knee pain matthew a. close, do steadman-hawkins sports medicine greenville hospital system...

Knee PainMatthew A. Close, DO

Steadman-Hawkins Sports MedicineGreenville Hospital System University Medical Center

Chief Complaint and HistoryCC:

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 gameSwelling and moderate pain afterwards No giving way, locking or catchingMild numbness over the top of his kneeNo previous injury

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.

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.

Differential Diagnosis

Differential Diagnosis

ACL tear

Medial meniscal tear

Patella contusion

Partial quadriceps tear

Thigh contusion

Prepatellar bursitis

MCL sprain

Tests and Results

Tests and Results

5 Days Post-Injury

MRI

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.

Final Working Diagnosis

Final Working Diagnosis

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

Treatment and Outcome

TreatmentNeoprene compression sleeve, cryotherapy, rest. Rehabilitation coordinated with school’s athletic

trainer, emphasizing ROM exercises and quadriceps strengthening.

Swelling and ecchymosis eventually resolved.

OutcomePt returned to football practice after 2 weeks, and

resumed starting position 3 weeks after injury.

Prepatellar Bursitis