Knee Injury in a Soccer Player

Nell Kopp DO

University of Kentucky Primary Care Sports Fellow

• 15 yo female high school soccer player • Presents to sports medicine clinic on crutches• 2 day history of right knee pain

• MOI: During a soccer game, she tripped over another player's feet going for the ballo suffered valgus injury to her right kneeo Felt a pop with immediate pain over medial aspect

• Swelling developing within 24 hours• Pain worsening since injury• Worse w/ knee flexion and weightbearing• Denies radiation of pain, numbness or tingling

• Small effusion• ROM

o Flexion limited to 90 degreeso Full Extension

• TTP o MCL: more proximalo Lateral Femoral Condyle

• Negative Patellar Apprehension

• Valgus/Varus Stresso No laxity at 0 Degreeso 30 degrees

Valgus: Guarding, Laxity (1+) Varus: Stable

• Lachman: guarding without firm endpoint• Negative Posterior Drawer

• McMurray's: pain without catch/clunko Localized deep in knee

• FROM at ankle• Distal pulses 2+, Sensation Intact

• Plain Films:o 3 views right knee: no acute fracture

• ACL injury• Patellar Dislocation• Bone Bruise• Occult Fracture• Meniscus Injury• MCL sprain

• MCL injuryo Due to location of paino Guarding/Laxity at 30 degree Valgus Stress

• Possible ACL injuryo MOIo Guarding with Lachman

• Treatment Plan o TROM locked in Extensiono Crutcheso MRI for further evaluation

• MRI:o Nondisplaced Salter-Harris IV fracture distal femuro Grade 2 sprain of the superficial medial collateral

ligament and patellofemoral ligament at the femoral attachment

o Bone marrow contusion pattern suggesting a pivot shift injury with intact ACL

• MCL sprain with non displaced Salter IV femur fracture

• Patient had routine follow up After MRI, 2wks, 5 wks and 10 wks post injury

• 6 wks nonweightbearing in TROM• Progressive return to weightbearing activities• TROM:

o Locked in Extension x 4 wkso Unlocked for 2 wks following

• Physical Therapyo Initially: SLR, Quad Sets and ROMo 4 wks: Weightbearing activitieso 6 wks: Transitioned to sport specific modalities and

agility drillso 10 wks: Return to play

• Returned to Soccer at 10 wks post injury• 6 mos post injury denies any knee pain or

instability symptoms