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5. Sports Medicine MCQs

Practice Set 55 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 1081

Topic: Shoulder & Hip Sports

A 45-year-old male presents with acute anterior shoulder pain and weakness after attempting to break a fall with his arm extended and externally rotated. On examination, he exhibits a positive lift-off test and increased passive external rotation compared to the contralateral side. Which tendon is most likely ruptured?

. Supraspinatus
. Infraspinatus
. Subscapularis
. Teres minor
. Long head of the biceps

Correct Answer & Explanation

. Subscapularis

Explanation

The subscapularis is the primary internal rotator of the shoulder. A positive lift-off test, belly-press test, and increased passive external rotation are classic physical exam findings for a subscapularis tear.

Question 1082

Topic: 5. Sports Medicine

A 25-year-old professional baseball pitcher presents with vague, deep shoulder pain occurring primarily during the late cocking phase of throwing. MRI arthrogram reveals a SLAP tear. The pathophysiology of this specific injury pattern in throwers is most commonly attributed to which of the following mechanisms?

. Direct impaction from a fall on an outstretched hand
. Traction injury during the deceleration phase
. A "peel-back" mechanism from torsional forces on the biceps anchor during maximal external rotation
. Subcoracoid impingement during follow-through
. Ischemic degeneration of the superior labrum

Correct Answer & Explanation

. A "peel-back" mechanism from torsional forces on the biceps anchor during maximal external rotation

Explanation

In overhead throwing athletes, a SLAP tear is typically caused by the "peel-back" mechanism. During maximal abduction and external rotation (late cocking phase), a torsional force is transmitted to the superior labrum via the biceps anchor.

Question 1083

Topic: 5. Sports Medicine

A 21-year-old collegiate gymnast presents with deep, persistent ankle pain 1 year after a severe inversion sprain. MRI reveals a 16x16 mm osteochondral lesion of the posteromedial talar dome with significant subchondral cystic changes. She has failed 6 months of nonoperative management. What is the most appropriate surgical intervention?

. Arthroscopic bone marrow stimulation (microfracture)
. Arthroscopic debridement and retrograde drilling
. Osteochondral autograft transfer (OATS)
. Matrix-induced autologous chondrocyte implantation (MACI)
. Tibiotalar arthrodesis

Correct Answer & Explanation

. Osteochondral autograft transfer (OATS)

Explanation

Osteochondral lesions of the talus larger than 1.5 cm in diameter or those with deep subchondral cysts are poorly responsive to simple marrow stimulation techniques. Osteochondral autograft transfer (OATS) restores the structural bone defect and provides viable hyaline cartilage.

Question 1084

Topic: 5. Sports Medicine

A 24-year-old male sustains an inversion ankle sprain that fails to improve after 6 months of conservative management. MRI reveals a 1.2 cm diameter, uncontained anterolateral osteochondral lesion of the talus (OLT). What is the most appropriate initial surgical management?

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

Correct Answer & Explanation

. Arthroscopic bone marrow stimulation (microfracture)

Explanation

Arthroscopic bone marrow stimulation (microfracture) is the first-line surgical treatment for small, primary osteochondral lesions of the talus measuring less than 1.5 cm in diameter. Larger, cystic, or failed lesions typically require OATS or fresh allografting.

Question 1085

Topic: Knee Sports

A 22-year-old soccer player undergoes an anterior cruciate ligament (ACL) reconstruction. To address persistent anterolateral rotatory instability and a high-grade pivot shift, the surgeon performs an extra-articular tenodesis. Which anatomical structure is being reconstructed or augmented?

. Popliteofibular ligament
. Iliotibial band
. Oblique popliteal ligament
. Posterolateral corner
. Anterolateral ligament

Correct Answer & Explanation

. Anterolateral ligament

Explanation

The anterolateral ligament (ALL) is a distinct capsular structure that works synergistically with the ACL to control internal tibial rotation and the pivot shift phenomenon. ALL reconstruction or lateral extra-articular tenodesis is increasingly utilized in high-risk patients to prevent ACL graft failure.

Question 1086

Topic: Knee Sports

During anterior cruciate ligament (ACL) reconstruction, non-anatomic vertical placement of the femoral tunnel primarily leads to which of the following outcomes?

. Loss of terminal extension
. Increased anterior tibial translation in deep flexion
. Residual rotatory instability and a positive pivot shift test
. Increased tension on the graft during early flexion
. Patella baja

Correct Answer & Explanation

. Residual rotatory instability and a positive pivot shift test

Explanation

A vertically placed femoral tunnel in ACL reconstruction fails to anatomically recreate both the anteromedial and posterolateral bundle kinematics. This geometry offers poor control of rotational forces, leading to residual rotatory instability and a persistent pivot shift.

Question 1087

Topic: Shoulder & Hip Sports

During an orthopedic structured oral examination (viva), a candidate rapidly identifies a 'lightbulb sign' on a shoulder radiograph and diagnoses a posterior dislocation, completely missing a subtle reverse Hill-Sachs lesion. This cognitive error, where the examiner stops searching for further abnormalities once an initial finding is made, is known as:

. Anchoring bias
. Availability heuristic
. Premature closure
. Satisfaction of search
. Confirmation bias

Correct Answer & Explanation

. Satisfaction of search

Explanation

Satisfaction of search is a common perceptual error in radiology and clinical assessments where the observer stops looking for additional, potentially critical findings after discovering the first abnormality. Recognizing this error is a key component of clinical reasoning and viva preparation.

Question 1088

Topic: 5. Sports Medicine

Which of the following knee ligament reconstruction grafts provides an initial ultimate tensile load of approximately 4090 Newtons, significantly exceeding both the native ACL (2160 N) and a 10-mm bone-patellar tendon-bone autograft (2977 N)?

. 10-mm bone-patellar tendon-bone autograft
. Quadrupled semitendinosus-gracilis autograft
. Single-strand semitendinosus autograft
. Double-bundle Achilles tendon allograft
. Fascia lata autograft

Correct Answer & Explanation

. Quadrupled semitendinosus-gracilis autograft

Explanation

Biomechanical studies have shown that a quadrupled hamstring (semitendinosus and gracilis) autograft has the highest initial ultimate tensile load (approx. 4090 N). While strong, structural properties drop rapidly post-implantation during the ligamentization phase.

Question 1089

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, placing the femoral tunnel too anteriorly (shallow) relative to the anatomic footprint will result in which of the following kinematic abnormalities?

. 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 restrict internal rotation only
. The graft will cause obligate external rotation during extension
. The graft will remain isometric throughout the entire range of motion

Correct Answer & Explanation

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

Explanation

An anteriorly placed femoral tunnel (anterior to the normal isometric point) results in a graft that becomes excessively tight as the knee moves into flexion. This can lead to significant flexion loss or early graft rupture. Conversely, a posterior placement causes tightness in extension.

Question 1090

Topic: 5. Sports Medicine

A 22-year-old soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Biomechanically, at what time point post-operatively is the graft structurally the strongest compared to the native ACL?

. Immediately post-operatively (Time zero).
. 6 weeks post-operatively.
. 3 months post-operatively.
. 6 months post-operatively.
. 12 months post-operatively.

Correct Answer & Explanation

. Immediately post-operatively (Time zero).

Explanation

A BPTB autograft is biomechanically strongest at time zero (immediately post-op), where it is significantly stronger than the native ACL. It subsequently undergoes a process of necrosis, revascularization, and remodeling (ligamentization), during which its strength drops considerably before recovering.

Question 1091

Topic: 5. Sports Medicine

A 16-year-old female soccer player requires ACL reconstruction. She and her parents are discussing graft options. Which of the following is a known biomechanical or clinical disadvantage of using a hamstring autograft compared to a bone-patellar tendon-bone (BTB) autograft?

. Higher incidence of anterior knee pain and kneeling discomfort
. Increased risk of postoperative patellar fracture
. Decreased deep knee flexion strength
. Slower graft incorporation at the tunnel interface due to indirect healing
. Higher risk of postoperative extension deficit

Correct Answer & Explanation

. Slower graft incorporation at the tunnel interface due to indirect healing

Explanation

Hamstring autografts heal to bone via indirect healing (soft tissue to bone), which takes longer to incorporate than the direct bone-to-bone healing of a BTB graft. They are also associated with decreased deep knee flexion strength.

Question 1092

Topic: Knee Sports

A 22-year-old soccer player presents with a locked knee. An MRI demonstrates an ACL rupture with a displaced bucket-handle tear of the medial meniscus. What is the recommended management?

. Immediate partial meniscectomy followed by delayed ACL reconstruction
. Simultaneous ACL reconstruction and meniscus repair
. ACL reconstruction and non-operative management of the meniscus
. Diagnostic arthroscopy only
. Knee immobilization for 6 weeks followed by physical therapy

Correct Answer & Explanation

. Simultaneous ACL reconstruction and meniscus repair

Explanation

Simultaneous ACL reconstruction and meniscal repair is the gold standard. The intra-articular bleeding from the ACL reconstruction enhances the healing environment for the meniscus repair.

Question 1093

Topic: Knee Sports

A 45-year-old male falls from a ladder, sustaining an L1 burst fracture. He is neurologically intact. Which of the following is a universally accepted indication for operative stabilization of this fracture?

. Canal compromise of 20%
. Anterior wedge compression of 10 degrees
. Posterior ligamentous complex (PLC) disruption
. Intact neurological exam
. Loss of vertebral body height of 20%

Correct Answer & Explanation

. Posterior ligamentous complex (PLC) disruption

Explanation

Disruption of the posterior ligamentous complex (PLC) indicates a highly unstable three-column spine injury. Operative stabilization is indicated even in the absence of neurological deficits.

Question 1094

Topic: 5. Sports Medicine

Following a Zone II flexor tendon repair, what is the primary biomechanical advantage of an early active motion rehabilitation protocol over a passive motion protocol?

. Decreased risk of tendon rupture
. Increased gap formation at the repair site
. Improved tendon excursion with decreased adhesion formation
. Reduced need for a strong core suture
. Earlier return to heavy manual labor

Correct Answer & Explanation

. Improved tendon excursion with decreased adhesion formation

Explanation

Early active motion protocols promote significant tendon excursion, which minimizes adhesion formation. Modern multi-strand core sutures provide the necessary strength to allow this without unacceptably increasing rupture risk.

Question 1095

Topic: Knee Sports

Regarding the medial patellofemoral ligament (MPFL), which statement is most accurate concerning its anatomy and function?

. The MPFL primarily resists lateral patellar translation at full knee extension.
. The femoral attachment of the MPFL is consistently found on the medial epicondyle.
. The MPFL is the primary static restraint to lateral patellar translation between 0 and 30 degrees of knee flexion.
. The patellar attachment of the MPFL is typically broader on the medial facet and superior border of the patella.
. Complete rupture of the MPFL is typically associated with a bone avulsion from the patella rather than the femur.

Correct Answer & Explanation

. The MPFL is the primary static restraint to lateral patellar translation between 0 and 30 degrees of knee flexion.

Explanation

Correct Answer: CThe MPFL is recognized as the primary static restraint to lateral patellar translation, particularly in the initial 20-30 degrees of knee flexion, where the trochlear groove is shallowest. At full knee extension, the joint is less constrained, but the MPFL's role is critical. The femoral attachment is variable but typically found distal and posterior to the adductor tubercle, often blended with the adductor magnus tendon and medial gastrocnemius origin, not consistently on the medial epicondyle. The patellar attachment is usually on the superior medial patella. While avulsions can occur at either end, femoral avulsions are more common in acute dislocations.

Question 1096

Topic: Knee Sports

During an MPFL reconstruction using a semitendinosus autograft, the most critical step to prevent iatrogenic patellar fracture or over-constraining the patella is:

. Fixing the graft to the patella with a suture anchor.
. Ensuring the knee is in full extension during femoral fixation.
. Tensioning the graft with the knee in 30 degrees of flexion.
. Performing a lateral retinacular release prior to graft placement.
. Utilizing fluoroscopy to confirm proper femoral tunnel placement.

Correct Answer & Explanation

. Tensioning the graft with the knee in 30 degrees of flexion.

Explanation

Correct Answer: COver-constraining the patella is a known complication of MPFL reconstruction, leading to patellofemoral pain and stiffness. The MPFL is isometric in the initial 0-30 degrees of flexion. Tensioning the graft with the knee in 30 degrees of flexion is crucial. If the graft is tensioned in full extension or hyperflexion, it becomes too tight in mid-flexion, causing increased patellofemoral contact pressures and potentially pain or articular cartilage damage. Fluoroscopy for femoral tunnel placement is essential to avoid violating the physis in skeletally immature patients or drilling too anterior/posterior, but it doesn't directly prevent over-tensioning. Patellar fixation is standard; lateral retinacular release is not routinely performed with MPFL reconstruction unless specific lateral tightness is present.

Question 1097

Topic: Knee Sports

Which of the following is an absolute contraindication to performing a tibial tubercle osteotomy in a patient with patellar instability?

. Patella alta.
. Open proximal tibial physis.
. Severe trochlear dysplasia.
. Generalized ligamentous laxity.
. History of a prior MPFL reconstruction.

Correct Answer & Explanation

. Open proximal tibial physis.

Explanation

Correct Answer: BAn open proximal tibial physis is an absolute contraindication for a standard tibial tubercle osteotomy (e.g., Fulkerson or Elmslie-Trillat) due to the significant risk of growth arrest, angular deformities, or leg length discrepancies. In skeletally immature patients, if a bony procedure is absolutely necessary, techniques that spare the physis (e.g., physis-sparing MPFL reconstruction) or physeal bridging procedures with careful monitoring are considered. Patella alta, severe trochlear dysplasia, and generalized ligamentous laxity are risk factors that may necessitate a tibial tubercle osteotomy, not contraindications. A prior MPFL reconstruction does not contraindicate a subsequent tibial tubercle osteotomy if malalignment persists.

Question 1098

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction, identifying the anatomical femoral attachment is critical to avoid graft anisometry. Where is the normal femoral origin of the MPFL located?
. Anterior to the medial epicondyle and distal to the adductor tubercle
. Posterior to the medial epicondyle and proximal to the adductor tubercle
. Between the medial epicondyle and the adductor tubercle
. Distal to the medial collateral ligament origin
. Directly on the gastrocnemius tubercle

Correct Answer & Explanation

. Between the medial epicondyle and the adductor tubercle

Explanation

The MPFL originates in a saddle-like groove situated between the medial epicondyle and the adductor tubercle on the medial femur (Schöttle's point). Non-anatomic femoral tunnel placement is a primary cause of postoperative MPFL graft failure.

Question 1099

Topic: Knee Sports

A 21-year-old female presents with recurrent lateral patellar instability. Imaging demonstrates a tibial tubercle-trochlear groove (TT-TG) distance of 24 mm and a Caton-Deschamps index of 1.0. Trochlear depth is normal. What is the most appropriate surgical intervention?

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

Correct Answer & Explanation

. MPFL reconstruction with medializing tibial tubercle osteotomy

Explanation

A TT-TG distance > 20 mm is an indication for a medializing tibial tubercle osteotomy (Fulkerson procedure) to correct the abnormal lateral extensor mechanism vector. MPFL reconstruction is performed concurrently to restore the torn primary medial soft-tissue restraint.

Question 1100

Topic: Knee Sports

The medial patellofemoral ligament (MPFL) provides the primary soft-tissue restraint to lateral patellar translation at which of the following knee flexion angles?

. 0 to 30 degrees
. 45 to 60 degrees
. 60 to 90 degrees
. 90 to 120 degrees
. Beyond 120 degrees

Correct Answer & Explanation

. 0 to 30 degrees

Explanation

The MPFL is the primary restraint to lateral patellar translation in early flexion (0 to 30 degrees). Beyond 30 degrees of flexion, the patella engages the trochlea, and the bony architecture becomes the primary stabilizer.

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