KNEE PAIN

Abstract

HISTORY: A 14 year old male was playing basketball at school when he came down on his knee after a rebound. He felt a ôpopö in his knee and was unable to continue playing. He said that his knee went ôbackwardsö or hyperextended. Because he was unable to walk without pain he was taken by his parents that day to the local emergency room. They left before a full evaluation could be completed. He presented to our office two weeks later on crutches. He had been non-weight bearing those two weeks. Despite icing the knee it had swelled. He did not have any complaints of parasthesias or weakness. He was in good health with no systemic medical problems. He had a history of a right knee arthroscopy for a presumed discoid meniscus but records were not available. PHYSICAL EXAMINATION: He was in no distress and comfortable. He had no atrophy but had a large, 3 plus effusion. He was neurologically intact to motor testing and sensation. His knee range of motion was 5 to 90 degrees. He was tender over his medial joint line with no tenderness elsewhere. He had no collateral laxity to varus or valgus stress testing, in full extension or thirty degrees of flexion. He had a negative Lachman's, anterior and posterior drawers, pivot shift, tibial sag sign and quadriceps active drawer. There was no crepitus and he had an intact extensor mechanism with no apprehension. DIFFERENTIAL DIAGNOSIS: Torn medial meniscus Fracture Chondral injury Partial anterior or posterior cruciate ligament tear TESTS AND RESULTS: Plain radiographs including sunrise: normal Magnetic resonance imaging: Anterior tibial plateau contusion, medial femoral condyle contusion, posterior capsule disruption and tear medial head gastrocnemius muscle; intact ACL, PCL and meniscal cartilages FINAL OR WORKING DIAGNOSIS: Bone and cartilage contusion tibia and femur due to hyperextension Tear posterior capsule and gastrocnemius muscle due to hyperextension TREATMENT: Re-evaluation after MRI revealed large calf swelling Doppler ultrasound revealed no DVT Symptomatic treatment with weight bearing as tolerated, ice and tylenol as needed Gradual return to sports over three months No further symptoms with athletic activities at nine month follow-up