An 18-year-old male lacrosse player presents to the clinic for evaluation of left knee pain. He states that he stepped awkwardly with his cleat while taking a shot and had twisted the knee. He had immediate pain, but was able to bear weight afterwards. There was no swelling initially, but the following morning he noticed swelling of the knee. He reports that the knee has an occasional “catching” sensation but does not get stuck. On exam, he has a moderate effusion. He can perform a straight-leg raise and has full active range of motion. He has medial joint line tenderness and pain with squatting.
What is the most likely diagnosis?
A. Anterior cruciate ligament tear
B. Lateral collateral ligament tear
C. Medial collateral ligament tear …show more content…
An athlete with knee pain after a twisting injury raises concern for a possible ligamentous or cartilage injury. The menisci are cartilaginous fibrous shock-absorbing spacers within the tibiofemoral joint. In a twisting injury, the femoral condyle can rotate relative to the tibia and pinch or crush the meniscus between its bony surface and the tibia. Meniscal tears in older patients tend to be degenerative, age-related wear and tear. Joint line tenderness and mechanical symptoms, such as locking and catching, are descriptive for meniscal pathology. An MRI can be obtained to confirm the diagnosis, evaluate for other pathology or injuries, and plan treatment. Only the peripheral 25% of the meniscus has a blood supply and this is the only portion with a chance for repair. A damaged inner rim of meniscus is usually treated by arthroscopic partial meniscectomy. It is important to try and retain the outer portion, which has the critical function of distributing the load of the femoral head and preventing degenerative cartilaginous changes.
Choice "A" is not the best answer. There is no suggestion here of anterior translation instability, such as a positive Lachman test, anterior drawer, or pivot shift. Additionally, ACL ruptures tend to have larger and more immediate effusions due to tearing of the small artery within the ligament and the resulting
What is the most likely diagnosis?
A. Anterior cruciate ligament tear
B. Lateral collateral ligament tear
C. Medial collateral ligament tear …show more content…
An athlete with knee pain after a twisting injury raises concern for a possible ligamentous or cartilage injury. The menisci are cartilaginous fibrous shock-absorbing spacers within the tibiofemoral joint. In a twisting injury, the femoral condyle can rotate relative to the tibia and pinch or crush the meniscus between its bony surface and the tibia. Meniscal tears in older patients tend to be degenerative, age-related wear and tear. Joint line tenderness and mechanical symptoms, such as locking and catching, are descriptive for meniscal pathology. An MRI can be obtained to confirm the diagnosis, evaluate for other pathology or injuries, and plan treatment. Only the peripheral 25% of the meniscus has a blood supply and this is the only portion with a chance for repair. A damaged inner rim of meniscus is usually treated by arthroscopic partial meniscectomy. It is important to try and retain the outer portion, which has the critical function of distributing the load of the femoral head and preventing degenerative cartilaginous changes.
Choice "A" is not the best answer. There is no suggestion here of anterior translation instability, such as a positive Lachman test, anterior drawer, or pivot shift. Additionally, ACL ruptures tend to have larger and more immediate effusions due to tearing of the small artery within the ligament and the resulting