Knee Injury From Basketball

HISTORY: A 16-year-old male who is a high-level basketball athlete with no medical history presented to a sports medicine clinic for left sided knee pain. He stated he suffered direct trauma to the posterior region of his left hamstring by another player and he fell onto a flexed left knee during a basketball game. He was able to ambulate but his pain increased until he could not practice, prompting him to seek medical care 4 days later. He was an athlete with multiple Division 1 college basketball scholarship offers and was concerned his injury would affect his ability to return to play. PHYSICAL EXAMINATION: Patient demonstrated normal mentation with no external visible injuries. Bilateral knees appeared symmetric with no visible effusion. Had limited range of motion on active flexion of the left knee due to pain. No medial and no lateral joint line tenderness to palpation. An exam of the left knee demonstrated laxity on anterior drawer test and grade II on Lachman test compared to his right knee. Patient had no pain on McMurray’s testing. DIFFERENTIAL DIAGNOSIS: 1: ACL tear 2: Popliteal cyst rupture 3: Stress fracture 4. Meniscal injury TEST AND RESULTS: On initial X ray of the left knee, there was no acute traumatic fracture or cortical disruption. Segond sign was negative. Patellofemoral joint space was intact. On initial MRI of the left knee, there was bone marrow edema at the posterolateral aspect of the medial femoral condyle consistent with a contusion. The anterior cruciate ligament was edematous with partial midsubstance discontinuity of ACL fibers consistent with an ACL tear. FINAL WORKING DIAGNOSIS: Grade II anterior cruciate ligament tear TREATMENT AND OUTCOMES: Patient underwent platelet rich plasma (PRP) treatment twice after injury, and repeat MRI 4 weeks later showed interval decrease in bone marrow edema in posteromedial femoral condyle, with remodeling of the previously visualized partial tear of the ACL with intact appearing fibers. The patient wore a knee brace for 6 weeks post injury and worked with the physical therapy team focusing on manual stretching and strengthening of the hamstring muscle group. Due to concern for exacerbation of the ACL tear, quadricep strengthening exercises were deferred for 6 weeks. Patient was able to return to play with no restrictions 10 weeks after the initial date of injury.