Sports Medicine and Arthroscopy
What this domain tests
Clinical diagnosis of ligament, meniscal, and tendon pathology, imaging choices, surgical indications, graft and fixation selection, and return-to-sport criteria.
Core rules
- Anterior cruciate ligament reconstruction is indicated in young active patients with functional instability. Bone-patellar tendon-bone, hamstring, and quadriceps grafts all give acceptable results; the choice depends on harvest-site morbidity, graft size, and sport. Return to sport usually needs 9-12 months plus quadriceps strength of at least 90% of the contralateral side.
- Meniscal preservation is the default. Repairable peripheral tears in the red-red zone, root tears, and bucket-handle tears in young patients should be repaired, not resected.
- Anterior shoulder instability: arthroscopic Bankart repair suffices without bone loss; glenoid bone loss above roughly 20-25%, or an off-track Hill-Sachs lesion, calls for a coracoid transfer (Latarjet) or glenoid reconstruction.
- Rotator cuff: assess tear pattern, retraction, fatty infiltration, and tendon quality; repair tension determines the configuration.
- Cartilage lesions are graded and treated by size: microfracture, osteochondral autograft, or cell-based techniques.
Worked example
A 24-year-old rugby player with six anterior dislocations, a bony Bankart, and 25% glenoid bone loss. Arthroscopic Bankart repair alone has an unacceptably high recurrence rate at this bone loss. Answer: Latarjet coracoid transfer, which restores the glenoid arc and adds a sling effect from the conjoint tendon.
Traps that cost marks
- Missing a ramp lesion or a meniscal root tear on MRI and leaving it untreated at the time of ACL reconstruction.
- Diagnosing a SLAP tear in a 55-year-old with degenerative changes instead of recognizing rotator cuff pathology.
- Rushing return to sport based on time alone rather than strength and functional testing.