What diagnosis is likely in a 16 y/o volleyball player that complains of anterior knee pain at the inferior border of the patella. This occurs often when she is jumping up during a game,
Patellar tendinitis
Recommended therapy for a minor MCL strain
Rest, ice, NSAIDS, bracing, and physical therapy
The test to assess for a posterior cruciate ligament tear
Posterior Drawer Test
What is the most likely injury in a 17 y/o presenting two days after feeling a pop behind his thigh while running. NSAIDS have provided some relief. Resisted knee flexion has some weakness and reproduces pain.
Acute Hamstring Strain
(Rest, ice, compression)
Inflammation of the sac that is anterior to the kneecap. Caused by a fall or direct blow to the anterior knee cap that can occur in wrestling or basketball
Prepatellar bursitis
- Rest, ice, elevation, NSAIDS (consider needle aspiration if no improvement)
What diagnosis is likely in a healthy 11 y/o active soccer player who reports a 2 week history of anterior right knee pain. No knee-joint effusion or ligamentous laxity. Exam shows a painful "bump" over the tibial tubercle and pain with resisted knee extension
Osgood-Schlatter disease (reassurance and supportive care)
Imaging to help diagnose an ACL tear
MRI
- Most cases require surgical reconstruction to allow return to cutting and jumping sports
The test to assess for a medial collateral ligament injury
Valgus stress test
What is the most likely diagnosis in a 17 y/o cheerleader who landed awkwardly on her right leg and twisted her knee. She felt an immediate pop and noted an obvious knee deformity which resolved on its own when she straightened her leg. She had knee swelling immediately and is currently unable to ambulate. Apprehension test is positive. X-ray is normal.
Patellar dislocation (often have large knee effusion and cannot do full knee extension)
(Knee dislocation when 3 or more ligaments disrupted)
What is the bulge sign?
Test for minor knee effusions
- With the knee extended, place hand above knee and place downward pressure on supra patellar pouch, displacing or "milking" fluid downward. Stroke downward on medial aspect of knee and apply medial pressure to force fluid into lateral area. Then, tap the knee just behind the lateral margin of patella and watch for fluid wave.
Diffuse pain in the peripatellar or retropatellar portion in a 16 y/o cross country runner that is exacerbated with walking up or down the stairs, prolonged, sitting, squatting, or kneeling
Patellofemoral syndrome
What is the best next management step for a 15 y/o boy who plays basketball and presents with 4 months of knee pain. Intermittent knee swelling and reports often times that knee will get "stuck"
Crutches and radiographs (concern for osteochondritis desicans)
The test to assess for a lateral collateral ligamentous tear
Varus Stress Test
What is the most likely injury in a 13 y/o girl who was playing soccer and was planting her foot to kick the ball when she felt a pop and her knee buckled?
Anterior Cruciate Ligament Tear
What injury is likely in 15 y/o girl with a 2 week history of bilateral lower extremity pain that developed after her first high school track season. She describes it as a deep ache over the medials aspect of both lower knees between knee and ankle the worsens with running. She has tenderness to palpation over the distal 2/3 of both posteromedial tibial surfaces and a normal knee exam.
Medial tibial stress syndrome (shin splints)
- Traction on the periosteum by the calf muscles and repetitive bending loads across tibia
- Rest, ice, compression, pre and post exercise stretching
What diagnosis presents in an 18 y/o cross country runner complaining of a "stinging" feeling localized over her lateral femoral epicondyle during activity just proximal to the lateral knee joint. The pain is worse when she is running on indoor tracks or doing uphill drills.
Iliotibial band bursitis
Average recovery time after an ACL tear and surgery in the United States
The test to assess for a medial meniscus tear
McMurry Test
What is the most likely injury in a 16 y/o soccer player who fell after sustaining a kick to the lateral aspect of her knee? She is limping and know complains of pain on the medical aspect of her knee. Valgus stress testing is painful
Medial collateral ligament (MCL) tear
What diagnosis is most likely in a 2 y/o boy who presents several days after an episode of URI symptoms with fever, new limp, and a red, hot, and swollen knee?
Septic arthritis
What condition causes a piece of bone or cartilage to break off into the joint from necrosis of subchondral bone? Can occur either after a single injury or after repetitive trauma from overuse. Pain that worsens with activity, decreased range of motion, and joint popping/locking.
Osteochondritis Dissecans
What is the best sports schedule recommendation for an 11 year old boy with focal swelling and tenderness over the tibial tuberosities and resisted extension of the knees? Exam findings otherwise unremarkable
Spend at least 2-3 months per year away from structured sports
The most sensitive and specific test for an ACL tear
Lachman test
Most likely injury in a 13 y/o figure skater who lost step during a twisting maneuver and fell into knee hyperflexion.
Meniscal tear
17 y/o long distance runner complaining of anterior and medial knee pain as well as a popping sensation of the knee with flexion. She also frequently experiences a catching or pseudo-locking sensation. This only occurs in her R knee.
Plica syndrome (interarticular band of thickened, fibrotic tissue)