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Published byScarlett Dungey Modified over 9 years ago
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Knee Injury in a Soccer Player Nell Kopp DO University of Kentucky Primary Care Sports Fellow
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15 yo female high school soccer player Presents to sports medicine clinic on crutches 2 day history of right knee pain
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MOI: During a soccer game, she tripped over another player's feet going for the ball o suffered valgus injury to her right knee o 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
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Small effusion ROM o Flexion limited to 90 degrees o Full Extension TTP o MCL: more proximal o Lateral Femoral Condyle Negative Patellar Apprehension
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Valgus/Varus Stress o No laxity at 0 Degrees o 30 degrees Valgus: Guarding, Laxity (1+) Varus: Stable Lachman: guarding without firm endpoint Negative Posterior Drawer
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McMurray's: pain without catch/clunk o Localized deep in knee FROM at ankle Distal pulses 2+, Sensation Intact
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Plain Films: o 3 views right knee: no acute fracture
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ACL injury Patellar Dislocation Bone Bruise Occult Fracture Meniscus Injury MCL sprain
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MCL injury o Due to location of pain o Guarding/Laxity at 30 degree Valgus Stress Possible ACL injury o MOI o Guarding with Lachman
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Treatment Plan o TROM locked in Extension o Crutches o MRI for further evaluation
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MRI: o Nondisplaced Salter-Harris IV fracture distal femur o Grade 2 sprain of the superficial medial collateral ligament and patellofemoral ligament at the femoral attachment o Bone marrow contusion pattern suggesting a pivot shift injury with intact ACL
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MCL sprain with non displaced Salter IV femur fracture
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Patient had routine follow up After MRI, 2wks, 5 wks and 10 wks post injury
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6 wks nonweightbearing in TROM Progressive return to weightbearing activities TROM: o Locked in Extension x 4 wks o Unlocked for 2 wks following
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Physical Therapy o Initially: SLR, Quad Sets and ROM o 4 wks: Weightbearing activities o 6 wks: Transitioned to sport specific modalities and agility drills o 10 wks: Return to play
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Returned to Soccer at 10 wks post injury 6 mos post injury denies any knee pain or instability symptoms
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