Knee Injury - Tae Kwon Do

Abstract

2221 HISTORY: An 11 year old female presented to the outpatient clinic for follow up of a right knee injury, from Tae Kwon Do, seen at the ER 2 weeks prior. She described a progressive discomfort in her right knee over the couple of days preceeding the ER visit, localizing it to the region of a 'lump' on her right knee near the patellar tendon. She described having to 'crawl on the. oor on her knees' at Tae Kwon Do. At this time, she described being able to finish the exercise with no pain or discomfort. She had no pain with jumping, twisting, and kicking. Pain was increased while climbing stairs. She then visited the ER where they took X-rays, placed her in an immobilizer, and directed her to follow up with the primary care physician. She was advised to rest, take NSAIDS, and avoid physical activity until the pain subsided at which time the immobilizer could be removed. She presented to the clinic with the immobilizer, which had been worn continuously since the ER. There was a pain rating of 5-6/10 and concern about her future activities. PHYSICAL EXAM: Examination in the clinic revealed patient in an immobilizer. Once removed, patient was able to walk to the exam table with a slight limb and step onto the table. Right knee had full range of motion, negative Lachman test, negative Valgus/Vargus test, and negative McMurray test. There was localized swelling and tenderness on palpation of the right tibial tuberosity. There was no effusion. Left knee examination normal. Hip and ankle exam normal. DIFFERENTIAL DIAGNOSIS: Osgood-Schlatter disease Osteomyelitis Bursitis-prepatellar/retropatellar Patellar tendonitis Sinding-Larsen-Johansson syndrome Malignant tumor- osteosarcoma or Ewing's Proximal tibial physeal fracture Avulsion Fracture off the Anterior Tibial Tubercle TEST AND RESULTS: X-ray of Right knee Soft tissue swelling over the proximal anterior tibia with some thickening of the patellar tendon. Avulsion fracture off the anterior tibial tubercle. FINAL/WORKING DIAGNOSIS: Osgood Schlatter disease with possible avulsion fracture off the anterior tibial tubercle. TREATMENT AND OUTCOMES: Relative rest NSAID, Ice Allow ROM, walking, and tolerated activity Follow up appointment