Knee Pain - Football, Basketball

Abstract

HISTORY: 16 year-old high school football and basketball athlete was referred to Sports Medicine. He could not recall a specific injury, but had 2 months of recurrent pain and swelling with high-impact activities. No neuropathic, mechanical, nor instability symptoms. No prior knee orthopedic history. PHYSICAL EXAMINATION: Inspection showed slight genu valgum and small right knee effusion. No pain with palpation of all bony and soft tissue landmarks of the knee. Active range of motion was pain free and symmetric for knee flexion and extension. Strength was intact at 5/5 hip flexion, knee extension and knee flexion. Provocative maneuvers showed no pain with bounce and McMurrays, firm 1+ endpoint with Lachmans, anterior drawer, and posterior drawer. He was stable and symmetric with no laxity or pain during varus and valgus stressing of the knee at 0 and 30 degrees of flexion. No pain with patellar compression and negative dial testing. DIFFERENTIAL DIAGNOSIS: Includes meniscus pathology, plica syndrome, patellofemoral pain, osteochondritis dissecans (OCD), stress injury TESTS AND RESULTS: 1. Standing knee xrays showed medial femoral condyle OCD with knee effusion and loose body in suprapatellar space. 2. MRI of right knee showed 1.7 x 1.3 cm osteochondral defect at the central weight-bearing surface of the medial femoral condyle with displaced osteochondral fragment in the suprapatellar bursa. FINAL WORKING DIAGNOSIS: Grade IV osteochondritis dissecans lesion TREATMENT AND OUTCOMES: 1. Recommended non-weight bearing and medial unloader brace requested while physical therapy initiated. 2. Diagnostic arthroscopy for loose body removal and biopsy for matrix-induced chondrocyte implantation. 3. Low impact activities only, physical therapy and medial unloader brace with ambulation until harvested cells ready for implantation. 4. Matrix-induced autologous chondrocyte implantation was performed after 6 weeks of cell culturing. 5. Athlete treated with post-operative rehabilitation protocol. 6. MRI at 6 months demonstrated interval progression of healing medial femoral condyle OCD. 7. Athlete will continue post-operative rehabilitation protocol and will be assessed for readiness for sport progression at 12 and 18 months.