Knee Injury - Motorcycling

Abstract

HISTORY: A 29-year-old male presented to our sports medicine clinic with right knee pain. Three months ago, he had an accident during motorcycle racing in which he fell off the bike. He sustained multiple lacerations including a large laceration on the right knee that was managed nonoperatively. He developed pain and numbness over the anterolateral aspect of the right knee interfering with mobility. He also reported mild right knee weakness and frequent knee buckling. PHYSICAL EXAMINATION: Examination revealed healed laceration with significant scar tissue growth over the anterolateral aspect of the distal third of right thigh. There was moderate tenderness to palpation along borders of the scar, quadriceps tendon, and lateral femoral condyle. Neurologic exam was intact with normal sensation, reflexes, and strength of bilateral lower extremities. There was full active range of motion of right knee but with discomfort at end range of flexion. There was midline tracking of patella throughout range of motion. DIFFERENTIAL DIAGNOSIS: 1. Hypertrophic/Keloid scar pain 2. Arthrofibrosis 3. Chronic patellar dislocation 4. Quadriceps and patellar tendinosis 5. Lateral femoral condyle contusion 6. Patella alta TEST AND RESULTS: Right knee anterior-posterior, lateral and patella radiographs: —there is no evidence of displaced fracture or dislocation.—the patellofemoral alignment is maintained. Right knee magnetic resonance imaging: —patterns of contusion and stress response involving the anterior and lateral aspects of the lateral femoral condyle and inferior pole of the patella, findings suspect for patellar dislocation with subsequent reduction.—medial and lateral collateral ligament scarring. Medial and lateral retinacular sprains.—patella alta with limited arthrosis.—quadriceps and patellar tendinosis. FINAL WORKING DIAGNOSIS: Hypertrophic/Keloid scar pain TREATMENT AND OUTCOMES: 1. Home exercises with quadriceps strengthening for 12-15 weeks, no improvement in pain or function. 2. Two courses of physical therapy with quadriceps and vastus medialis oblique strengthening, range of motion exercises, improvement in range of motion but limited improvement in pain. 3. Ultrasound-guided intralesional corticosteroid injection to the right knee, notable reduction in pain.