Knee Pain-Basketball

Abstract

HISTORY: 11 yo male basketball player referred to sports medicine for B/L anterior knee pain out of proportion to exam, right worse than left. He denied trauma. It started in his right knee 1 month prior, and he began having similar left knee pain. It was worse with activity including walking. He would feel popping in his knees. They felt unstable. He had failed conservative measures. As a result of his pain, he had to quit his basketball team and wasn’t able to run or play during recess. PHYSICAL EXAMINATION: B/L Knee Exam: Antalgic gait. No swelling. Normal alignment. Tender on medial and lateral joint lines and patella, less tender in patellar and quad tendons. Significant pain with flexion, range normal. Normal extension. Normal ligament and meniscus tests. Pain with patellar compression. Pain and difficulty with single leg hop, R > L. DIFFERENTIAL DIAGNOSIS: Sickle cell disease, OCD, discoid menisci, rheumatologic disorder, SCFE vs LCP TEST AND RESULTS: X-Rays B/L knees: Suggest mild B/L trochlear OCD X-Rays AP pelvis and lateral of both hips: Negative Sickle screen: Absent MRI right knee: Superior trochlea with 2.4 x 1.4 cm osteochondritis dissecans lesion, depth 0.4 cm. Sclerosis and subchondral cysts along the rim worrisome for instability MRI left knee: Superior central trochlea with subchondral sclerosis suggesting 9 mm osteochondritis dissecans lesion. Minimal subchondral sclerosis of the medial tibial plateau weight bearing surface with OCD lesion vs subacute/healing insufficiency fracture in the differential. FINAL WORKING DIAGNOSIS: Bilateral femoral trochlea osteochondritis dissecans TREATMENT AND OUTCOMES: Patient was referred to orthopedics for staged knee arthroscopy with retrograde transcartilaginous subchondral drilling of the trochlea, starting with the right knee. After each respective knee procedure, the patient was given a specific rehab protocol. Symptoms began improving. Intermittent symptoms returned ~9 months after right knee and 4 months after left knee surgery, so B/L knee MRIs were completed and showed significant improvement in the prior pathology. At his most recent visit, the patient was overall doing better noting significant bilateral knee improvement since the surgeries. He was back to playing basketball with his friends with only some post-activity soreness.