Abstract
HISTORY: A 17 y.o. offensive lineman on a Div. I football team sustained a knee injury during practice. The patient was blocking in open field when the back of his extended planted leg was struck lightly. He stated "it felt like my knee cap shifted." He was removed for evaluation. PMH: One year h/o intermittent anterior knee pain that was worse during high school basketball. Pain subsided then returned during summer workouts for football 6 weeks prior to acute injury. Normal x-ray. Dx. with quadriceps tendonitis. Placed on modified activity with eccentric strengthening, quad stretching, and NSAIDS for 2 weeks prior to acute injury. PHYSICAL EXAMINATION: Exam on Field- rapid moderate effusion; marked apprehension to lateral stress of patella with mild pain over medial retinaculum; neg. Lachman, valgus and varus stress; unable to perform McMurray secondary to pain; VMO fired with leg extension Exam in Training Room- persistent patella pain and apprehension with decreased retinacular pain; compression, knee immobilizer with patella support, ice, crutches for non-weight bearing, and pain meds. Exam 24 Hours- large effusion; patella pain laterally with reduced pain over medial retinaculum; mild apprehension, minimal pain over the quadricep tendon; difficulty firing VMO and straight leg lift DIFFERENTIAL DIAGNOSIS: Patella Subluxation Meniscal Tear Fracture - Tibial Plateau, Patella Patella/Quadricep Tendon Tear TEST AND RESULTS: Knee X-ray: Transverse fracture of the patella that appears old with smooth sclerotic edges Review of knee x-ray taken 2 weeks prior: Questionable lucency on the lateral aspect of patella Knee X-ray of left knee: Normal Knee MRI: Acute patella fracture with suspected chondral fragment at the fracture site along the medial retropatellar cartilage; partial tear of the quadriceps tendon; partial tear of the lateral patellar retinaculum; hemarthrosis; no meniscal tear FINAL WORKING DIAGNOSIS: Acute noncontact fracture of transverse bipartite patella TREATMENT AND OUTCOMES: ORIF with bone grafting Repeat x-ray at 5 weeks with union of fracture Clinical outcome pending rehab
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