AANA Lab Course 913 - Advanced Knee Course-Sharing My Tough Cases and Summary Case Presentations

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The document presents three knee injury cases:<br /><br />Case 1 involves a 14-year-old female basketball player who suffered a twisting injury with an audible pop and immediate swelling. Examination revealed moderate effusion, limited flexion (0-60° initially), abnormal Lachman, Lateral Pivot Shift, and Losee tests indicating ligamentous injury, and positive medial and lateral McMurray tests suggestive of meniscal involvement. No significant joint laxity was noted, and neurovascular status was intact. Follow-up showed improvement in flexion to 120°, persistent mild tenderness, and continued positive ligament tests, though lateral patellar apprehension resolved.<br /><br />Case 2 concerns a 63-year-old active female who twisted her knee on a slide about 3-4 weeks prior, experiencing mild early swelling that subsided. She reports medial joint line pain exacerbated by turning and pivoting but denies patellofemoral symptoms. Physical exam revealed minimal effusion, 0-120° flexion, medial joint line tenderness with equivocal medial McMurray, and otherwise normal ligament and patellofemoral exams. Follow-up showed no improvement with physical therapy, mild effusion, persistent medial joint line tenderness, and a positive medial McMurray test indicating possible meniscal pathology.<br /><br />Case 3 describes a 16-year-old male football player injured while diving to block a punt. He was unable to bear weight and developed swelling within hours. Exam showed moderate effusion, flexion limited to 60° by pain, moderate tenderness on both medial and lateral joint lines, positive Lachman, Lateral Pivot Shift, and Losee tests suggesting ligament injury, and medial joint opening with valgus stress indicating possible medial collateral ligament involvement or capsular injury. Pulses and motor examination were normal.<br /><br />Overall, these cases illustrate varied presentations of knee injuries involving ligamentous and meniscal components following twisting mechanisms, with assessments focusing on effusion, range of motion, ligament stability tests, and joint tenderness to guide diagnosis and management.

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Panel: LaPrade, Arendt, Bonner, Sgaglione, Richmond, Johnson, Koh, Alaia, Mulcahey, Shelton,
Zacchilli, Sugarman
Moderators: David C. Neuschwander, MD, Mark A. Heard, MD

Keywords

knee injury

ligamentous injury

meniscal injury

twisting mechanism

effusion

range of motion

Lachman test

McMurray test

medial collateral ligament

joint tenderness