Bilateral Recurring Knee Injury - High School Football

Abstract

HISTORY: A 16-year old high school football player (wt=106.8kg; ht=180cm, position: center), two weeks into the 2007 season reported to the Athletic Trainer complaining of right knee pain. He stated his knee "popped out of place" and it happened 3-4 times during the previous 2 years. Pain lasted 3-4 days during previous instances, with minimal swelling or discoloration. Due to recurrent symptoms, the athlete was referred to an orthopedic surgeon and placed in a lateral J brace. The athlete was allowed to continue participation and completed the 2007 football season, but experienced 2 more episodes while wearing the brace. A follow-up appointment was made with the physician. PHYSICAL EXAMINATION: The athlete revealed equal quadriceps tone and girth bilaterally. He complained of pain along the lateral border of the right patella, along with mild tenderness over the medial and lateral joint lines. He had normal neurovascular sensation. DIFFERENTIAL DIAGNOSIS: Meniscus tear Patella dislocation/subluxation Loose body Plica syndrome Chronic ACL tear TEST AND RESULTS: High Q-angle Mild genu valgum (right > left) Bilateral Patella-Femoral CAT scan: - Mild bilateral subluxation (right greater than left) - Bilateral tilt Fulkerson distal realignment osteotomy Lateral release FINAL WORKING DIAGNOSIS: Chronic bi-lateral patella subluxations TREATMENT AND OUTCOMES: 1. Upon initial evaluation the athlete was treated with ice, compression, and rest. 2. Athlete underwent surgery (Fulkerson distal realignment osteotomy) for his right knee at the conclusion of 2007 season and completed rehabilitation before returning to play for 2008 season. 3. Throughout 2008 the patient had intermittent pain and sustained 2 more subluxation episodes with the operative knee, as well as 2 subluxations on the left knee. 4. Following the 2008 season, further surgery was recommended for both right and left knee, but patient refused. 5. For the 2009 season the athlete wore a combination of McConnell taping and lateral j-brace for both knees, the athlete sustained 2 more subluxations in the operative knee and 1 more in the left knee. 6. Athlete was referred again to physician who, upon evaluation, determined the operative knee patella continues to be tilted, predisposing subluxations, and recommends surgery, which the athlete refuses.