A0S
AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS
Your Source for Lifelong Orthopaedic Learning
Sports
Medicine
Answer Book
, 20 10 Sports Medicine Examination Answer Book' 7
Question 1
What is the most common maxillofacial/dental injury in ice hockey?
1. Temporomandibular contusion
2. Lip laceration
3. Tooth avulsion
4. Crown fracture
5. Mandible fracture
PREFERRED RESPONSE: 4
DISCUSSION: Lahti and associates reported that the most common dental inj ury in a study of 479 injured
ice hockey players was a noncomplicated crown fracture, which accounted for 43.5% of all maxillofacial!
dental injuries. The most common cause of injury was a blow from an ice hockey stick. As a cause of
injury, the stick was approximately three times as common in games as in training, and only 1 0% of
injured players wore some sort ofprotective guard. A tooth avulsion is a partial or complete displacement
of the tooth from aleveolar support. A crown fracture is an incomplete loss or fracture of the tooth
enamel without loss of the tooth. The other injuries (mandible fracture, lip laceration, tooth avulsion, and
temporomandibul ar contusion) occur but are not nearly as common.
REFERENCES: Lahti H, Sane J, Ylipaavalniemi P: Dental inj uries in ice hockey games and training.
Med Sci Sports Exerc 2002;34:400-402.
Minkoff J, Stecker S, Varlotta GP, et al: Ice hockey, in Fu FH, Stone DA (cds) : Sports Injuries, ed 2.
Philadelphia, PA, 2001 , pp 5 16-5 1 7.
Figure 2a Figure 2b Figure 2c
Question 2
The MRI scans and diagnostic ultrasound shown in Figures 2a through 2c show what pathologic condition?
1. Articular-sided supraspinatus tendon tear
2. Bursal-sided supraspinatus tear
3. Superior labral tear
4. Humeral avulsion of the anterior glenoid ligament
5. Avulsion of the anterior inferior glenohumeral ligament
PREFERRED R E S P
ONSE: 1
,8 American Academy of Orthopaedic Surgeons
•
DISCUSSION: The MRI scans and ultrasound show an articular surface partial-thickness rotator c uff tear
of the supraspinatus tendon. This condition most commonly involves the supraspinatus tendon and is
usually found on the articular surface where the blood supply is less robust. There are multiple intrinsic
and extrinsic factors contributing to this condition which include age-related metabolic and vascular
changes that lead to degenerative tearing, subacromial impingement, shoulder instability (typically
anterior), internal impingement, and repetitive microtrauma. Acute trauma is less often the cause. The
physical examination for this condition is often nonspecific and requires supplemental imaging studies for
diagnosis.
REFERENCES: Matava MJ, Purcell DB, Rudzki lR: Partial-thickness rotator cuff tears. Am J Sports
Med 2005 ;33: 1 4 0 5 - 1 4 1 7 .
Wright SA, Cofield RH: Management of partial-thickness rotator cuff tears. J Shoulder Elbow Surg
1 996;5 :45 8-466.
McConville OR, Iannotti IP : Partial-thickness tears of the rotator cuff: Evaluation and management. J Am
Acad Orthop Surg 1 999;7 : 32-43 .
Question 3
Which of the following statements best describes the anatomy of the sartorial branch of the saphenous
nerve dUling medial meniscal repair?
I. The nerve is reliably extrafascial at the joint line.
2. The nerve is anterior to the sartorius.
The nerve becomes extrafascial between th e gracilis and the semitendinosus.
4. The nerve is anterior to the semitendinosus with the knee in extension.
The sartorial branch exits the adductor canal and travels to the anteromedial aspect of the knee.
PREFERRED RESPONSE: 4
DISCUSSION: Dunaway and associates reported that the nerve was extrafascial in only 43% of their
cadaveric specimens. Therefore, in medial meniscal repair, the nerve may be present during deep
dissection. The sartorial branch ofthe saphenous nerve is posterior to the sartorius; dissection should
remain anterior to the sartorius. The branch becomes extrafascial between the gracilis and the sartorius.
The nerve is anteri or to the semitendinosus with the knee in extension. The infrapateUar branch of the
saphenous nerve exits the adductor canal and travels to the anteromedial aspect of the knee.
REFERENCES: Dunaway DJ, Steensen RN, Wiand W, et al: The sartorial branch of the saphenous nerve:
Its anatomy at the j oint line of the knee. Arthroscopy 2005;21 :547-5 5 l .
Rodeo SA: Arthroscopic meniscal repair with use of the outside-in technique. lnstr Course Lect
2000;49: 1 95-206.
Question 4
What portion of the pitching phase creates forces approaching the tensile limit of the medial collateral
ligament?
1. E arly cocking phase
2. Late cocking phase
, 20 1 0 Sports Medicine Examination Answer Book · 9
3. Early acceleration phase
4. Follow-through phase
5. Deceleration phase
PREFERRED RESPONSE: 2
DISCUSSION: The late cocking phase of the overhand throw places a marked valgus moment across the
medial elbow. This repetitive force reaches the tensile limits of the medial collateral ligament.
REFERENCES: Fleisig OS, Andrews JR, Dillman CJ, et al: Kinetics of baseball pitching with
implications about injury mechanisms. Am J Sports Med 1 995;23 :233-23 9.
Lynch JR, Waitayawinyu T, Hanel DP, et al: Medial collateral ligament injury in the overhand-throwing
athlete. J Hand Surg 2008;33 :430-437.
AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS
Your Source for Lifelong Orthopaedic Learning
Sports
Medicine
Answer Book
, 20 10 Sports Medicine Examination Answer Book' 7
Question 1
What is the most common maxillofacial/dental injury in ice hockey?
1. Temporomandibular contusion
2. Lip laceration
3. Tooth avulsion
4. Crown fracture
5. Mandible fracture
PREFERRED RESPONSE: 4
DISCUSSION: Lahti and associates reported that the most common dental inj ury in a study of 479 injured
ice hockey players was a noncomplicated crown fracture, which accounted for 43.5% of all maxillofacial!
dental injuries. The most common cause of injury was a blow from an ice hockey stick. As a cause of
injury, the stick was approximately three times as common in games as in training, and only 1 0% of
injured players wore some sort ofprotective guard. A tooth avulsion is a partial or complete displacement
of the tooth from aleveolar support. A crown fracture is an incomplete loss or fracture of the tooth
enamel without loss of the tooth. The other injuries (mandible fracture, lip laceration, tooth avulsion, and
temporomandibul ar contusion) occur but are not nearly as common.
REFERENCES: Lahti H, Sane J, Ylipaavalniemi P: Dental inj uries in ice hockey games and training.
Med Sci Sports Exerc 2002;34:400-402.
Minkoff J, Stecker S, Varlotta GP, et al: Ice hockey, in Fu FH, Stone DA (cds) : Sports Injuries, ed 2.
Philadelphia, PA, 2001 , pp 5 16-5 1 7.
Figure 2a Figure 2b Figure 2c
Question 2
The MRI scans and diagnostic ultrasound shown in Figures 2a through 2c show what pathologic condition?
1. Articular-sided supraspinatus tendon tear
2. Bursal-sided supraspinatus tear
3. Superior labral tear
4. Humeral avulsion of the anterior glenoid ligament
5. Avulsion of the anterior inferior glenohumeral ligament
PREFERRED R E S P
ONSE: 1
,8 American Academy of Orthopaedic Surgeons
•
DISCUSSION: The MRI scans and ultrasound show an articular surface partial-thickness rotator c uff tear
of the supraspinatus tendon. This condition most commonly involves the supraspinatus tendon and is
usually found on the articular surface where the blood supply is less robust. There are multiple intrinsic
and extrinsic factors contributing to this condition which include age-related metabolic and vascular
changes that lead to degenerative tearing, subacromial impingement, shoulder instability (typically
anterior), internal impingement, and repetitive microtrauma. Acute trauma is less often the cause. The
physical examination for this condition is often nonspecific and requires supplemental imaging studies for
diagnosis.
REFERENCES: Matava MJ, Purcell DB, Rudzki lR: Partial-thickness rotator cuff tears. Am J Sports
Med 2005 ;33: 1 4 0 5 - 1 4 1 7 .
Wright SA, Cofield RH: Management of partial-thickness rotator cuff tears. J Shoulder Elbow Surg
1 996;5 :45 8-466.
McConville OR, Iannotti IP : Partial-thickness tears of the rotator cuff: Evaluation and management. J Am
Acad Orthop Surg 1 999;7 : 32-43 .
Question 3
Which of the following statements best describes the anatomy of the sartorial branch of the saphenous
nerve dUling medial meniscal repair?
I. The nerve is reliably extrafascial at the joint line.
2. The nerve is anterior to the sartorius.
The nerve becomes extrafascial between th e gracilis and the semitendinosus.
4. The nerve is anterior to the semitendinosus with the knee in extension.
The sartorial branch exits the adductor canal and travels to the anteromedial aspect of the knee.
PREFERRED RESPONSE: 4
DISCUSSION: Dunaway and associates reported that the nerve was extrafascial in only 43% of their
cadaveric specimens. Therefore, in medial meniscal repair, the nerve may be present during deep
dissection. The sartorial branch ofthe saphenous nerve is posterior to the sartorius; dissection should
remain anterior to the sartorius. The branch becomes extrafascial between the gracilis and the sartorius.
The nerve is anteri or to the semitendinosus with the knee in extension. The infrapateUar branch of the
saphenous nerve exits the adductor canal and travels to the anteromedial aspect of the knee.
REFERENCES: Dunaway DJ, Steensen RN, Wiand W, et al: The sartorial branch of the saphenous nerve:
Its anatomy at the j oint line of the knee. Arthroscopy 2005;21 :547-5 5 l .
Rodeo SA: Arthroscopic meniscal repair with use of the outside-in technique. lnstr Course Lect
2000;49: 1 95-206.
Question 4
What portion of the pitching phase creates forces approaching the tensile limit of the medial collateral
ligament?
1. E arly cocking phase
2. Late cocking phase
, 20 1 0 Sports Medicine Examination Answer Book · 9
3. Early acceleration phase
4. Follow-through phase
5. Deceleration phase
PREFERRED RESPONSE: 2
DISCUSSION: The late cocking phase of the overhand throw places a marked valgus moment across the
medial elbow. This repetitive force reaches the tensile limits of the medial collateral ligament.
REFERENCES: Fleisig OS, Andrews JR, Dillman CJ, et al: Kinetics of baseball pitching with
implications about injury mechanisms. Am J Sports Med 1 995;23 :233-23 9.
Lynch JR, Waitayawinyu T, Hanel DP, et al: Medial collateral ligament injury in the overhand-throwing
athlete. J Hand Surg 2008;33 :430-437.
