Knee Pain in a Young Wake Boarder

Abstract

HISTORY: 19 year old healthy male, seen in Family Medicine Clinic for left knee pain and swelling after a wake boarding injury one week prior. The patient was initially evaluated at the ER 5 hours after the acute event and placed in a hinged knee brace and prescribed Vicodin 5/500 for severe pain and OTC Ibuprofen for inflammation. He complained of persistent left knee discomfort with minimal response to treatment of NSAID's and rest. He also continued to have restricted left knee extension and an inability to bear weight. He denied previous knee trauma or concomitant medical conditions. PHYSICAL EXAMINATION: Wt: 77.1 kg BP: 118/70 P: 68 General: Alert, pleasant male without distress Left knee: scant effusion and tenderness noted inferior to lateral patella, equivocal McMurray, negative anterior & posterior drawer, and negative Lachman's. He lacked full extension. Patient unable to bear weight without crutches. Neurological exam intact. DIFFERENTIAL DIAGNOSIS: Knee sprain Femoral condyle contusion Meniscal Tear ACL/PCL Tear Tibial Plateau Fracture TESTS AND RESULTS: 4 view Knee X-Ray: Negative for fracture dislocation or joint effusion (In ER) MR Left Knee: Minimal depression 3 mm impaction fracture along anterior articular surface of lateral tibial plateau with edema like signal at both femoral condyles. No meniscal tears. Ligaments intact. Small effusion. (Two weeks after injury) Knee X-Ray Patella+Flexion views: Negative for dislocation or fracture. No definite interval change. Minimal medial joint compartment narrowing. (6 weeks after injury) FINAL DIAGNOSIS: Impaction Tibial Plateau Fracture with Femoral Condyle Contusions TREATMENT: Sports Medicine Consultation: Non-weight bearing activities advised for initial 6 weeks post event. No surgical intervention warranted. Slow introduction of weight bearing exercises advised; i.e., bicycling, elliptical track, etc. No contact sports advised at this time. Patient recovering with minimal restrictions or pain.