Author: Joseph Kennedy, BS
Co Author #1: David Soma, M.D., Mayo Clinic Department of Pediatric and Adolescent Medicine
Editor: Peter Seidenberg, MD
Knee pain evaluated in sports medicine clinic approximately one month following initial injury.
A 14 year-old boy with a history of acute lymphocytic leukemia (ALL) now in remission was at football practice in August of 2014 participating in a tackling drill when he fell to the ground and landed on his left knee. He could not recall any specific mechanism for the fall but immediately noticed diffuse pain of the knee and associated suprapatellar swelling. He was initially evaluated in the emergency department where plain radiographs and clinical examination were unremarkable; his symptoms were attributed to mild ligamentous injury. He presented for sports medicine evaluation six weeks following the injury having continued to play football with daily, dull and aching left knee/distal anterior thigh pain worse with activity and intermittently present at rest. He denied any erythema, drainage, fevers, chills, myalgias or arthralgias elsewhere in his body, or other systemic symptoms.
Left knee on inspection appeared to have increased fullness over the suprapatellar region without any erythema or overlying skin/soft tissue abnormality. On palpation, the distal quadriceps felt fibrous and firm, yet still mobile, and was mildly to moderately tender. No effusion was present and he was without tenderness over either the medial or lateral joint lines. Extension of the knee was full; however, pain limited active and passive flexion to 120 degrees and 130 degrees, respectively. Strength was 5/5 and he was neurovascularly intact throughout the LE bilaterally. Negative Lachman, varus and valgus stress maneuvers, posterior and anterior drawer. McMurray maneuver, limited by pain, was without any frank abnormality. No patellar apprehension. Mild crepitus noted with lateral greater than medial patellar deviation.
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