Return To Sports After A Contact Knee Injury In An Elite Female Soccer Player

Abstract

HISTORY A 17 - year - old female soccer athlete sustained a contact injury to her right knee when she collided with an opposing defender. The athlete recalled falling to the turf after her knee hyperextended as a result of the impact. She had to be helped off the field and was unable to return to competition. Her chief complaints on the sidelines were pain in the distal thigh as well as tingling or numbness just below the knee. Upon presentation in the emergency room, she was diagnosed with a right knee sprain, given a knee immobilizer, and instructed to follow-up with her orthopaedic surgeon. PHYSICAL EXAMINATION On initial presentation to the orthopaedist, 3 days post injury, the patient showed trace effusion of the right knee and was able to bear weight fully with a slight hyperextension gait pattern. Her chief complaints were intermittent posterior knee pain, medial knee pain, swelling and weakness. Significant findings included a positive posterior drawer and a positive valgus stress test at 30 degrees of knee flexion. She rated her knee pain 6/10 on a Visual Analog Scale. DIFFERENTIAL DIAGNOSIS Posteromedial rotary instability Medial meniscus tear Tibial plateau fracture TEST AND RESULTS X-rays showed no acute bony changes MRI revealed an intermediate to high grade MCL sprain and a high grade PCL sprain. MRI revealed a small contusion of the anterolateral tibial plateau with small joint effusion. MRI confirmed the ACL was intact. FINAL WORKING DIAGNOSIS Grade III PCL sprain and Grade II MCL sprain. TREATMENT AND OUTCOMES Conservative treatment started 1 week post injury with activity modification, hinged knee bracing, quadriceps isometric leg lifting and NSAIDs. Home exercise instruction for stationary biking began 3 weeks post injury. Physical therapy emphasizing strength and neuromusuclar control training started at 4 weeks post injury. PCL had tightened up to Grade I+ and MCL demonstrated only residual laxity by 6 weeks post-injury. Dynamic neuromuscular training and speed training started 6 weeks post injury with functional PCL brace support. Returned to sports 2 months post injury after demonstrating no neuromuscular deficits with a single leg hop for distance, a box drop vertical jump, and cutting maneuvers.