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5. Sports Medicine MCQs

Practice Set 87 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 1721

Topic: 5. Sports Medicine

A 22-year-old collision athlete presents with recurrent anterior shoulder instability. A 3D CT scan reveals 26% anterior glenoid bone loss. What is the most appropriate surgical intervention?

. Arthroscopic Bankart repair
. Open Bankart repair
. Latarjet procedure
. Arthroscopic Remplissage
. Iliac crest bone autograft to the humeral head

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

For glenoid bone loss greater than 20-25% in a collision athlete, an arthroscopic or open Bankart soft-tissue repair has an unacceptably high failure rate. A coracoid transfer (Latarjet procedure) or structural bone graft is indicated to restore the anterior bony arc and provide a sling effect via the conjoined tendon.

Question 1722

Topic: 5. Sports Medicine

When comparing bone-patellar tendon-bone (BTB) autograft to hamstring autograft for anterior cruciate ligament reconstruction, BTB autograft is associated with a statistically higher incidence of which of the following postoperative complications?

. Graft rupture
. Anterior knee pain
. Deep vein thrombosis
. Hardware-related failure
. Septic arthritis

Correct Answer & Explanation

. Graft rupture

Explanation

While both BTB and hamstring autografts provide excellent stability and return to play, BTB autograft has been consistently shown in the literature to have a higher rate of donor site morbidity, specifically anterior knee pain and difficulty kneeling, compared to hamstring autograft.

Question 1723

Topic: Knee Sports
A 28-year-old male sustains a multiligamentous knee injury. Which of the following injury patterns (Schenck classification) carries the highest risk of associated common peroneal nerve injury?
. Anterior knee dislocation without rotatory instability
. Posterior knee dislocation without rotatory instability
. KD-III-M (ACL, PCL, Medial side disrupted)
. KD-III-L (ACL, PCL, Lateral side disrupted)
. KD-I (Isolated ACL or PCL with dislocation)

Correct Answer & Explanation

. KD-III-L (ACL, PCL, Lateral side disrupted)

Explanation

Multiligament knee injuries involving the posterolateral corner (PLC) and lateral side (KD-III-L) are most highly associated with common peroneal nerve palsies. This is often due to the traction mechanism (varus and hyperextension) that injures both the lateral structures and the tethered peroneal nerve.

Question 1724

Topic: Shoulder & Hip Sports

A 48-year-old manual laborer presents with persistent shoulder pain. MRI arthrogram reveals an isolated Type II SLAP tear. Nonoperative management has failed. Current literature suggests which of the following surgical interventions provides the most reliable return to work and highest patient satisfaction in this demographic?

. Arthroscopic SLAP repair using one suture anchor
. Arthroscopic SLAP repair using two suture anchors
. Open stabilization of the labrum
. Primary subpectoral biceps tenodesis
. Debridement of the superior labrum without tenodesis

Correct Answer & Explanation

. Arthroscopic SLAP repair using one suture anchor

Explanation

In older patients (typically >35-40 years) and workers' compensation populations, primary biceps tenodesis for isolated Type II SLAP tears has been shown to have lower complication rates, lower reoperation rates, higher satisfaction, and more reliable return to work compared to SLAP repair, which carries a higher risk of postoperative stiffness and persistent pain.

Question 1725

Topic: Knee Sports

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

. Popliteal artery injury during tunnel reaming
. Anterior knee pain from graft harvest
. The "killer turn" effect on the graft
. Postoperative extension deficit
. Iatrogenic damage to the medial meniscus root

Correct Answer & Explanation

. Popliteal artery injury during tunnel reaming

Explanation

The tibial inlay technique avoids the acute sharp angle (the "killer turn") that the graft must negotiate when passed through a transtibial tunnel and over the posterior proximal tibia. This acute angle is theorized to lead to graft abrasion, attenuation, and eventual failure over time.

Question 1726

Topic: Knee Sports
In medial patellofemoral ligament (MPFL) reconstruction, incorrect femoral tunnel placement is the most common cause of graft failure. If the femoral tunnel is placed erroneously proximal to the anatomic footprint (Schรถttle point), how will the graft tension behave during knee range of motion?
. The graft will maintain isometric tension throughout motion.
. The graft will become excessively tight in flexion and loose in extension.
. The graft will become excessively tight in extension and loose in flexion.
. The graft will exclusively limit terminal extension.
. The graft will only be tight between 30 and 60 degrees of flexion.

Correct Answer & Explanation

. The graft will become excessively tight in flexion and loose in extension.

Explanation

The MPFL normally acts as a checkrein primarily in early flexion (0-30 degrees). If the femoral tunnel is placed too far proximal, the distance between the patellar and femoral attachments increases as the knee goes into deeper flexion. This causes the graft to become excessively tight in flexion, leading to medial patellar overload, stiffness, or graft failure.

Question 1727

Topic: Shoulder & Hip Sports

A 22-year-old competitive rugby player presents with recurrent anterior shoulder instability. He has had four prior dislocations. Imaging reveals a 22% anterior glenoid bone loss and an engaging Hill-Sachs lesion. His Instability Severity Index Score (ISIS) is 7. Which of the following is the most appropriate surgical management?

. Arthroscopic Bankart repair alone
. Arthroscopic Bankart repair with remplissage
. Open Latarjet procedure
. Open Bankart repair with inferior capsular shift
. Superior capsular reconstruction

Correct Answer & Explanation

. Arthroscopic Bankart repair alone

Explanation

In a young, high-demand contact athlete with recurrent anterior instability, significant glenoid bone loss (>20%), and a high ISIS score (>6), soft-tissue stabilization alone carries an unacceptably high failure rate. The Latarjet procedure (coracoid transfer to the anterior glenoid) is the standard of care for restoring stability through the 'triple blocking effect' (increasing articular arc, sling effect of the conjoint tendon, and capsular repair). Remplissage with Bankart is typically reserved for subcritical glenoid bone loss (<15-20%) with off-track engaging Hill-Sachs lesions.

Question 1728

Topic: Knee Sports

A complete radial tear adjacent to the posterior horn medial meniscus root attachment alters the biomechanics of the knee joint. Biomechanical studies have shown that peak contact pressures in this scenario most closely resemble which of the following conditions?

. An intact meniscus
. Total meniscectomy
. Partial meniscectomy
. Peripheral longitudinal tear repaired with inside-out technique
. Bucket-handle meniscal tear

Correct Answer & Explanation

. An intact meniscus

Explanation

A complete radial tear at or near the meniscal root completely disrupts the circumferential hoop fibers of the meniscus. Biomechanically, this leads to extrusion of the meniscus under axial load, effectively eliminating its load-sharing capability. Consequently, the peak contact pressures and contact areas in the medial compartment become essentially equivalent to those seen in a knee following a total meniscectomy.

Question 1729

Topic: 5. Sports Medicine

A 58-year-old manual laborer presents with profound weakness in external rotation of the shoulder and a positive hornblower's sign. MRI demonstrates a massive, retracted, and irreducible tear of the posterosuperior rotator cuff with advanced fatty infiltration of the infraspinatus and teres minor. The glenohumeral joint shows no signs of osteoarthritis. Which of the following tendon transfers is most appropriate to restore external rotation?

. Pectoralis major transfer
. Latissimus dorsi transfer
. Serratus anterior transfer
. Lower trapezius transfer
. Rhomboid major transfer

Correct Answer & Explanation

. Pectoralis major transfer

Explanation

In the setting of a massive, irreparable posterosuperior rotator cuff tear with an absent teres minor (evidenced by external rotation lag/Hornblower's sign) and intact glenohumeral cartilage, tendon transfer is indicated. The lower trapezius transfer, often augmented with Achilles allograft, has gained favor over latissimus dorsi transfer because its line of pull more closely replicates that of the infraspinatus, making it mechanically superior for restoring active external rotation and treating pseudoparalysis of external rotation.

Question 1730

Topic: 5. Sports Medicine

When considering graft choices for Anterior Cruciate Ligament (ACL) reconstruction, high-dose irradiation of bone-patellar tendon-bone allografts is sometimes utilized to ensure sterility. At what minimum irradiation dose are the structural and biomechanical properties of the graft significantly compromised?

. 0.5 Mrad
. 1.0 Mrad
. 1.5 Mrad
. 2.0 Mrad
. Greater than 2.5 Mrad

Correct Answer & Explanation

. 0.5 Mrad

Explanation

Terminal sterilization of allografts using gamma irradiation decreases the risk of disease transmission (e.g., HIV) but dose-dependently alters the biomechanical properties of the tissue. Studies show that doses > 2.5 Mrad cause significant alterations in the collagen cross-linking, leading to reduced structural integrity, stiffness, and ultimate load to failure, increasing the risk of graft rupture.

Question 1731

Topic: Knee Sports

A 12-year-old patient presents with vague knee pain and is diagnosed with Osteochondritis Dissecans (OCD) of the medial femoral condyle. Which of the following is the most reliable predictor of spontaneous healing with non-operative management?

. Lesion size greater than 2 cm
. Open distal femoral and proximal tibial physes
. Location on the central weight-bearing aspect of the lateral condyle
. Presence of mechanical symptoms such as catching or locking
. Sclerotic margins surrounding the lesion on plain radiographs

Correct Answer & Explanation

. Lesion size greater than 2 cm

Explanation

The healing potential of OCD lesions in the knee is highly correlated with skeletal maturity. Juvenile OCD (patients with open physes) has a very high rate of spontaneous healing with non-operative management (e.g., rest, activity modification). In contrast, adult OCD (closed physes), larger lesions, cystic changes, or sclerotic margins suggest a poor prognosis for non-operative healing.

Question 1732

Topic: Shoulder & Hip Sports

When utilizing the modified Judet (posterior) approach to the scapula for the fixation of a highly displaced extra-articular scapular body fracture, the primary intermuscular interval is developed between which of the following two muscles?

. Teres minor and teres major
. Supraspinatus and infraspinatus
. Infraspinatus and teres major
. Infraspinatus and teres minor
. Teres major and latissimus dorsi

Correct Answer & Explanation

. Teres minor and teres major

Explanation

The classic Judet approach is an extensile posterior approach reflecting the infraspinatus from medial to lateral. The modified Judet approach minimizes muscle detachment by exploiting the interval between the infraspinatus (suprascapular nerve) and the teres minor (axillary nerve). This exposes the lateral border and body of the scapula for plating.

Question 1733

Topic: Shoulder & Hip Sports

On an anteroposterior (AP) radiograph of the pelvis, the 'crossover sign' is indicative of acetabular retroversion. Which of the following correctly describes this radiographic finding?

. The line of the anterior acetabular rim projects medial to the line of the posterior rim in the superior aspect.
. The line of the posterior acetabular rim projects medial to the line of the anterior rim in the superior aspect.
. The ischial spine is visible prominently within the pelvic basin.
. The iliopectineal line intersects the ilioischial line.
. The center of the femoral head lies lateral to the posterior acetabular wall.

Correct Answer & Explanation

. The line of the anterior acetabular rim projects medial to the line of the posterior rim in the superior aspect.

Explanation

The crossover sign is a classic plain radiographic marker of cranial acetabular retroversion, commonly seen in pincer-type femoroacetabular impingement (FAI). It occurs when the projection of the anterior acetabular wall crosses medial to the projection of the posterior acetabular wall on a true AP pelvis radiograph.

Question 1734

Topic: Knee Sports

During a physical examination of a knee following acute trauma, the dial test (tibial external rotation) demonstrates 15 degrees of increased external rotation at 30 degrees of flexion compared to the contralateral side. At 90 degrees of flexion, the external rotation is identical to the normal side. What is the most likely diagnosis?

. Isolated anterior cruciate ligament (ACL) injury
. Isolated posterior cruciate ligament (PCL) injury
. Combined ACL and PCL injury
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injury

Correct Answer & Explanation

. Isolated anterior cruciate ligament (ACL) injury

Explanation

The dial test assesses injury to the posterolateral corner (PLC) and the posterior cruciate ligament (PCL). Increased external rotation (>10 degrees compared to the normal side) at 30 degrees of knee flexion but NOT at 90 degrees indicates an isolated PLC injury. If increased external rotation is present at both 30 and 90 degrees, it indicates a combined PLC and PCL injury.

Question 1735

Topic: Shoulder & Hip Sports

A 45-year-old weightlifter feels a pop in his anterior shoulder. MRI shows an isolated full-thickness subscapularis tendon tear. What structure is most likely to be unstable or subluxated as a result?

. Supraspinatus tendon
. Long head of the biceps tendon
. Short head of the biceps tendon
. Coracohumeral ligament
. Teres minor tendon

Correct Answer & Explanation

. Supraspinatus tendon

Explanation

The subscapularis is crucial for stabilizing the long head of the biceps (LHB) tendon in the bicipital groove. A full-thickness tear often leads to medial subluxation or dislocation of the LHB tendon.

Question 1736

Topic: Knee Sports

A 30-year-old football player sustains a posterolateral corner (PLC) knee injury. Which physical exam finding best differentiates an isolated PLC injury from a combined PCL and PLC injury?

. Positive dial test at 30 degrees only
. Positive dial test at both 30 and 90 degrees
. Positive pivot shift
. Positive Lachman test
. Varus gapping at 0 degrees

Correct Answer & Explanation

. Positive dial test at 30 degrees only

Explanation

An isolated PLC injury typically presents with increased external rotation (positive dial test) at 30 degrees of knee flexion but not at 90 degrees. Increased external rotation at both 30 and 90 degrees indicates a combined PCL and PLC injury.

Question 1737

Topic: Knee Sports

During a medial patellofemoral ligament (MPFL) reconstruction, the femoral tunnel is being localized. According to Schottle's radiographic criteria on a true lateral radiograph, where should the anatomic femoral footprint be positioned?

. Anterior to the posterior cortical line and distal to the posterior aspect of Blumensaat's line
. Posterior to the posterior cortical line and proximal to the posterior aspect of Blumensaat's line
. Anterior to the posterior cortical line and proximal to the posterior aspect of Blumensaat's line
. Posterior to the posterior cortical line and distal to the posterior aspect of Blumensaat's line
. Directly on the medial epicondyle

Correct Answer & Explanation

. Anterior to the posterior cortical line and distal to the posterior aspect of Blumensaat's line

Explanation

Schottle's point defines the anatomic femoral footprint of the MPFL. On a strict lateral radiograph, it is located 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the posterior aspect of Blumensaat's line.

Question 1738

Topic: 5. Sports Medicine

A 14-year-old male presents with knee pain. Radiographs reveal a large osteochondritis dissecans (OCD) lesion on the lateral aspect of the medial femoral condyle. MRI shows fluid behind the lesion, indicating instability. What is the most appropriate surgical management?

. Drilling of the lesion with bioabsorbable pin fixation
. Microfracture of the lesion bed
. Osteochondral autograft transfer
. Fresh osteochondral allograft
. Nonoperative management with cast immobilization

Correct Answer & Explanation

. Drilling of the lesion with bioabsorbable pin fixation

Explanation

In a young patient with open physes and an unstable OCD lesion (fluid behind the lesion on MRI), fixation with drilling to stimulate healing is the standard of care. Cartilage restoration techniques are reserved for unsalvageable or failed cases.

Question 1739

Topic: Shoulder & Hip Sports
Following an arthroscopic rotator cuff repair, tendon-to-bone healing occurs through the formation of a fibrocartilaginous transition zone. What collagen type is predominantly found in the uncalcified fibrocartilage layer of a normal rotator cuff insertion?
. Type I
. Type II
. Type III
. Type IV
. Type X

Correct Answer & Explanation

. Type II

Explanation

The normal rotator cuff insertion consists of four zones: tendon (Type I), uncalcified fibrocartilage (Type II and aggrecan), calcified fibrocartilage (Type II and Type X), and bone (Type I).

Question 1740

Topic: Knee Sports

A 45-year-old woman undergoes repair of a posterior medial meniscal root tear. Biomechanically, complete avulsion of the posterior horn of the medial meniscus root alters the peak contact pressures of the medial compartment to be most comparable to which of the following conditions?

. Total meniscectomy
. A bucket-handle meniscal tear
. A horizontal cleavage tear
. An isolated ACL tear
. A radial tear of the lateral meniscus

Correct Answer & Explanation

. Total meniscectomy

Explanation

A complete posterior medial meniscal root tear eliminates the hoop stresses of the meniscus, causing it to extrude. Biomechanically, this failure causes peak contact pressures in the medial compartment to approximate those seen in a totally meniscectomized knee.

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