Nothing Fun-knee About This Knee

HISTORY: 24-year-old male collegiate wrestler with one month of left knee pain. Reports the pain worsens with deep squats, stairs, kneeling and wrestling knee striking maneuvers. Denies a specific injury or trauma leading to symptoms. Pain is localized to the anterior aspect of the left knee. There is no swelling, numbness, tingling, or weakness to his left lower extremity. No previous injury to the left knee. History of a right patellar open reduction and internal fixation due to a patella fracture. PHYSICAL EXAMINATION: Normal gait. Trace effusion of the left knee. Patella alta. Tenderness at inferior pole of the patella. No tenderness over the joint lines, lateral or medial femoral condyle, lateral or medial patellar facet. Left knee range of motion 0-130 degrees with discomfort. Left anterior drawer, posterior drawer and Lachman tests negative. Left Valgus and Varus stress test negative. Left McMurray's test negative. Left patellar apprehension test is positive. Left squat test is positive. No rashes, lesions, or ecchymosis. DIFFERENTIAL DIAGNOSIS: Patellofemoral syndrome, Patella stress fracture, Patella bursitis, Tibial plateau fracture TEST AND RESULTS: Left Knee Xray: lateral, tunnel, sunrise and AP standing views. No evidence of fracture dislocation. Left Knee MRI without contrast: Acute subacute transversely oriented non-displaced incomplete stress fracture of the inferior margin of the patella with mild surrounding marrow edema. Intact menisci, articular cartilage, ligaments, and tendons. Trace joint effusion. FINAL WORKING DIAGNOSIS: Left Patella Stress Fracture TREATMENT AND OUTCOMES: Initial physical therapy to assist patellofemoral symptoms provided no improvement. MRI of the left knee showed an incomplete stress fracture to the distal pole of the patella. Patient underwent left knee patellar open reduction and internal fixation. Goal to return to practice at four weeks and return to wrestling matches at six weeks from surgery with physical therapy. Three weeks post operative he had a pre-patellar bursa swelling and 70 cc of bloody fluid was aspirated in the office. Five weeks post operative patient started return to wrestling protocol. Six weeks post operative patient is wresting with no complaints. Plan for patient to follow up in six weeks for repeat left knee x-rays and reevaluation.