Concealed Degloving Injury (the Morel-Lavallée Lesion) in Childhood Sports

Abstract

Morel-Lavallee lesions (MLLs), described in 1853 by Maurice Morel-Lavallee, are uncommon closed internal degloving injuries in which the subcutaneous tissues are stripped off the fascia with a hematoma and, in some cases, necrotic fat1-4. These lesions are most commonly noted with high-energy pelvic trauma1,3 and can require weeks to resolve. Accurate diagnosis is delayed in up to one-third of patients because of inconsistent clinical presentation and because initial skin bruising can mask the importance of the underlying soft-tissue injury5. These lesions occur less frequently in the knee region; knee MLLs have been reported in professional football players6. A few reports1,6,7 in the literature indicate that MLLs most commonly occur in people in their third and fourth decades of life. In 1986, Letts8 documented cases of degloving injuries in children following major trauma; we report the rare case of a boy who presented with an MLL two weeks after a football injury. The patient and parents were informed that nonidentifying information from the case would be submitted for publication, and they provided consent. While playing outdoor pick-up football, an eleven-year-old boy sustained a left knee injury after being tackled and falling onto the asphalt, landing directly on the anterior aspect of the knee. He was not wearing any protective padding at the time of injury. He developed left thigh and knee pain as well as a large bruise about the thigh and was taken to the local emergency department. He was healthy with no medical problems. On presentation, he had fully intact neurologic and vascular function in the lower extremities and had 5 of 5 hip and knee flexor and extensor strength despite some pain. He had moderate pain with knee motion, with an …