Module 49, Pediatric 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
Knee pain is the most common symptom of a meniscus tear in children.
Question 49B
Discoid meniscus often present with a complaint of a snapping knee.
Question 49C
MRI
is as reliable in children for the diagnosis of meniscus tears and anterior
cruciate tears as it is in adults.
Question 49D
Popliteus
tendinitis is one of the items on differential diagnosis list with the
above history and physical examination.
Question 49E
An
anterior cruciate tear is seen on arthroscopic examination. Because this
boy still has wide open epiphysis a reconstruction is not possible.
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