1 Sports Medicine CASES

CASE 1

 

A 22-year-old, female jogger presents complaining of right knee pain. She describes an insidious onset of her symptoms during the last 3 months. She enjoys running most days and is training for a five-mile road race. Recently, she has been running more and has added hill training. Her pain is centered around the patella with little swelling. She has crepitus and pain when climbing stairs or getting out of a chair. X-rays are shown in Figure 9–1A–C.

 

 

 

Figure 9–1 A–B

 

 

 

Figure 9–1 C

 

The most likely diagnosis for the condition described is:

1. Patellofemoral syndrome (runner’s knee)

2. Osgood–Schlatter disease

3. Femoral stress fracture

4. Meniscal tear

5. ACL rupture

 

Discussion

The correct answer is (A). Patellofemoral syndrome (runner’s knee) is very common, resulting from overuse. It is seen frequently in runners and active women. Many believe that it results from maltracking of the patella within the femoral groove due to vastus medialis weakness.

Osgood–Schlatter’s disease also results from overuse. It is more common in men and jumping athletes who have not reached skeletal maturity. Stress fractures can result from a sudden increase in activity and cause pain with all weight-bearing activities. Meniscal tears cause mechanical symptoms and are associated with knee swelling. Athletes with ACL tears complain of knee instability following an injury.

What is the preferred treatment for this female runner?

1. Corticosteroid injection

2. Knee arthroscopy

3. Activity modification and physical therapy

4. Endocrine evaluation

5. Strict immobilization

 

Discussion

The correct answer is (C). Increasing vastus medialis strength is believed to balance the pull on the patella. Lower extremity mechanics and function are thought to improve with combining increased quadriceps flexibility, balance, and proprioceptive training. Oral anti-inflammatories and cross-training will provide symptomatic improvement while maintaining fitness.

Three months later, she presents with recurrent right knee pain, medial to the patella. As before, her pain is exacerbated by knee flexion. On examination, there is tenderness and an area of fullness about 1 cm medial to the patella. The most likely diagnosis is:

1. Meniscal tear

2. Pigmented villonodular synovitis

3. Medial collateral ligament (MCL) strain

4. Plica syndrome

5. Patellofemoral pain syndrome

 

Discussion

The correct answer is (D). Her symptoms and examination are typical of plica syndrome. The synovial fold on the medial knee becomes irritated in sports that require repeated flexion of the knee (running, biking, rowing, etc.). Treatment should address the local inflammation with rest, ice, and oral anti-inflammatories. In recalcitrant cases, local corticosteroid injections may be helpful. If conservative management fails, arthroscopic resection is an option.

 

Objectives: Did you learn...?

 

Identify runner’s knee?

 

 

Understand conservative treatment of anterior knee pain? Recognize plica syndrome?