Dunkin' Ain't Easy - Page #1

Author: Nate McKinney, DO
Co Author #1: Jeremy Wells, MD Hattiesburg Clinic Sports Medicine Hattiesburg, MS
Editor: Marc Hilgers, MD, PhD, FAMSSM
Senior Editor: Christian Fulmer, DO
Editor: Marc Hilgers, MD, PhD, FAMSSM
Senior Editor: Marc P. Hilgers

Patient Presentation:
A 13 year old male presents for a second opinion regarding left knee pain/deformity stemming from an injury sustained 3 months earlier.

During the eccentric phase of a powerful jump, the patient felt a pop and pull in the anterior left knee. He fell to the ground with immediate pain and difficulty moving. He was initially evaluated in a local ER and placed in a knee immobilizer. He followed up at a local orthopedic clinic where he was directed to continue knee extension bracing. He was given orders for physical therapy with gradual return to play instructions. Three months following initial injury, he presented for another opinion after failing to return to full activity. At presentation he had mild dull ache over the anterior knee that worsened with activity. Walking gradually improved from time of injury but he was unable to run or jump. There was persistent weakness and abnormal appearance of the left knee since the injury.

Physical Exam:
General: well developed, high percentile height for age

Gait: Antalgic

Left knee:
-patella alta
-left quadriceps atrophy/strength reduction
-extensor lag of 30 degrees
-tender, boggy patellar tendon. No bony tenderness at patella or tibial tuberosity.
-no joint instability
-McMurray's test negative

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415

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