Differential Diagnosis Of Knee Pain Research Articles

Arthroscopic decompression and debridement for the treatment of anterior cruciate ligament ganglion cyst in a 45-year-old female

Anterior cruciate ligament (ACL) cysts are infrequently encountered in clinical practice, with limited reported cases. These cysts usually present with chronic knee pain and clinical examination is usually unremarkable except for knee tenderness. Due to the lack of characteristic symptoms and deficiency of precise clinical techniques to diagnose the condition, timely diagnosis requires a high index of suspicion, supported by magnetic resonance imaging (MRI). Hence management of ACL ganglion cysts poses unique challenges for healthcare providers. We present a case study of a 45-year-old female with an ACL ganglion cyst successfully treated with arthroscopic decompression and debridement. This article outlines the clinical presentation, diagnostic workup, surgical intervention, and post-operative outcomes of this case, providing insights into the effective management of this uncommon condition. Furthermore, we provide a comprehensive review of the existing literature on ACL ganglion cyst, emphasizing findings and treatment outcomes reported in previous studies. This case underscores the importance of considering ACL cysts in the differential diagnosis of knee pain and discomfort. Early identification and appropriate management, such as arthroscopic cyst excision, can lead to favorable outcomes and complete recovery.

Saphenous Nerve Schwannoma: A Rare Differential Diagnosis of Knee Pain in Children

Schwannomas are uncommon benign tumors of the peripheral nerves with a low risk of malignant transformation. They rarely affect children, can affect any part of the body but rarely occur in the lower extremity and typically present with a palpable mass, pain or neurological signs. Imaging helps to orient the diagnosis and anatomopathological examination helps to confirm it. We report a case of a 12-year-old girl who presented with left knee pain with subcutaneous mass overlying the tibial tuberosity medially. Clinical examination revealed a positive Tinel's sign. Magnetic resonance imaging (MRI) of the knee was performed, which revealed an encapsulated subcutaneous soft tissue mass overlying the tibial tuberosity medially, eccentric to the course of the infrapatellar branch of the saphenous nerve. The patient was operated with total intracapsular excision of the lesion and the anatomopathological study of the surgical specimen came back in favor of a schwannoma. Postoperatively, the patient showed a good recovery with disappearance of pain and swelling.

Association between knee pain location and abnormal imaging or arthroscopic findings: A systematic review.

Assessment of pain location is an essential component of the differential diagnosis of knee pain because pain location is thought to indicate pathology. Previous studies have questioned whether abnormal imaging findings are related to the presence of pain, but none has systematically reviewed the association between knee pain location and the location of abnormal imaging or arthroscopic findings. To systematically review the association between the location of knee pain and the location of abnormal imaging or arthroscopic findings. Databases were searched up to November 2021 for articles in English that investigated the association between pain location reported using pain mapping and the location of abnormal imaging or arthroscopic findings. Risk of bias was assessed with the modified Newcastle-Ottawa scale. Results were sub-grouped by pathology and data analysis was performed as appropriate. Among 7730 articles identified, 10 (n=2034 participants) met the inclusion criteria. Three sub-pathologies were evaluated: patellar tendinopathy (n=2), knee osteoarthritis (n=7), and degenerative meniscal tears (n=1). The primary analysis found poor sensitivity and specificity of patellar tendon hypoechogenic areas and local patellar tendon pain in adult (n=55) and adolescent athletes (n=114). The location of pain and the location of abnormal imaging findings was associated in 2 studies of knee osteoarthritis (n=166). Five articles reported no relationship (n=1563). No association was reported between the location of pain and the location of arthroscopic findings in degenerative meniscus tears (n=193). All articles included were rated at low risk of bias. Sensitivity and specificity of the presence of patellar tendon hypoechogenic areas and localised patellar tendon pain was poor. Pain location was not associated with the location of abnormal imaging findings in knee osteoarthritis or to abnormal arthroscopic findings in degenerative meniscus tears.

A case of schwannoma of the common peroneal nerve in the knee

Schwannomas are benign neurogenic tumors of peripheral nerves that originate from neural sheath. The aim of this case report is to bring to mind the schwannoma in the patient with knee pain. A 39-year-old woman presented with a complaint of knee pain of three months history. After surgical intervention, the patient’s complaints completely disappeared in the post-operative period. This should come to mind in the differential diagnosis of knee pain.

Cystiysticercosis as a differential diagnosis of knee pain: A rare case report

Cysticercosis is caused by larval stage of pork tapeworm(Taenia solium). There is difficulty in diagnosing cysticercosis by ultrasound alone in its early stage especially if the lesion is small.we need to adopt MRI for early diagnosis and for starting optimum treatment for the patient. We discuss about a case of cysticercosis of vastus medialis muscle who presented with knee pain in orthopedic OPD and medical treatment was given with complete resolution of infection. Case Report: A 31 years old male who presented with complaints of pain in the (L) knee for 2 weeks duration, difficulty in sitting cross legged and squatting for 1 week. He was also complaining of mild swelling on the medial aspect of the knee. On local examination, a diffuse swelling of distal thigh (medial aspect) with knee effusion was present with induration of vastus medialis muscle. On ultrasonography it was diagnosed as a small tear in the vastus medialis muscle.But MRI scan showed evidence of 1x0.8x0.5cm well defined oval cystic lesion in the deep muscular plane of vastus medialis in its distal one third with surrounding muscle edema and knee effusion. Patient was completely asymptomatic with full range of knee ROM after treatment with albendazole alone for 4 weeks..Conclusion: We should keep Intra muscular cysticercosis as a differential diagnosis for knee pain especially in endemic areas. Muscular cysticercosis with no other systemic involvement can be treated with albendazole alone. Since isolated cysticercosis is a rare entity we should always rule out other systemic involvement including central nervous system.

Pellegrini–Stieda Disease in Traumatic Brain Injury Rehabilitation

Pellegrini–Stieda disease (PSD) is posttraumatic ossification of the proximal attachment of the medial collateral ligament of the knee, diagnosed by radiography.1 Antecedent traumas include direct and indirect injury to the medial side of the knee. Repeated microtraumas, including therapeutic manipulation of a stiff joint and postsurgical rehabilitation, have also been reported.2 Because PSD is rarely diagnosed in neurologic rehabilitation patients, only one case of spinal cord injury having this disease was reported.3 We describe a traumatic brain injury patient with clinical and radiologic findings of PSD. Our aim in this report is to show that this entity can be seen in neurological rehabilitation patients during the course of exercise treatment and must be taken into account in differential diagnosis of knee pain, swelling, and range-of-motion limitation. A 22-yr-old man, with contusion lesions determined by cranial computerized tomography secondary to a motorcycle accident, attended our clinic for rehabilitation. The patient had a history of 3 mos of hospitalization in the intensive care unit and anesthesia clinic in another hospital for multiple traumas. The patient did not describe any known injury or trauma to the knee in the motorcycle accident. On examination, the patient was found to have range-of-motion limitation with swelling and complaint of pain in his left knee. The patient had no history of systemic diseases such as gout, rheumatoid arthritis, systemic sclerosis, sarcoidosis, or hyperparathyroidism. On physical examination, the left knee was limited at 60 degrees of flexion, extension was at a normal range, and the knee joint was stable. Serum calcium, phosphate, and alkaline phosphatase levels were within normal ranges. The plain radiographs demonstrated a characteristic bony formation, calcification medial to the femoral condyle (Fig. 1). Because of the characteristic radiographic findings and the clinical course, the diagnosis of PSD was considered.FIGURE 1: Anteroposterior radiogram reveals a massive bony tissue (arrows) medial to the femoral condyle.PSD manifests radiographically, with ossification arising from the epicondylar portion of the medial femoral condyle.1 In the etiology of neurogenic ectopic bone formation, humoral, neural, and local factors, including tissue hypoxia, hypercalcemia, changes in sympathetic nerve activity, prolonged immobilization, and mobilization with frequent periods of exercising after prolonged immobilization, play a role. In traumatic brain injury patients, neurogenic heterotopic ossification can result in accelerated fracture healing. Reduced collagen degradation in polytraumas with traumatic brain injury causes enhanced osteogenesis.4 Radiographically, the ossification is seen as a thin crescent or curvilinear line of a few millimeters from the femoral condyle. This feature is crucial for ruling out other lesions including fracture of the femoral condyle, periostitis, and osteoma.1 In conclusion, PSD can be seen in neurologic rehabilitation patients during the course of exercise treatment, and it must be taken into account in the differential diagnosis of knee pain, swelling, and range-of-motion limitation.

Differential Diagnosis of Knee Pain Commonly Encountered in Clinical Practice

The knee is a complex structure and far from being the simple hinge joint of popular belief. Knee pain would not be properly understood unless one is familiar with the anatomy and understands the role of the various structures. For patient consultation or for selecting a treatment option, it is crucial to find the central cause of symptoms and functional disabilities of the patient based on a detailed history, a focused examination and, when indicated, the selective use of appropriate imaging and laboratory studies. The history taking should be comprehensive and include the demographic characteristics, past medical history, comprehending the associated trauma, pain characteristics and quality of life. Basic physical examination should include inspection of walking pattern and the knee, evaluation of joint effusion, range of motion and the location of tenderness, and precise assessment of joint stability. Although many advanced diagnostic tools are available, plain radiographs are frequently utilized as a primary tool to evaluate conditions of the knee joint for practical and economic reasons. A weight-bearing anteroposterior radiographs should be taken for appropriate evaluation of the condition of the tibiofemoral joint, and weight-bearing radiographs in semi-flexed position is valuable to evaluate the joint space more precisely. To evaluate the patellofemoral joint, axial and lateral views should be included in the routine radiographs. In practice, physicians need to be cautious not to easily reach the conclusion that the symptoms of the knee joint can be attributed to only a few clinical findings in consulting the patients with knee pain.

An intra-articular vascular malformation with a ganglion in a knee

We report a case of an intra-articular vascular malformation occurring simultaneously with a ganglion in a knee joint. We believe this to be the first reported case of an intra-articular vascular malformation occurring simultaneously with a ganglion. The malformation was cauterized resulting in resolution of knee pain. We suggest that vascular malformations be considered in the differential diagnosis of knee pain.

The migration of a BioScrew® as a differential diagnosis of knee pain, locking after ACL reconstruction: a report of two cases

Problems with the initial fixation strength and widening of the femoral and tibial canal after ACL reconstruction using a triple or quadruple semitendinosus autograft have led to the introduction of the so-called Hybrid fixation with the additional use of interference screws. Pain and intraarticular migration have been reported with metal interference screws requiring implant removal (Am J Knee Surg 11:32-34, 2000, Arthroscopy 11:289-291, 1995) but not yet with bioabsorbable screws. We report on two cases were the intraarticular position of a bioabsorbable interference screw possibly due to migration in the early postoperative period lead to symptoms, the need for further surgery, and implant removal. A preoperative MRI revealed the diagnosis. After removal of the tibial interference screw both knees were settling down, albeit with residual instability and only a moderate clinical result. Despite the attractiveness of bioabsorbable screws due to the very fact that they are being reabsorbed over time, there is a slight risk of migration in the first month after the operation. In any suspicious case an MRI will easily clarify the diagnosis.

Limited Posterolateral Surgical Approach to the Knee for Excision of Osteoid Osteoma

An 18-year-old man suffered four years of undiagnosed knee pain until a CAT scan revealed an epiphyseal osteoid osteoma of the tibia located subchondrally, just medial to the proximal tibiofibular joint. A nidus in this location is not easily accessible, and its proximity to the joint surface raised concerns about damage to the tibial plateau. To facilitate excision of the tumor, cadaveric dissections were performed to develop a limited posterior approach to the proximal, lateral portion of the tibia. The CAT scan was used to calculate the precise dimensions of the tumor and its relation to the posterior tibial cortex and the proximal tibiofibular joint. With the use of the exposure developed in the laboratory and the calculations derived from the CAT scan, the tumor could be excised by removing a single block of bone 15 mm3. Intraoperative radiographs confirmed the presence of the nidus within the excised block of bone. This case report reaffirms the frequent difficulties and tardiness in diagnosing osteoid osteomas and the need to include these tumors in the differential diagnosis of knee pain and epiphyseal lesions. Before CAT scans were used, the working diagnoses were torn meniscus, juvenile rheumatoid arthritis, and bone hemangiomatosis.

Chondral fractures of the knee

Knee pain in the athlete can pose difficulty in diagnosis. At the United States Military Academy at West Point we have had occasion to see a group of patients presenting with meniscal symptoms of locking, catching, giving way, and joint line tenderness who, on arthroscopic examination, have chondral fractures of the medial or lateral femoral condyle. These individuals have undergone arthroscopy and debridement of the chondral defect. Both retrospectively and prospectively we have been unable to find any defects on radiographs and there appears to be purely cartilaginous involvement. These individuals appear to have a relatively poor prognosis for recovery after arthroscopy. Treatment has been a standard course of range of motion exercises, strengthening, and antiinflammatory medications. However, the mean rehabilitation time has been almost triple the time associated with a routine meniscal injury. We feel that it is important to discuss the chondral fracture so that the orthopaedic surgeon can be aware of this possibility in the differential diagnosis of knee pain in the athlete.

Neuropathy of the infrapatellar branch of the saphenous nerve in the differential diagnosis of knee pain

A 58-year-old woman complained of pain and paresthesia localized on the medial side of both knees. Neurological examination disclosed signs, referrable to a bilateral compression lesion of the infrapatellar branch of the saphenous nerve. Gonyalgia paresthetica should be taken into consideration in the differential diagnosis of knee pain and sensory disturbances.