Management of Acute Knee Injury:A Story of 16 Years old boy
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Management of Acute Knee Injury:A Story of 16 Years old boy
This case highlights the benefits of a comprehensive sports medicine program for student athletes. The Center for Sports Medicine at Children’s Mercy provides care for acute injuries in a timely manner and coordinates care between physicians, ancillary services including physical therapy, and the patient’s school. The team is focused on meeting the needs of the patient and family, returning the student athlete to sports participation. Prompt evaluation and surgical treatment for ACL injuries offers the student athlete the best chance for a full return to sports activity without limitations, and certainly may reduce the risk of secondary injury.
Meniscus Tear
Presentation: A 16-year-old male presented with a sports-related knee injury. When playing basketball, he jumped for a rebound, was hit in the knee and was unable to continue playing. The patient presented to the ER with complaints of swelling and pain and difficulty bearing weight on the medial side of the knee. Based on the injury, the patient was referred to the Center of Sports Medicine at Children’s Mercy. The following day he was evaluated and found to have a mild knee effusion, medial joint line tenderness, limited motion and pain with valgus stress. Due to concerns that he may of sustained a meniscal tear, an MRI was ordered and obtained within the next three days.
Diagnosis: The MRI verified a meniscal tear and the patient received a referral to see an orthopaedic surgeon. The young man met with one of the surgeons for further evaluation and discussion of treatment options, including arthroscopic surgical repair or resection. Based on his activities and schedule, the decision was made to schedule surgery for the following week. He worked with Physical Therapy during the visit to learn how to use crutches prior to the surgery, limiting extra appointments that would cause him to miss school.
Treatment: When deciding on the best treatment option for a torn meniscus, there are many things to take into consideration, including the tear location, the child’s age, activity level and the extent of the tear. If viable, it is beneficial to save as much of the meniscus as possible. By saving and repairing the injured meniscus, the rate of knee joint degeneration is reduced, as compared to a total removal of the meniscus.
When surgery is determined to be the best course of treatment, research supports that optimal results are seen with early intervention. Before the operation, we also refer the patient to physical therapists who work only with student athletes. This helps the patient set realistic expectations post-surgery. Compliance with physical therapy and rehabilitating the patient’s ACL is equally important to a successful return to activity, in our opinion. We also take the patient’s academic and psychosocial needs into consideration when developing a treatment plan, and making referrals to other pediatric specialists.
This student athlete had surgery for a meniscal repair less than two weeks after his injury. He remained on crutches with limited weight bearing for three to four weeks after surgery to protect the repair. Physical therapy resumed, and physical therapists continued to work with him for the next 10 weeks, preparing him to return to sporting activity.
Outcome: After completing physical therapy and undergoing functional testing, an objective test that assesses strength and eccentric control, this student athlete was released back to sports. At eight months, the patient reports a full return to sports activity without limitations.










