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Orthogate  Cases Sports Medicine Knee Pain in an Athlete
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Click on image to view radiographs and clinical pictures.
Introduction
This 18 year old male basketball player
complained of pain in the left knee. This pain was of
gradual onset for the past year and had been getting worse
since he jumped up to block a pass a few weeks prior to his
office visit. His pain was localized over the both the
medial and lateral joint lines, but worse on the lateral
side. Examination of the knee revealed a small effusion,
slightly diminished active and passive flexion, but full
extension. Ligamentous examination showed a negative
Lachmann, negative Pivot Shift, and negative Anterior and
Posterior Drawer Tests. There was no ligamentous laxity,
nor tenderness along the course of the LCL or MCL.
However, varus and valgus stress exacerbated the pain in the
lateral and medial compartments. McMurray's Test was
inconclusive for both menisci. There was no patellar
apprehension or patellar grind.
What is your provisional diagnosis?
Radiographs of the Left Knee
What is your diagnosis and management ?
This patient underwent a diagnostic
arthroscopy. The patellofemoral comparment, medial
gutter, and medial meniscus were normal. The ACL was
intact, and the findings in the lateral femoral compartment
are shown below.
What are your diagnoses and management
for these lesions ?
There was a radial tear of the lateral
meniscus in the white-white zone which required partial
meniscectomy. There was also a soft osteochondral lesion
on the weightbearing portion of the lateral femoral condyle.
This was debrided to expose subchondral bone below, and
saucerized to normal articular cartilage around the defect.
What are your management options ?
Because of the young age of this patient,
a mosaicplasty was performed. The donor area was the
intercondylar notch. More careful inspection of the
medial femoral condyle showed a similar, less extensive lesion
on the weightbearing portion of the MFC. Therefore, the
same procedure was performed in both compartments.
What is your postoperative management ?
Intraarticular Marcaine was administered
prior to wound closure. This patient was kept touch
weightbearing for two weeks until the sutures were removed,
and we plan to progress to full weightbearing over the next
four weeks.
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