1. Acute vs Chronic Knee Injury- Basketball
Brian Wu, MD/PhD Candidate
ACSM Clinical Case Presentation
May 28th, 2014

2. History 30-year-old male present with L knee pain, instability
16 years ago: dirt bike injury, injured ACL, MCL
No surgery, no issues since
5 days ago: playing basketball, player fell on L knee with valgus force
Immediate swelling and ecchymosis
3/10 pain in posterior and lateral knee

3. Physical Exam
Moderate effusion present and ecchymosis on posterior and lateral knee
Tenderness to palpation on lateral joint line
Trace laxity with valgus stress test
2+ Lachman, 2+ anterior drawer
Guarded on pivot shift
8 cm prone heel height difference
Antalgic gait

4. X-Ray
Preo AP
No bony abnormalities, arthritis fractures, or dislocations bilaterally

5. PA and lateral

6. Differential Diagnosis
Acute ACL tear
Chronic ACL tear
MCL strain
Medial femoral condyle cartilage lesion
Meniscal tear

7. ACL tear
Sagittal one

8. ACL tear
Coronal 1

9. Bone bruise, fluid changes in lateral femoral condyle

10. Bone bruise, fluid changes in lateral femoral condyle

11. MRI
Torn L ACL
Intact fibers of MCL and LCL with increased fluid signal
Bone bruising at lateral femoral condyle and posterior lateral tibial plateau with significant joint effusion
Increased signal change in posterior horn of lateral meniscus

12. Final Diagnosis
Acute pivoting injury resulting in acute MCL sprain, LCL sprain, lateral femoral condyle and lateral bone bruise, lateral meniscal tear in setting of chronic ACL rupture

13. Treatment PT for 2 weeks to regain full ROM
Autograft vs allograft options
BTB allograft chosen for ACL recon
Knee swelled. Really strong after.
Running – 3 months
Check chart- for final details

16. Treatment PT began 1week following surgery
ROM exercises progressed to full ext/flex
Began strengthening exercises and progressed to running at 4 months w/ brace
Return to physical activity at 7 months when full painless ROM and normal strength

17. Additional Data Lean Body Mass L Leg Peak Torque Dynamometer
Pre: kg Post: kg
Peak Torque Dynamometer
Pre: R Leg: 184 N-M L Leg: 161 N-M
Post: R Leg: 228 N-M L Leg: 167 N-M