Wk 3, Case 5 - Review

Patient History
15-year-old boy, status post football injury 2 days ago, with pain and swelling in the left knee. Evaluate for meniscus and/or ACL tear.

Findings
Menisci:

Medial Meniscus: Intact.

Lateral Meniscus: Intact.

Ligaments:

Anterior Cruciate Ligament: Intact.

Posterior Cruciate Ligament: Intact.

Medial Collateral Ligament: Intact.

Lateral Collateral Ligament: Intact.

Posterolateral Corner Structures: Intact.

Posteromedial Corner Structures: Intact.

Extensor Mechanism:

Patellar Tendon: Distal deep fiber insertional partial-thickness tear. Extensive periligamentous edema and hemorrhage. Incomplete avulsion of the tibial tuberosity, with elevation/diastasis of the anterior proximal tibial physis. Subperiosteal hematoma at the tibial tuberosity extending into the anterior proximal tibial metaphysis. 0.6 x 0.6 cm corticated ossicle adjacent to the deep fibers of the distal insertional patellar tendon, in the vicinity of the infrapatellar bursa. Reactive infrapatellar bursal thickening without effusion.

Distal Quadriceps Tendon: Intact.

Medial Patellofemoral Ligament: Intact.

Medial and Lateral Patellar Retinacula: Intact.

Hoffa’s Fat Pad: Unremarkable.

Articulations:

Patellofemoral Compartment: Incidental patellar lateralization and tilt. Borderline increased TT-TG distance measuring 1.8 cm. Trochlear dysplasia with hypoplastic medial facet (Dejour C). No intermediate or high-grade patellar trochlear chondromalacia or traumatic osteochondral defect.

Medial Compartment: Unremarkable.

Lateral Compartment: Unremarkable.

General:

Bones: Proximal tibial metaphyseal fracture extending into the physis. No extension into the proximal tibial epiphysis. Mild widening of the anterior proximal tibial physis. Anterior tibial tuberosity subperiosteal stripping and subperiosteal hematoma. Extensive periligamentous and periosteal edema with hemorrhage noted adjacent to the tibial tubercle. No other acute fracture or physeal injury

Effusion: Small reactive suprapatellar effusion/hemarthrosis.

Baker’s Cyst: Multiloculated gastrocnemius semimembranosus bursal cyst measuring 2.1 x 1.8 x 1.1 cm. No dehiscence or rupture. No extension into the popliteus fossa or compression of the neurovascular.

Loose Bodies: None.

Soft tissue and Neurovascular: Diffuse post-traumatic hematoma and edema surrounding the tibial tuberosity/apophysis as described above. Small grade 2 sprain with small intramuscular/myotendinous hematoma at the origin of the tibialis anterior, measuring approximately 9 x 6 mm.

Conclusion

1. Nondisplaced Salter-Harris 2 fracture of posterior proximal tibia.
2. Anterior proximal tibial physeal widening and incomplete tibial apophyseal avulsion (form friste Salter-Harris 1 injury) with adjacent subperiosteal hematoma adjacent to the tibial apophysis and proximal anterior tibial metaphysis.
3. Partial thickness tear distal insertional deep fiber patellar tendon.
4. Small grade 2 strain (small intramuscular hematoma) proximal tibialis anterior origin/myotendinous junction.
5. No ACL injury or meniscal tear.