JEFF GUTTMAN, MD, Resident, Orthopaedic Surgery

Brian Galinat, M.D., Orthopaedic Surgeon

April 1, 1996





Case History:

The patient is an 8 year old white male with no significant past medical history who complains of right knee pain, swelling, and decreased range of motion after having his knee slammed in a car door 5 weeks prior to presentation. At the time of injury, the patient was seen in the Emergency Room where X-rays were negative, and the patient was told he had a contusion of the knee. Patient denies locking of the knee, but gives a questionable history of "giving way" of the knee. It is unclear whether these episodes are truly secondary to instability. On physical examination, the patient has a small effusion. There is no medial or lateral joint line tenderness. There is no tenderness around the collateral ligaments. Range of motion is 30-90 degrees. There is no instability to varus or valgus stressing at 0 degrees and 30 degrees. MacMurray test is negative. Lachman test shows a slight increase in laxity compared to the contralateral side, but with an endpoint. Anterior drawer test also shows a good endpoint. Posterior drawer is negative. KT-1000 testing was equal on both sides. The patient was sent for physical therapy and an MRI to rule out ligament or meniscal injury. MRI was read by radiologist as anterior cruciate ligament tear and small medial meniscal tear . When the patient was seen one month later, he had full range of motion of the knee. There was still a slight increase in laxity on Lachman test, but again with an endpoint. KT-1000 testing was again equal on both sides. Patient was told he could resume participation in sports and to return if he experienced any further symptoms.




Physical Examination


Less accurate in diagnosing tears in children

Conservative Treatment

Operative Treatment

*High incidence of meniscal injury in ACL-deficient knee

*Protect repaired meniscus

*Prevent Degenerative Joint Disease

*Greater potential risk of growth arrest with intraarticular so some prefer extraarticular in younger patients.

*McCarroll and Shelbourne

*Lipscomb and Anderson

*Parker and Drez


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