Author: Drew Duerson, MD
Senior Editor: Rachel Coel, MD, PhD
Editor: Cleo Stafford, II, MD, MS

Patient Presentation:
A 13-year-old female track and field athlete presents to a sports medicine clinic with insidious onset of right knee pain.

History:
The patient was recently diagnosed with T12 and L1 compression fractures after a sledding accident in which she was cleared by neurosurgery to return to physical activity. She describes mostly anterior knee pain with running. She was not running much prior to her vertebral compression fractures and her activity was restricted during treatment. The knee pain gradually worsened as she started running more in track and field practice. She does not have pain at rest. She denies night pain or fever. She denies any swelling, catching, or knee locking. Her knee feels weak at times and wants to give way. She reports no prior knee injuries and specifically no history of stress fractures. She is premenarchal. Family denies any dietary concerns. There is no pertinent surgical or family history.

Physical Exam:
Constitutional: Healthy appearing female in no apparent distress.

Gait: Mildly antalgic gait present.

Musculoskeletal: Inspection of the right knee reveals no knee swelling, effusion, erythema, or ecchymosis.
Tenderness to palpation beneath both patellar facets and the proximal tibial plateau.

Full active and passive range of motion of the knee and hip.

Full strength in flexion and extension.

Extensor mechanism is intact. Pain with patellar grind. No pain or apprehension with patella manipulation. Lachman, anterior and posterior drawer tests are negative. Knee stable with valgus and varus stress at 0 and 30 degrees. Meniscal signs are negative. Pain elicited with single leg hop.

Neurovascularly intact.

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