VCOM Research Day Program Book 2023

Medical Resident Research Case Reports

26 An Oddly Shaped Loose Calcification Within the Knee

Patrick Ryan, DO; Cristofer Catterson, MD Corresponding author Pryan01@vcom.edu

An 18-year-old male with no medical history and a history of a right distal intercondylar notch femoral stress fracture and osteochondroma of the right distal lateral femur presented with 3 years of symptoms including locking, clicking, pain, and swelling of the right knee. The patient felt as though there was “something” that was moving around his knee that he had to manipulate his knee to gain range of motion when the knee was “locked.” He stated he could palpate “something” at the lateral borders of his patella whenever it would “lock up.” He states 3 years ago suffered an intercondylar stress fracture of the right knee from overuse. He states he successfully completed rehab for the stress fracture. He also stated his osteochondroma diagnosed 2 years ago was giving him pain at the distal lateral thigh. He felt as though his osteochondroma had increased in size. He denied recent injury, instability, erythema, history of other knee injuries, weakness or numbness of his right lower extremity. Edward Via College of Osteopathic Medicine-Virginia Campus Virginia Tech Sports Medicine Fellowship Carilion Clinic

Physical exam revealed no erythema, swelling, skin lesions, bony abnormality. There was no tenderness to palpation throughout the knee and no swelling, Active and passive range of motion was zero degrees in extension and 140 degrees in flexion. Muscle strength 5/5 with flexion and extension. Sensation intact to light touch. Patellar grind, patellar apprehension, ballotment, Varus/Valgus stress, Lachmans, Anterior/ Posterior drawer, and McMurrays tests were all negative. X-Ray of the right knee showed a circular, coin shaped, 3.5 cm x 3.5 cm calcification visualized within the suprapatellar area the of the knee. This likely represented a calcific loose body of unknown origin. The patient subsequently had an arthroscopy with debridement of the circular loose body located in the lateral gutter of the knee. The patient also had a standardized diagnostic arthroscope during the procedure with normal menisci, ACL, PCL and articular cartilage. It was noted there was an area in the intercondylar fossa that had perforative lesions,

likely representative of the area where the loose body originated from. The loose body was removed successfully through an arthroscope port site during arthroscopy. Additionally, the patient had removal of the osteochondroma successfully. The patient tolerated the procedure and was discharged home. The patient started physical therapy several days after discharge. The patient continues to progress with physical therapy and no longer has “locking” sensations in his right knee.

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