The Knee’d For Compliance

HISTORY: A 12yo M presented w/ chronic, b/l knee pain, ongoing for 1 yr. He played basketball & football (multiple positions). Pain localized to anterior knees, aching, recurrent, worse w/ activity—esp running & jumping. Denied trauma, F/C, N/V, D/C, body aches. Pt seen 1 yr prior, dx w/ Osgoode-Schlatter, seen by PT once, lost to f/u PHYSICAL EXAM: B/l knee: +J sign, VMO atrophy; no scars, discoloration, erythema, swelling. TTP of the L patella, L tib tubercle, L patellar facets, & b/l glut med. ROM 0° – 140° w/o pain. 5/5 strength on flexion and extension, w/o pain. Neurovascularly intact. Special tests neg DIFFERENTIAL DIAGNOSIS: Osgood Schlatter Patellofemoral syndrome Sinding-Larsen-Johansson OCD TEST AND RESULTS XR b/l knee A-P, lat, tunnel, & merchant Cortical irregularity of L inf patellar pole w/ adjacent calcific density Suspected OCD lesion in L medial femoral condyle L knee MRI w/o con Cortical defect posterior central weight-bearing surface of the medial femoral condyle w/ bone marrow edema. Overlying cartilage appears intact Partial-thickness tear of patellar tendon origin. Associated tiny avulsion fracture XR L knee A-P, lat, tunnel, and merchantOCD of the medial femoral condyle present, appears smoother. No definite cavity Interval healing of avulsion fracture inf patellar pole XR L knee A-P, lat, tunnel, & merchant OCD of the mid medial femoral condyle present, appears smoother. No definite cavity. Interval healing of avulsion fracture inf patellar pole XR L knee A-P, lat, tunnel, & merchant OCD lesion healing Healed inf patellar pole FINAL/WORKING DIAGNOSIS:: OCD Patellar sleeve fracture TREATMENT AND OUTCOMES:: Patella knee strap & PT for patellofemoral syndrome (while MRI pending) 6 wks: Not started PT nor completed MRI. C/o knee catching 2mo: MRI L knee - stable OCD lesion. Pt cont’d c/o of L knee pain & swelling, denied mechanical sx. Made NWB w/ crutches, restricted from sport 3.5mo: Asx. L knee XR w/ interval healing of OCD defect and patella avulsion fx. Progressed to PWB w/ crutches 4.5mo: L knee XR w/ cont’d healing of OCD defect & patella avulsion fx. Able to ambulate w/o pain w/o crutches. D/c crutches, fitted w/ knee immobilizer, restricted to walking 5.5mo: Pt asx & compliant w/ PT. Allowed activity progression. XR noted OCD defect healing well & healed patella sleeve fx. Lost to f/u