Abstract
HISTORY: 25 y/o soccer player p/w 2-day h/o acute severe right knee pain after being slide-tackled in a game. Mechanism of injury included blunt trauma to the medial aspect of the knee, sustaining a varus & twisting-type stress - resulting in a painful "pop," immediate pain, swelling & inability to bear weight. Patient c/o right foot drop the following day. Additionally on post-injury day 10, the patient developed calf pain & swelling. PHYSICAL EXAMINATION: Post-injury day 2 exam of the right knee limited by pain, guarding & inability to bear weight. Significant effusion noted. ROM limited by guarding. Strength testing showed 4+/5 knee extension & 2/5 ankle dorsiflexion. Equivocal Lachman test. Pain & laxity to varus stress; valgus stress testing negative. Diminished sensation in deep & superficial peroneal distributions. Normal distal pulses & cap refill. Repeat exam on post-injury day 10 revealed calf TTP & 2+leg edema. Exam under anesthesia 12 days post-injury revealed a palpable soft tissue defect laterally, proximal to fibular head. Lachman test c/w grade 2 laxity w/ soft endpoint. Pivot shift & anterior drawer tests were positive, & the lateral joint opened easily (3+) w/ varus stress. Posterior drawer & valgus stress tests were normal. Posterolateral corner (PLC) tests: positive reverse pivot shift, dial & PLC drawer tests. DIFFERENTIAL DIAGNOSIS: ACL tear PCL tear LCL tear Peroneal nerve injury PLC injury Meniscal tear DVT Fracture or osteochondral lesion Dislocation or subluxation TEST AND RESULTS: Plain X-rays -No bony abn NCS & needle EMG -Severe peroneal neuropathy; no evid of transmission MRI w/o contrast -Marrow edema in medial femoral condyle; no fracture -Effusion -Complete ACL, LCL & biceps femoris tears -Thick PCL w/o abn signal -Medial meniscus tear Venous Duplex Doppler US -Peroneal vein DVT FINAL WORKING DIAGNOSIS: -ACL, PCL, LCL & medial meniscal tears -PLC injury -Peroneal nerve injury; foot drop -Peroneal vein DVT TREATMENT AND OUTCOMES: 1. IVC filter 2. ACL reconstr w/ hamstring autograft; partial medial meniscectomy 3. LCL & PLC repair; peroneal nerve dissection 4. Post-op unloader knee brace, AFO orthotic & rehabilitation 5. 6 month post-op -FROM; no laxity -Improved ankle strength -Weaned off brace & AFO 6. 12 month post-op -Doing well; jogging w/o biomechanical support
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call