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Knee Pain

Knee Pain. Matthew A. Close, DO Steadman-Hawkins Sports Medicine Greenville Hospital System University Medical Center. Chief Complaint and History. CC: 16-year-old offensive lineman who presented to the training room with left knee pain after a football game HPI:

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Knee Pain

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  1. Knee Pain Matthew A. Close, DO Steadman-Hawkins Sports Medicine Greenville Hospital System University Medical Center

  2. Chief Complaint and History • CC: • 16-year-old offensive lineman who presented to the training room with left knee pain after a football game • HPI: • No specific injury during the game • Swelling and moderate pain afterwards • No giving way, locking or catching • Mild numbness over the top of his knee • No previous injury

  3. Physical Exam • Inspection: Moderate soft tissue edema antero-medially. Antalgic gait. • Palpation: Trace effusion, TTP at anterior medial joint line, and distal medial quadriceps with deep palpation. • ROM: Active 5/0/115, Passive produced pain with flexion past 120 degrees.

  4. Physical Exam • Strength: 5/5 strength in knee flexion/extension. • Stability: Stable in varus/valgus at 0 and 30 degrees. Negative Lachman. Stable ant/post drawers. • Special Tests: Discomfort with McMurray, but no click. • Neurovascular: Numbness over top of knee. Pulses 2/4 at DP and PT.

  5. Differential Diagnosis

  6. Differential Diagnosis • ACL tear • Medial meniscal tear • Patella contusion • Partial quadriceps tear • Thigh contusion • Prepatellar bursitis • MCL sprain

  7. Tests and Results

  8. Tests and Results

  9. 5 Days Post-Injury

  10. MRI

  11. MRI Results • Extensive subcutaneous edema anteriorly with mild fluid collection between subQ fat and underlying fascia. • Increased signal in posterior medial meniscus, no tear. • Grade 1 chondromalacia of patella. • Cruciate and collateral ligaments without injury.

  12. Final Working Diagnosis

  13. Final Working Diagnosis Morel-Lavallee Lesion

  14. Historical Perspective • Maurice Morel-Lavallee (1853) • Tejwani SG, et al. Management of Morel-Lavallee lesion of the knee: twenty-seven cases in the National Football League. Am J Sports Med. 2007; 35(7):1162-1167. • 24 patients (27 knees) • 14 (52%) conservative • 13 (48%) aspiration (mean 2.7 times) • 3 (11%) doxycycline sclerodesis • Time to full resolution 16.3 days

  15. Treatment and Outcome • Treatment • Neoprene compression sleeve, cryotherapy, rest. • Rehabilitation coordinated with school’s athletic trainer, emphasizing ROM exercises and quadriceps strengthening. • Swelling and ecchymosis eventually resolved. • Outcome • Pt returned to football practice after 2 weeks, and resumed starting position 3 weeks after injury.

  16. Thank You

  17. Prepatellar Bursitis

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