Image Quiz
Knee Pain and Loss of Motion in a Thirteen-Year-Old Boy
By James L. Carey, MD, Daniel Osei, BA, and Lawrence Wells, MD*,
Children's Hospital of Philadelphia, Division of Orthopaedic Surgery, Philadelphia, Pennsylvania. E-mail address for L. Wells: wellsl@email.chop.edu
A thirteen-year-old boy sustained an injury to the right knee at a track-and-field event. He jumped into a long-jump pit that had not been raked and, on landing in a previous footmark, he heard a pop in the right knee and experienced immediate pain and swelling. The patient and his family initially treated the injury with elevation and ice. The next day the patient was evaluated by a chiropractor, who ordered magnetic resonance imaging.
The patient presented to us ten days after injury. The boy walked with the assistance of crutches and was reluctant to bear weight on the right lower extremity. Physical examination revealed a moderate effusion of the right knee. The range of flexion in the right knee was 30° to 120°, both actively and passively. The medial joint line was exquisitely tender to palpation; the lateral joint line was not tender. The McMurray test was positive, with clicking noted from the medial compartment. The anterior drawer, posterior drawer, and Lachman tests were negative. The knee was stable to valgus and varus stresses in 30° of flexion. There was no neurovascular deficit.
Selected magnetic resonance images of the right knee are shown below (Figs. 1-4).
Fig. 1 |
Fig. 2 |
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Fig. 3 |
Fig. 4 |
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