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5. Sports Medicine MCQs

Practice Set 85 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 1681

Topic: Knee Sports
What is the primary advantage of Matrix-Induced Autologous Chondrocyte Implantation (MACI) compared to traditional first-generation Autologous Chondrocyte Implantation (ACI) for treating full-thickness chondral defects?
. It can be performed as a single-stage procedure.
. It eliminates the need for a periosteal patch, reducing the risk of graft hypertrophy.
. It stimulates the production of Type I collagen predominantly, making the graft stronger.
. It utilizes allogeneic chondrocytes, eliminating donor site morbidity entirely.
. It does not require adherence to strict postoperative weight-bearing restrictions.

Correct Answer & Explanation

. It eliminates the need for a periosteal patch, reducing the risk of graft hypertrophy.

Explanation

MACI utilizes a type I/III porcine collagen bilayer membrane seeded with the patient's cultured chondrocytes. A major advantage over first-generation ACI is that it does not require harvesting a periosteal patch to cover the defect. The use of a periosteal patch in traditional ACI was associated with a high rate of graft hypertrophy (up to 25%), which MACI significantly avoids.

Question 1682

Topic: Knee Sports

In a 14-year-old male with an osteochondritis dissecans (OCD) lesion of the medial femoral condyle, which of the following MRI findings is the most reliable indicator of lesion instability warranting surgical intervention over non-operative management?

. Bone marrow edema confined to the epiphysis
. A hyperintense T2 signal line extending completely behind the osteochondral fragment
. Subchondral sclerosis surrounding the lesion on T1-weighted images
. A lesion size of 1.5 cm in diameter
. Intact overlying articular cartilage visualized on proton density sequences

Correct Answer & Explanation

. Bone marrow edema confined to the epiphysis

Explanation

A high-intensity T2 signal line completely interposing between the OCD fragment and the underlying bone bed indicates that synovial fluid has tracked behind the fragment. This is a definitive sign of instability (a fluid cleft). Unstable lesions in both juveniles and adults generally require surgical stabilization, whereas stable lesions in juveniles with open physes may heal with rest.

Question 1683

Topic: Knee Sports
Following a microfracture procedure for a full-thickness chondral defect of the medial femoral condyle, a marrow-stimulating healing response occurs. The resulting repair tissue that fills the defect is predominantly characterized by the presence of which of the following?
. Type II collagen and high proteoglycan content
. Type I collagen and a lack of organized hyaline architecture
. Type X collagen and extensive calcification
. Type III collagen and abundant elastic fibers
. Type IX collagen and stratified squamous epithelium

Correct Answer & Explanation

. Type I collagen and a lack of organized hyaline architecture

Explanation

Microfracture penetrates the subchondral bone plate, releasing marrow elements (MSCs) that form a super-clot. This repairs the defect with fibrocartilage, which is predominantly composed of Type I collagen, unlike native hyaline articular cartilage, which is rich in Type II collagen. Fibrocartilage has inferior biomechanical properties and wear resistance compared to hyaline cartilage.

Question 1684

Topic: Shoulder & Hip Sports

A 30-year-old female presents with persistent groin pain exacerbated by hip flexion. An AP pelvis radiograph demonstrates that the center of the femoral head is located medial to the ilioischial line. Which of the following is the most accurate diagnosis?

. Coxa profunda
. Acetabular protrusio
. Cam-type femoroacetabular impingement
. Developmental dysplasia of the hip
. Focal acetabular retroversion

Correct Answer & Explanation

. Coxa profunda

Explanation

Acetabular protrusio is diagnosed when the center of the femoral head (or the medial wall of the acetabulum) crosses medial to the ilioischial line on an AP pelvis radiograph. In coxa profunda, the acetabular fossa touches or crosses the ilioischial line, but the center of the femoral head remains lateral to it.

Question 1685

Topic: Knee Sports
A 24-year-old professional athlete undergoes Matrix-induced Autologous Chondrocyte Implantation (MACI) for a symptomatic 4 cm² full-thickness chondral defect on the medial femoral condyle. What histological type of tissue is predominantly expected to form in the defect at 2 years postoperatively?
. Fibrocartilage rich in Type I collagen
. Hyaline-like cartilage rich in Type II collagen
. Fibrocartilage rich in Type X collagen
. Scar tissue lacking collagen network
. Calcified cartilage rich in Type IX collagen

Correct Answer & Explanation

. Hyaline-like cartilage rich in Type II collagen

Explanation

Autologous chondrocyte implantation techniques, including MACI, are designed to generate a repair tissue that closely resembles native hyaline cartilage ('hyaline-like'), which is predominantly composed of Type II collagen. In contrast, bone marrow stimulation techniques like microfracture produce primarily Type I collagen-rich fibrocartilage.

Question 1686

Topic: Knee Sports
What is the primary clinical and biological advantage of utilizing Matrix-induced Autologous Chondrocyte Implantation (MACI) compared to first-generation Autologous Chondrocyte Implantation (ACI) for focal full-thickness chondral defects?
. MACI completely eliminates the need for an initial arthroscopic cartilage harvest.
. MACI produces mature type II hyaline cartilage significantly faster than primary ACI.
. MACI utilizes a periosteal patch, increasing the integration rate with native subchondral bone.
. MACI avoids the harvest and suturing of a periosteal patch, significantly reducing the incidence of symptomatic graft hypertrophy.
. MACI relies exclusively on mesenchymal stem cells derived from bone marrow aspirate concentrate.

Correct Answer & Explanation

. MACI avoids the harvest and suturing of a periosteal patch, significantly reducing the incidence of symptomatic graft hypertrophy.

Explanation

First-generation ACI utilized a harvested periosteal patch sutured over the defect to contain the injected cultured chondrocytes. This periosteal patch was highly associated with symptomatic graft hypertrophy, often requiring reoperation for debridement. MACI seeds the cultured chondrocytes onto a biodegradable porcine collagen membrane (Type I/III), which can be glued or sutured into the defect, eliminating the need for periosteal harvest and significantly reducing the risk of graft hypertrophy.

Question 1687

Topic: Knee Sports

A 14-year-old male presents with knee pain. MRI reveals an osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. Which of the following MRI findings is the most specific indicator that the OCD lesion is unstable and requires surgical fixation rather than non-operative management?

. Subchondral bone marrow edema surrounding the lesion on T2-weighted imaging.
. A high-signal T2 line completely surrounding the osteochondral fragment.
. Intact overlying articular cartilage on a T1-weighted sequence.
. Sclerotic margins bordering the defect on proton density sequences.
. Presence of multiple small subchondral cysts adjacent to the fragment.

Correct Answer & Explanation

. A high-signal T2 line completely surrounding the osteochondral fragment.

Explanation

The most specific and reliable MRI sign of instability in an OCD lesion is a high T2-signal line that completely surrounds the fragment, indicating fluid interposition between the fragment and the native bone bed (a true non-union/separation). Subchondral cysts and edema can be present in stable lesions, but a complete rim of fluid beneath the fragment confirms mechanical instability requiring surgical intervention.

Question 1688

Topic: Shoulder & Hip Sports

In a patient presenting with isolated Pincer-type femoroacetabular impingement (FAI), characterized by focal acetabular overcoverage, what is the classic pattern of chondral damage encountered during hip arthroscopy?

. Broad delamination of the anterosuperior acetabular cartilage from sheer forces.
. Diffuse uniform thinning of the articular cartilage across the entire femoral head.
. A narrow circumferential strip of chondral damage along the acetabular rim with a 'contre-coup' chondral lesion on the posteroinferior acetabulum.
. Central acetabular full-thickness cartilage loss with an intact peripheral rim.
. Isolated ligamentum teres avulsion with corresponding medial head chondromalacia.

Correct Answer & Explanation

. A narrow circumferential strip of chondral damage along the acetabular rim with a 'contre-coup' chondral lesion on the posteroinferior acetabulum.

Explanation

Pincer FAI occurs due to acetabular overcoverage (e.g., retroversion, coxa profunda). The femoral neck linearly impacts the acetabular rim, causing damage to the labrum and a narrow strip of adjacent peripheral cartilage. As the neck levers against the anterior rim, the femoral head is driven backwards, creating a 'contre-coup' chondral lesion on the posteroinferior aspect of the acetabulum or posterior femoral head. In contrast, Cam FAI (nonspherical femoral head) causes sheer stress leading to deep, broad delamination of the anterosuperior acetabular cartilage.

Question 1689

Topic: 5. Sports Medicine
A 24-year-old athlete undergoes a microfracture procedure for a 1.5 cm² full-thickness chondral defect on the medial femoral condyle. Six months later, a second-look arthroscopy with biopsy is performed. The repair tissue filling the defect is predominantly characterized by which of the following?
. A disorganized matrix primarily composed of Type I collagen with inferior compressive stiffness compared to native cartilage.
. A highly organized matrix primarily composed of Type II collagen with superior tensile strength.
. A matrix rich in aggrecan and Type II collagen, virtually indistinguishable from the surrounding hyaline cartilage.
. An avascular matrix predominantly containing Type X collagen indicative of endochondral ossification.
. A dense network of elastin fibers and Type III collagen, characteristic of scar tissue.

Correct Answer & Explanation

. A disorganized matrix primarily composed of Type I collagen with inferior compressive stiffness compared to native cartilage.

Explanation

Microfracture is a marrow-stimulating technique that relies on the influx of bone marrow-derived mesenchymal stem cells into the chondral defect. These cells differentiate and produce fibrocartilage, rather than native hyaline cartilage. Fibrocartilage is predominantly composed of Type I collagen (unlike the Type II collagen of hyaline cartilage). It is biomechanically inferior, possessing lower compressive stiffness and wear resistance, which can lead to deterioration of the repair over time.

Question 1690

Topic: 5. Sports Medicine

A 20-year-old male develops rapid and devastating glenohumeral chondrolysis within 6 months following an arthroscopic Bankart repair. A review of the intraoperative and postoperative records suggests a highly implicated iatrogenic cause. Which of the following factors has been most definitively linked to postoperative chondrolysis in this setting?

. The use of bioabsorbable poly-L-lactic acid (PLLA) suture anchors.
. The prolonged intra-articular continuous infusion of bupivacaine via a pain pump.
. Aggressive thermal capsulorrhaphy using radiofrequency ablation.
. The use of high-volume normal saline irrigation fluid during arthroscopy.
. Postoperative immobilization for longer than 6 weeks.

Correct Answer & Explanation

. The prolonged intra-articular continuous infusion of bupivacaine via a pain pump.

Explanation

Postarthroscopic glenohumeral chondrolysis (PAGH) is a devastating complication characterized by rapid destruction of articular cartilage. A vast body of literature has definitively linked this complication to the use of continuous intra-articular pain pumps infusing local anesthetics, particularly bupivacaine (often combined with epinephrine). Bupivacaine has been shown in vitro and in vivo to be directly cytotoxic to chondrocytes, leading to widespread cellular necrosis and subsequent cartilage loss.

Question 1691

Topic: 5. Sports Medicine

When utilizing the impaction bone grafting (IBG) technique for femoral revision, which of the following mechanical conditions is an absolute biomechanical prerequisite for a successful outcome?

. A completely intact femoral diaphysis without any contained cortical defects
. The use of a polished, collarless, double-tapered cemented stem
. The use of large cortical strut allografts inside the medullary canal
. A minimum of 10 mm of residual host endosteal cortical bone thickness
. The concurrent use of a constrained acetabular liner

Correct Answer & Explanation

. A completely intact femoral diaphysis without any contained cortical defects

Explanation

Impaction bone grafting (IBG) on the femoral side relies on the radial expansion of the cement and graft mantle under compressive load to "lock" the construct. This biomechanical concept (slip-subsidence) absolutely requires a highly polished, collarless, double-tapered stem (such as the Exeter stem) that can predictably subside slightly into the cement/graft mantle and generate the necessary hoop stresses.

Question 1692

Topic: 5. Sports Medicine
A 24-year-old athlete undergoes marrow stimulation (microfracture) for a 2 cm² full-thickness chondral defect on the medial femoral condyle. The resultant repair tissue generated by this procedure is primarily characterized by the presence of which of the following?
. Type II collagen and high proteoglycan content
. Type I collagen and low proteoglycan content
. Type X collagen and calcium hydroxyapatite
. Type III collagen and extreme hypercellularity
. Elastin and lubricin

Correct Answer & Explanation

. Type I collagen and low proteoglycan content

Explanation

Microfracture allows marrow elements to fill the chondral defect, resulting in a fibrocartilage repair. Unlike native hyaline cartilage (which is primarily Type II collagen and rich in proteoglycans), fibrocartilage is predominantly composed of Type I collagen, has a lower proteoglycan content, and exhibits inferior mechanical properties and wear characteristics.

Question 1693

Topic: 5. Sports Medicine
Which factor has the most negative influence on the success of knee osteochondral allograft transplantation?
. Mechanical axis malalignment
. Blood-type matching of the host and donor
. Sex of the donor
. Failed previous cartilage procedure

Correct Answer & Explanation

. Mechanical axis malalignment

Explanation

Mechanical axis malalignment is a critical factor that must be addressed to ensure the success of osteochondral allograft transplantation. Failure to correct malalignment leads to increased contact pressures on the graft, resulting in premature failure. Other factors like donor-host blood matching or sex are not primary determinants of clinical success.

Question 1694

Topic: 5. Sports Medicine
A 15-year-old boy who participates in track reports acute pain along the left iliac crest during a sprint. Examination reveals that the anterior superior iliac spine is nontender. The most likely diagnosis is an injury to the:
. epiphysis.
. apophysis.
. enthesis.
. tendon.
. muscle.

Correct Answer & Explanation

. apophysis.

Explanation

The patient has iliac apophysitis. The radiographic findings are easily overlooked but usually reveal slight asymmetric widening of the iliac crest apophysis. The apophysis is the most vulnerable structure, as it is three to five times weaker than the tendon. This is not an epiphyseal site, and injury to the muscle or the tendinous insertion to bone (enthesis) is unlikely.

Question 1695

Topic: 5. Sports Medicine
What is the primary goal of the initial (acute) rehabilitation phase of an overhead athlete’s shoulder?
. Improve flexibility
. Strengthen muscles
. Enhance power and endurance
. Regain neuromuscular control
. Perform functional drills

Correct Answer & Explanation

. Improve flexibility

Explanation

DISCUSSION: The goal in the initial phase of shoulder rehabilitation is to improve flexibility, reestablish baseline dynamic stability, normalize muscle balance, and restore proprioception. In the advanced strengthening and final phase, the goals are to initiate aggressive strengthening drills, enhance power and endurance, perform functional drills, and to gradually initiate throwing activities.

Question 1696

Topic: Shoulder & Hip Sports
Figure 4a shows the radiograph of a 20-year-old man who has an injury to the right shoulder. Figure 4b shows an arthroscopic view (posterior portal). The arrow points to a
. rotator cuff tear.
. bare area.
. Hill-Sachs defect.
. Bankart tear.
. glenoid fracture.

Correct Answer & Explanation

. Hill-Sachs defect.

Explanation

DISCUSSION: The radiograph shows an anterior dislocation of the shoulder. A frequently encountered sequela of this is a compression fracture of the posterolateral humeral head, commonly referred to as a Hill-Sachs defect. The arthroscopic view of the glenohumeral joint visualizes the posterior aspect of the humeral head. In the image, the area devoid of cartilage to the right is the bare area. The indentation seen to the left is a Hill-Sachs defect.

Question 1697

Topic: 5. Sports Medicine

A 57-year-old man who plays recreational sports reports pain in his dominant shoulder. An MR arthrogram is shown in Figure 57. During arthroscopy of the shoulder, what pathology is most likely to be found? Review Topic

. Complete disruption of the transverse humeral ligament
. Acromioclavicular joint arthritis
. Absent coracohumeral ligament
. Subscapularis tear and biceps subluxation
. Complete rupture of the short head of the biceps

Correct Answer & Explanation

. Complete disruption of the transverse humeral ligament

Explanation

The MR arthrogram shows medial subluxation of the biceps tendon out of the bicipital groove and a subscapularis tendon tear. Biceps tendon subluxation is almost always associated with subscapularis tears. Whereas other diagnoses can be associated, none of them is directly related to this finding or seen on the MR arthrogram.

Question 1698

Topic: Shoulder & Hip Sports
Which of the following muscles attaches to the coracoid process of the scapula?
. Subscapularis
. Supraspinatus
. Pectoralis minor
. Long head of the biceps brachii
. Serratus anterior

Correct Answer & Explanation

. Pectoralis minor

Explanation

DISCUSSION: The insertion of the pectoralis minor is on the base of the coracoid process. The coracoid helps define the interval between the subscapularis and supraspinatus muscles but neither attaches to it. The coracobrachialis and short head of biceps attach to the tip of the coracoid but are not listed as options. The long head of the biceps attaches to the supraglenoid tubercle. The serratus arises from the vertebral border of the scapula.

Question 1699

Topic: 5. Sports Medicine
One week after closed reduction of a primary anterior shoulder dislocation, a 25-year-old athlete should be counseled that
. recurrence rate is reduced with 4 weeks of immobilization instead of 2 weeks of immobilization.
. age at the time of injury is the most consistent risk factor for recurrent instability.
. a majority of patients in this age group will elect to have surgery for recurrent instability.
. after an in-season return to sports, his likelihood of choosing surgery after the season is 25%.

Correct Answer & Explanation

. age at the time of injury is the most consistent risk factor for recurrent instability.

Explanation

In a study by Sachs and associates, age younger than 25 years at the time of presentation was found to be the strongest predictor of recurrent instability. In this age group (20-to 29-year-olds), only 14% elected to proceed with surgery. After an in-season return to sports, about 50% of patients in this same study chose to proceed with surgery after completing the season. Immobilization in a sling for longer than 2 weeks has no effect on future instability.

Question 1700

Topic: Knee Sports

The posterior horn of the medial meniscus receives its primary blood supply from what artery? Review Topic

. Middle genicular
. Medial inferior genicular
. Medial superior genicular
. Lateral superior genicular
. Inferior lateral genicular

Correct Answer & Explanation

. Middle genicular

Explanation

The middle genicular artery supplies the posterior capsule and intracapsular structures (anterior cruciate ligament, posterior cruciate ligament, posterior horns of the meniscus). The medial and lateral inferior geniculates anastomose anteriorly to form a capillary network to supply the fat pad, synovial cavity, and patellar tendon. The lateral superior and inferior genicular arteries supply the lateral retinaculum.

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