Knee Injury Case Study
A 15-year-old gymnast has noted knee pain that has become progressively worse during the past several months of intensive training for a statewide meet. Her physical examination indicated swelling in and around the left knee. She had some decreased range of motion and a clicking sound on flexion of the knee. The knee was otherwise stable.
|Routine laboratory values||Within normal limits (WNL)|
|Long bone (femur, fibula, and tibia) X-ray||No fracture|
|Arthrocentesis with synovial fluid analysis|
|Appearance||Bloody (normal: clear and straw-colored)|
|Mucin clot||Good (normal: good)|
|Fibrin clot||Small (normal: none)|
|White blood cells (WBCs)||<200 WBC/mm3 (normal: <200 WBC/mm3)|
|Glucose||100 mg/dL (normal: within 10 mg/dL of serum glucose level)|
|Magnetic resonance imaging (MRI) of the knee||Blood in the joint space. Tear in the posterior aspect of the medial meniscus. No cruciate or other ligament tears|
|Arthroscopy||Tear in posterior aspect of medial meniscus|
The radiographic studies of the long bones eliminated any possibility of fracture.
Arthrocentesis indicated a bloody effusion, which was probably a result of trauma. The fibrin clot was further evidence of bleeding within the joint. Arthrography indicated a tear of the medial meniscus of the knee, a common injury for gymnasts. Arthroscopy corroborated that finding. Transarthroscopic medial meniscectomy was performed. Her postoperative course was uneventful.
Critical Thinking Questions
- One of the potential complications of arthroscopy is infection. What signs and symptoms of joint infection would you emphasize in your patient teaching?
- Why is glucose evaluated in the synovial fluid analysis?
- What are special tests used to differentiate type of Tendon tears in the knee? Explain how they are performed (Always on boards)