Knee Pain 10 Years After An Acl Tear - Page #1

Author: Miranda Gordon-Zigel, MD
Co Author #1: Rahul Kapur, MD
Editor: Meghan (Mimi) Raleigh, MD, MS
Senior Editor: Meghan (Mimi) Raleigh, MD, MS
Editor: Marc Hilgers, MD, PhD, FAMSSM

Patient Presentation:
Patient presented with worsening knee pain for 2 months.

A 28 year old female presents with a 2 month history of worsening left knee pain. Her pain worsened after a recent bicycle crash in which she fell directly on her left knee. Prior to that she occasionally had pain with activity, but it did not limit her activity. Now she complains of lateral knee pain, 3/10 at rest, and with activity it can get up to 8/10. She has buckling, locking, catching, giving way and swelling.
Prior to this acute pain she exercised 7 days a week. She ran 5-12 miles 4-5 days a week and played flag football. Now she has pain with even low impact exercise.
Her past surgical history is notable for ACL reconstruction at age 18.
Her past medical history includes three stress fractures in her early 20s while training for marathons. She had osteoporosis on DEXA scan and was started on Teriparatide, but stopped taking it after 5-6 months. She currently only takes Calcium. She was referred to a nutritionist, but never followed up with them. She reports irregular menses and has not had a normal cycle in over two years.

Physical Exam:
Left knee shows well healed surgical scars, full range of motion, no effusion, and is notable for crepitus, lateral joint line tenderness, Lachman 1+, and positive McMurray. She has a stable posterior drawer and valgus and varus stress. Her gait is antalgic with a prominent valgus deformity.

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