VCOM Research Day Program Book 2023

Medical Student Research Case Reports

18 Acute Non-Traumatic Patellar Pain in a Collegiate Football Player

The rigorous demands of collegiate division 1 football provide ample opportunity for acute conditions presenting in a range of severity. These injuries can be evaluated based on the demands and mechanics used based on specific requirements of the athlete’s position, especially when investigating a mechanism of action for injury onset. In our presenting athlete, localized inferior, anterior knee pain began the morning after a recent game where his position was moved to play the opposite side of the line. On exam, he had normal alignment, loss of about 20 degrees of full flexion, and inability to do an active straight leg raise due to pain. He did not have any effusion or ecchymosis . The patient admitted to having a previous injury/pain that presented similarly around the time he was in 6 th grade. Based on presentation, the differential diagnoses included potential for a patellar fracture, sleeve fracture, patellar tendon tear, and acute on chronic Sinding Larsen Johansson (SLJ) syndrome. Upon evaluation, knee radiographs were obtained, followed Lauren Olevnik; Alex Black; Brett Griesemer; Mark Rogers Corresponding author: Edward Via College of Osteopathic Medicine-Virginia Campus Virginia Tech Athletics Blacksburg, VA

by an MRI. In review of these images, the radiograph showed a possible fracture line along the inferior pole of the patella that suggested chronicity due to the blunting of the bone anteriorly. The MRI demonstrated hyperintensity in signal of his distal patellar apophysis, as well as edema of the distal patella, with the patellar tendon intact. The imaging findings, presenting symptoms, and chronic nature to the injury all suggest to the possibility of an acute on chronic injury of Sinding Larsen Johansson syndrome. This may be further complicated by the occurrence of a possible fatigue fracture of the inferior patellar pole. Concomitantly, without proper attention given for the initial injury, continued work and loading of the irritated epiphyses may have prevented complete healing. The re-inciting event for the current presentation is thought to be brought upon from having changed sides of the field which required different loading and push-offs mechanics. He was removed from football related activities, and consulted with orthopedics. Discussion about

conservative versus surgical treatments, meanwhile he started in rehabilitation, with the ultimate goal of returning to play prior to the end of the season. Ultimately, the decision was made to continue with conservative management with rehabilitation, osteopathic manipulative medicine, and active rest. This is a unique case of an acute on chronic SLJ injury, that could be confused with an acute patellar fracture, or other surgical conditions.

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