This young female football player presents after a hyperextension injury to her knee. She describes experiencing a ‘crunching’ sesation followed by pain and almost immediate swelling. When she was assessed two weeks after her injury she was found to have an effusion. There was no ligamentous laxity and no evidence of patella insability. The key findings were of tenderness around the antero-medial joint line and of pain with passive extension of the knee.
An x-ray image showed an effusion but no bony injury. Large bony contusions involving the anterior medial tibial plateau and medial femoral condyle are demonstrated on the MRI images. There is also a 14 x 13 mm sub cortical fracture in the anterior lateral tibial plateau. This fracture appears to involve the cortex at the anteromedial border of the tibial eminence.
The player was manged with avoidance of pain provoking activy. Her symptoms resolved over an eight week period. She was able to return to football without any ongoing issues over a four week period.
This player’s history (rapid swelling) is suggestive of a haemarthrosis. In this situation it is also important to consider whether they may have injured their anterior cruciate ligament (ACL) or experienced a patella instability episode.
This increased signal seen on MRI represents a microtrabecular fracture. It is generally associated with direct trauma, ligament injury, or patellar dislocation. It can be the cause of prolonged pain following injury. The pattern of the bruising can give important clues to the mechanism of injury and for the diagnosis. The pattern seen here is common following hyperextension injuries. An impaction injury involving the lateral femoral condyle and posterolateral tibia is commonly associated with an ACL rupture while increased signal in the medial patella/lateral femoral condyle is seen after a patella insability episode.
In most cases a period of rest from running and other pain provoking activities is effective. In some situations however the injury can progress to a more significant osteochondral injury.
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