KNEE PAIN AND GIVING WAY - ACTIVE ADOLESCENT

Abstract

HISTORY: Fifteen-year-old female was seen for an episode of right knee giving way walking downstairs. No previous problems. No other joint complaints. Family history is significant in that her father has congenital knee abnormality for which he may require total knee replacements. PHYSICAL EXAMINATION: Right knee range of motion of 20–110. Mild effusion. There was tenderness over the medial femoral condyle (MFC). Mild pain on lateral patellar subluxation maneuvers. Ligaments stable. There was no palpable loose body. No joint line tenderness. DIFFERENTIAL DIAGNOSIS: Osteochondritis dissecans medial femoral condyle. Osteochondral fracture. Loose body. Medical meniscus tear. Patellar subluxation. TEST AND RESULTS: Plain radiographs of AP, notch, lateral, and patellar views show radiolucency of the medial femoral condyle. This appears to be central weight bearing area on the lateral view. There are no radiopaque loose bodies, no fractures. The lesion on notch view measures 26 mm in width. Radiographs of AP, lateral, notch, and sunrise view show a loose body. MFC appeared normal. Arthroscopy again was suggested and was performed. The findings at the time of arthroscopy were a 2.5 × 2.5 × 1.5 cm osteochondral loose body which was removed. The OCD lesion of the MFC was completely healed in the medial femoral condyle without any area of abnormality on probing. Postoperatively, she did well. FINAL/WORKING DIAGNOSIS: Loose body, OCD medial femoral condyle. Completely healed MFC lesion. TREATMENT AND OUTCOMES: She was seen nine years postop for left knee pain. Follow up weight bearing radiographs revealed normal and symmetrical joint spaces and normal-appearing MFC. She was having no problems with her right knee.