Musculoskeletal-Chronic Left Knee Pain in a High School Athlete Competing in Football and Basketball

Abstract

0109 HISTORY: A 15 year-old high school basketball and football player presents with complaint of intermittent left knee pain for 3 months. One week prior to presentation, the athlete notes that while running and cutting in football practice he “felt something pop in his left knee during contact drills.” After this episode, the patient describes acute swelling over his left knee, occasional “locking” of the knee, and has had to reduce his activities to non-contact drills due to the increased pain with his left knee. The pain presently is located over “the front, inside part of my knee.” Denies any 'giving out' of the knee when ambulating, and has no difficulty ascending or descending stairs. PHYSICAL EXAM: On examination, atrophy of the left thigh over vastus medialis (left thigh girth 2 cm smaller in diameter). Tenderness over medial femoral condyle and anteromedial aspect of knee. Small joint effusion was noted over the left knee. Normal range of motion, no other areas of point tenderness over patella, patellar tendon, or tibial tubercle, and normal patellar tracking with negative apprehension test. No point tenderness over medial or lateral joint lines. Negative Lachman's, posterior drawer, valgus and varus stress testing. Negative McMurray's test. Wilson's test negative. Tanner stage 4. DIFFERENTIAL DIAGNOSIS: Osteochondritis Dissecans of the Knee Stress Fracture of the Knee Medial Meniscal injury Medial Collateral Ligament Sprain Patellar subluxation Tibial Plateau fracture Idiopathic Anterior Knee pain (patellofemoral knee syndrome) TESTS AND RESULTS: Left Knee plain radiographs – Partial loose body defect of lateral part of medial femoral. FINAL/WORKING DIAGNOSIS: Osteochondritis Dissecans of the Left Knee TREATMENT AND OUTCOMES: Restriction of all athletic competition and placed on non-weight bearing status via crutches. Two fragments were fixed into position using Acutrak screws followed by chondroplasty. Athlete was placed into immobilizing brace and advised to follow up on a monthly basis to determine weight bearing status via physical examination and follow up radiographs. Follow up radiographs from his first visit showed good approximation of osteochondral body in situ by Acutrak screws. Due to the osteochondral body in situ, patient will likely be non-weight bearing for 8–12 weeks with avoidance of pivoting. For the first 4 weeks, the patient was advised to start range-of-motion exercises with extension and flexion only. Following this, he will start quadriceps strengthening and rehabilitation of left knee. The athlete will likely return to sports in 3–4 months from surgery with graded progression of activity.