Unusual Injury Pattern Causing Lateral Knee Pain: A Case Report - Page #1

Author: Richard Pearson, MD
Co Author #1: Bradley Jaskulka, MD

Patient Presentation:
16 year-old male football player presented due to referral from his athletic trainer. He reports a 3 day history of progressive stiffness, tightness, and popping in his right knee after being struck in the knee during a football game over the weekend.

16 year-old male high school football fullback with no previous knee injury was struck in the anterior right knee by an opposing team member's helmet during the first 2 minutes of the first quarter of a game. He had sudden onset of knee pain but was able to ambulate off the field with assistance by the athletic trainer. Within a couple minutes, he was ambulating without assistance and without pain. Within a couple more minutes, he was able to sprint, backpedal, and perform lateral cutting maneuvers without pain or instability. He was allowed to return to the game and played the remainder of the game with his only complaint being right hamstring tightness late in the fourth quarter. He had some knee swelling later that evening and began noticing popping, stiffness, and tightness over the next few days. His athletic trainer was concerned about a possible varus laxity and continued effusion on re-examination. She referred him for further evaluation.

Physical Exam:
Mild effusion
Tenderness at the lateral joint line and lateral patellar facet
Active ROM from 0 degrees extension to 130 degrees flexion
Moderate laxity with varus stress at 30 degrees of flexion
Negative dial test
Negative Lachman, anterior drawer, posterior drawer. No sag sign
Positive McMurray's, Apley grind, and Thessaly's
Mild pain with patellar apprehension testing

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