ABOS Orthopaedic Sports Medicine common mistakes
ABOS Orthopaedic Sports Medicine · Understand the traps and how to avoid them.
Selects arthroscopic Bankart repair for every anterior instability case, including a 25-year-old with 25% anterior glenoid bone loss and an off-track Hill-Sachs lesion.
Pattern-matching the phrases 'first dislocation' and 'Bankart lesion' straight to the most familiar operation; glenoid track and bone-loss concepts are learned late and rarely rehearsed under time pressure.
What to do instead
On every instability stem, quantify bone loss (percent or Instability Severity Index Score) and classify the Hill-Sachs lesion as on-track or off-track before choosing a procedure. If loss exceeds roughly 20% or the lesion is off-track, answer coracoid transfer or bone grafting rather than soft-tissue repair.
Recommends ulnar collateral ligament reconstruction for a high school pitcher with a partial proximal (humeral-side) tear, an intact flexor-pronator mass, and no valgus extension overload.
Treating 'thrower with medial elbow pain' as synonymous with reconstruction; forgetting that partial proximal tears frequently do well nonoperatively and that surgery in an adolescent adds physeal and ulnar nerve risk.
What to do instead
For each elbow valgus item, state tear location and completeness, flexor-pronator integrity, and level of play. Choose nonoperative care first for partial proximal tears without valgus extension overload, and reserve reconstruction for complete tears or failed rehabilitation in athletes who must throw.
Discharges a patient with anatomic snuffbox tenderness after a fall and negative plain radiographs, giving no immobilization and no follow-up imaging.
Anchoring on the negative radiograph; forgetting that scaphoid fractures are radiographically occult in a substantial minority early on and that missed proximal pole fractures risk avascular necrosis and nonunion.
What to do instead
Treat snuffbox tenderness with negative films as an occult fracture: thumb-spica immobilization plus repeat imaging or MRI/CT within 7 to 14 days. Recall the retrograde blood supply so proximal pole involvement flags higher nonunion and avascular necrosis risk, sometimes requiring vascularized grafting.
Plans arthroscopic labral repair and cam osteochondroplasty for a 30-year-old with groin pain, a lateral center-edge angle of 17 degrees, and a shallow dysplastic acetabulum.
Seeing a labral tear on MRI and stopping the analysis there; forgetting that undercoverage overloads the joint and that arthroscopic bony resection alone in dysplasia has a high failure rate.
What to do instead
Measure lateral center-edge angle, Tonnis angle, and femoral version on every hip stem. An angle below roughly 20 to 25 degrees means dysplasia: answer periacetabular osteotomy with or without arthroscopy, not isolated arthroscopic osteochondroplasty.
Recommends meniscal repair for a degenerative horizontal cleavage tear in the avascular white zone of a 58-year-old with Kellgren-Lawrence grade 2 arthritic changes.
Over-applying 'save the meniscus' as a universal rule without weighing tear pattern, vascularity, acuity, and arthrosis, all of which predict repair failure.
What to do instead
Classify each meniscal tear by pattern, zone (red-red versus white-white), acuity, and associated cartilage disease. Degenerative tears in arthritic knees get debridement or nonoperative care; repair is reserved for acute peripheral tears in younger patients with preserved cartilage and stable alignment.
Chooses end-to-end primary repair for a 12-week-old neglected Achilles tendon rupture with a 3 cm gap.
Recalling 'Achilles rupture equals repair' without checking chronicity; retracted chronic tendon ends cannot be apposed and predictably fail when simply sutured.
What to do instead
Document time from injury and gap size on every Achilles item. Acute ruptures get repair or functional bracing; chronic retracted ruptures need augmentation such as flexor hallucis longus transfer, V-Y lengthening, or turndown, plus correction of equinus contracture.
Clears a football player for return to play after an episode of transient quadriparesis using a normal MRI and a Torg ratio of 0.7 alone.
Treating the Torg ratio as a diagnostic test for cervical stenosis when it is a screening ratio with poor specificity in athletes, whose large vertebral bodies artificially lower the ratio.
What to do instead
Measure the actual sagittal canal diameter (stenosis below 13 mm) and cord available space on advanced imaging, document symptom duration and number of episodes, and treat recurrent episodes or cord signal change as reasons to advise against collision sport.
Returns an athlete to contact practice in the same week symptoms resolve, using a single symptom checklist score as the only gate.
Equating symptom resolution with physiologic recovery; vestibular, oculomotor, and exertional deficits outlast resting symptoms, and a stepwise protocol is required before contact.
What to do instead
Apply a stepwise return-to-learn and return-to-sport progression with at least 24 hours per step, entered only when asymptomatic at rest and after provocative exertional and vestibular/oculomotor testing. Treat each step as a gate, not a calendar date.
Concludes that a physical examination maneuver is useful for confirming a diagnosis in a low-prevalence population because its sensitivity was reported as 95%.
Confusing sensitivity with predictive value; positive predictive value depends on prevalence, so a sensitive but nonspecific test in a rare condition produces many false positives.
What to do instead
Apply SnNout and SpPin: sensitive tests rule out, specific tests rule in. Before answering, identify the prevalence implied by the stem and reason about the direction of change in post-test probability instead of quoting sensitivity in isolation.
Clears an athlete for sport 9 months after anterior cruciate ligament reconstruction based on elapsed time and full range of motion alone.
Calendar-based clearance feels safe and is easy to memorize, while objective discharge criteria demand more recall and are often skipped during study.
What to do instead
Use criterion-based return to play: quadriceps limb symmetry index of at least 90%, hop-test symmetry, no effusion, and psychological readiness. Time since surgery is a covariate, not a criterion, and graft type shifts the expected timeline.