Module 49, General Orthopaedist Level

A 13 year old boy presented with left knee pain after sustaining an injury while wrestling three months prior to this visit. The patient stated that his left knee was in a hyperflexed position when it was twisted. He felt a "pop" associated with pain on the lateral aspect of his knee. He stated that he had minimal knee swelling which had resolved, but his pain persisted. On physical exam he had full range of motion of his left knee with a trace effusion. There was lateral joint line tenderness, and he described a 'clunky' sensation as his knee was brought into extension from a hyper-flexed position. There was a negative Lachman test and no instability to varus or valgus stress. Neurologic exam was normal.

Question 49A

This history and physical examination is most consistent with an anterior cruciate tear in a an adolescent.

Question 49B

An MRI scan was obtained which showed no definite tear in the meniscus or anterior cruciate. You can reassure the parents that there is no significant problem and encourage the child to return to wrestling.

Question 49C

An arthroscopy was performed which showed a posterior horn medial meniscus tear in the peripheral 1/3 region. Partial meniscectomy is the procedure of choice in the young boy.

Question 49D

A tear in the lateral meniscus is the most common tear occurring in the adolescent of this age.

Question 49E

Meniscus tears in children are more difficult to diagnosis than in adults.

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