Ligamentous Injury Is Quite A Stretch - Page #1

Author: Mohammad Ibrahim, DO
Co Author #1: Mohammad Ibrahim, D.O.
Co Author #2: Andrew Cunningham, M.D.
Senior Editor: Carolyn Landsberg, MD
Editor: Kathryne Bartolo, MD

Patient Presentation:
A 22-year-old female college soccer player with a prior left Anterior Cruciate Ligament (ACL) tear status post reconstruction with bone-tendon-bone autograft and lateral meniscus repair 17 months prior, presented for sudden onset of left knee pain and swelling following a non-contact instability episode 2 days prior to presentation while she was running in a straight line.

Prior operative report showed a full rupture of her ACL, vertical tear of her lateral meniscus, and grade 1 lateral femoral and tibial chondromalacia with no loose bodies. Since the recent reinjury, she has been able to ambulate with some difficulty noting a popping sensation in her knee. The pain was intermittent, generalized, and worse with flexion of the knee.

Physical Exam:
On inspection, the left knee showed a small effusion and turf burn to the anterior region, as well as evidence of prior patellar tendon harvesting and arthroscopic surgery. There was tenderness over the lateral joint line. Range of motion was 10-120 degrees with pain at end-range flexion. Lachman test revealed a 5-10 mm translation with an ill-defined end point. Patellar apprehension and grind tests were negative. McMurray, valgus and varus stress tests were also negative. Knee flexion strength was 5/5.

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