Abstract
Skiing as a recreational activity has increased exponentially in the last twenty-years. Similar to any sporting activity, participants can sustain various types of injury, which provides the emergency departments with a continuous supply of patients. The injury pattern from the slopes has also changed over this time period, due to alterations and improvements in ski equipment. An increased diversity in alpine skiing techniques, as well as snowboarding and cross-terrain disciplines has also influenced this change.We present a multi-media experience of a high-speed ski fall that caused a valgus-external rotation injury to the right knee that precluded the patient from further ski activity. There was no bruising, swelling or instability demonstrated and the patient returned to ski activities 24-hours post-injury. Although this injury appeared clinically benign initially, the patient complained of persistent pain around the right knee which was causing occupational difficulties. Following normal clinical assessment, the patient returned to work but continued to complain of persistent pain at the lateral aspect of the right knee. Magnetic Resonance Imaging (MRI) demonstrated extensive bone marrow oedema (BMO), a mild depression of the articular cortex compression with a small focus of articular cartilage disruption and microfractures of the lateral tibial plateau. The patient was treated conservatively and remains well with avoidance of impact exercises 14-months post-injury.In the presence of any high speed injury, we would stress that regardless of initial normal investigations, clinical suspicion should remain paramount and not deter the physician from further investigation in the presence of continuing symptomatology.
Highlights
A 30 year-old male presented to the Accident and Emergency Department in March 2006 with persisting right knee pain
On assessment at the resort, maximal tenderness was elicited around the lateral tibial plateau and mid-tibial region
Impact training still exacerbates the discomfort around the right knee joint, and he prefers to continue with non-impact exercises
Summary
A 30 year-old male presented to the Accident and Emergency Department in March 2006 with persisting right knee pain He described a high-speed fall during a ski holiday in January 2006 in which he sustained a valgus-external rotation knee injury (Additional file 1). On assessment in the Accident and Emergency Department 6-weeks following the injury, tenderness was again elicited around the lateral aspect of the knee and mid-tibia with no clinical evidence of a haemarthrosis or joint instability. Various factors guide the clinician to the diagnosis such as the force and type of fall (twisting, hyperextension, or falling backward), whether a "pop" was heard by the skier, the presence of instability after the fall and any associated swelling In this case, the patient complained of pain following an external-rotation injury and described no actual feeling of joint instability or swelling. Impact training still exacerbates the discomfort around the right knee joint, and he prefers to continue with non-impact exercises
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