Acute Knee Injury

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Acute Knee Injury

• LTC Fred H. Brennan, Jr., DO, FAOASM, FAAFP
• Director, Tri-Service Primary Care Sports
  Medicine Fellowship
• Assistant Professor
• Uniformed Services University of the Health
  Sciences
• Bethesda, MD

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Case Study

• 21 year old All American football player
  entangled in broken play injuring left knee
• Intense pain
• Difficult to bear weight
• Iced, crutches, your office in morning

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Exam

• WB with crutches
• Swollen knee
• Unable to get an accurate exam
• Neurovascular intact
• What is your differential diagnosis?

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Possibilities

• ACL tear
• Peripheral meniscal tear
• Pre-patellar bursitis
• Patellar subluxation/dislocation
• Osteochondral fracture

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Do You Want an X-ray?
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X-ray
Segond fracture
Femoral condyar fracture
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Aspirate the Knee?

• Indications post trauma
• Pain
• Improve motion
• Diagnosis
• Hemarthrosis
• Fat globules
• Contraindications
• - Overlying infection
• - Inexperience

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Put it Together

• Hemarthrosis
• Fat globules
• X-ray findings
• History
• What is your diagnosis?

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Case Study

• Intra-articular fracture
• Probable ACL tear
• How do we acutely manage this?

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Management

• NWB on crutches
• PRICE-M
• Education
• Refer to Ortho within 72 hours

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Take Home Points

• 5 causes of acute knee swelling
• X-ray preferable before exam but sometimes not
  practical
• Timing and amount of swelling is helpful
• Inability to weight bear is concerning
• Consider aspiration for diagnosis and therapeutic
  relief of pain

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