Knee Injury in a Soccer Player

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

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

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

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

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• Plain Films
• 3 views right knee no acute fracture

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

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

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

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• 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

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• MCL sprain with non displaced Salter IV femur
  fracture

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

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

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• 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

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