Virginia Research Day 2022

Medical Resident Research Case Reports

14 Cartilaginous Conundrum Knee Pain In A Division 1 College Football Player

Daniel Tiller, DO; Nicholas Valle, OMS II, Mark Rogers, DO Christofer Catterson, MD; Zack Maust, MS, ATC Corresponding author: Dtiller01@vcom.edu

Virginia Tech VCOM Virginia

Case History: 21-year-old-male Division 1 college football player presents with right knee pain. He has a history of chronic right knee pain in the context of 2 meniscus tears. Despite surgery and other treatments, he has persistent soreness and pain along the lateral joint line, and sharp pain with running, planting, and cutting. The patient has undergone multiple treatment modalities including unloader bracing, Euflexxa injection and arthroscopic meniscectomies with only partial relief. The patient is also currently using 800 mg Ibuprofen 2-3 times daily. There is no pertinent family history or other medical history. Physical Examination: Right Knee: No significant swelling or ecchymosis. Trace effusion present. Tenderness to palpation along lateral joint line. McMurray’s test causes some pain, but no clicking. Tibial and peroneal nerve grossly intact to motor and sensory stimulation and light touch distally. Dorsalis pedis pulse 3+. Range of motion is from 0-130 degrees of flexion. Lachman’s and posterior drawer tests are negative, and the knee is stable to varus and valgus stress in extension and at 30 degrees of flexion.

Differential Diagnosis: Osteochondritis dissecans, Meniscus tear/extrusion, Infrapatellar neuralgia, Avascular Necrosis, Osteoarthritis Tests and Results: MRI with contrast (4/21): suggestive of recurrent tear of medial meniscus R Knee Arthroscopy (7/21): complex tears of lateral and medial menisci, partial medial and lateral meniscectomies performed with plica excision R Knee arthroscopy of lateral femoral condyle (9/21): ACL and PCL intact, no retears of the medial or lateral meniscus present. Large chondral lesion of the lateral femoral condyle with full thickness delamination was noted upon entering the lateral joint line. Final/Working Diagnosis: Right Knee full thickness osteochondritis dissecans lesion of the lateral femoral condyle Discussion: Cartilage injuries are relatively common among athletes and can cause lost play time as well as promote degenerative disease. A survey of retired professional soccer

players revealed that 25% retired because of chronic or acute injuries that affected the knee. Return to high level sports following full thickness cartilage injuries poses a challenge which has not been well studied. A case series reviewed 43 athletes who had undergone knee allograft with 79% returning to preinjury levels of play, however only 25% of the patients reviewed played at the collegiate level or above. Multiple surgical modalities exist with no clear consensus on which is the most optimal for return to play. Outcome: The patient was treated operatively with open osteochondral allograft transplantation of the right lateral femoral condyle. Return to Activity and Follow Up :He is currently progressing through physical therapy with plans to return to Division 1 football play next season.

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