diameter is chosen based on patient size and graft strength requirements, not as a primary solution for bony impingement from the intercondylar notch.Option E (Proceed with graft insertion, as minor impingement is clinically insignificant)is incorrect. The case emphasizes that 'abnormally narrow intercondylar notch correlates directly with increased incidence of ACL tears' and that impingement must be assessed and addressed, implying it is clinically significant and can lead to graft failure.

Question 928

Topic: Shoulder & Hip Sports

A 22-year-old male presents with recurrent anterior shoulder instability following multiple dislocations. Advanced imaging reveals 28% anterior glenoid bone loss.

Which of the following is the most appropriate surgical management?

. Arthroscopic anterior labral repair with capsular plication
. Coracoid transfer to the anterior glenoid (Latarjet procedure)
. Arthroscopic remplissage
. Open inferior capsular shift
. Superior capsule reconstruction

Correct Answer & Explanation

. Coracoid transfer to the anterior glenoid (Latarjet procedure)

Explanation

Glenoid bone loss greater than 20-25% is an absolute indication for bony augmentation. The Latarjet procedure provides both a bony block and a sling effect from the conjoined tendon to stabilize the joint.

Question 929

Topic: Knee Sports

A 55-year-old female presents with acute medial knee pain and a popping sensation while ascending stairs. MRI demonstrates a complete radial tear of the posterior horn of the medial meniscus near its root, with 4 mm of meniscal extrusion. If left untreated, what is the most likely biomechanical consequence?

. Increased contact pressure equivalent to a total meniscectomy
. Subluxation of the patella due to altered tracking
. Spontaneous healing of the meniscal root over 6 months
. Excessive anterior translation of the tibia
. Development of a symptomatic popliteal cyst without cartilage damage

Correct Answer & Explanation

. Increased contact pressure equivalent to a total meniscectomy

Explanation

A medial meniscal root tear completely disrupts the circumferential hoop stresses of the meniscus. Biomechanically, this is functionally equivalent to a total meniscectomy, leading to exponentially increased peak contact pressures and rapid progression of osteoarthritis.

Question 930

Topic: Knee Sports

When reconstructing the medial patellofemoral ligament (MPFL) for recurrent patellar instability, understanding the native biomechanics is crucial to prevent over-constraining the joint. At which point in the range of motion does the native MPFL provide the greatest restraint to lateral patellar translation?

. From 0 to 30 degrees of flexion
. From 30 to 60 degrees of flexion
. From 60 to 90 degrees of flexion
. Beyond 90 degrees of flexion
. Equally throughout the entire range of motion

Correct Answer & Explanation

. From 0 to 30 degrees of flexion

Explanation

The MPFL is the primary soft-tissue restraint to lateral patellar translation from full extension up to 30 degrees of flexion. Beyond 30 degrees, the patella engages the trochlear groove, and bony geometry dictates stability.

Question 931

Topic: Knee Sports

Regarding the anatomy and biomechanics of the native anterior cruciate ligament (ACL), which of the following statements is most accurate?

. The anteromedial bundle is tight in extension and loose in flexion
. The posterolateral bundle is tight in flexion and loose in extension
. The anteromedial bundle is tight in flexion, and the posterolateral bundle is tight in extension
. Both bundles are equally tight throughout the entire range of motion
. The posterolateral bundle provides the primary restraint to anterior translation at 90 degrees of flexion

Correct Answer & Explanation

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

Explanation

The ACL consists of two main bundles. The anteromedial (AM) bundle is tight in flexion and provides primary anterior-posterior stability, while the posterolateral (PL) bundle is tight in extension and primarily controls rotational stability.

Question 932

Topic: Shoulder & Hip Sports

A 40-year-old male sustains a seizure resulting in a locked posterior glenohumeral dislocation. CT scan shows an anteromedial humeral head impression fracture (reverse Hill-Sachs lesion) involving 30% of the articular surface. The injury occurred 10 days ago. What is the most appropriate surgical treatment?

. Arthroscopic posterior labral repair alone
. Arthroscopic remplissage of the posterior defect
. Open reduction and Latarjet procedure
. Open reduction and transfer of the lesser tuberosity into the defect (McLaughlin procedure)
. Shoulder hemiarthroplasty

Correct Answer & Explanation

. Open reduction and transfer of the lesser tuberosity into the defect (McLaughlin procedure)

Explanation

A reverse Hill-Sachs lesion involving 20-40% of the articular surface is generally treated with a modified McLaughlin procedure. This involves transferring the subscapularis tendon and/or the lesser tuberosity into the defect to prevent engagement on the posterior glenoid rim.

Question 933

Topic: Knee Sports

A 55-year-old female presents with sudden onset posteromedial knee pain after squatting. MRI demonstrates a radial tear at the meniscal attachment. Which of the following best explains the rapid progression of osteoarthritis often seen with this specific injury?

. Loss of the shock-absorbing properties of the articular cartilage
. Disruption of circumferential hoop stresses leading to meniscal extrusion
. Increased valgus alignment increasing medial compartment contact pressures
. Chronic hemarthrosis causing synovitis and cartilage degradation
. Incompetence of the posterior cruciate ligament

Correct Answer & Explanation

. Disruption of circumferential hoop stresses leading to meniscal extrusion

Explanation

Posterior meniscal root tears completely disrupt the circumferential hoop stresses of the meniscus. This leads to peripheral meniscal extrusion, functionally equivalent to a total meniscectomy, causing rapid articular cartilage degeneration.

Question 934

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player presents with recurrent anterior shoulder instability. A 3D CT scan reveals 28% anterior glenoid bone loss. Which of the following is the most appropriate surgical intervention?

. Arthroscopic Bankart repair with suture anchors
. Arthroscopic remplissage with Bankart repair
. Open inferior capsular shift
. Coracoid transfer to the anterior glenoid (Latarjet procedure)
. Latissimus dorsi tendon transfer

Correct Answer & Explanation

. Coracoid transfer to the anterior glenoid (Latarjet procedure)

Explanation

The Latarjet procedure is the gold standard for anterior shoulder instability in patients with greater than 20-25% glenoid bone loss. Arthroscopic soft tissue repairs in this setting have an unacceptably high failure rate.

Question 935

Topic: Knee Sports

A 19-year-old female presents with recurrent patellar dislocations. Advanced imaging reveals a tibial tubercle-trochlear groove (TT-TG) distance of 24 mm and a normal Patellotrochlear Index. What is the most appropriate surgical management?

. Isolated medial patellofemoral ligament (MPFL) reconstruction
. Lateral retinacular release
. Tibial tubercle anteromedialization (Fulkerson osteotomy) with MPFL reconstruction
. Trochleoplasty
. Proximal realignment (Insall procedure)

Correct Answer & Explanation

. Tibial tubercle anteromedialization (Fulkerson osteotomy) with MPFL reconstruction

Explanation

A TT-TG distance >20 mm is a strict indication for a tibial tubercle osteotomy (medialization) to correct the anatomic malalignment. This is typically combined with an MPFL reconstruction to restore the primary soft-tissue restraint.

Question 936

Topic: 5. Sports Medicine

An 11-year-old boy sustains a complete anterior cruciate ligament (ACL) tear. His physes are widely open, and he is Tanner stage II. Which of the following surgical techniques has the lowest risk of causing a significant leg length discrepancy or angular deformity?

. Transphyseal bone-patellar tendon-bone autograft
. Transphyseal hamstring autograft with interference screws
. Iliotibial band extra-articular tenodesis with physeal-sparing reconstruction
. Primary repair of the ACL with internal bracing
. Conservative management with delayed reconstruction after skeletal maturity

Correct Answer & Explanation

. Iliotibial band extra-articular tenodesis with physeal-sparing reconstruction

Explanation

Physeal-sparing ACL reconstructions, such as the Micheli-Kocher IT band technique, avoid crossing open growth plates and minimize the risk of physeal arrest in prepubescent children. Transphyseal techniques carry a higher risk of growth disturbances in patients with significant remaining growth.

Question 937

Topic: Shoulder & Hip Sports

A 26-year-old professional baseball pitcher presents with vague posterior shoulder pain and decreased velocity. MRI arthrogram reveals a Type II SLAP tear. What biomechanical mechanism is most directly responsible for this pathology during the throwing motion?

. Internal impingement during the follow-through phase
. Peel-back mechanism during late cocking and early acceleration
. Excessive superior translation during the wind-up phase
. Direct impaction of the greater tuberosity during deceleration
. Coracoid impingement during early cocking

Correct Answer & Explanation

. Peel-back mechanism during late cocking and early acceleration

Explanation

The 'peel-back' mechanism occurs during the late cocking phase of throwing when the arm is in maximum abduction and external rotation. The long head of the biceps twists at its anchor, transmitting torsional forces that peel the superior labrum off the glenoid.

Question 938

Topic: Shoulder & Hip Sports

A 65-year-old laborer presents with an irrepairable, massive posterosuperior rotator cuff tear. He has full passive range of motion, severe weakness in external rotation, and an intact subscapularis. If the patient declines a reverse total shoulder arthroplasty, which tendon transfer is most appropriate?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Lower trapezius transfer
. Pectoralis minor transfer
. Rhomboid major transfer

Correct Answer & Explanation

. Latissimus dorsi transfer

Explanation

Latissimus dorsi or lower trapezius transfers are indicated for massive, irrepairable posterosuperior cuff tears to restore active external rotation and forward elevation. Pectoralis major transfers are utilized for irrepairable subscapularis tears.

Question 939

Topic: Knee Sports

A 30-year-old soccer player sustains a twisting injury to his knee. On examination, the dial test reveals 15 degrees of increased external rotation compared to the contralateral side at 30 degrees of knee flexion, but symmetrical external rotation at 90 degrees. What is the diagnosis?

. Isolated posterior cruciate ligament (PCL) injury
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injury
. Isolated anterior cruciate ligament (ACL) injury
. Combined ACL and posteromedial corner injury

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

The dial test assesses for posterolateral corner and PCL injuries. Asymmetry of >10 degrees at 30 degrees of flexion only indicates an isolated PLC injury. If asymmetry is present at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 940

Topic: Shoulder & Hip Sports

A 32-year-old volleyball player presents with insidious onset of posterior shoulder pain and weakness in external rotation. MRI reveals a paralabral cyst located in the spinoglenoid notch. Which muscle will primarily exhibit atrophy as a result of this specific nerve compression?

. Supraspinatus only
. Infraspinatus only
. Both supraspinatus and infraspinatus
. Teres minor
. Subscapularis

Correct Answer & Explanation

. Infraspinatus only

Explanation

The suprascapular nerve innervates the supraspinatus, then travels through the spinoglenoid notch to innervate the infraspinatus. Compression specifically at the spinoglenoid notch (often due to cysts from posterior labral tears) results in isolated infraspinatus weakness and atrophy.

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