KNEE PAIN/LOCKING - WATER SKIING

Abstract

2040 HISTORY - A 24-year-old female, former soccer athlete, was water skiing and fell. She was able to swim back to the boat. She had immediate swelling and pain of her left knee. She did hear a pop. She was unable to weight bear and straighten the left knee. She informed us that her knees always felt weak when growing up but denied specific knee injury. Her pain was mainly located on the lateral joint line. PHYSICAL EXAM - Revealed a healthy young lady with inability to weight bear on the affected leg. Left knee examination showed a mild effusion with active and passive range of motion from 20-115 degrees. There was a moderate effusion with severe tenderness on the lateral joint line and a clicking sensation on knee flexion. The ligamentous examination was normal and symmetrical. Mild quadriceps muscle atrophy was noted. Neurocirculatory status was intact. Displaced lateral meniscus tear Loose body with locked knee Discoid lateral meniscus Osteochondritis dissecans with detached fragment TESTS AND RESULTS: Plain radiographs of AP, lateral, notch, bilateral Hughston patellar views showed a 4 cm × 1.5 cm radiolucency consistent with osteochondritis dissecans of lateral femoral condyle. The notch and lateral views showed the lesion best. A loose body in posterolateral compartment was also seen. She was placed nonweight bearing on crutches. Arthroscopic surgery was scheduled. Osteochondritis dissecans lateral femoral condyle, with an unstable fragment. Loose body in posterior compartment. TREATMENT: Patient underwent diagnostic arthroscopy and removal of loose body. Fixation of unstable fragment from lateral femoral condyle with arthroscopic internal fixation using absorbable PDS pins was done. Postoperatively she remained nonweight bearing for 6 weeks with knee range of motion limited to 0-45 degrees. At follow up of 3 months, her motion was 0-90 degrees, no effusion, and she has started full weight bearing mobilization. At 4 months she was cleared for nonimpact closed chain strengthening exercises, but avoid plyometrics and sports involving rotational movements and rapid cutting/change in direction for 8 to 12 months. Radiographs showed evidence of early healing of the lateral femoral condylar defect.