KNEE INJURY-BASKETBALL

Abstract

HISTORY: A 34 year-old recreational athlete without significant past medical history sustained a left knee injury while participating in a three-on-three basketball tournament. After coming down hard from a lay-up in which he collided with an opponent, he heard “a pop” and felt “a cramp” in his left knee. The athlete experienced immediate pain, was unable to bear weight or extend his knee and noticed a knee deformity. He denied a history of prior knee injuries but did report prior episdoes of “tendonitis” without local corticosteroid injections. He described himself as a weekend, recreational athlete. PHYSICAL EXAMINATION: On the court the athlete was in obvious discomfort sitting in a chair with his left knee passively extended. On inspection, the left patella was located proximal to the tibiofemoral joint and a large effusion was present. There was a palpable gap in the infrapatellar tendon and the inferior pole of the patella was tender. The athlete could not actively extend the knee against gravity and passive range of motion was limited to 10–45 degrees of knee flexion secondary to pain. Palpation over the tibial and femoral condyles produced no tenderness. Varus and valgus testing revealed no instability. Assessment of the cruciate ligaments could not be performed due to pain. Distal pulses, capillary refill and light touch senation were intact. Bilateral hips, ankles and right knee were pain-free with full range of motion. DIFFERENTIAL DIAGNOSIS: Petellar tendon rupture Patellar dislocation/fracture Quadriceps tendon rupture Anterior/posterior curciate ligament rupture TESTS AND RESULTS: EMERGENCY ROOM RADIOGRAPHS: Left knee AP and lateral views- patella alta with an avulsion fracture of the inferior pole of the patella. FINAL/WORKING DIAGNOSIS: Left patellar tendon rupture involving avulsed fragments of the inferior pole of the patella. TREATMENT AND OUTCOME: Knee immobilization, ice elevation. Open reduction, internal flxation day six after injury. Weight-bearing as tolerated, static quadriceps exercises and straight-leg raises 2 weeks post surgery. Directed active knee flexion/extension exercises with soft-tissue modalities, manual therapy, TENS unit 6 weeks post surgery. Submaximal cycling, stepping, wall-seats 12 weeks post surgery.