Soccer Player With Quadriceps Weakness After Patellar Dislocation - Page #1

Author: Kameron Bazmi, MD
Co Author #1: Caitlin Cicone MD
Co Author #2: Richard G. Chang MD, MPH
Co Author #3: Sanjeev Agarwal MD
Senior Editor: Eric Schub, DO
Editor: Mandeep Ghuman, MD, FAMSSM

Patient Presentation:
19 year male presented to the clinic complaining of right thigh weakness and difficulty walking.

Patient presented 2 years following patellar dislocation with complaints of weakness and atrophy of his right quadriceps since the initial injury. At the time of the injury, he received non-operative care including physical therapy for an entire year post-injury with no improvement. Subsequently, he underwent medial patellofemoral ligament reconstruction. Post-operatively, he was initially fitted in a Bledsoe brace which he eventually stopped using. He also underwent another course of physical therapy with partial benefit. Surgical intervention did not improve patient's right quadriceps weakness and atrophy. He denied numbness, tingling or pain but did report intermittent right lower extremity buckling.

Physical Exam:
Examination revealed right quadriceps atrophy with knee effusion. There was no tenderness to palpation along the right quadriceps, joint line, patella or patellar tendon. There was limited active range of motion secondary to weakness. Passive range of motion 0 to 90 degrees limited by pain. Manual muscle testing right lower extremity 5/5, except for right knee extension 1/5 and right hip abduction 4-/5. Lower extremity reflexes were 2+ and symmetric bilaterally. No ligamentous laxity was appreciated upon provocative tests. Spine and hip exam were unremarkable. There was right knee buckling during ambulation.

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