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):
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. Axial section at femoral metaphysis.
Confluent fluid collection between vastus musculature and subQ fat

17. Treatment and Outcome Treatment Outcome
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.

18. Thank You

19. Prepatellar Bursitis