Presentation on theme: "Knee Pain Matthew A. Close, DO Steadman-Hawkins Sports Medicine Greenville Hospital System University Medical Center."— Presentation transcript:
Knee Pain Matthew A. Close, DO Steadman-Hawkins Sports Medicine Greenville Hospital System University Medical Center
Chief Complaint and History CC: 16-year-old offensive lineman who presented to the training room with left knee pain after a football game HPI: No specific injury during the game Swelling and moderate pain afterwards No giving way, locking or catching Mild numbness over the top of his knee No previous injury
Physical Exam Inspection: Moderate soft tissue edema antero- medially. Antalgic gait. Palpation: Trace effusion, TTP at anterior medial joint line, and distal medial quadriceps with deep palpation. ROM: Active 5/0/115, Passive produced pain with flexion past 120 degrees.
Physical Exam Strength: 5/5 strength in knee flexion/extension. Stability: Stable in varus/valgus at 0 and 30 degrees. Negative Lachman. Stable ant/post drawers. Special Tests: Discomfort with McMurray, but no click. Neurovascular: Numbness over top of knee. Pulses 2/4 at DP and PT.
MRI Results Extensive subcutaneous edema anteriorly with mild fluid collection between subQ fat and underlying fascia. Increased signal in posterior medial meniscus, no tear. Grade 1 chondromalacia of patella. Cruciate and collateral ligaments without injury.
Final Working Diagnosis
Historical Perspective Maurice Morel-Lavallee (1853) Tejwani SG, et al. Management of Morel-Lavallee lesion of the knee: twenty-seven cases in the National Football League. Am J Sports Med. 2007; 35(7): patients (27 knees) 14 (52%) conservative 13 (48%) aspiration (mean 2.7 times) 3 (11%) doxycycline sclerodesis Time to full resolution 16.3 days
Treatment and Outcome Treatment Neoprene compression sleeve, cryotherapy, rest. Rehabilitation coordinated with schools athletic trainer, emphasizing ROM exercises and quadriceps strengthening. Swelling and ecchymosis eventually resolved. Outcome Pt returned to football practice after 2 weeks, and resumed starting position 3 weeks after injury.