Rare Knee Injury In A Hurdler

Abstract

HISTORY: 18-year-old female with history of asthma presented to the ED with injury to knee. About 20 minutes prior to arrival she tripped over a hurdle and landed awkwardly. Immediately felt pain to the left knee and left hip and had an obvious left knee deformity. The high school trainer was able to palpate distal pulses. EMS was called and patient was placed in an air splint and transferred to the ED. PHYSICAL EXAM: In the ED Patient had stable vital signs. She had notable deformity to the left knee, left lower limb notably shorter than right and externally rotated with dimpling at the medial knee. Unable to flex at the left knee joint. Tenderness at the left knee joint, no erythema, no swelling. Able to wiggle toes, dorsiflex and plantarflex. L3-S1 Sensation intact. Dorsalis pedis and posterior tibialis pulses 1+ on the left, weaker than the right. Brisk cap refill. DIFFERENTIAL DIAGNOSES: 1. Anterior Knee Dislocation with multiple ligamentous damage with vascular compromise. 2. Anterior Knee Dislocation with multiple ligamentous damage without vascular compromise. 3. Anterior Knee Dislocation with minimal ligamentous injury. 4. Hip Fracture/dislocation TESTS AND RESULTS: 1. XR KNEE LT 2V IMPRESSION: Complete dislocation at the left knee joint. Distal femur displaced posteriorly with respect to proximal tibia. No fractures noted. No radiopaque foreign body. 2. XR PELVIS 1V IMPRESSION: Normal Xray, no fracture, dislocations or deformities noted. 3. XR KNEE LT 2V Post Reduction IMPRESSION: Relocation of previously seen dislocation. Normal alignment noted. No fractures. FINAL WORKING DIAGNOSIS: Anterior Knee Dislocation with multiple ligamentous damage and vascular compromise. TREATMENT AND OUTCOME: 1. Pt underwent a closed reduction in the ED with sedation by ortho and ED physicians. 2. Distal pulses improved and patient was placed in an immobilizer. 3. Vascular surgery was consulted, and a CTA of the lower extremity was done which showed no vascular injury. 4. Pt had external fixation procedure with fluoroscopy for knee stabilization. 5. Pt was followed up with outpatient Ortho. External fixation was removed 2-3 months after the surgery. 6. Pt was placed in an immobilizer and was started with physical therapy. Further management pending orthopedic evaluation and patient progression.