Sports Medicine and Arthroscopy
Concepts
Sports medicine questions are built around anatomy, mechanism, examination and return-to-play decisions. For the knee, know the ACL examination (Lachman, pivot shift), meniscal signs (joint line tenderness, McMurray), and the fact that degenerative meniscal tears in older adults usually respond to physical therapy rather than arthroscopy. In the shoulder, distinguish traumatic anterior instability (Bankart, Hill–Sachs) from multidirectional instability and from SLAP lesions; apprehension and relocation tests assess anterior instability, while O'Brien is sensitive but not specific for SLAP. Rotator cuff: painful arc, drop arm and external rotation lag; acute traumatic tears in young patients are repaired, chronic degenerative tears often respond to rehabilitation.
Traps: over-reading MRI, since labral and chondral signal is common in asymptomatic shoulders and knees; ignoring the kinetic chain; clearing an athlete on imaging alone. Rehabilitation is phased - protect, restore motion, strengthen, power, sport-specific - and return-to-sport decisions are functional, not calendar-based.
Worked example: a 19-year-old soccer player with a noncontact pivot injury, immediate swelling and a positive Lachman has an ACL tear; history and examination justify referral, and MRI confirms associated meniscal injury. By contrast, a 55-year-old with medial knee pain and a degenerative tear on MRI should begin a structured strengthening program.
Rule of thumb: first anterior shoulder dislocation under age 25 carries high recurrence - consider stabilization.