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Question 161

Topic: Shoulder & Hip Sports

A 22-year-old female runner complains of a painful clicking sensation deep in her anterior groin when extending her hip from a flexed position. Ultrasound confirms the diagnosis of internal snapping hip syndrome. Which anatomical structure is responsible for this snapping?

. Iliotibial band over the greater trochanter
. Gluteus maximus over the greater trochanter
. Iliopsoas tendon over the iliopectineal eminence
. Rectus femoris over the anterior inferior iliac spine
. Hamstring tendon over the ischial tuberosity

Correct Answer & Explanation

. Iliopsoas tendon over the iliopectineal eminence


Explanation

Internal snapping hip syndrome is caused by the iliopsoas tendon snapping over the iliopectineal eminence or the anterior femoral head. External snapping hip involves the IT band snapping over the greater trochanter.

Question 162

Topic: 5. Sports Medicine

A 55-year-old man stumbles on the stairs and feels a pop in his knee. He is unable to perform a straight leg raise. Lateral radiographs show patella baja (inferior displacement of the patella). What is the most likely diagnosis?

. Patellar tendon rupture
. Quadriceps tendon rupture
. Tibial tubercle avulsion fracture
. Patellar fracture
. Anterior cruciate ligament tear

Correct Answer & Explanation

. Quadriceps tendon rupture


Explanation

Quadriceps tendon ruptures typically occur in older patients (>40 years) and result in an inferiorly displaced patella (patella baja) due to intact distal attachments. Patellar tendon ruptures cause an upwardly displaced patella (patella alta).

Question 163

Topic: 5. Sports Medicine

In overhead throwing athletes, a Type II SLAP tear is most commonly generated by which of the following biomechanical mechanisms during the late cocking phase of throwing?

. Subacromial impingement of the greater tuberosity
. Peel-back of the biceps-labral complex
. Eccentric contraction of the short head of the biceps
. Direct compression of the humeral head against the glenoid
. Traction failure of the middle glenohumeral ligament

Correct Answer & Explanation

. Peel-back of the biceps-labral complex


Explanation

The 'peel-back' mechanism occurs during the late cocking phase when the shoulder is in maximum abduction and external rotation. This position creates a torsional force at the biceps anchor, peeling the superior labrum off the glenoid.

Question 164

Topic: Knee Sports

When performing a posterior cruciate ligament (PCL) reconstruction, the tibial inlay technique is theoretically chosen over the transtibial endoscopic technique to minimize which of the following graft-related complications?

. Popliteal artery injury
. Posterior capsular contracture
. The 'killer turn' graft abrasion
. Saphenous nerve injury
. Graft-tunnel length mismatch

Correct Answer & Explanation

. The 'killer turn' graft abrasion


Explanation

The tibial inlay technique places the bone block directly into the posterior tibia, avoiding the sharp angulation ('killer turn') seen in transtibial techniques. This theoretically reduces graft abrasion and subsequent attenuation.

Question 165

Topic: Shoulder & Hip Sports

A 16-year-old gymnast presents with bilateral shoulder pain, a sensation of subluxation, a positive sulcus sign, and generalized ligamentous laxity. What should be the initial management for this condition?

. Arthroscopic capsular plication
. Open inferior capsular shift
. Physical therapy emphasizing periscapular strengthening
. Immobilization in external rotation for 6 weeks
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Physical therapy emphasizing periscapular strengthening


Explanation

This patient has multidirectional instability (MDI). The primary and initial treatment for MDI is a prolonged course of physical therapy focusing on rotator cuff and periscapular stabilizer strengthening.

Question 166

Topic: Knee Sports

A 30-year-old male sustains a traumatic knee dislocation. Clinical examination reveals an asymmetric foot drop and an inability to extend the great toe. Which of the following injury patterns is most likely present?

. Isolated ACL rupture
. Isolated PCL rupture
. Posteromedial corner injury
. Posterolateral corner injury
. Medial meniscus root tear

Correct Answer & Explanation

. Posterolateral corner injury


Explanation

Foot drop indicates common peroneal nerve palsy. This nerve travels around the fibular neck and is highly susceptible to traction injuries during a posterolateral corner (PLC) injury or knee dislocation.

Question 167

Topic: Knee Sports
When reconstructing the medial patellofemoral ligament (MPFL) for recurrent patellar instability, the anatomical femoral attachment site (Schöttle's point) is best described as being located:
. Anterior to the medial epicondyle and proximal to the adductor tubercle
. Posterior to the medial epicondyle and distal to the adductor tubercle
. Distal to the adductor tubercle and posterior to the medial epicondyle
. Between the adductor tubercle and the medial epicondyle
. Directly on the medial epicondyle

Correct Answer & Explanation

. Between the adductor tubercle and the medial epicondyle


Explanation

The anatomic femoral origin of the MPFL lies in a saddle-shaped depression between the adductor tubercle proximally and the medial epicondyle distally. Precise placement is critical to avoid non-isometric graft tensioning.

Question 168

Topic: Knee Sports

A patient presents with knee instability after a hyperextension injury. The dial test shows 15 degrees of increased external rotation compared to the contralateral side at 30 degrees of knee flexion, but symmetric rotation at 90 degrees. This finding indicates an isolated injury to the:

. Anterior cruciate ligament
. Posterior cruciate ligament
. Posterolateral corner
. Posteromedial corner
. Medial collateral ligament

Correct Answer & Explanation

. Posterolateral corner


Explanation

Increased external rotation at 30 degrees of flexion that normalizes at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If rotation is increased at both 30 and 90 degrees, a combined PLC and PCL injury is present.

Question 169

Topic: Knee Sports

Which of the following surgical or patient factors provides the best prognosis for healing following a meniscal repair?

. Patient age over 40 years
. Tear location in the avascular white-white zone
. Concomitant anterior cruciate ligament (ACL) reconstruction
. Complex multi-planar tear pattern
. Surgical delay greater than 6 months from injury

Correct Answer & Explanation

. Concomitant anterior cruciate ligament (ACL) reconstruction


Explanation

Concomitant ACL reconstruction enhances meniscal healing. The intra-articular bleeding and release of bone marrow elements from drilling the ACL tunnels create a biologically favorable environment for the meniscus to heal.

Question 170

Topic: 5. Sports Medicine

A 45-year-old male feels a pop in his knee while descending stairs. Lateral radiographs reveal patella alta (high-riding patella). He is unable to perform an active straight leg raise. The most likely diagnosis is:

. Quadriceps tendon rupture
. Patellar tendon rupture
. Anterior cruciate ligament tear
. Patellar sleeve fracture
. Tibial tubercle avulsion

Correct Answer & Explanation

. Patellar tendon rupture


Explanation

Patella alta is indicative of a patellar tendon rupture because the unopposed pull of the quadriceps pulls the patella proximally. A quadriceps tendon rupture would typically result in patella baja (low-riding patella).

Question 171

Topic: Shoulder & Hip Sports

A professional baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. MRI demonstrates articular-sided fraying of the posterior supraspinatus and posterosuperior labrum. This is classically described as:

. External impingement
. Internal impingement
. Subcoracoid impingement
. Primary outlet impingement
. TUBS syndrome

Correct Answer & Explanation

. Internal impingement


Explanation

Internal impingement occurs in overhead athletes during maximum abduction and external rotation. The articular surface of the rotator cuff gets pinched between the greater tuberosity and the posterosuperior glenoid.

Question 172

Topic: Shoulder & Hip Sports

A 24-year-old rugby player presents with recurrent anterior shoulder instability. A 3D CT scan reveals a 28% defect of the anterior glenoid rim. The most appropriate surgical intervention to prevent recurrence is:

. Arthroscopic Bankart repair
. Arthroscopic capsular plication
. Latarjet procedure
. Remplissage procedure alone
. Open inferior capsular shift

Correct Answer & Explanation

. Latarjet procedure


Explanation

In the setting of critical anterior glenoid bone loss (typically > 20-25%), a soft tissue repair (Bankart) has an unacceptably high failure rate. A bony augmentation procedure, such as the Latarjet (coracoid transfer), is required.

Question 173

Topic: 5. Sports Medicine

During hip arthroscopy, the establishment of the anterior portal places which of the following neurovascular structures at the greatest risk of iatrogenic injury?

. Sciatic nerve
. Superior gluteal nerve
. Lateral femoral cutaneous nerve
. Femoral artery
. Obturator nerve

Correct Answer & Explanation

. Lateral femoral cutaneous nerve


Explanation

The anterior portal in hip arthroscopy carries the highest risk of injury to the lateral femoral cutaneous nerve branches. Safe portal placement requires careful superficial dissection and proper trajectory.

Question 174

Topic: 5. Sports Medicine

In a throwing athlete, the peel-back mechanism of the superior labrum occurs predominantly during which phase of the throwing motion?

. Wind-up
. Early cocking
. Late cocking
. Acceleration
. Follow-through

Correct Answer & Explanation

. Late cocking


Explanation

The peel-back mechanism happens during the late cocking phase when the shoulder is maximally abducted and externally rotated. This position places increased torsional stress on the biceps anchor, peeling back the posterosuperior labrum.

Question 175

Topic: Knee Sports

A 24-year-old football player sustains a knee injury. The dial test shows 15 degrees of increased external rotation compared to the contralateral knee at 30 degrees of flexion, but equal external rotation at 90 degrees. What is the most likely diagnosis?

. Isolated anterior cruciate ligament tear
. Isolated posterior cruciate ligament tear
. Isolated posterolateral corner injury
. Combined PCL and posterolateral corner injury
. Medial collateral ligament tear

Correct Answer & Explanation

. Isolated posterolateral corner injury


Explanation

Asymmetrical external rotation at 30 degrees but symmetrical at 90 degrees indicates an isolated posterolateral corner (PLC) injury. A combined PCL and PLC injury would show increased external rotation at both 30 and 90 degrees.

Question 176

Topic: Shoulder & Hip Sports

When evaluating a patient with recurrent anterior shoulder instability, a glenoid bone loss of greater than 20% on a 3D CT scan is best treated with which of the following procedures?

. Arthroscopic Bankart repair
. Open Bankart repair with inferior capsular shift
. Latarjet procedure
. Remplissage procedure alone
. Thermal capsulorrhaphy

Correct Answer & Explanation

. Latarjet procedure


Explanation

Critical glenoid bone loss (>20-25%) is an indication for a bony augmentation procedure like the Latarjet. Soft tissue repairs (Bankart) have an unacceptably high recurrence rate in the setting of critical bone loss.

Question 177

Topic: Shoulder & Hip Sports

Which of the following radiographic findings is most specific for diagnosing Cam-type femoroacetabular impingement (FAI)?

. Center-edge angle < 20 degrees
. Alpha angle > 55 degrees on a frog-leg lateral radiograph
. Crossover sign on an AP pelvis radiograph
. Tonnis angle > 10 degrees
. Coxa profunda

Correct Answer & Explanation

. Alpha angle > 55 degrees on a frog-leg lateral radiograph


Explanation

An alpha angle > 55 degrees on a lateral or frog-leg lateral radiograph indicates a loss of normal femoral head-neck offset, which is characteristic of Cam-type FAI. The crossover sign is indicative of Pincer-type FAI (acetabular retroversion).

Question 178

Topic: Shoulder & Hip Sports

A 68-year-old male presents with pseudo-paralysis of the shoulder and a massive, irreparable rotator cuff tear involving the supraspinatus and infraspinatus. The subscapularis is intact. What is the most appropriate definitive surgical management?

. Arthroscopic debridement and biceps tenotomy
. Superior capsular reconstruction
. Latissimus dorsi tendon transfer
. Hemiarthroplasty
. Reverse total shoulder arthroplasty

Correct Answer & Explanation

. Reverse total shoulder arthroplasty


Explanation

Reverse total shoulder arthroplasty is the treatment of choice for older patients with massive, irreparable rotator cuff tears and pseudo-paralysis. It utilizes the deltoid to restore active elevation and joint stability.

Question 179

Topic: Shoulder & Hip Sports

When repairing an acute rupture of the pectoralis major tendon, to which anatomic location should the tendon be reattached to optimize biomechanical restoration?

. Medial to the bicipital groove
. Lateral to the bicipital groove
. At the lesser tuberosity
. At the coracoid process
. Superior to the subscapularis insertion

Correct Answer & Explanation

. Lateral to the bicipital groove


Explanation

The pectoralis major inserts onto the lateral lip of the bicipital groove on the humerus. Anatomic repair lateral to the bicipital groove restores the normal length-tension relationship and biomechanics of the shoulder.

Question 180

Topic: Knee Sports

Which of the following is the most consistent anatomic landmark for femoral tunnel placement during a Medial Patellofemoral Ligament (MPFL) reconstruction (Schottle's point)?

. Anterior to the posterior femoral cortical line, proximal to Blumensaat's line
. Posterior to the posterior femoral cortical line, distal to Blumensaat's line
. At the medial epicondyle
. At the adductor tubercle
. Distal to the medial joint line

Correct Answer & Explanation

. Anterior to the posterior femoral cortical line, proximal to Blumensaat's line


Explanation

Schottle's point is the radiographic landmark for the femoral origin of the MPFL. It is located 1 mm anterior to the posterior femoral cortical line and proximal to Blumensaat's line.