Abstract
A 72 year-old-male was referred to our institution with recalcitrant prepatellar bursitis. The injury was sustained after striking his right knee against a post whilst horse riding 9 months ago. Previous treatments included repeated aspiration and excision of the bursa with elastic compression bandaging. A diagnosis of a Morel-Lavallée internal degloving injury was made, and the lesion was satisfactorily managed by an internal quilting procedure to eliminate the potential dead space. A review of the literature reveals 29 published reports of Morel-Lavallée lesions with sufficient information for inclusion. These came from 14 separate countries with a total of 204 lesions in 195 patients. The most common anatomical location was the greater trochanter/hip (36%), followed by the thigh (24%) and the pelvis (19%). Most were managed surgically with evacuation of the haematoma and necrotic tissue followed by debridement, which was often repeated (36%). Conservative treatment with percutaneous aspiration and compression bandaging was the next most common treatment (23%). The knee was the fourth most common region affected (16%), and only 3 other lesions in the literature have been managed with a quilting procedure.
Highlights
In 1853 Maurice Morel-Lavallee first described the closed degloving lesion with which he became eponymous
There is an increased likelihood of underlying pelvic and acetabular fractures where these lesions are encountered [3, 4] and their presence is associated with increased surgical site infection rates [5, 6]
This case illustrates an unusual cause for recurrent prepatellar bursitis resistant to conventional management
Summary
In 1853 Maurice Morel-Lavallee first described the closed degloving lesion with which he became eponymous. The space that is created becomes filled with blood, lymph, and necrotic fat around which granulation tissue may become organised into a fibrous pseudocapsule. The presence of such a capsule prevents absorption of the contained fluid and explains why clinical presentation of these lesions can be several months or even years following injury. Letournel and Judet were the first to use the name “Morel-Lavallee lesion” (MLL) in their classification of acetabular fractures. In this context, the lesion referred to the closed degloving injuries over the region of the greater trochanter [2]. This paper highlights an unusual presentation of persistent knee swelling and addresses the literature regarding diagnosis, management, and outcome of MLL
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