Knee Injury - Football

Abstract

HISTORY: 19 y/o NCAA -DI long snapper who jumped up to catch a pass. He landed straight legged, felt immediate left knee pain, and was unable stand. He was examined on the field. When posterior drawer was performed, the knee dislocated and had to be manually reduced. When attempting to return the knee to resting extension, the knee remained unstable. As such, he was immediately splinted. Initially, the patient had no complaints of parasthesias, but while awaiting EMS transport, he began to complain of parasthesias. PHYSICAL EXAMINATION: NAD, alert and oriented Left knee: (+) effusion; unstable in resting extension; patella in appropriate position with negative patellar apprehension. No valgus laxity or varus laxity but exam limited by guarding. Posterior drawer resulted in posterior knee dislocation requiring immediate reduction. Anterior drawer not performed due to instability. McMurray not able to be performed. Generalized tenderness of anterior knee. Neurovascular exam: Initially intact sensation to light touch in the left foot with intact posterior tibialis and dorsalis pedis pulses. Approximately 5 minutes later, sensation deficit was present on the dorsum of the foot and pulses were absent in the foot and ankle. DIFFERENTIAL DIAGNOSIS: - Posterior knee dislocation - Isolated PCL tear - Multiligament injury - Patella dislocation - Neurovascular injury TEST AND RESULTS: - Knee x-rays - no fracture or dislocation; (+) effusion - CT angiogram - possible injury to popliteal artery - Arteriogram - anomalous proximal take off of posterior tibail artery. Anterior tibial and peroneal arteries severed. The posterior tibial artery is intact with good collateralization of the anterior tibial and peroneal arteries distal to the vascular injury. - MRI - PCL tear, LCL partial tear, anterior lateral and medial tibial plateau and lateral femoral condyle edema with slight compression deformities FINAL WORKING DIAGNOSIS: Posterior knee dislocation with vascular injury TREATMENT AND OUTCOMES: - Pulses and sensation returned in ER. - Arthroscopy - femoral PCL avulsion which was repaired. Menisci and ACL intact. Open exploration of the LCL was performed - avulsion of LCL from fibula, which was repaired. - Progressing well. No claudication. Expect 7-9 month rehabilitation.