3 Sports Medicine CASES

CASE                                3                               

A 44-year-old man slips while dancing at a wedding. With the help of his spouse, he is able to get home safely, but the next morning he has difficulty standing on his left leg. His knee is swollen, with little pain. If he gets on his feet, he is able to get around the house, but he is unable to go up or down stairs and feels unsteady on his feet.

His examination reveals a large swollen knee, held at 30 degrees of knee flexion. He has little pain with passive flexion or extension and no tenderness to palpation. He is unable to actively extend his leg when supine. When lying on his right side, however, he can make his left leg straight.

What is the most likely diagnosis?

1. Quadriceps tendon rupture

2. Meniscal tear

3. ACL rupture

4. Patella fracture

5. Patella dislocation

 

Discussion

The correct answer is (A). An MRI of a quadriceps tendon rupture is demonstrated in Figure 9–3. The inability to extend the leg against gravity is most consistent with an injury to the extensor mechanism. The absence of tenderness on palpation and pain with passive motion makes a patella fracture unlikely. A transient patella dislocation can result in swelling but does not prevent a straight-leg raise. Placing the patient in the lateral decubitus position eliminates gravity as a resisting force.

 

 

 

Figure 9–3

 

In an active young man, the best outcomes will result from what treatment?

1. Early range of motion

2. Cast immobilization

3. Bracing

4. Surgical repair

 

Discussion

The correct answer is (D). Extensor mechanism repairs are recommended in all patients in whom surgery is not contraindicated in order to restore normal function to the leg. Nonoperative treatment is reserved for incomplete (partial) injuries (<50%) and people unable to tolerate surgery.

Immediately following surgery, which of the following activities is appropriate?

1. Range of motion as tolerated

2. Closed chain strengthening

3. Open chain strengthening

4. Prone active knee flexion

5. Assisted passive knee flexion

 

Discussion

The correct answer is (D). Following surgical repair of the extensor mechanism,

range of motion and strengthening should be limited to allow for tendon to bone healing. Assisted passive knee flexion can negatively affect the healing process. Prone, active knee flexion promotes motion without stressing the repair site.

 

Objectives: Did you learn...?

 

 

Recognize extensor mechanism injury? Describe treatment options?

 

Understand rehabilitation of tendon to bone healing?