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Beyond The Sidelines: Persistent Atraumatic Knee Pain In A Collegiate Athlete - Page #1
 

Author: Aditi Kumar, MD
Co Author #1: Morgan Gochnauer, MD, MEd
Co Author #2: Cayce Onks, DO, MS, ATC, FAMSSM, FACSM
Senior Editor: Christian Fulmer, DO, FAMSSM
Editor: Robert Oh, MD, MPH

Patient Presentation:
A 23-year-old collegiate womens lacrosse player presents with 4 months of progressive left knee pain. She denies preceding trauma or a specific inciting event. During the competitive season she continued to play despite persistent symptoms. Meloxicam, bracing, activity modification, and rehabilitation provided only mild temporary relief. Following the season, her symptoms persisted despite reduced activity and continued conservative management. Her pain was primarily localized to the medial knee and worsened with running, cutting, and prolonged activity. She denied swelling, locking, catching, instability, fevers, night sweats, or unintentional weight loss.

History:
Past medical history was significant for anxiety and depression. Medications include a combined oral contraceptive. Family history was notable for maternal breast cancer resulting in the death of her mother in her early 50s.

Physical Exam:
Her vital signs were normal and she was in no acute distress with a non-antalgic gait. Her left knee examination demonstrated full range of motion without effusion or deformity. Tenderness was present along the medial joint line, medial patellar facet, and medial plica region. McMurray and circumduction testing reproduced pain. Lachman, anterior drawer, posterior drawer, valgus stress, varus stress, and patellar apprehension testing were negative. Hamstring tightness was present with limited flexibility on 90-90 testing to approximately 75 degrees. Hip examination was normal.

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