A Lower Extremity Injury That Occurred While Playing Flag Football

HISTORY: 25-year-old male presents for evaluation of acute left knee pain following a varus injury while playing flag football. While attempting to make a catch, an opponent landed on his medial left leg, resulting in a “pop” sensation, immediate pain, and subsequent swelling. Pain is localized to the left lateral knee and is worse with lateral movements, but improves with rest. He also endorsed left leg weakness and buckling, but does not report associated locking, numbness, or tingling. PHYSICAL EXAMINATION: No erythema or gross deformities were noted on inspection, though he had antalgic gait with mild decrease in left knee flexion. Full range of motion of the left knee. Tenderness to palpation at the lateral joint line, LCL, and Gerdy’s tubercle. No crepitus or warmth was noted. Special testing: Pain and laxity with varus stress testing at knee flexion 0 and 30 degrees. No laxity with valgus stress testing. Mild laxity with anterior drawer test, but firm endpoint. Utilizing the KT-1000 arthrometer, there was 7 mm of anterior translation of the left tibia and 5 mm of anterior translation of the right tibia. Posterior drawer, Lachman’s, McMurray’s, Thessaly, and sag sign were negative. Sensation to light touch was intact. Strength and pulses were normal. DIFFERENTIAL DIAGNOSIS: 1. Lateral collateral ligamentous injury, 2. Partial tear of the anterior collateral ligament, 3. Lateral meniscus injury TEST AND RESULTS: Radiographs of the left knee:-Unremarkable. MRI of the left knee -Complete, full-thickness tear of the LCL with proximal retraction measuring approximately 2 cm.-Full thickness tear of the distal biceps femoris with some fibers still intact-Popliteus, popliteal fibular ligament, and IT band intact. FINAL WORKING DIAGNOSIS: Varus left knee injury with grade 3 tearing of the LCL and distal biceps femoris TREATMENT AND OUTCOMES: 1. Trial of conservative management: RICE, physical therapy, home exercise program, and use of an over-the-counter hinged left knee brace.2. Patient had continued improvement in symptoms, functioning, and physical examination with during follow up visits. At 12 weeks post-injury, he was transitioned into Bledsoe brace and began return to play conditioning.3. At four months post-injury, he was cleared to return to flag football with use of Bledsoe brace during physical activity.