Presentation on theme: "Knee Pain Matthew A. Close, DO Steadman-Hawkins Sports Medicine"— Presentation transcript:
1 Knee Pain Matthew A. Close, DO Steadman-Hawkins Sports Medicine Greenville Hospital System University Medical Center
2 Chief Complaint and History CC:16-year-old offensive lineman who presented to the training room with left knee pain after a football gameHPI:No specific injury during the gameSwelling and moderate pain afterwardsNo giving way, locking or catchingMild numbness over the top of his kneeNo previous injury
3 Physical ExamInspection: 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.
4 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.
11 MRI ResultsExtensive 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.
14 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):24 patients (27 knees)14 (52%) conservative13 (48%) aspiration (mean 2.7 times)3 (11%) doxycycline sclerodesisTime to full resolution 16.3 days
15 Axial section at femoral metaphysis. Confluent fluid collection between vastus musculature and subQ fat
17 Treatment and Outcome Treatment Outcome Neoprene compression sleeve, cryotherapy, rest.Rehabilitation coordinated with school’s athletic trainer, emphasizing ROM exercises and quadriceps strengthening.Swelling and ecchymosis eventually resolved.OutcomePt returned to football practice after 2 weeks, and resumed starting position 3 weeks after injury.