KNEE INJURY - BASEBALL 830

Abstract

HISTORY: A 23 year old minor league baseball player collides with a team mate while attempting to field a fly ball. While the player is unsure of the mechanism, he believes his right knee was bent when he collided with the other player. Further, he believes the leg was off the ground, and he remembers no twisting motion during the injury. At the end of the play, he fell on his back with the knee bent in flexion. This could not be described any further. He was able to extend the leg, and no clicking or popping was noted. Evaluation by the trainer showed point tenderness along both the medial and lateral joint line. Laxity of the lateral collateral and anterior cruciate ligaments. Over the last 3 days, swelling has occurred despite icing and immobilization of the knee. The pain has localized to the lateral joint line, femoral condyle and tibial condyle. Player is still reluctant to bear weight with out the immobilizer. PHYSICAL EXAMINATION: Right knee is swollen with ballottable patella, but no discoloration. There is point tenderness along the lateral collateral ligament, as well as the lateral joint line. Range of motion showed extension to zero with recurvatum of about 10 degrees on the left knee. Flexion was to 90 degrees on the right side. Muscle strength was 4+ out of 5 for flexion and extension. Laxity of the right knee noted with varus force. Lachman's, and anterior drawer tests. These test did increase pain. Unable to evaluate McMurray test due to swelling. Slight patella laxity with no apprehension or pain, and normal tracking. Neurovascualar was intact. DIFFERENTIAL DIAGNOSIS- Lateral Collateral Sprain, 2nd to 3rd degree. Possible Anterior Cruciate Ligament Sprain, 2nd to 3rd degree. Possible lateral meniscus tear. TESTS AND RESULTS- Right knee X-ray: normal knee without fracture, dislocation, or avulsion fractures. Right knee MRJ: joint effusion, intact PCL, intact MCL, normal appearing menisci, tear of ACL, LCL, and Tensor Fascia Lata. FINAL DIAGNOSIS- LCL 3rd degree sprain ACL 3rd degree sprain Torn Tensor Fascia Lata TREATMENT- Patient under went arthroscopic evaluation and repair of torn structures. This was followed by aggressive rehabilitation.