A Case Of Morel-Lavallee Lesion In A Football Player

HISTORY: A 15 year old high school football player presented to the injury clinic with left knee pain, swelling, and limited range of motion. He denied specific inciting events that preceded the swelling. He first noted swelling 1 week prior during practice but had played in a game three days later, where the swelling worsened. He denied any popping sensation of his knee during his game. He complained of stiffness and weakness but denied numbness, tingling, and buckling. PHYSICAL EXAMINATION: On initial examination he was tender to palpation at the medial joint line, medial collateral ligament region, and distal quadriceps. His range of motion was limited from 0 to 120°. His strength was intact. He initially had positive McMurray's and Thessaly tests, which were both negative on follow-up. Follow-up examinations also showed persistent but improved swelling and improved range of motion. DIFFERENTIAL DIAGNOSIS: Meniscal injury MCL sprain Distal quadriceps contusion Morel-Lavallée Lesion TEST AND RESULTS: Left Knee Radiograph:No acute osseous injury Left Knee MRI:Menisci: IntactJoint spaces: Preserved Trace joint effusion Cruciate ligaments: Intact Medial/Lateral Collateral ligaments: Intact Extensor mechanism: Minimally edematous distal quadriceps tendon. Mild quadriceps in Hoffa’s fat pad edemaLocalized medial prefascial high T2 fluid collection adjacent the medial femoral condyle measuring 1.1 x 5.5 x 6.0 cm, statistically a Morel-Lavallée lesion FINAL/WORKING DIAGNOSIS: Morel-Lavallée Lesion at medial femoral condyle TREATMENT AND OUTCOMES: 1. Given the size of his Morel-Lavallée lesion, he started conservative management with compression therapy using ace wraps. 2. He started physical therapy to progress range of motion and increase strength 3. He planned to return to sport once his swelling resolved, he has full painless range of motion, normal strength, and is able to complete sport specific activities.