Author: Jason Alvarado, M.D.
Co Author #1: Bernadette Pendergraph, M.D.
Co Author #2: Bernadette Pendergraph, M.D.
Co Author #3: Bernadette Pendergraph, M.D.
Editor: Mandeep Ghuman, MD
Senior Editor: Mandeep Ghuman, MD
Editor: Brian Kim, MD, MS
Senior Editor: Mandeep Ghuman, M.D.
A 17-year old male football player presented to sports medicine clinic with complaints of right knee pain.
The patient reported right knee pain stemming from an injury one week prior. He sustained a direct trauma to the knee from another player, followed by forced knee flexion against the ground. He heard an audible "pop," followed by immediate pain and swelling. His knee was immobilized by the school athletic trainer and was treated initially with ice and non-steroidal anti-inflammatory medication.
On exam there was diffuse ecchymoses about the knee. There was a large effusion with extensive soft tissue swelling. On palpation there was generalized tenderness throughout the knee, most significantly over the distal patella. Range of motion was limited to a range of 5-90 degrees and the patient was unable to perform an active straight leg raise. Lachman and anterior/posterior drawer testing were negative and there was no laxity with varus or valgus stress at 0 and 30 degrees of knee flexion. The patient was unable to tolerate McMurray test due to pain. An intact patellar tendon could not be visualized on bedside ultrasound.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.