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5. Sports Medicine MCQs

Practice Set 68 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 1341

Topic: 5. Sports Medicine
A patient undergoes hip arthroscopy, and the pathology is seen in Figure 18. What is the most likely diagnosis?
. Femoral head articular defect
. Acetabular articular defect
. Haversian fat pad hypertrophy
. Labral tear
. Loose body

Correct Answer & Explanation

. Labral tear

Explanation

The motorized shaver is adjacent to the acetabular labrum, which is torn. The femoral head and acetabulum are normal in appearance. Neither the fat pad nor a loose body is identified.

Question 1342

Topic: 5. Sports Medicine

A 22-year-old college baseball pitcher reports the recent onset of anterior and posterosuperior shoulder pain in his throwing shoulder. Examination shows a 15-degree loss of internal rotation, tenderness over the coracoid, and a positive relocation test. Radiographs are normal, and an MRI scan without contrast shows no definitive lesions. A rehabilitation program is prescribed. Which of the following regimens should be initially employed? Review Topic

. Stretching the posterior capsule and pectoralis minor tendon
. Stretching the posterior capsule and strengthening the subscapularis
. Stretching the posterior capsule and using shoulder plyometrics
. Stretching the anterior capsule and strengthening all components of the rotator cuff
. Stretching the anterior capsule and improving pitching mechanics

Correct Answer & Explanation

. Stretching the posterior capsule and pectoralis minor tendon

Explanation

Throwing athletes, particularly pitchers, have a high incidence of shoulder pain. Recent evidence suggests that posteroinferior capsular tightness and scapular dyskinesis may play a substantial role in the pathologic cascade, culminating in the development of articular surface rotator cuff tears and tearing of the posterosuperior labrum. These patients have posterosuperior shoulder pain primarily. Furthermore, these athletes are susceptible to a muscular fatigue syndrome, the SICK (Scapular malposition, Inferior medial border prominence, Coracoid pain and malposition, and dysKinesis of scapular movement) scapula syndrome. This patient has an internal rotation deficit and tenderness over the coracoid. The internal rotation deficit is addressed by stretching the posterior capsule. The tenderness over the coracoid has been attributed to a contracture of the pectoralis minor tendon secondary to scapular malposition. The initial phase of the rehabilitation regimen is directed at stretching the posterior capsule and pectoralis minor tendon.

Question 1343

Topic: Shoulder & Hip Sports
A 23-year-old man reports a 6-year history of recurrent instability in the right dominant shoulder. He has not undergone surgery and has essentially stopped all of his sporting activities. On examination, he has instability and apprehension in the midrange of motion (abduction of 45 to 60 degrees with external rotation) and a palpable clunk representing a transient dislocation over the anterior glenoid rim. A three-dimensional CT scan is shown in Figure 31. What is the most appropriate surgical intervention to provide him with reliable stability postoperatively?
. Arthroscopic Bankart surgery
. Bony glenoid augmentation procedure
. Subscapularis advancement
. Open capsular shift
. Hemiarthroplasty

Correct Answer & Explanation

. Bony glenoid augmentation procedure

Explanation

DISCUSSION: In the setting of significant anteroinferior glenoid bone deficiency (greater than 20% to 25%), both open and arthroscopic Bankart repairs have demonstrated higher rates of failure. Bony glenoid augmentation procedures such as the Bristow-Latarjet, which describe coracoid transfers to reconstruct the deficient glenoid, have led to decreased rates of recurrent shoulder instability. In this scenario, the patient has a significant loss of glenoid bone. There are also several clues in the history to suspect bone deficiency: multiple recurrences, a long history of recurrence, and instability in the midranges of motion. A bony augmentation procedure such as the Latarjet has been well-described to provide a well functioning and stable shoulder joint.

Question 1344

Topic: 5. Sports Medicine

Figures 1 and 2 are the AP and lateral radiographs of a 32-year-old man 10 years after anterior cruciate ligament (ACL) reconstruction. The patient now has worsening medial knee pain and a failed ACL with instability. What is the best surgical option?

. Revision ACL with bone-patellar tendon-bone (BTB) allograft and meniscal transplant
. Distal femoral osteotomy
. Pure sagittal osteotomy
. Closing wedge and slope neutralizing high-tibial osteoto

Correct Answer & Explanation

. Revision ACL with bone-patellar tendon-bone (BTB) allograft and meniscal transplant

Explanation

Lateral closing wedge (LCW) and medial opening wedge (MOW) high-tibial osteotomies (HTOs) can both correct varus knee alignment and stabilize the ACL–deficient knee. Increasingly, HTO is being proposed as a singular or concomitant procedure with ACL reconstruction for restoring knee stability and as a more reliable slope correction. LCW HTO demonstrates more reliable slope correction than does MOW HTO. Revision ACL with BTB allograft and meniscal transplant will not help early arthritis in varus alignment. Distal femoral osteotomy is usually considered for valgus knee. Pure sagittal osteotomywould not help the patient’s medial knee pain, arthritis, and malalignment.

Question 1345

Topic: 5. Sports Medicine
Figure 16 shows the lateral radiograph of a patient who is scheduled to undergo an anterior cruciate ligament (ACL) reconstruction. If the graft is tensioned at 20° of flexion and the femoral tunnel is created by passing a reamer over the guide wire marked “A,” the resulting ligament reconstruction will excessively
. tighten as the knee extends past 10° of flexion.
. tighten as the knee flexes past 90°.
. loosen as the knee extends past 10° of flexion.
. loosen as the knee flexes past 30°.
. loosen as the knee flexes past 90°.

Correct Answer & Explanation

. tighten as the knee flexes past 90°.

Explanation

DISCUSSION: If the femoral tunnel is created using guide wire A, it will be too far anterior in the intercondylar notch. The distance between a central tibial insertion for the ACL and an anterior femoral tunnel will progressively increase as the knee is flexed. Therefore, if the graft is tensioned near extension, the ligament will excessively tighten as the knee flexes past 90°. This will result in restricted knee flexion or failure of the graft as full flexion is gained. There will be little effect on the ligament as it extends from 20° to 0° of flexion. If the graft is tensioned in significant flexion (greater than 60°), it will be excessively loose as the knee fully extends.

Question 1346

Topic: Knee Sports

A player on a professional football team sustains a knee injury and is diagnosed with an anterior cruciate ligament rupture. When employed as the team physician, your ethical obligation is to inform

. the player but not the team.
. the team but not the player.
. neither the team nor the player.
. both the team and the player.
. the team, the player, and the media

Correct Answer & Explanation

. the player but not the team.

Explanation

When you are employed as a team physician, you are obligated to inform the players and the team organization of all athletically relevant medical issues. This differs significantly from the normal rule of patient confidentiality. If the player came to see you and you were not the team physician, you may not inform the team unless the player so desires. As the team physician, you are not obligated to inform the media.

Question 1347

Topic: 5. Sports Medicine

A high school football player asks you about an oral supplement that increases body mass and improves sprint times. He would like to use it to improve performance. What is the most likely agent? Review Topic

. Creatine
. Caffeine
. Testosterone
. Human growth hormone
. Ephedrine

Correct Answer & Explanation

. Creatine

Explanation

The supplement is creatine. Approximately 17% of high school athletes and about 30% of high school football players use creatine. Creatine is a protein synthesized in the liver and the kidney, circulates in the bloodstream, and is incorporated into muscle. Its use is associated with increased muscle mass, short-term improvement in sprinting, and may allow for increased anaerobic resistance performance. Caffeine and ephedrine are taken orally but do not increase muscle mass. Testosterone and human growth hormone are both associated with increased body mass but must be injected.

Question 1348

Topic: 5. Sports Medicine
What tendon has an intra-articular (intrasynovial) location in the knee joint?
. Patellar
. Popliteal
. Semitendinosus
. Semimembranosus
. Biceps femoris

Correct Answer & Explanation

. Popliteal

Explanation

The popliteal tendon arises from the posterior aspect of the tibia and courses through the knee joint through the popliteus hiatus of the lateral meniscus before attaching on the lateral femur anterior to the lateral collateral ligament. It is the only tendon in the knee joint that can be viewed directly on arthroscopy.

Question 1349

Topic: Shoulder & Hip Sports

In evaluating a patient for femoroacetabular impingement (FAI), a true AP pelvis radiograph demonstrates the projection of the anterior acetabular wall crossing the posterior acetabular wall. This 'crossover sign' is most strongly indicative of which of the following pathomorphologies?

. Cam impingement
. Focal cranial acetabular retroversion
. Global acetabular retroversion
. Coxa profunda
. Protrusio acetabuli

Correct Answer & Explanation

. Focal cranial acetabular retroversion

Explanation

The 'crossover sign' is a key radiographic marker seen on an AP pelvis radiograph where the line of the anterior acetabular rim crosses the line of the posterior acetabular rim. It specifically indicates focal cranial (or anterior) acetabular retroversion, which is a common cause of pincer-type femoroacetabular impingement. Global retroversion would also typically show an abnormal prominent ischial spine sign.

Question 1350

Topic: Knee Sports
During reconstruction of the medial patellofemoral ligament (MPFL) for recurrent patellar instability, accurate identification of the anatomic femoral attachment (Schöttle's point) is critical to prevent graft anisometry. On a strictly lateral radiograph of the knee, where is Schöttle's point accurately located?
. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line
. 5 mm posterior to the posterior cortex extension line, exactly centered on Blumensaat's line
. 2 mm anterior to the anterior cortex extension line, distal to the deepest portion of the trochlear groove
. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and distal to Blumensaat's line
. Exactly at the intersection of the posterior cortex extension line and Blumensaat's line

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat's line

Explanation

According to Schöttle et al., the radiographic landmark for the femoral footprint of the MPFL on a strict lateral radiograph is 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and distinctly proximal to the posterior extension of Blumensaat's line. Placing the graft here ensures optimal isometry during knee flexion and extension.

Question 1351

Topic: Knee Sports

A 45-year-old female presents with acute medial knee pain after a squatting maneuver. MRI reveals a complete radial tear at the posterior root of the medial meniscus, with 4 mm of medial meniscal extrusion. Biomechanically, this specific injury pattern is most equivalent to which of the following conditions?

. Total medial meniscectomy
. Loss of exactly 50% of the medial meniscal volume
. Anterior cruciate ligament deficiency
. Isolated deep medial collateral ligament tear
. Loss of the meniscofemoral ligaments of Wrisberg and Humphrey

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

The meniscal roots securely anchor the meniscus to the tibial plateau, allowing the meniscus to convert axial loads into circumferential 'hoop stresses'. A complete tear of the posterior root disrupts these hoop stresses entirely, leading to meniscal extrusion. Biomechanical studies have demonstrated that a root tear results in contact pressures and kinematics that are statistically equivalent to a total meniscectomy.

Question 1352

Topic: 5. Sports Medicine

A 10-year-old male (Tanner stage 1, skeletal age 10) sustains a midsubstance anterior cruciate ligament (ACL) rupture. To successfully reconstruct the ligament while minimizing the risk of physeal growth arrest and iatrogenic angular deformity, which of the following reconstructive techniques is most appropriate?

. Standard transphyseal reconstruction utilizing bone-patellar tendon-bone autograft
. Iliotibial band extra-articular tenodesis combined with a central transphyseal hamstring graft
. All-epiphyseal reconstruction using a soft-tissue autograft
. Partial transphyseal reconstruction involving only the tibial tunnel with an over-the-top femoral position
. Primary ACL repair utilizing rigid suture anchors implanted deeply into the intercondylar notch

Correct Answer & Explanation

. All-epiphyseal reconstruction using a soft-tissue autograft

Explanation

In prepubescent children with significant growth potential remaining (Tanner stage 1 or 2), physeal-sparing techniques are strongly recommended to avoid growth arrest or angular deformity. The all-epiphyseal reconstruction places the tunnels entirely within the epiphysis, avoiding the distal femoral and proximal tibial physes completely. Standard transphyseal techniques and bone plugs carry an unacceptably high risk of growth arrest in this age group.

Question 1353

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, the surgeon inadvertently places the femoral tunnel too anterior (shallow) in the intercondylar notch. What is the expected kinematic consequence of this technical error?

. Excessive graft tension in extension and laxity in flexion
. Excessive graft tension in flexion and laxity in extension
. Equal tension throughout the entire range of motion
. Severe graft impingement in the intercondylar notch during extension
. Medial compartment overload leading to early arthrosis

Correct Answer & Explanation

. Excessive graft tension in extension and laxity in flexion

Explanation

An anteriorly (shallow) placed femoral tunnel in ACL reconstruction captures a rotational axis that causes the graft to become excessively tight in flexion and loose in extension, potentially limiting terminal flexion.

Question 1354

Topic: Shoulder & Hip Sports

In the evaluation of a 22-year-old athlete with suspected femoroacetabular impingement (FAI), a cross-table lateral radiograph of the hip demonstrates an alpha angle of 65 degrees. Where is the cam morphology most likely located based on this specific view?

. Anterosuperior head-neck junction
. Posteroinferior head-neck junction
. Direct superior head-neck junction
. Anteroinferior head-neck junction
. Fovea capitis

Correct Answer & Explanation

. Anterosuperior head-neck junction

Explanation

The cross-table lateral radiograph best profiles the anterosuperior aspect of the femoral head-neck junction, which is the most common location for cam lesions in FAI.

Question 1355

Topic: 5. Sports Medicine

A patient with chronic posterolateral corner (PLC) deficiency presents with a varus thrust during gait. Full-length standing radiographs reveal a mechanical axis that passes medial to the medial tibial plateau. What is the most appropriate initial surgical intervention?

. Isolated fibular collateral ligament reconstruction
. High tibial osteotomy (valgus-producing)
. Distal femoral osteotomy (varus-producing)
. Primary total knee arthroplasty
. Meniscal allograft transplantation

Correct Answer & Explanation

. Isolated fibular collateral ligament reconstruction

Explanation

In a patient with chronic PLC deficiency and significant varus malalignment, a valgus-producing high tibial osteotomy should be performed first. Soft tissue reconstruction alone in the presence of severe varus malalignment has a high failure rate.

Question 1356

Topic: Knee Sports

During medial patellofemoral ligament (MPFL) reconstruction, the surgeon places the femoral tunnel proximal and anterior to the true anatomic insertion (Schottle point). What is the primary kinematic abnormality caused by this error?

. Excessive graft tightness in extension
. Excessive graft tightness in flexion
. Lateral patellar subluxation in deep flexion
. Medial patellar subluxation in extension
. No significant effect on patellar tracking

Correct Answer & Explanation

. Excessive graft tightness in extension

Explanation

A femoral tunnel placed too proximal and anterior in MPFL reconstruction will result in the graft increasing in tension as the knee flexes. This excessive tightness in flexion restricts motion and increases medial patellofemoral contact pressures.

Question 1357

Topic: Knee Sports
During medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon uses fluoroscopy to identify Schöttle's point for the femoral tunnel. Which of the following radiographic landmarks correctly defines this location on a strict lateral radiograph?
. 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior articular border, and proximal to Blumensaat's line
. 1 mm anterior to the posterior cortex extension line, 2.5 mm proximal to the posterior articular border, and proximal to Blumensaat's line
. 2 mm posterior to the anterior cortex extension line, and distal to Blumensaat's line
. At the exact center of the medial femoral epicondyle
. At the intersection of the adductor tubercle and the medial epicondyle

Correct Answer & Explanation

. 1 mm anterior to the posterior cortex extension line, 2.5 mm proximal to the posterior articular border, and proximal to Blumensaat's line

Explanation

Schöttle's point identifies the anatomic femoral origin of the MPFL. On a strict lateral view, it is located 1 mm anterior to a line extending the posterior femoral cortex, 2.5 mm proximal to the posterior articular border, and proximal to Blumensaat's line.

Question 1358

Topic: Shoulder & Hip Sports

A 25-year-old professional hockey player presents with groin pain exacerbated by hip flexion and internal rotation. Imaging reveals a prominent osseous bump at the anterolateral femoral head-neck junction with an alpha angle of 68 degrees. This morphology primarily leads to which type of labral and chondral damage?

. Contrecoup cartilage injury of the posteroinferior acetabulum
. Avulsion of the ligamentum teres
. Delamination of the anterosuperior acetabular cartilage with relative labral sparing initially
. Primary labral tearing with secondary central cartilage wear
. Global uniform loss of articular cartilage space

Correct Answer & Explanation

. Contrecoup cartilage injury of the posteroinferior acetabulum

Explanation

Cam morphology (alpha angle >55 degrees) produces shear forces during hip flexion/internal rotation, causing 'outside-in' delamination of the anterosuperior acetabular cartilage. The labrum is often pushed outward and spared initially, unlike pincer impingement where labral failure is primary.

Question 1359

Topic: Knee Sports

During reconstruction of the posterior cruciate ligament (PCL), anatomically recreating the anterolateral (AL) bundle is crucial for restoring native kinematics. What is the primary biomechanical function of the AL bundle of the PCL?

. Resist posterior tibial translation in full extension
. Resist posterior tibial translation at 90 degrees of knee flexion
. Resist external tibial rotation at 30 degrees of flexion
. Resist anterior tibial translation in deep flexion
. Act as the primary restraint to varus stress

Correct Answer & Explanation

. Resist posterior tibial translation in full extension

Explanation

The PCL consists of two main bundles: the anterolateral (AL) and posteromedial (PM). The AL bundle is tightest in flexion and is the primary restraint to posterior tibial translation at 90 degrees of knee flexion, making it the primary target in single-bundle reconstructions.

Question 1360

Topic: Shoulder & Hip Sports

In the pathomorphology of femoroacetabular impingement (FAI), what specific pattern of articular cartilage damage is most characteristic of a classic Cam-type lesion?

. Circumferential global acetabular chondromalacia
. Posterior labral tearing with contrecoup anterior cartilage injury
. Anterosuperior labral detachment with adjacent deep acetabular cartilage delamination
. Hypertrophy and ossification of the transverse acetabular ligament
. Avulsion of the ligamentum teres with foveal cartilage erosion

Correct Answer & Explanation

. Circumferential global acetabular chondromalacia

Explanation

Cam impingement occurs when a non-spherical femoral head engages the acetabulum during flexion. This creates severe shear forces that typically result in anterosuperior labral tears and classic 'delamination' of the adjacent acetabular articular cartilage.

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