AAOS Sports Medicine MCQs: Knee, Shoulder & Ankle Review

Question 1

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?

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. Burkhart SS, Morgan CD, Kibler WB: The disabled throwing shoulder: Spectrum of pathology. Part III. Arthroscopy 2003;19:641-661.

Question 2

A 28-year-old professional football player reports painless loss of ankle motion after sustaining a "severe" ankle sprain 12 months ago. A mortise radiograph is shown in Figure 1. Surgical treatment should be reserved for which of the following conditions?

Explanation

The radiograph shows posttraumatic tibiofibular synostosis. This condition typically follows an eversion (high) ankle sprain that results in disruption of the interosseous membrane. Ossification usually develops within 6 to 12 months after the injury. Return to sports is possible despite the lack of normal ankle dorsiflexion and mobility between the tibia and fibula. Surgical excision is reserved for persistent pain that fails to respond to nonsurgical management once the ossification is "cold" on bone scintigraphy. Whiteside LA, Reynolds FC, Ellsasser JC: Tibiofibular synostosis and recurrent ankle sprains in high performance athletes. Am J Sports Med 1978;6:204-208. Henry JH, Andersen AJ, Cothren CC: Tibiofibular synostosis in professional basketball players. Am J Sports Med 1993;21:619-622.

Question 3

The most common mechanism of injury to the triangular fibrocartilage complex (TFCC) involves

Explanation

TFCC tears are common in athletes. As the athlete braces for a fall, the wrist is most commonly in an extended position and the forearm is pronated. Cohen MS: Ligamentous injuries of the wrist in the athlete. Clin Sports Med 1998;17:533-552.

Question 4

The force generated by a muscle is most highly dependent on its

Explanation

The cross-sectional area of a muscle determines to a great extent the force generated by the muscle. The force of a muscle contraction is controlled by the amount of myofibrils that contract; the greater the amount of contracting myofibrils, the greater the force of contraction. Fiber types have less to do with the force of contraction and more to do with the duration and speed of contraction. Muscle length affects contraction force through the Blix curve. The morphology of a muscle can affect the cross-sectional area by varying the angle of the fibers in relation to the force vector. Conditioning mostly affects duration and fatigability. Buckwalter JA, Mow VC, Ratcliffe A: Restoration of injured or degenerated articular cartilage. J Am Acad Orthop Surg 1994;2:192-201.

Question 5

A 31-year-old woman has increasing pain and tightness in her right knee, with occasional stiffness and recurrent hemorrhagic effusions. MRI scans are shown in Figures 2a and 2b. What is the most likely diagnosis?

Explanation

PVNS is a rare inflammatory granulomatous condition of unknown etiology, and causes proliferation of the synovium of joints, tendon sheaths, or bursa. The disorder occurs most commonly in the third and fourth decades but can occur at any age. MRI provides excellent delineation of the synovial disease. Characteristic features of PVNS on MRI include the presence of intra-articular nodular masses of low signal intensity on T1- and T2-weighted images and proton density-weighted images. Synovial biopsy should be performed if there is any doubt of the diagnosis. Total synovectomy (open or arthroscopic) is required for the diffuse form, although recurrence is common. Rheumatoid arthritis and synovial chondromatosis are not typically associated with hemorrhagic effusions. De Ponti A, Sansone V, Malchere M: Result of arthroscopic treatment of pigmented villonodular synovitis of the knee. Arthroscopy 2003;19:602-607. Chin KR, Barr SJ, Winalski C, et al: Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee. J Bone Joint Surg Am 2002;84:2192-2202.

Question 6

A 30-year-old elite marathon runner reports chronic pain over the lateral aspect of the distal right leg and dysesthesia over the dorsum of the foot with active plantar flexion and inversion of the foot. Examination reveals a tender soft-tissue fullness approximately 10 cm proximal to the lateral malleolus. The pain is exacerbated by passive plantar flexion and inversion of the ankle. There is also a positive Tinel's sign over the site of maximal tenderness. There is no motor weakness, and deep tendon reflexes are normal. Radiographs and MRI of the leg are normal. What is the next most appropriate step in management?

Explanation

The patient has entrapment of the superficial peroneal nerve against its fascial opening in the distal leg. It is typically exacerbated by passive or active plantar flexion and inversion of the foot, which leads to traction of the nerve as it exits this opening. Treatment involves release of the fascial opening to reduce this traction phenomenon. Closure of the defect will only aggravate the condition and potentially result in an exertional compartment syndrome. A four-compartment fasciotomy is only indicated for an established compartment syndrome of the leg. Styf J: Diagnosis of exercise-induced pain in the anterior aspect of the lower leg. Am J Sports Med 1988;16:165-169. Sridhara CR, Izzo KL: Terminal sensory branches of the superficial peroneal nerve: An entrapment syndrome. Arch Phys Med Rehabil 1985;66:789-791.

Question 7

A 21-year-old soccer player reports pain and is unable to straighten his knee following an acute injury during a game. He is unable to continue to play. An MRI scan is shown in Figure 3. What is the next most appropriate step in management?

Explanation

The patient has a locked knee that cannot be fully extended. This is most likely the result of the mechanical block of a bucket-handle tear that has flipped into the notch. Also, the pain may be so severe that the muscle spasm prevents the knee from straightening out. When the patient is anesthetized, the muscle spasm relaxes and the meniscus can be reduced out of the notch. Arthroscopy is the treatment of choice. A meniscal repair is usually possible in large bucket-handle tears because the meniscus is torn in the red-red zone where most of the vascular supply is located. If the handle portion is badly frayed or damaged, a partial meniscectomy should be performed. The classic finding on MRI is a "double PCL sign." This is due to the flipped portion of the meniscus in the notch. Critchley IJ, Bracey DJ: The acutely locked knee: Is manipulation worthwhile? Injury 1985;16:281-283.

Question 8

When performing an inside-out lateral meniscal repair, capsule exposure is provided by developing the

Explanation

Capsular exposure for an inside-out lateral meniscal repair is performed by developing the interval between the iliotibial band and biceps tendon. Posterior retraction of the biceps tendon exposes the lateral head of the gastrocnemius. Posterior retraction of the gastrocnemius provides access to the posterolateral capsule. Miller DB Jr: Arthroscopic meniscus repair. Am J Sports Med 1988;16:315-320.

Question 9

A 50-year-old man reports left shoulder pain and weakness after undergoing a lymph node biopsy in his neck 2 years ago. Examination reveals winging of the left scapula. Electromyography shows denervation of the trapezius. Surgical treatment for this condition involves

Explanation

The muscle transfer procedure most commonly performed for trapezius paralysis is the Eden-Lange procedure. Trapezius paralysis in this patient is secondary to iatrogenic injury to the spinal accessory nerve during lymph node biopsy. In this procedure, the levator scapulae and rhomboid minor and major muscles are transferred laterally. Pectoralis transfer to the inferior border of the scapula is used as a dynamic transfer for serratus anterior winging. Kuhn JE, Plancher KD, Hawkins RJ: Scapular winging. J Am Acad Orthop Surg 1995;3:319-325. Langenskiold A, Ryoppy S: Treatment of paralysis of the trapezius muscle by Eden-Lange operation. Acta Orthop Scand 1973;44:383-388.

Question 10

A 15-year-old female field hockey player sustains a blow to the mouth from a hockey stick. Three front teeth are knocked out and shown in Figure 4. In addition to calling a dentist immediately, what is the next best step in management?

Explanation

Tooth avulsions can occur in contact or collision sports. An avulsed tooth is a medical emergency. The likelihood of survival of the tooth depends on the length of time that the tooth is out of the socket and the degree to which the periodontal ligament is damaged. The tooth should be handled only by the crown end and not the root end. It can be rinsed of debris with water or normal saline solution. The tooth should not be brushed or cleaned otherwise. During transport, the tooth must be kept moist. An avulsed tooth can be transported in whole milk, saliva, sterile saline solution, or commercially available kits with physiologic buffer solutions. The tooth and the athlete should be transported to the dentist for reinsertion as soon as possible and preferably within an hour. Krasner P: Management of sports-related tooth displacements and avulsions. Dent Clin North Am 2000;44:111-135. Sullivan JA, Anderson SJ (eds): Care of the Young Athlete. Rosemont IL, American Academy of Orthopaedic Surgeons, Elk Grove Village, IL, American Academy of Pediatrics, 2000, p 190.

Question 11

Commotio cordis is best treated with

Explanation

Commotio cordis is a rare but catastrophic condition that is caused by blunt chest trauma. It results in cardiac fibrillation and is universally fatal unless immediate defibrillation is performed. Although case reports of successful use of the chest thump maneuver exist, the best method of treatment is cardiac defibrillation. IV fluids, epinephrine, and albuterol inhalers are used to treat dehydration, anaphylactic shock, and bronchospasm respectively, and are not effective in the treatment of commotio cordis. McCrory P: Commotio cordis. Br J Sports Med 2002;36:236-237.

Question 12

Which of the following is considered an advantage of arthroscopic distal clavicle excision compared with open distal clavicle excision?

Explanation

Arthroscopic versus open distal clavicle excision has the advantage of allowing evaluation of the glenohumeral joint arthroscopically prior to moving into the subclavicular and subacromial space to perform the distal clavicle excision. This can be of value in both confirming the diagnosis as well as avoiding diagnostic errors. Berg and Ciullo showed that in 20 patients who underwent open distal clavicle excision that resulted in failure, 15 of those patients had a superior labral anterior posterior (SLAP) lesion. Of these 15 patients who had the lesion treated surgically, 9 went on to a good to excellent result after the surgery was performed arthroscopically. Fewer complications, lower infection rate, and decreased surgical time have not been documented in the literature. Arthroscopic technique sacrifices the inferior acromioclavicular ligament and preserves the superior acromioclavicular ligament. Berg EE, Ciullo JV: The SLAP lesion: A cause of failure after distal clavicle resection. Arthroscopy 1997;13:85-89.

Question 13

A 40-year-old woman reports the atraumatic onset of severe knee pain and swelling after undergoing an uncomplicated elective cholecystectomy 1 week ago. She denies any history of diabetes mellitus or HIV but has had occasional episodes of mild knee pain and swelling that have always responded to nonsteroidal anti-inflammatory drugs. Radiographs are shown in Figures 5a and 5b. A knee aspiration yields a WBC count of 35,000/mm3. The aspirate should also yield which of the following findings?

Explanation

The radiographs reveal chondrocalcinosis of the menisci. This is caused by calcium pyrophosphate crystals, which are weakly positive birefringent rhomboid-shaped crystals. Frequently, this condition is asymptomatic; however, routine abdominal surgery may cause precipitation of these crystals and pain. Gout, which is caused by strongly negative birefringent needle-shaped sodium urate crystals, is not associated with chondrocalcinosis and is rare in younger women. Gross blood is uncommon without trauma. Infection is not likely in a healthy patient who underwent uncomplicated surgery. Fisseler-Eckhoff A, Muller KM: Arthroscopy and chondrocalcinosis. Arthroscopy 1992;8:98-104.

Question 14

What is the maximum acceptable amount of divergence of the interference screw in the femoral tunnel from the bone plug of a bone-patellar tendon-bone graft in anterior cruciate ligament (ACL) reconstruction before pull-out strength is statistically decreased?

Explanation

In the early 1990s, a transition was made from a two-incision ACL reconstruction to a single-incision ACL reconstruction, and there was concern over divergence of the femoral screws. It was shown radiographically that approximately 5% of the time, divergence of the screw was greater than 15 degrees from the bone plug. In a bovine model, there was significant loss of pull-out strength with an increase in divergence from 15 degrees to 30 degrees. Therefore, attempts should be made to minimize divergence to 15 degrees or less. Lemos MJ, Jackson DW, Lee TO, et al: Assessment of initial fixation of endoscopic interference femoral screws with divergent and parallel placement. Arthroscopy 1995;11:37-41.

Question 15

A 21-year-old professional ballet dancer reports a painful popping sensation over her right hip joint. Examination reveals that symptoms are reproduced with hip flexion and external rotation. Which of the following studies will best confirm the diagnosis?

Explanation

The patient has snapping hip syndrome of the internal type, which is more common in ballet dancers. It is caused by the iliopsoas tendon gliding over the iliopectineal line or the femoral head. The diagnosis usually can be made by the history and physical examination. Snapping is reproduced by hip flexion and extension or flexion with external rotation and abduction. Conventional and dynamic ultrasonography will confirm the snapping structure. Radiographs occasionally show calcifications near the lesser trochanter. MRI can be used to rule out other diagnoses that can simulate snapping hip. Gruen GS, Scioscia TN, Lowenstein JE: The surgical treatment of internal snapping hip. Am J Sports Med 2002;30:607-613.

Question 16

The posterior circumflex artery provides blood supply to what portion of the proximal humerus?

Explanation

The posterior circumflex artery provides blood supply only to the posterior portion of the greater tuberosity and a small posteroinferior portion of the humeral head. The humeral head is supplied primarily by the anterolateral ascending branch of the anterior circumflex artery; the terminal branch of this artery is termed the arcuate artery. Norris TR (ed): Orthopaedic Knowledge Update: Shoulder and Elbow 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2002, pp 267-274.

Question 17

Use of prophylactic knee bracing in contact sports participants results in which of the following?

Explanation

Several studies have looked at the effects of knee bracing, and it appears to be effective in prophylactically decreasing the incidence of medial collateral ligament sprains. Najibi and Albright reported that although evidence is not conclusive, bracing appears to help decrease the incidence of medial collateral ligament injuries. Albright and associates showed similar findings. Prophylactic knee braces have been associated with an increased incidence of ankle injuries. Albright JP, Powell JW, Smith W, et al: Medial collateral ligament knee sprains in college football: Effectiveness of preventive braces. Am J Sports Med 1994;22:12-18.

Question 18

A 22-year-old college football player reports shortness of breath and dyspnea after a tackle. Examination reveals tachypnea, tachycardia, the trachea is shifted to the right, and there are decreased breath sounds on the left lung fields. The first line of treatment on the field should be

Explanation

The patient has a tension pneumothorax. This is a life-threatening emergency where air is trapped between the pleura and the lung, which prevents expansion of the lung. This causes hypoxia and cardiopulmonary compromise. The first line of treatment is to place a needle into the second intercostal space in the midclavicular line. The athlete should then be transported to the emergency department for chest tube placement. The athlete cannot return to play, and resuscitation is not necessary because he has not gone into cardiopulmonary arrest. Amaral JF: Thoracoabdominal injuries in the athlete. Clin Sports Med 1997;16:739-753.

Question 19

Anabolic steroid use has which of the following effects on serum lipoprotein levels?

Explanation

The use of anabolic steroids causes a decrease in high-density lipoprotein levels but has no effect on low-density lipoprotein levels. An abnormally low high-density lipoprotein level should alert the physician to the possibility of steroid use in an athlete. Hartgens F, Rietjens G, Keizer HA, et al: Effects of androgenic-anabolic steroids on apolipoproteins and lipoprotein (a). Br J Sports Med 2004;38:253-259.

Question 20

A 20-year-old professional female jockey who is wearing a helmet is thrown from her horse. What is the most likely location of her injury?

Explanation

The incidence of injury associated with horseback rising is estimated to be one per 350 riding hours to one per 1,000 riding hours. Of these injuries, approximately 15% to 27% are severe enough to warrant hospital admission. Significant and serious injuries in equestrian activities are associated with recreational riders and those not wearing a helmet. Head and spine injuries are more common in recreational and nonhelmeted riders. Extremity injuries are more common in professional and helmeted riders. Professional riders are less likely to be admitted to the hospital than recreational riders, and are about half as likely to be disabled at 6 months after injury as recreational riders. Lim J, Puttaswamy V, Gizzi M, et al: Pattern of equestrian injuries presenting to a Sydney teaching hospital. ANZ J Surg 2003;73:567-571.

Question 21

A 62-year-old man with a long history of right shoulder pain and weakness is scheduled to undergo hemiarthroplasty. Based on the radiographs shown in Figures 6a through 6c, what preoperative factor will most affect postoperative functional outcome?

Explanation

The radiographs reveal osteoarthritis and proximal humeral head migration. Integrity of the rotator cuff must be questioned based on these radiographic changes. The status of the rotator cuff is the most influential factor affecting postoperative function in shoulder hemiarthroplasty. The coracoacromial ligament provides a barrier to humeral head proximal migration in the face of a rotator cuff tear. The radiographs do not indicate significant humeral head or glenoid erosion. Acromioclavicular arthritis is often asymptomatic. Iannotti JP, Norris TR: Influence of preoperative factors on outcome of shoulder arthroplasty for glenohumeral osteoarthritis. J Bone Joint Surg Am 2003;85:251-258.

Question 22

Which of the following complications is more likely with an inside-out repair technique compared to an all-inside techniques for a medial meniscus tear?

Explanation

All of the answers are possible complications of meniscal repair. There are large volumes of literature evaluating the results of meniscal repair, both for the all-inside technique, as well as the inside-out technique. Failure rates are similar. Intra-articular synovitis occurs with absorbable sutures and absorbable implants. Peroneal nerve injuries are more common with the lateral-sided repairs. Saphenous nerve injuries are more common with medial-sided tears. Because of the incision required and the technique of tying over soft tissue, the risk of a saphenous nerve injury is greater with an inside-out technique than with an all-inside technique. Farng E, Sherman O: Meniscal repair devices: A clinical and biomechanical literature review. Arthroscopy 2004;20:273-286.

Question 23

Figure 7 shows the CT scan of a 22-year-old professional baseball pitcher who has had elbow pain for the past 6 months despite rest from throwing. Management should consist of

Explanation

The CT scan shows a stress fracture of the olecranon. This injury is the result of repetitive abutment of the olecranon into the olecranon fossa, traction from triceps activity during the deceleration phase of the throwing motion, and impaction of the medial olecranon onto the olecranon fossa from valgus forces. Fractures may be either transverse or oblique in orientation. Initial treatment consists of rest and temporary splinting. Electrical bone stimulation may also be considered. Open fixation with a large compression screw is recommended when nonsurgical management has failed to provide relief. Ahmad CS, ElAttrache NS: Valgus extension overload syndrome and stress injury of the olecranon. Clin Sports Med 2004;23:665-676.

Question 24

A 17-year-old football player is injured during a play and reports abdominal pain that is soon followed by nausea and vomiting. What organ has most likely been injured?

Explanation

The spleen is the most common organ injured in the abdomen as the result of blunt trauma. It is also the most common cause of death because of an abdominal injury. The liver is the second most commonly injured organ. Injury to the other organs is rare. The diagnosis can be made with CT. Treatment ranges from observation to splenectomy, depending on the severity of injury. Green GA: Gastrointestinal disorders in the athlete. Clin Sports Med 1992;11:453-470.

Question 25

A 15-year-old high school soccer player collides with an opponent and is unconscious when the trainer arrives on the field. He is conscious within 15 seconds, breathing appropriately, and denies any headache, neck pain, or nausea. It is his first head injury. Provided that the athlete is free of symptoms, when should he be allowed to return to athletic activity?

Explanation

The loss of consciousness indicates a grade 2 concussion, which necessitates a 4-week period out of sport. The last week prior to return must be symptom-free and the athlete should not have symptoms in practice. Cantu RC: Return to play guidelines after a head injury. Clin Sports Med 1998;17:45-60.

Question 26

A 65-year-old man presents with chronic right shoulder pain and an inability to actively elevate his arm above 60 degrees. Passive elevation is preserved. MRI shows a massive, retracted tear of the supraspinatus and infraspinatus with Goutallier stage 4 fatty infiltration. What is the most appropriate definitive surgical management?

Explanation

Reverse total shoulder arthroplasty (RTSA) is the treatment of choice for older patients with pseudoparalysis and massive, irreparable rotator cuff tears with advanced fatty infiltration.

Question 27

A 24-year-old male undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. Compared to hamstring autograft, BPTB autograft has a higher incidence of which of the following postoperative complications?

Explanation

BPTB autografts are associated with a higher incidence of anterior knee pain and kneeling pain compared to hamstring autografts, despite having similar long-term graft survival rates.

Question 28

A 28-year-old soccer player sustains an ankle injury resulting from forceful inversion and dorsiflexion. MRI reveals an osteochondral lesion of the talus. Based on the mechanism of injury, where is this lesion most likely located?

Explanation

Anterolateral talar dome lesions are typically shallow, wafer-shaped, and caused by inversion and dorsiflexion trauma. Posteromedial lesions are typically deeper and caused by inversion and plantarflexion.

Question 29

A 45-year-old manual laborer presents with persistent anterior shoulder pain. MRI arthrogram reveals a Type II SLAP tear. Nonoperative management has failed. What is the most appropriate surgical intervention to minimize the risk of postoperative stiffness and maximize functional return?

Explanation

In patients over 40 years old, primary biceps tenodesis provides more reliable pain relief and functional return with less postoperative stiffness compared to primary SLAP repair.

Question 30

A 30-year-old male presents with a multi-ligamentous knee injury following a high-energy trauma. Physical examination reveals an abnormal dial test at both 30 and 90 degrees of knee flexion. Which of the following nerve injuries is most commonly associated with this specific structural injury pattern?

Explanation

A positive dial test at 30 and 90 degrees indicates injury to both the PCL and the posterolateral corner (PLC). PLC injuries have a well-documented association with common peroneal nerve palsies.

Question 31

An 18-year-old football player sustains a syndesmotic "high" ankle sprain. Which of the following mechanisms of injury is most classically responsible for this pathology?

Explanation

Syndesmotic ankle sprains most commonly occur due to external rotation of the foot on the tibia, which forcibly separates the distal tibiofibular joint.

Question 32

During diagnostic arthroscopy for chronic anterior shoulder instability, the surgeon identifies an impaction fracture of the anteroinferior glenoid rim with an associated disruption of the adjacent articular cartilage and labrum. What is the standard eponymous term for this lesion?

Explanation

The Glenolabral Articular Disruption (GLAD) lesion is defined as a superficial anterior inferior labral tear associated with an articular cartilage injury of the glenoid.

Question 33

A 42-year-old female experiences a sudden "pop" in her posterior knee while squatting. MRI reveals a posterior root tear of the medial meniscus. If left untreated, this injury biomechanically behaves most similarly to which of the following?

Explanation

Meniscal root tears result in a loss of hoop stresses, leading to medial meniscal extrusion. Biomechanically, this functions equivalently to a total meniscectomy and accelerates rapid joint degeneration.

Question 34

A 35-year-old recreational athlete sustains an acute Achilles tendon rupture. He discusses nonoperative versus operative management with his orthopedic surgeon. What does current high-level evidence indicate regarding functional rehabilitation (nonoperative) versus surgical repair?

Explanation

Recent trials indicate that with early functional rehabilitation protocols, nonoperative management of Achilles tendon ruptures yields re-rupture rates equivalent to operative repair while avoiding surgical wound complications.

Question 35

A 24-year-old overhead throwing athlete complains of deep shoulder pain during the late cocking phase of throwing. MRI arthrography reveals a Type II SLAP tear. Which of the following mechanisms is most responsible for this specific injury pattern in the overhead athlete?

Explanation

The peel-back mechanism occurs in the late cocking phase of throwing, where the biceps vector shifts posteriorly. This torsional force leads to the detachment of the superior labrum, resulting in a Type II SLAP tear.

Question 36

When counseling a 19-year-old female collegiate soccer player regarding anterior cruciate ligament (ACL) reconstruction, she asks about the differences between bone-patellar tendon-bone (BPTB) and hamstring autografts. Compared to hamstring autografts, BPTB autografts are associated with a higher incidence of:

Explanation

BPTB autografts are associated with a higher incidence of donor-site morbidity, specifically anterior knee pain and kneeling pain. Hamstring grafts generally cause less anterior knee pain but may have slightly higher rates of clinical laxity.

Question 37

A 25-year-old rugby player sustains an inversion and plantarflexion injury to his ankle. Which osteochondral lesion of the talus is most characteristically associated with this specific mechanism?

Explanation

Plantarflexion and inversion injuries typically cause posteromedial talar dome lesions (DIAL a PIMP: Dorsiflexion/Inversion=AnteroLateral; Plantarflexion/Inversion=Posteromedial). These lesions are usually deep and cup-shaped.

Question 38

A 21-year-old collegiate linebacker presents with recurrent anterior shoulder instability. CT scan indicates 25% anterior glenoid bone loss. What is the most appropriate definitive management?

Explanation

Anterior glenoid bone loss exceeding 20-25% is a strict indication for a bony augmentation procedure like the Latarjet. Soft tissue repairs alone in this setting carry an unacceptably high recurrence rate.

Question 39

A 26-year-old male undergoes ACL reconstruction and a concurrent peripheral longitudinal tear of the medial meniscus is repaired. The healing rate of this meniscal repair is enhanced compared to an isolated meniscal repair primarily due to:

Explanation

Concurrent ACL reconstruction enhances meniscal healing due to the release of pluripotent stem cells and growth factors from the marrow during tunnel drilling. This hemarthrosis acts as an optimal biological environment.

Question 40

A 35-year-old recreational athlete sustains an acute Achilles tendon rupture. In comparing surgical versus functional nonoperative management, surgical repair is historically associated with:

Explanation

Operative repair of acute Achilles ruptures lowers the rerupture rate compared to nonoperative casting but introduces surgical risks. The most common complications of surgery are wound breakdown and iatrogenic sural nerve injury.

Question 41

A 28-year-old tennis player exhibits a Glenohumeral Internal Rotation Deficit (GIRD) of 30 degrees compared to the contralateral side. Her total arc of motion is symmetric. Initial management should consist of:

Explanation

GIRD is defined by a loss of internal rotation with a preserved total arc of motion, common in overhead athletes. Initial treatment is nonoperative, focusing on posteroinferior capsular stretching via sleeper stretches.

Question 42

During a posterolateral corner (PLC) reconstruction of the knee, the surgeon must be acutely aware of the anatomy to avoid iatrogenic injury. Which nerve is at the greatest risk during the surgical approach and lateral dissection for a PLC reconstruction?

Explanation

The common peroneal nerve winds around the fibular neck and is highly vulnerable during the lateral dissection required for PLC reconstruction. Careful identification and neurolysis are mandatory.

Question 43

A 20-year-old gymnast experiences patellar instability. The medial patellofemoral ligament (MPFL) is deemed incompetent. The femoral footprint of the MPFL (Schöttle's point) is anatomically located:

Explanation

Schöttle's point represents the anatomical femoral origin of the MPFL. Radiographically and anatomically, it is located just anterior and distal to the adductor tubercle, and proximal to the medial epicondyle.

Question 44

A 29-year-old male sustains an isolated posterior cruciate ligament (PCL) tear after a dashboard injury. If nonoperative management is chosen, physical therapy should primarily focus on strengthening which muscle group to restrict posterior tibial translation?

Explanation

The quadriceps act as an antagonist to the PCL by dynamically pulling the tibia anteriorly. Strengthening the quadriceps helps stabilize a PCL-deficient knee.

Question 45

A 31-year-old volleyball player complains of isolated painless weakness in external rotation of his dominant shoulder. Examination reveals infraspinatus atrophy but normal supraspinatus strength. MRI is most likely to show a cyst in which location?

Explanation

The spinoglenoid notch transmits the suprascapular nerve to the infraspinatus only. A cyst here (often associated with posterior labral tears) causes isolated infraspinatus weakness without affecting the supraspinatus.

Question 46

A 22-year-old football player sustains a multiligamentous knee injury. Physical examination demonstrates >10 degrees of increased external tibial rotation compared to the contralateral knee at both 30 degrees and 90 degrees of knee flexion. This finding indicates injury to the:

Explanation

The dial test evaluates external tibial rotation. Asymmetry of >10 degrees at 30 degrees only indicates an isolated PLC injury, while asymmetry at both 30 and 90 degrees indicates a combined PLC and PCL injury.

Question 47

Which of the following physical examination tests is the most sensitive and specific for diagnosing an acute high ankle (syndesmotic) sprain?

Explanation

The external rotation stress test is considered the most reliable clinical test for a syndesmotic injury. It reproduces pain over the anterior tibiofibular ligament and interosseous membrane by gapping the syndesmosis.

Question 48

A 19-year-old collegiate soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft. She successfully returns to sport at 9 months. Which of the following is the most commonly reported long-term complication associated with this specific graft choice compared to hamstring autografts?

Explanation

The most common complication of BPTB autograft for ACL reconstruction is donor site morbidity, specifically anterior knee pain and kneeling pain. Hamstring autografts have lower rates of anterior knee pain but may be associated with decreased hamstring strength at deep flexion angles.

Question 49

A 16-year-old high school football player sustains a first-time traumatic anterior shoulder dislocation. Closed reduction is performed in the emergency department. If this patient is treated nonoperatively, which of the following is the most significant risk factor for recurrent instability?

Explanation

Patient age is the most critical prognostic factor for recurrent anterior shoulder instability following a first-time dislocation. Patients younger than 20 years have a recurrence rate approaching 70-90% with nonoperative management.

Question 50

A 23-year-old lacrosse player sustains an inversion and external rotation injury to his ankle. Examination reveals tenderness over the anterior inferior tibiofibular ligament (AITFL) and a positive squeeze test. Non-weight-bearing radiographs appear normal. What is the most appropriate next step to evaluate for syndesmotic instability?

Explanation

A gravity stress radiograph (or external rotation stress radiograph) is the most appropriate next step to evaluate for dynamic syndesmotic instability when standard radiographs are normal. It is highly sensitive for detecting medial clear space widening indicative of deltoid and syndesmotic disruption.

Question 51

A 52-year-old female presents with sudden onset medial knee pain after stepping down from a curb. She denies mechanical locking but reports an audible "pop." MRI demonstrates a radial tear at the attachment of the medial meniscus posterior horn with meniscal extrusion. If left untreated, this injury most predictably leads to:

Explanation

A medial meniscus posterior root tear disrupts the hoop stresses of the meniscus, functionally equating to a total meniscectomy. This leads to meniscal extrusion and rapid progression of medial compartment osteoarthritis if left untreated.

Question 52

A 45-year-old recreational tennis player has persistent anterior shoulder pain. MRI confirms a Type II SLAP (Superior Labrum Anterior to Posterior) tear. After failing 6 months of conservative management, surgical intervention is planned. Evidence suggests that which of the following produces the most reliable clinical outcomes and highest return to sport in this age group?

Explanation

In patients over the age of 40 with a Type II SLAP tear, primary biceps tenodesis provides superior clinical outcomes, higher satisfaction, and more reliable return to sport compared to SLAP repair. SLAP repairs in older patients have higher rates of persistent pain and stiffness.

Question 53

A 35-year-old male sustains an acute Achilles tendon rupture playing basketball. He is debating between operative and nonoperative management. Recent level I evidence indicates that when an early functional rehabilitation protocol is employed, nonoperative management is associated with:

Explanation

Recent high-quality studies demonstrate that nonoperative management with early functional rehabilitation (weight-bearing and early mobilization) yields rerupture rates similar to operative management. However, nonoperative treatment avoids surgical complications such as infection and wound breakdown.

Question 54

A 28-year-old male is diagnosed with an isolated Grade II posterior cruciate ligament (PCL) tear following a dashboard injury. He is prescribed a physical therapy program. To optimize dynamic stabilization of the knee, the rehabilitation protocol should heavily emphasize strengthening of which muscle group?

Explanation

The quadriceps act as dynamic antagonists to the PCL by providing an anterior translational force on the tibia. Strengthening the quadriceps is the cornerstone of nonoperative rehabilitation for PCL injuries to prevent posterior tibial sag.

Question 55

A 15-year-old female requires medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. Anatomic femoral graft placement is critical to avoid anisometry. Radiographically, the anatomic femoral origin of the MPFL (Schöttle's point) is located:

Explanation

Schöttle's point, the radiographic anatomic origin of the MPFL, is located 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the medial epicondyle (between the medial epicondyle and adductor tubercle).

Question 56

A 30-year-old manual laborer sustains a Grade III acromioclavicular (AC) joint separation. If surgical reconstruction is eventually required, an understanding of the coracoclavicular ligaments is essential. Which of the following describes the anatomic orientation of these ligaments?

Explanation

The coracoclavicular (CC) ligaments consist of the conoid and trapezoid. The conoid is situated medial and posterior to the trapezoid and acts as the primary restraint to superior translation of the clavicle.

Question 57

A 24-year-old female presents with chronic ankle pain. Imaging shows an osteochondral lesion of the talus.

Regarding the typical characteristics of talar dome osteochondral lesions, which statement is true?

Explanation

Medial talar dome lesions are typically posteromedial, deep, cup-shaped, and often non-traumatic in origin. Lateral lesions are typically anterolateral, shallow, wafer-shaped, and strongly associated with a history of trauma.

Question 58

A 26-year-old male sustains a high-energy knee dislocation (KD-III). Upon reduction in the trauma bay, his foot is warm and pink, but his ankle-brachial index (ABI) is calculated at 0.7. What is the most appropriate next step in management?

Explanation

An ABI less than 0.9 in the setting of a knee dislocation is highly suspicious for a popliteal artery injury. CT angiography is the standard next step to rapidly and precisely localize the vascular lesion prior to surgical intervention.

Question 59

A 21-year-old collegiate baseball pitcher presents with vague posterior shoulder pain. Physical exam reveals a Glenohumeral Internal Rotation Deficit (GIRD) of 25 degrees compared to the contralateral side, with a total arc of motion deficit of 15 degrees. What is the most appropriate initial treatment?

Explanation

Pathologic GIRD is defined by a loss of internal rotation >20 degrees with a corresponding loss of total arc of motion >5 degrees. The first-line treatment is a dedicated physical therapy program emphasizing posterior capsular stretching (e.g., sleeper stretches, cross-body adduction).

Question 60

During an ACL reconstruction, the surgeon evaluates the two functional bundles of the anterior cruciate ligament. Which of the following accurately describes the anatomy and biomechanics of the ACL bundles?

Explanation

The ACL has two main bundles named for their tibial footprint: anteromedial (AM) and posterolateral (PL). The PL bundle is tight in extension, loose in flexion, and is the primary restraint to rotatory loads (tested via the pivot shift).

Question 61

A 22-year-old gymnast presents with snapping over the lateral aspect of her ankle following a severe dorsiflexion-inversion injury. Exam reveals subluxation of the peroneal tendons over the lateral malleolus with resisted active dorsiflexion and eversion. This condition is primarily caused by an injury to which structure?

Explanation

Peroneal tendon subluxation is caused by attenuation or tearing of the superior peroneal retinaculum (SPR), often accompanied by a shallow fibular groove. Surgical management typically involves SPR repair and fibular groove deepening.

Question 62

A 25-year-old cyclist falls directly onto his shoulder and sustains a completely displaced, midshaft clavicle fracture. Which of the following fracture characteristics is the most accepted absolute or relative indication for open reduction and internal fixation?

Explanation

Relative indications for operative fixation of a midshaft clavicle fracture include >2 cm of shortening, 100% displacement (no cortical contact), severe comminution with z-deformity, and impending skin necrosis. Shortening >2 cm is associated with worse functional outcomes and higher nonunion rates if treated nonoperatively.

Question 63

A 12-year-old boy presents with vague, activity-related anterior knee pain. Radiographs reveal a juvenile osteochondritis dissecans (JOCD) lesion. What is the most common anatomic location for this lesion?

Explanation

The most common location for osteochondritis dissecans of the knee is the lateral aspect of the medial femoral condyle, accounting for approximately 70-80% of lesions. In a patient with open physes, initial treatment is usually nonoperative.

Question 64

A 32-year-old male bodybuilder feels a "pop" in his anterior chest wall while performing a heavy bench press. He presents with bruising and loss of the axillary fold. MRI confirms a pectoralis major tendon rupture. Which portion of the muscle-tendon unit is most commonly injured in this scenario?

Explanation

Pectoralis major ruptures almost exclusively occur in weightlifters during the eccentric phase of a bench press. The sternal head at its humeral insertion (tendon or tendon-bone interface) is the most frequently torn component due to high tension placed on its inferior fibers when the arm is extended and externally rotated.

Question 65

A 19-year-old runner sustains an acute inversion ankle sprain. In the emergency department, anterior drawer testing is positive. Which ligament is the primary restraint to anterior translation of the talus in the ankle mortise when the foot is in plantarflexion?

Explanation

The anterior talofibular ligament (ATFL) is the weakest of the lateral ankle ligaments and the first to tear during an inversion injury. It is the primary restraint to anterior translation of the talus, especially when the ankle is plantarflexed.

Question 66

A 40-year-old male undergoes knee arthroscopy for a 1.5 cm symptomatic focal chondral defect on the medial femoral condyle. A microfracture procedure is performed. The tissue that eventually fills this defect is histologically characterized by:

Explanation

Microfracture relies on marrow stimulation to form a superclot that matures into repair tissue. This repair tissue is fibrocartilage, which is characterized by a predominance of Type I collagen, unlike native hyaline cartilage which is primarily Type II collagen.

Question 67

A 68-year-old male presents with chronic right shoulder pain and the inability to actively raise his arm above 60 degrees. Passive range of motion is full. Radiographs show a high-riding humeral head with acromiohumeral articulation (Hamada grade 3). What is the most appropriate surgical intervention?

Explanation

This patient has pseudoparalysis secondary to a massive, irreparable rotator cuff tear with associated cuff tear arthropathy (Hamada 3). Reverse total shoulder arthroplasty is the treatment of choice as it utilizes the deltoid to restore active elevation while addressing the joint arthritis.

Question 68

A 19-year-old female soccer player sustains a non-contact knee injury. Which of the following is considered a primary anatomic risk factor for anterior cruciate ligament (ACL) rupture in female athletes?

Explanation

Anatomic risk factors for ACL tears include a narrow intercondylar notch, increased posterior tibial slope, and increased anterior pelvic tilt. Female athletes also face neuromuscular risk factors such as ligament dominance and quadriceps dominance.

Question 69

A 24-year-old competitive rugby player presents with recurrent anterior shoulder instability. CT scan shows a 25% anterior glenoid bone loss. Which of the following is the most appropriate surgical treatment?

Explanation

In contact athletes with critical anterior glenoid bone loss (>20-25%), an arthroscopic Bankart repair has an unacceptably high failure rate. The Latarjet procedure (coracoid transfer) is the gold standard for restoring stability in these patients.

Question 70

During a minimally invasive repair of an acute Achilles tendon rupture, the surgeon places percutaneous sutures in the proximal stump. Which of the following structures is at greatest risk of iatrogenic injury during this step?

Explanation

The sural nerve crosses from medial to lateral and runs in close proximity to the lateral border of the Achilles tendon proximally. It is highly susceptible to entrapment during percutaneous or minimally invasive suture passage.

Question 71

A 50-year-old patient sustains a medial meniscus posterior root tear. Biomechanical studies have demonstrated that this injury alters knee contact pressures most similarly to which of the following conditions?

Explanation

A posterior root tear of the medial meniscus disrupts hoop stresses, leading to radial extrusion of the meniscus. Biomechanically, this results in peak contact pressures and contact areas equivalent to a total meniscectomy.

Question 72

A 21-year-old collegiate baseball pitcher presents with vague posterior shoulder pain during the late cocking phase of throwing. Examination shows increased external rotation and a 25-degree loss of internal rotation compared to the contralateral side. What is the primary pathologic mechanism of this condition?

Explanation

Glenohumeral internal rotation deficit (GIRD) in throwers is primarily caused by contracture of the posterior capsule and posterior band of the inferior glenohumeral ligament (IGHL). This shifts the glenohumeral contact point posterosuperiorly, leading to internal impingement.

Question 73

A 25-year-old hockey player sustains a rotational ankle injury. The external rotation stress test is positive.

Which ligament is typically the first to tear in a syndesmotic injury?

Explanation

In an ankle syndesmosis injury, the anterior inferior tibiofibular ligament (AITFL) is typically the first to tear. This is followed sequentially by the interosseous ligament and finally the posterior inferior tibiofibular ligament (PITFL).

Question 74

A 16-year-old female sustains an acute lateral patellar dislocation. She is scheduled for medial patellofemoral ligament (MPFL) reconstruction. The normal anatomic femoral origin of the MPFL is located:

Explanation

The femoral attachment of the MPFL is located in a saddle-like depression between the adductor tubercle (superiorly) and the medial epicondyle (inferiorly). Properly placing the femoral tunnel here is critical for restoring normal patellofemoral kinematics.

Question 75

A 45-year-old manual laborer has a massive, retracted, and irreparable posterosuperior rotator cuff tear. He has intact subscapularis function and severe external rotation weakness. Which of the following is the most appropriate surgical intervention to restore active external rotation?

Explanation

Latissimus dorsi transfer is indicated for younger, active patients with irreparable posterosuperior rotator cuff tears to restore active external rotation and forward elevation. An intact or reparable subscapularis is a prerequisite for success.

Question 76

A 32-year-old runner presents with deep ankle pain. MRI reveals an osteochondral lesion of the talus. Compared to anterolateral lesions, posteromedial talar dome lesions are characteristically:

Explanation

Posteromedial osteochondral lesions of the talus are classically deeper, cup-shaped, and less frequently associated with a distinct history of trauma. Anterolateral lesions are usually shallower, wafer-shaped, and trauma-induced.

Question 77

A 28-year-old male is brought to the emergency department after a motorcycle accident with a grossly unstable knee (KD-III). His ankle-brachial index (ABI) is 0.8. What is the most appropriate next step in management?

Explanation

In the setting of a knee dislocation, an ABI less than 0.9 is highly concerning for a popliteal artery injury. This mandates advanced imaging, typically CT angiography, to accurately localize the vascular lesion before surgical intervention.

Question 78

During an anatomic reconstruction of the coracoclavicular (CC) ligaments for a chronic Type V acromioclavicular joint separation, the surgeon must recreate the conoid and trapezoid ligaments. Which of the following correctly describes the normal anatomy of these ligaments?

Explanation

The conoid ligament is the more medial of the CC ligaments and inserts more posteriorly onto the conoid tubercle of the clavicle. The trapezoid ligament is lateral and inserts more anteriorly.

Question 79

A 22-year-old basketball player complains of a snapping sensation at the posterolateral ankle when cutting. Examination reveals subluxation of the peroneal tendons over the lateral malleolus with resisted active dorsiflexion and eversion. What is the primary pathomechanical defect in this condition?

Explanation

Peroneal tendon subluxation is primarily caused by an injury or avulsion of the superior peroneal retinaculum (SPR) from its fibular attachment. Surgical management often involves repairing the SPR and deepening the fibular groove.

Question 80

A 25-year-old professional soccer player has a symptomatic 3.5 cm² full-thickness chondral defect on the weight-bearing surface of the medial femoral condyle. Which of the following treatments provides the most durable long-term hyaline-like cartilage repair for a lesion of this size?

Explanation

For large (> 2-3 cm²), full-thickness articular cartilage defects in highly active patients, Autologous Chondrocyte Implantation (ACI) or osteochondral allografting is recommended. Microfracture and OATS are typically reserved for smaller lesions (< 2 cm²).

Question 81

A 45-year-old recreational tennis player has a symptomatic Type II SLAP tear that has failed conservative management. Current literature suggests that compared to primary SLAP repair, primary biceps tenodesis in this age group will likely result in:

Explanation

In patients older than 35-40 years with Type II SLAP tears, primary biceps tenodesis has been shown to yield higher patient satisfaction, lower rates of postoperative stiffness, and lower reoperation rates compared to SLAP repair.

Question 82

A 30-year-old male sustains a dashboard injury to his knee. Examination reveals a posterior sag sign and a posterior drawer test showing 8 mm of posterior tibial translation with a firm endpoint. There is no other ligamentous laxity.

What is the recommended initial management?

Explanation

An isolated Grade II PCL tear (5-10 mm of posterior translation) is typically treated non-operatively. Rehabilitation focuses on resolving swelling, regaining motion, and strengthening the quadriceps to counteract posterior tibial translation.

Question 83

A 21-year-old collegiate pitcher undergoes evaluation for internal impingement. Which of the following capsuloligamentous structures is most likely contracted, contributing to glenohumeral internal rotation deficit (GIRD) in this athlete?

Explanation

GIRD in overhead athletes is typically driven by contracture of the posteroinferior capsule, specifically the posterior band of the inferior glenohumeral ligament (IGHL). This contracture alters normal glenohumeral kinematics, leading to posterosuperior labral impingement during the late cocking phase of throwing.

Question 84

A 26-year-old soccer player undergoes an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft. Six months postoperatively, she reports persistent stiffness and restricted knee flexion. What is the most common cause of technical failure leading to loss of flexion in ACL reconstruction?

Explanation

The most common cause of technical failure in ACL reconstruction is non-anatomic tunnel placement. A femoral tunnel placed too anteriorly results in increased graft tension during flexion, leading to restricted knee motion or eventual graft stretching and rupture.

Question 85

A 22-year-old rugby player sustains an external rotation injury to his right ankle. Evaluation reveals a syndesmotic sprain. During the sequential failure of the distal tibiofibular syndesmosis from this mechanism, which structure is typically injured first?

Explanation

In external rotation injuries of the ankle, the anterior inferior tibiofibular ligament (AITFL) is typically the first syndesmotic structure to rupture. If the rotational force continues, it is followed by the tearing of the interosseous ligament and finally the PITFL.

Question 86

A 25-year-old male presents with recurrent anterior shoulder instability. Imaging and diagnostic arthroscopy reveal an anteroinferior glenoid bone loss of 28%. Which of the following procedures is most appropriate to restore stability and minimize recurrence in this patient?

Explanation

In the setting of critical glenoid bone loss (typically >20-25%), isolated soft tissue stabilization (Bankart repair) has an unacceptably high failure rate. A bone-block augmentation procedure, such as the Latarjet procedure, is indicated to restore the glenoid arc and provide a dynamic sling effect.

Question 87

A 31-year-old man sustains an acute traumatic knee dislocation following a motorcycle collision. After closed reduction, his Ankle-Brachial Index (ABI) is 0.85. What is the most appropriate next step in management?

Explanation

An Ankle-Brachial Index (ABI) < 0.9 following a knee dislocation is highly suspicious for a vascular injury. CT angiography is the standard next step to definitively localize and characterize popliteal artery injuries before surgical intervention.

Question 88

A 45-year-old recreational basketball player experiences a "pop" in his posterior ankle followed by weakness in plantar flexion. He is diagnosed with an acute Achilles tendon rupture. If he elects to undergo open surgical repair, which of the following is the most commonly reported significant complication compared to nonoperative management?

Explanation

Surgical repair of the Achilles tendon is associated with a significantly lower rerupture rate compared to traditional nonoperative management. However, operative intervention carries a higher risk of soft-tissue and wound healing complications, including infection.

Question 89

A 50-year-old male presents with acute onset of medial joint line pain in his knee after a deep squat. MRI reveals a medial meniscus posterior root tear with 4 mm of meniscal extrusion. Biomechanically, this injury is most similar to which of the following conditions?

Explanation

A posterior root tear of the medial meniscus completely disrupts circumferential hoop stresses, causing meniscal extrusion under axial load. Biomechanical studies demonstrate that this loss of hoop tension results in joint contact pressures and kinematics equivalent to a total medial meniscectomy.

Question 90

A 24-year-old cyclist falls directly onto the point of his shoulder. Radiographs demonstrate a Type V acromioclavicular (AC) joint injury. Which of the following ligaments must be reconstructed to reliably restore superior-inferior stability of the clavicle?

Explanation

Type V AC joint injuries involve >100% superior displacement of the clavicle due to complete rupture of both the AC ligaments and the coracoclavicular (CC) ligaments. The CC ligaments (conoid and trapezoid) are the primary restraints against superior clavicular displacement and must be reconstructed.

100 High-Yield Orthopedic MCQs: Shoulder & Elbow | Mock Exam 251

AAOS Sports Medicine MCQs (Set 1): Knee, Shoulder & Ankle Injuries | Board Review

Key Takeaway

AAOS Sports Medicine MCQs (Set 1): Knee, Shoulder & Ankle Injuries | Board Review

Chapter Index