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5. Sports Medicine MCQs

Practice Set 8 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 141

Topic: Shoulder & Hip Sports

To avoid injury associated with repetitive internal impingement, the pitchers long humeral axis must be in which position during the late cocking phase of throwing:

. 20° extended relative to the plane of the scapula
. 10° extended relative to the plane of the scapula
. Parallel to the plane of the scapula
. 10° flexed relative to the plane of the scapula
. 20° flexed relative to the plane of the scapula

Correct Answer & Explanation

. Parallel to the plane of the scapula

Explanation

Hyperangulation during the late cocking phase of throwing can result in impingement of the greater tuberosity on the posterosuperior glenoid rim leading to labral or rotator cuff lesions. Positioning of the humeral axis parallel to the plane of the scapula is recommended to avoid injury associated with internal impingement.

Question 142

Topic: Shoulder & Hip Sports

Which of the following factors is related to recurrence after primary anterior shoulder dislocation:

. Type of sport practiced
. Treatment with immobilization
. Treatment with physical therapy
. Patient gender
. Patient age

Correct Answer & Explanation

. Patient age

Explanation

The only known factor that statistically correlates with recurrence of anterior shoulder instability is patient age at the time of initial dislocation. A recent study demonstrated that patients having an initial dislocation during the third decade have more than a 60% chance of redislocating. The type of sport practiced, type of nonoperative treatment, and patient gender do not influence recurrence rate.

Question 143

Topic: Knee Sports

Use of functional knee bracing after anterior cruciate ligament (AC L) reconstruction will most likely result in which of the following scenarios:

. Better range of motion at the 2-year follow-up
. Better knee stability at the 2-year follow-up
. Better knee function at the 2-year follow-up
. More knee pain at the 3-month follow-up
. More quadriceps atrophy at the 3-month follow-up

Correct Answer & Explanation

. More quadriceps atrophy at the 3-month follow-up

Explanation

Two-year follow-up has failed to show any differences in range of motion, stability, function, strength, pain, or atrophy in patients who were braced after AC L reconstruction vs. patients who were treated without a brace. The only difference between the two groups is that the braced group has better knee function in the early postoperative period, despite having more quadriceps atrophy.

Question 144

Topic: Shoulder & Hip Sports

The stabilizing ligamentous pulley of the long head of the biceps at the shoulder is composed of fibers from all of the following structures except:

. Superior glenohumeral ligament
. Middle glenohumeral ligament
. Coracohumeral ligament
. Subscapularis tendon
. Supraspinatus tendon

Correct Answer & Explanation

. Middle glenohumeral ligament

Explanation

The stabilizing ligamentous pulley system of the long head of the biceps at the shoulder is a coalescence of the coracohumeral ligament and superior glenohumeral ligament. It also receives fiber contributions from the supraspinatus and subscapularis tendons.

Question 145

Topic: Shoulder & Hip Sports
When assessing patient outcomes after rotator cuff repair, which of the following is not related to poor functional outcome?
. Workman's compensation
. Revision rotator cuff repair
. Male gender
. Age older than 55 years at the time of repair
. Age younger than 55 years at the time of repair

Correct Answer & Explanation

. Male gender

Explanation

A large outcome study of more than 600 rotator cuff repairs demonstrated that workman's compensation, revision surgery, male gender, and age younger than 55 years at the time of repair are factors contributing to poor functional outcome and decreased workability following rotator cuff repair.

Question 146

Topic: 5. Sports Medicine

When using open measurement as the standard, which of the following is the most reliable instrument to measure rotator cuff tear size:

. Arthroscopy
. Magnetic resonance imaging
. Ultrasonography
. C omputed tomography
. C linical examination

Correct Answer & Explanation

. Arthroscopy

Explanation

Of the modalities listed, arthroscopy most closely estimates the actual size of a rotator cuff tear. Magnetic resonance imaging and ultrasound are similar in their ability to determine rotator cuff tear size. Computed tomography (without arthrography) is poor in evaluation of the rotator cuff. A detailed clinical examination is helpful in determining which tendons are torn, however elucidation of the specific size of the tear on physical examination is unlikely.

Question 147

Topic: Knee Sports

The microfracture technique for articular cartilage lesions is most successful for which chondral lesions:

. 2 cm diameter
. Smaller than a 2 cm diameter
. Kissing lesions
. Loss of subchondral bone integrity
. Partial thickness chondral lesions

Correct Answer & Explanation

. Smaller than a 2 cm diameter

Explanation

The inventors of the microfracture technique described a 70% to 80% success rate after microfracture of lesions smaller than 2 cm in diameter. The technique involves maintenance of some subchondral bone integrity and is indicated for full thickness chondral lesions. Lesions involving both the tibia and femur have resulted in less satisfactory outcomes.

Question 148

Topic: Knee Sports

The following structures are found in the superficial layer of the posterolateral corner:

. The biceps tendon and fabellofibular ligament
. The patellofemoral ligaments and quadriceps retinaculum
. The iliotibial tract and biceps tendon
. The joint capsule and fabellofibular ligament
. The popliteofibular ligament and biceps tendon

Correct Answer & Explanation

. The iliotibial tract and biceps tendon

Explanation

An anatomic study described three distinct layers that compose the posterolateral corner of the knee. Layer one includes the biceps tendon, the iliotibial tract, the prepatellar bursa, and peroneal nerve. Layer two includes the quadriceps retinaculum and patellofemoral ligaments. Layer three, the deepest layer, includes the lateral part of the joint capsule, the popliteus tendon passing through the hiatus, the fibular collateral ligament, the fabellofibular ligament, arcuate complex, and popliteofibular ligament.

Question 149

Topic: Knee Sports

The following structures are found in the second, or middle layer, of the posterolateral corner:

. The biceps tendon and fabellofibular ligament
. The patellofemoral ligaments and quadriceps retinaculum
. The iliotibial tract and biceps tendon
. The joint capsule and fabellofibular ligament
. The popliteofibular ligament and biceps tendon

Correct Answer & Explanation

. The patellofemoral ligaments and quadriceps retinaculum

Explanation

An anatomic study described three distinct layers that compose the posterolateral corner of the knee. Layer one includes the biceps tendon, the iliotibial tract, the prepatellar bursa, and peroneal nerve. Layer two includes the quadriceps retinaculum and patellofemoral ligaments. Layer three, the deepest layer, includes the lateral part of the joint capsule, the popliteus tendon passing through the hiatus, the fibular collateral ligament, the fabellofibular ligament, arcuate complex, and popliteofibular ligament.

Question 150

Topic: Knee Sports

The following structures are found in the deep layer of the posterolateral corner:

. The biceps tendon and fabellofibular ligament
. The patellofemoral ligaments and quadriceps retinaculum
. The iliotibial tract and biceps tendon
. The joint capsule and fabellofibular ligament
. The popliteofibular ligament and biceps tendon

Correct Answer & Explanation

. The joint capsule and fabellofibular ligament

Explanation

An anatomic study described three distinct layers that compose the posterolateral corner of the knee. Layer one includes the biceps tendon, the iliotibial tract, the prepatellar bursa, and peroneal nerve. Layer two includes the quadriceps retinaculum and patellofemoral ligaments. Layer three, the deepest layer, includes the lateral part of the joint capsule, the popliteus tendon passing through the hiatus, the fibular collateral ligament, the fabellofibular ligament, arcuate complex, and popliteofibular ligament.

Question 151

Topic: Knee Sports

The reverse pivot shift is most useful for diagnosing which of the following knee injuries:

. Anterior cruciate ligament injuries
. Posterior cruciate ligament injuries
. Medial collateral ligament injuries
. Posterolateral corner injuries
. Meniscal injuries

Correct Answer & Explanation

. Posterolateral corner injuries

Explanation

The reverse pivot shift is positive if there is a palpable shift or jerk as the lateral tibial plateau reduces while bringing the knee from 90° of flexion to full extension with the foot in external rotation. This is indicative of posterolateral corner knee injury but has been reported to be positive in 11% to 35% of normal asymptomatic patients.

Question 152

Topic: Knee Sports

When using the tibial external rotation test on a patient, increased external rotation at 30° but not at 90° of knee flexion is indicative of:

. Anterior cruciate ligament injury
. Posterior cruciate ligament injury
. Isolated posterolateral corner injury
. Posterior cruciate and posterolateral corner injury
. Anterior cruciate and posterior cruciate ligament injury

Correct Answer & Explanation

. Isolated posterolateral corner injury

Explanation

The tibial external rotation test is performed at 30° and 90° of knee flexion. The degree of foot external rotation with regard to the femur is evaluated. Increased external rotation at 30 ° is consistent with an isolated posterolateral corner injury. Increased external rotation at 30° and 90° is consistent with a combined posterolateral and posterior cruciate ligament injury.

Question 153

Topic: 5. Sports Medicine

In a 16-year-old elite female soccer player undergoing primary ACL reconstruction, which of the following graft choices is associated with the highest risk of re-rupture?

. Bone-patellar tendon-bone autograft
. Hamstring autograft
. Quadriceps tendon autograft
. Irradiated bone-patellar tendon-bone allograft
. Non-irradiated soft tissue allograft

Correct Answer & Explanation

. Irradiated bone-patellar tendon-bone allograft

Explanation

Allografts, especially irradiated ones, have a significantly higher failure rate in young, highly active patients compared to autografts. Bone-patellar tendon-bone and hamstring autografts remain the gold standard in this demographic.

Question 154

Topic: Knee Sports

During reconstruction of the medial patellofemoral ligament (MPFL) for recurrent patellar instability, the femoral tunnel must be placed at the anatomic origin. Where is this located radiographically (Schottle's point)?

. Anterior to the posterior cortical line and proximal to Blumensaat's line
. Anterior to the posterior cortical line and distal to Blumensaat's line
. Posterior to the posterior cortical line and proximal to Blumensaat's line
. Posterior to the posterior cortical line and distal to Blumensaat's line
. Directly on Blumensaat's line at the anterior cortex

Correct Answer & Explanation

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

Explanation

Schottle's point is located approximately 1 mm anterior to the posterior cortical line and proximal to the posterior extension of Blumensaat's line. Precise placement is critical to avoid non-isometric graft tensioning.

Question 155

Topic: Knee Sports

A patient presents with knee pain and instability after a hyperextension injury. The Dial test demonstrates increased external rotation at 30 degrees of knee flexion but normal rotation at 90 degrees compared to the contralateral side. This finding indicates injury to which of the following structures?

. Posterior cruciate ligament (PCL) only
. Posterolateral corner (PLC) only
. Both PCL and PLC
. Anterior cruciate ligament (ACL)
. Medial collateral ligament (MCL)

Correct Answer & Explanation

. Posterolateral corner (PLC) only

Explanation

Increased external rotation at 30 degrees of flexion with normal rotation at 90 degrees indicates an isolated posterolateral corner injury. If external rotation is increased at both 30 and 90 degrees, it suggests a combined PLC and PCL injury.

Question 156

Topic: Knee Sports

A 50-year-old woman complains of posterior medial knee pain after a deep squat. MRI reveals a medial meniscus posterior root tear. Biomechanically, this injury is most equivalent to which of the following?

. Normal knee kinematics
. Anterior cruciate ligament tear
. Total medial meniscectomy
. Partial medial meniscectomy
. Posterior cruciate ligament tear

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior meniscal root tear disrupts the circumferential hoop stresses of the meniscus, causing it to extrude. Biomechanically, it leads to increased contact pressures comparable to a total meniscectomy.

Question 157

Topic: Knee Sports

In posterior cruciate ligament (PCL) reconstruction, the tibial inlay technique was developed primarily to avoid which of the following complications associated with the transtibial technique?

. Neurovascular injury
. Graft attenuation at the killer turn
. Posterior knee stiffness
. Deep joint infection
. Saphenous nerve neuritis

Correct Answer & Explanation

. Graft attenuation at the killer turn

Explanation

The tibial inlay technique avoids the sharp angle, known as the 'killer turn', at the posterior tibial aperture seen in transtibial PCL reconstruction. This sharp turn can lead to graft abrasion, attenuation, and eventual failure.

Question 158

Topic: 5. Sports Medicine

A 24-year-old overhead athlete is diagnosed with a Type II SLAP lesion. During diagnostic arthroscopy, the 'peel-back' mechanism is observed. In which shoulder position is this sign most optimally elicited?

. Abduction and external rotation
. Abduction and internal rotation
. Forward flexion and internal rotation
. Adduction and external rotation
. Adduction and internal rotation

Correct Answer & Explanation

. Abduction and external rotation

Explanation

The peel-back mechanism is evaluated by placing the arm in abduction and external rotation (ABER). This causes the biceps vector to shift posteriorly and peel the superior labrum off the glenoid rim.

Question 159

Topic: Shoulder & Hip Sports

A 19-year-old gymnast presents with bilateral shoulder pain and a sensation of instability. Examination shows a positive sulcus sign and positive apprehension in both anterior and posterior directions. What is the most appropriate initial management?

. Arthroscopic capsular plication
. Open inferior capsular shift
. Rotator cuff strengthening and periscapular stabilization program
. Thermal capsulorrhaphy
. Arthroscopic Bankart repair

Correct Answer & Explanation

. Rotator cuff strengthening and periscapular stabilization program

Explanation

The patient has multidirectional instability (MDI). The first-line treatment for MDI is a prolonged course of physical therapy focusing on periscapular and rotator cuff strengthening to provide dynamic stabilization.

Question 160

Topic: Knee Sports

A 12-year-old boy presents with vaguely localized knee pain and intermittent catching. Radiographs reveal an osteochondritis dissecans (OCD) lesion. What is the most common anatomic location for an OCD lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Lateral aspect of the lateral femoral condyle
. Medial aspect of the lateral femoral condyle
. Central trochlear groove

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for osteochondritis dissecans in the knee is the lateral aspect of the medial femoral condyle. It accounts for approximately 70-80% of all knee OCD lesions.

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