Character Limit: 2000
Bone Injury - Gymnastics
HISTORY: A 14-year old female level 10 USGA gymnast presented with right knee pain and swelling after hyperextending her knee during a landing while competing on vault. She did not feel or hear a pop but was unable to walk due to pain. The knee subsequently swelled and she sought medical treatment at a local facility. Radiographs were negative but she continued to have pain while walking with loss of motion. She had no previous knee injuries and did not complain of any parasthesias. She otherwise was in good health with no history of illnesses or medical conditions
PHYSICAL EXAM: The patient was in no distress but could not weight bear on her leg. She had a 2+ effusion and her knee motion was limited from 20 to
125 degrees. She was neurologically intact for sensation and motor strength in the extremity. She was tender only on her proximal tibia near the patellar tendon attachment. Her patellar tendon and quadriceps mechanism was intact. She had no laxity to varus or valgus stress testing of the collateral ligaments with the knee extended or flexed 30 degrees. A McMurray’s test was too painful to perform. She had a negative Lachman’s and posterior drawer test. Her vascular examination (pulses, color, capillary refill, temperature) of the extremity were all normal.
DIFFERENTIAL DIAGNOSIS:
1. Patellar dislocation
2. Partial tear patellar tendon
3. Meniscal tear
4. Cartilage contusion
5. Occult fracture - tibial plateau
TESTS AND RESULTS:
Plain radiographs of the knee (sunrise, true AP and lateral): Normal
MRI of the Knee: Normal ACL and PCL. Moderate knee effusion. Contusion of the lateral femoral condyle and the anterolateral tibial plateau.
CT scan of the Knee: Cortical break in the lateral tibial plateau anteriorly
FINAL WORKING DIAGNOSIS:
TREATMENT AND OUTCOMES:
1. Non-operative treatment: crutches until free of symptom (3 weeks) then progressive weight bearing
2. Ibuprofen 800 mg up to three times per day prn for two weeks; cryotherapy daily
3. Conditioning only at gymnastics with no WB on extremity for 6 weeks followed by slow progression back to sport
4. Returned to gymnastics at 3 months?