Module 40, General Orthopaedist Level
This patient is an 8 year old white male with no significant past medical
history, who slammed his knee in a car door 5 weeks prior to presentation.
He complains of right knee pain, swelling, and decreased range of motion.
The patient denies locking of the knee, but gives a questionable history
of "giving way" of the knee. 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 test is negative.
Question 40A
The next step in the work up is to do an MRI scan.
Question 40B
Evaluation
in physical therapy with KT-1000 testing would provide useful information.
Question 40C
Because
of this child's young age making the diagnosis of an anterior cruciate
injury is not very important because a reconstruction is not possible any
way.
Question 40D
Although
ACL tears do occur in young children they are usually associated with multiple
trauma instead of an isolated injury.
Question 40E
MRI
of the knee in children is less definitive than in adults.
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