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Knee Injury in a Soccer Player Nell Kopp DO University of Kentucky Primary Care Sports Fellow

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.

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Knee Injury in a Soccer Player Nell Kopp DO University of Kentucky Primary Care Sports Fellow

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  1. Knee Injury in a Soccer Player Nell Kopp DO University of Kentucky Primary Care Sports Fellow

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

  3. MOI: During a soccer game, she tripped over another player's feet going for the ball • suffered valgus injury to her right knee • 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

  4. Small effusion • ROM • Flexion limited to 90 degrees • Full Extension • TTP • MCL: more proximal • Lateral Femoral Condyle • Negative Patellar Apprehension

  5. Valgus/Varus Stress • No laxity at 0 Degrees • 30 degrees • Valgus: Guarding, Laxity (1+) • Varus: Stable • Lachman: guarding without firm endpoint • Negative Posterior Drawer

  6. McMurray's: pain without catch/clunk • Localized deep in knee • FROM at ankle • Distal pulses 2+, Sensation Intact

  7. Plain Films: • 3 views right knee: no acute fracture

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

  9. MCL injury • Due to location of pain • Guarding/Laxity at 30 degree Valgus Stress • Possible ACL injury • MOI • Guarding with Lachman

  10. Treatment Plan • TROM locked in Extension • Crutches • MRI for further evaluation

  11. MRI: • Nondisplaced Salter-Harris IV fracture distal femur • Grade 2 sprain of the superficial medial collateral ligament and patellofemoral ligament at the femoral attachment • Bone marrow contusion pattern suggesting a pivot shift injury with intact ACL

  12. MCL sprain with non displaced Salter IV femur fracture

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

  14. 6 wks nonweightbearing in TROM • Progressive return to weightbearing activities • TROM: • Locked in Extension x 4 wks • Unlocked for 2 wks following

  15. Physical Therapy • Initially: SLR, Quad Sets and ROM • 4 wks: Weightbearing activities • 6 wks: Transitioned to sport specific modalities and agility drills • 10 wks: Return to play

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

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