Carlos Alberto Neira , Orthopaedic Surgeeon
April 1, 1996
CLINICAL CASE PRESENTATION
SAN JUAN DE DIOS HOSPITAL
The patient is an 8 year old white male with no significant past medical history who complains of right knee pain, swelling, and decreased range of motion after having his kneeslammed in a car door 5 weeks prior to presentation. At the time of injury, the patient was seen in the Emergency Room where X-rays were negative, and the patient was told he had a contusion of theknee. Patient denies locking of the knee, but gives a questionable history of "giving way" of the knee. It is unclear whether these episodes are truly secondary to instability. On physical examination,the patient has a small effusion. There is no medial or lateral joint line tenderness. There is no tenderness around the collateral ligaments. Range of motion is 30-90 degrees. There is no instabilityto varus or valgus stressing at 0 degrees and 30 degrees. MacMurray test is negative. Lachman test shows a slight increase in laxity compared to the contralateral side, but with an endpoint. Anteriordrawer test also shows a good endpoint. Posterior drawer is negative. KT-1000 testing was equal on both sides. The patient was sent for physical therapy and an MRI to rule out ligament or meniscalinjury. MRI was read by radiologist as anterior cruciate ligament tear and small medial meniscal
tear. When the patient was seen one month later, he had full range of motion of the knee. There wasstill a slight increase in laxity on Lachman test, but again with an endpoint. KT-1000 testing was again equal on both sides. Patient was told he could resume participation in sports and to return ifhe experienced any further symptoms.
• Very uncommon injury in children with open physis
• Occurs much less commonly in children than adults (~1.5% of all ACL ruptures)