Knee Pain- Soccer

Abstract

HISTORY: 14 y/o male soccer player presented with c/o vague left posterolateral knee pain x 6 months. The pain was exacerbated with running, kicking, and lateral movements. The pain was “burning” starting at his lateral knee radiating to the heel. Acetaminophen and ibuprofen were not helpful, but ice relieved the pain. He denied known trauma, skin changes, or constitutional symptoms. He began to have nighttime pain 3-4 months after onset which led to self-removal of participation from soccer. PHYSICAL EXAM: No obvious deformity, erythema, or ecchymosis noted. Normal ROM from 0-115°. Mild tenderness to palpation on the posteromedial aspect of his knee in the popliteal fossa. Mildy TTP over lateral and medial joint line. Knee stable to varus and valgus stress at 0 and 30°. McMurray’s positive medially. Patellar grind, anterior and posterior drawer, and Lachman negative. Normal gait with 5/5 strength. Sensation intact to light touch in all 5 nerve distributions. Palpable pedal pulse with capillary refill less than 2 seconds. DIFFERENTIAL DIAGNOSIS: 1. Hamstring/popliteus/gastrocnemius tendinopathy 2. Medial meniscal injury 3. Neoplasm 4. Baker’s Cyst 5. Tibial stress fracture 6. Apophysitis 7. Thrombosis TESTS AND RESULTS Left knee xray: Cortical lesion at the location of the growth plate within the proximal tibia MRI: Lesion noted with signal intensity equal to that of cartilage at the posterior aspect of tibial epiphysis slightly medial to midline. FINAL WORKING DIAGNOSIS: Chondroblastoma of tibia TREATMENT AND OUTCOMES: 1. Biopsy taken with radical intralesional excision by currette performed with adjuvant resection with high speed burr. Bone graft placed. 2. Toe touch weight bearing of left lower extremity with T-ROM brace for 6 weeks 3. Chest xray to rule out metastases - normal 4. Knee xray 2 month interval - Stable 5. Return to full activities at 2 months 6. Knee xray 6 months - Stable 7. Return to soccer as scheduled at 6 months with no residual pain 8. Plan for knee xray at 6 month interval