Transcript Document

Knee Injury in a Soccer Player
Nell Kopp DO
University of Kentucky
Primary Care Sports Fellow
• 15 yo female high school soccer player
• Presents to sports medicine clinic on crutches
• 2 day history of right knee pain
• MOI: During a soccer game, she tripped over
another player's feet going for the ball
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suffered valgus injury to her right knee
Felt a pop with immediate pain over medial aspect
Swelling developing within 24 hours
Pain worsening since injury
Worse w/ knee flexion and weightbearing
Denies radiation of pain, numbness or tingling
• Small effusion
• ROM
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Flexion limited to 90 degrees
Full Extension
• TTP
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MCL: more proximal
Lateral Femoral Condyle
• Negative Patellar Apprehension
• Valgus/Varus Stress
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No laxity at 0 Degrees
30 degrees
 Valgus: Guarding, Laxity (1+)
 Varus: Stable
• Lachman: guarding without firm endpoint
• Negative Posterior Drawer
• McMurray's: pain without catch/clunk
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Localized deep in knee
• FROM at ankle
• Distal pulses 2+, Sensation Intact
• Plain Films:
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3 views right knee: no acute fracture
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ACL injury
Patellar Dislocation
Bone Bruise
Occult Fracture
Meniscus Injury
MCL sprain
• MCL injury
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Due to location of pain
Guarding/Laxity at 30 degree Valgus Stress
• Possible ACL injury
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MOI
Guarding with Lachman
• Treatment Plan
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TROM locked in Extension
Crutches
MRI for further evaluation
• MRI:
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Nondisplaced Salter-Harris IV fracture distal femur
Grade 2 sprain of the superficial medial collateral
ligament and patellofemoral ligament at the femoral
attachment
Bone marrow contusion pattern suggesting a pivot shift
injury with intact ACL
• MCL sprain with non displaced Salter IV femur
fracture
• Patient had routine follow up After MRI, 2wks, 5
wks and 10 wks post injury
• 6 wks nonweightbearing in TROM
• Progressive return to weightbearing activities
• TROM:
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Locked in Extension x 4 wks
Unlocked for 2 wks following
• Physical Therapy
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Initially: SLR, Quad Sets and ROM
4 wks: Weightbearing activities
6 wks: Transitioned to sport specific modalities and
agility drills
10 wks: Return to play
• Returned to Soccer at 10 wks post injury
• 6 mos post injury denies any knee pain or
instability symptoms