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5. Sports Medicine MCQs

Practice Set 50 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 981

Topic: Knee Sports

A 22-year-old female presents with recurrent lateral patellar dislocation. Imaging demonstrates a tibial tubercle-trochlear groove (TT-TG) distance of 21 mm, a Caton-Deschamps index of 1.0, and a Dejour Type A trochlea. Which of the following is the BEST surgical treatment plan?

. Isolated MPFL reconstruction
. MPFL reconstruction combined with medializing tibial tubercle osteotomy
. Isolated lateral retinacular release
. MPFL reconstruction combined with distalizing tibial tubercle osteotomy
. Sulcus-deepening trochleoplasty

Correct Answer & Explanation

. MPFL reconstruction combined with medializing tibial tubercle osteotomy

Explanation

A TT-TG distance >20 mm is generally considered pathologic and indicates excessive lateralization of the extensor mechanism. In the setting of recurrent patellar instability, this is treated with a medializing tibial tubercle osteotomy (TTO) in conjunction with MPFL reconstruction.

Question 982

Topic: Knee Sports

During medial patellofemoral ligament (MPFL) reconstruction, at what degree of knee flexion should the graft optimally be tensioned and fixed to avoid medial over-constraint?

. Full extension (0 degrees)
. 30 degrees
. 60 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 30 degrees

Explanation

The MPFL graft should be tensioned at approximately 30 degrees of knee flexion. At this angle, the patella is fully engaged in the trochlear groove, minimizing the risk of overtensioning and subsequent medial compartment overload.

Question 983

Topic: Knee Sports

On evaluation for recurrent patellofemoral instability, a lateral radiograph demonstrates a "crossing sign" and a "supratrochlear spur" (double contour). Axial MRI reveals a convex trochlear facet. This corresponds to which Dejour classification of trochlear dysplasia?

. Type A
. Type B
. Type C
. Type D
. Type E

Correct Answer & Explanation

. Type C

Explanation

Dejour Type C trochlear dysplasia is characterized by a convex trochlear facet and hypoplasia of the medial condyle. The corresponding lateral radiographic landmarks are the crossing sign and the presence of a double contour (supratrochlear spur).

Question 984

Topic: Knee Sports

A 19-year-old male with recalcitrant patellar instability has failed MPFL reconstruction and TTO. A rotational profile CT is ordered. A threshold of excessive femoral anteversion that often warrants a distal femoral derotational osteotomy in this setting is typically defined as greater than what value?

. 10 degrees
. 15 degrees
. 20 degrees
. 25 degrees
. 40 degrees

Correct Answer & Explanation

. 40 degrees

Explanation

While normal femoral anteversion is around 15 degrees, excessive anteversion greater than 30-40 degrees significantly alters patellofemoral mechanics. In cases of recalcitrant instability with anteversion >40 degrees, a distal femoral derotational osteotomy should be considered.

Question 985

Topic: 5. Sports Medicine

What is the most common clinical consequence of overtensioning the graft during a medial patellofemoral ligament (MPFL) reconstruction?

. Recurrent lateral dislocation
. Medial patellar overconstraint and subluxation
. Premature failure of the tibial tubercle osteotomy
. Patellar tendon rupture
. Lateral retinacular hypertrophy

Correct Answer & Explanation

. Medial patellar overconstraint and subluxation

Explanation

Overtensioning the MPFL graft is a frequent and severe technical error. It pulls the patella too tightly against the medial facet, leading to medial patellar overconstraint, increased contact pressures, pain, and iatrogenic medial subluxation.

Question 986

Topic: Knee Sports

Which of the following is considered an appropriate indication for a sulcus-deepening trochleoplasty?

. High-grade (Dejour B or D) trochlear dysplasia with an intact cartilage surface
. Dejour Type A dysplasia with a TT-TG distance of 22 mm
. Dejour Type C dysplasia with advanced patellofemoral osteoarthritis
. Isolated patella alta with a Caton-Deschamps index of 1.5
. First-time patellar dislocation in a skeletally immature patient

Correct Answer & Explanation

. High-grade (Dejour B or D) trochlear dysplasia with an intact cartilage surface

Explanation

Trochleoplasty is indicated for recurrent instability in the setting of severe (Dejour B or D) trochlear dysplasia with a supratrochlear spur. It is strictly contraindicated in patients with open physes or advanced patellofemoral osteoarthritis.

Question 987

Topic: Knee Sports
A 21-year-old female undergoes medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar instability. During surgery, the femoral tunnel is inadvertently placed 10 mm proximal to the anatomic origin (Schöttle's point). What is the expected biomechanical consequence of this malposition?
. The graft will be tight in flexion and loose in extension.
. The graft will be tight in extension and loose in flexion.
. The graft will maintain isometric tension throughout the full arc of motion.
. The graft will cause excessive medial subluxation of the patella in full extension.
. The patellofemoral contact pressures will decrease significantly in deep flexion.

Correct Answer & Explanation

. The graft will be tight in flexion and loose in extension.

Explanation

The anatomic femoral origin of the MPFL is distal to the central axis of femoral rotation. If the graft is placed too proximally, the distance between the attachment points increases as the knee flexes, causing the graft to be tight in flexion and loose in extension.

Question 988

Topic: Knee Sports

A 15-year-old female presents with recurrent patellar dislocations. Radiographs reveal a 'double contour' sign on the true lateral view. According to the Dejour classification, what anatomic abnormality does this specific radiographic finding represent?

. A supratrochlear spur
. A hypoplastic medial trochlear facet
. A convex lateral trochlear facet
. Excessive patella alta
. An abnormally lateralized tibial tubercle

Correct Answer & Explanation

. A hypoplastic medial trochlear facet

Explanation

The 'double contour' sign seen on a true lateral radiograph represents a hypoplastic medial facet of the trochlea. It is a hallmark of Dejour Type C and Type D trochlear dysplasia.

Question 989

Topic: 5. Sports Medicine

A 19-year-old male athlete sustained a primary lateral patellar dislocation. MRI reveals a full-thickness osteochondral defect of the lateral femoral condyle with an intra-articular 15-mm loose body, as well as a complete tear of the MPFL at its femoral origin. What is the most appropriate management?

. Non-weight bearing in full extension for 6 weeks
. Arthroscopic excision or fixation of the loose body and concurrent MPFL stabilization
. Physical therapy focusing exclusively on vastus medialis obliquus (VMO) strengthening
. Distal femoral varus-producing osteotomy
. Tibial tubercle medialization osteotomy

Correct Answer & Explanation

. Arthroscopic excision or fixation of the loose body and concurrent MPFL stabilization

Explanation

While conservative management is standard for uncomplicated first-time dislocations, the presence of a sizable osteochondral loose body is a surgical indication. It requires excision or fixation, often combined with MPFL repair or reconstruction.

Question 990

Topic: Knee Sports

A 23-year-old female is evaluated for recurrent patellofemoral instability. Axial CT scans are utilized to measure the Tibial Tubercle-Trochlear Groove (TT-TG) distance. Above what threshold is a tibial tubercle medialization osteotomy strongly indicated?

. 10 mm
. 15 mm
. 20 mm
. 25 mm
. 30 mm

Correct Answer & Explanation

. 20 mm

Explanation

A TT-TG distance greater than 20 mm is considered highly abnormal and is a primary indication for a tibial tubercle medialization osteotomy in the setting of recurrent patellar instability.

Question 991

Topic: Knee Sports

A 13-year-old male with wide-open physes presents with recurrent patellar dislocations. Imaging confirms normal TT-TG distance but a torn MPFL. Surgical intervention is selected. Which of the following procedures is most appropriate while minimizing the risk of growth arrest?

. Tibial tubercle medialization osteotomy
. Fulkerson osteotomy
. MPFL reconstruction with physeal-sparing femoral fixation
. Dejour trochleoplasty
. Lateral retinacular release as an isolated procedure

Correct Answer & Explanation

. MPFL reconstruction with physeal-sparing femoral fixation

Explanation

In skeletally immature patients with open physes, bony procedures like tibial tubercle osteotomies carry a high risk of physeal arrest (e.g., recurvatum deformity). Soft-tissue MPFL reconstruction utilizing physeal-sparing techniques (avoiding the distal femoral physis) is the treatment of choice.

Question 992

Topic: Knee Sports

A patient undergoes a tibial tubercle medialization osteotomy for a TT-TG distance of 24 mm. If the surgeon over-medializes the tubercle excessively, what is the most likely postoperative complication?

. Increased lateral compartment contact pressures
. Increased medial compartment contact pressures
. Recurrent lateral patellar dislocation
. Patella infera
. Genu recurvatum

Correct Answer & Explanation

. Increased medial compartment contact pressures

Explanation

Excessive medialization of the tibial tubercle alters the Q-angle to a varus alignment, unnaturally increasing the contact pressures in the medial tibiofemoral compartment and predisposing the patient to medial unicompartmental osteoarthritis.

Question 993

Topic: Knee Sports

The medial patellofemoral ligament (MPFL) serves as the primary restraint to lateral patellar translation at which of the following degrees of knee flexion?

. Full extension to 30 degrees
. 30 degrees to 60 degrees
. 60 degrees to 90 degrees
. 90 degrees to 120 degrees
. Deep flexion past 120 degrees

Correct Answer & Explanation

. Full extension to 30 degrees

Explanation

The MPFL provides approximately 50-60% of the restraining force against lateral patellar displacement during early knee flexion (0 to 30 degrees). Beyond 30 degrees, the patella engages the trochlear groove, which then becomes the primary osseous stabilizer.

Question 994

Topic: Knee Sports
A 28-year-old female presents with patellar instability. MRI demonstrates isolated lateralization of the tibial tubercle. Her TT-TG distance is 22 mm, but her Tibial Tubercle-Posterior Cruciate Ligament (TT-PCL) distance is measured at 26 mm (Normal < 24 mm). What does an elevated TT-PCL distance primarily indicate in this context?
. Significant femoral anteversion
. Severe trochlear dysplasia
. Tubercle lateralization that is independent of tibiofemoral rotation
. Compensatory external tibial torsion
. Excessive patellar tilt

Correct Answer & Explanation

. Tubercle lateralization that is independent of tibiofemoral rotation

Explanation

The TT-PCL distance isolates true lateralization of the tibial tubercle relative to the proximal tibia. An elevated TT-TG with a normal TT-PCL suggests the lateralization is due to knee rotation, whereas an elevated TT-PCL confirms true structural lateralization of the tubercle itself.

Question 995

Topic: Knee Sports
Which anatomic landmark safely directs the femoral placement of the medial patellofemoral ligament (MPFL) graft on lateral fluoroscopy (Schöttle's point)?
. Anterior to the posterior cortical line, distal to Blumensaat's line
. Anterior to the posterior cortical line, proximal to Blumensaat's line
. Posterior to the posterior cortical line, proximal to Blumensaat's line
. Posterior to the posterior cortical line, distal to Blumensaat's line
. Directly centered on the intercondylar notch

Correct Answer & Explanation

. Anterior to the posterior cortical line, proximal to Blumensaat's line

Explanation

Schöttle's point is located 1 mm anterior to the posterior cortical line of the femur, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line.

Question 996

Topic: Shoulder & Hip Sports

When repairing a proximal humerus fracture via a standard deltopectoral approach, which structure serves as the primary anatomic landmark to identify the interval between the greater and lesser tuberosities?

. The coracoid process
. The subscapularis tendon insertion
. The long head of the biceps tendon
. The axillary nerve
. The anterior circumflex humeral artery

Correct Answer & Explanation

. The long head of the biceps tendon

Explanation

The long head of the biceps tendon lies within the bicipital groove and acts as the key anatomic landmark. It separates the greater tuberosity (with its supraspinatus/infraspinatus attachments) from the lesser tuberosity (with its subscapularis attachment).

Question 997

Topic: 5. Sports Medicine

A 78-year-old female sustains a depressed lateral tibia plateau fracture. If a synthetic bone void filler is used to support the articular reduction, which material provides the highest immediate compressive strength to resist subsidence in osteoporotic bone?

. Calcium sulfate
. Demineralized bone matrix (DBM)
. Calcium phosphate cement
. Cancellous allograft chips
. Cancellous autograft from the iliac crest

Correct Answer & Explanation

. Calcium phosphate cement

Explanation

Calcium phosphate cement provides the highest compressive strength among bone void fillers, significantly higher than cancellous bone, making it excellent for resisting articular subsidence in osteoporotic plateau fractures.

Question 998

Topic: Knee Sports

During a TKR for a valgus knee, the surgeon encounters a situation where excessive posterior cruciate ligament (PCL) release is performed during soft tissue balancing. Based on the principles outlined in the case, what is the most likely consequence of this excessive PCL release and the appropriate implant choice?

. Option A: It will lead to a tighter flexion gap, requiring a PCL-retaining implant.
. Option B: It will result in a balanced knee, allowing for a PCL-retaining implant.
. Option C: It will necessitate cruciate sacrificing implants in order to balance the knee.
. Option D: It will primarily affect the extension gap, requiring a thicker insert but still allowing PCL retention.
. Option E: It will have no significant impact on knee balance or implant choice.

Correct Answer & Explanation

. Option C: It will necessitate cruciate sacrificing implants in order to balance the knee.

Explanation

Correct Answer: CThe case explicitly states: 'Excessive PCL release usually requires cruciate sacrificing implants in order to balance the knee.' This is a direct consequence of losing the PCL's contribution to stability and balance.Option A is incorrectbecause excessive PCL release would lead to a looser, not tighter, flexion gap, and would preclude PCL retention.Option B is incorrectbecause excessive PCL release would destabilize the knee, making it unbalanced, and would not allow for PCL-retaining implants.Option D is incorrectbecause while soft tissue releases can affect the extension gap, excessive PCL release specifically impacts flexion stability and necessitates a change in implant type, not just insert thickness while retaining the PCL.Option E is incorrectbecause PCL release has a significant impact on knee kinematics and balance, directly influencing implant choice.

Question 999

Topic: Shoulder & Hip Sports

A 28-year-old professional baseball pitcher presents with recurrent anterior glenohumeral instability despite extensive rehabilitation and a prior arthroscopic Bankart repair. Imaging reveals significant anterior glenoid bone loss (28%) and an engaging Hill-Sachs lesion. Which of the following procedures, performed via the deltopectoral approach, is most indicated for this patient?

. Open Bankart repair with capsular plication
. Subscapularis tenotomy and repair
. Latarjet procedure
. Total shoulder arthroplasty
. Proximal humerus locking plate fixation

Correct Answer & Explanation

. Latarjet procedure

Explanation

Correct Answer: CExplanation:The case explicitly lists indications for the deltopectoral approach: "Latarjet Procedure (Coracoid Transfer):The procedure of choice for recurrent anterior instability associated with significant anterior glenoid bone loss (>20-25%), engaging Hill-Sachs lesions, or failed soft tissue repairs." This patient meets all these criteria: recurrent instability, failed prior arthroscopic repair, significant glenoid bone loss (28%), and an engaging Hill-Sachs lesion.A. Open Bankart repair with capsular plication:While an open Bankart can be performed via this approach, it is primarily a soft tissue repair. Given the significant bone loss and engaging Hill-Sachs lesion, a soft tissue repair alone is unlikely to provide sufficient stability and would have a high failure rate.B. Subscapularis tenotomy and repair:Subscapularis tenotomy is typically performed for arthroplasty to gain access to the joint, or for direct repair of a subscapularis tear. It is not a primary procedure for glenohumeral instability with bone loss.D. Total shoulder arthroplasty:TSA is indicated for end-stage glenohumeral osteoarthritis or other arthritic conditions, not for isolated instability in a young, active patient.E. Proximal humerus locking plate fixation:This is a procedure for proximal humerus fractures, which is not the patient's primary pathology.

Question 1000

Topic: Shoulder & Hip Sports

A 55-year-old male undergoes open reduction and internal fixation of a 3-part proximal humerus fracture via the deltopectoral approach. Post-operatively, he exhibits excellent deltoid function with minimal weakness. This outcome primarily highlights which biomechanical advantage of the deltopectoral approach?

. Its ability to provide direct access to the posterior glenoid.
. Its inherent capacity to re-tension the rotator cuff without repair.
. Its respect for the integrity of the deltoid muscle by utilizing an internervous plane.
. Its superior visualization of the suprascapular nerve.
. Its minimal risk of infection compared to other shoulder approaches.

Correct Answer & Explanation

. Its respect for the integrity of the deltoid muscle by utilizing an internervous plane.

Explanation

Correct Answer: CExplanation:The case emphasizes: "The biomechanical advantage of the deltopectoral approach lies in its respect for the integrity of the deltoid muscle. By dissecting along an internervous plane, the muscle fibers are not transected, preserving the deltoid's origin, insertion, and innervation. This minimizes post-operative weakness and facilitates early rehabilitation." The patient's excellent deltoid function directly reflects this advantage.A. Its ability to provide direct access to the posterior glenoid:The deltopectoral approach is an anterior approach and provides limited, if any, direct access to the posterior glenoid. Posterior pathologies require a posterior approach.B. Its inherent capacity to re-tension the rotator cuff without repair:The deltopectoral approach often requires management of the subscapularis (tenotomy or peel), which then necessitates meticulous repair to restore rotator cuff integrity and tension. It does not inherently re-tension the cuff without repair.D. Its superior visualization of the suprascapular nerve:The suprascapular nerve is located more posteriorly and superiorly, passing through the suprascapular notch. The deltopectoral approach does not offer superior visualization of this nerve.E. Its minimal risk of infection compared to other shoulder approaches:While all surgical approaches carry an infection risk, the deltopectoral approach does not inherently have a 'minimal' risk compared to other approaches. Infection risk is multifactorial.

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