KNEE PAIN - FOOTBALL

Abstract

530 HISTORY - A 16-year-old sophomore football player presented with severe left knee pain of 5 days duration. The pain came on suddenly after a golf shot on the second hole of play. He experienced no "pop" or "click." The pain was diffuse and deep over the medial left knee. It was achy in character and worse with weight bearing or bending. Reclining in bed with the knee supported made the pain better. His pain was worse in severity but similar in character to his chronic knee pain, which first developed insidiously 4 years previously. At that time, he was diagnosed with Osgood Schlatter's disease of the left knee and was treated with NSAIDS, ice, augmented soft tissue mobilization and a knee brace. His pain never fully resolved but he had been able to play football the past 3 seasons with a knee brace. During the past summer, he played 18-36 holes of golf every other day with no worsening of his chronic knee pain. He has had no previous trauma or injury in the affected extremity. He denied chronic groin pain, meniscal signs, or a sense of the knee locking or giving out. PHYSICAL EXAMINATION - Well developed male in obvious pain, on crutches. Gait was antalgic, favoring the left leg. The left heel did not touch the ground. On the table, the left leg was externally rotated. Right leg length was 87 cm; left was 83.5 cm. Inspection of left knee revealed no ecchymosis or joint effusion. There was no joint line tenderness and Lachmann's test had good endpoint. No MCL or LCL tenderness. McMurray's not assessed secondary to limitation of hip rotation. Hip flexion limited to 40 degrees. External and internal rotation limited by pain and palpation of medial and posterior hip also produced pain. Decreased quadriceps muscle bulk was noted on left. Both lower extremities neurovascularly intact with reflexes 2+ at knee and ankle. Slipped capital femoral epiphysis Avascular necrosis of left hip Left medial meniscus tear Osgood Schlatter's disease Medial collateral ligament strain TESTS AND RESULTS: Bilateral hip and frog-leg radiographs: - Greater than 50% displacement of left hip slipped capital femoral epiphysis. FINAL DIAGNOSIS: Left hip slipped capital femoral epiphysis, greater than 50% displacement. Non-weight bearing. Pain control. Referral for percutaneous fixation and epiphysiodesis.