Occult tibial plateau fracture

Case
A 19-year-old male university level collegiate player sustained an acute injury to his left knee after a collision with an opponent.  The injury involved a direct blow to the lateral aspect of the knee. The player had immediate pain but was able to weight-bear and attempted to continue playing for a short time. Eventually he had to leave the field due to pain and the knee swelled within a few minutes.  There was no history of prior knee injuries.  A clinical examination conducted on the sidelines demonstrated a moderate effusion, tenderness along the lateral aspect of the knee and no ligamentous laxity.

Findings
X-rays of the left knee including AP, lateral, notch and skyline views, were obtained in clinic the following day.  These showed a subtle cortical irregularity at the lateral aspect of the posterior and lateral tibial plateau.  Further imaging with MRI demonstrated a non-displaced fracture involving the lateral tibial plateau with intra-articular extension (illustrated by the arrows) and pronounced increased signal associated associated with this (illustrated by the star).

Discussion
The day following the injury the player had a tense effusion. The knee was aspirated to provide pain relief (with 130 ml of blood being removed).  After the diagnosis was made, the player was treated conservatively with non-weightbearing for 3 weeks followed by progressive weight-bearing and rehabilitation. He was able to return to play two months following the injury.

The differential diagnosis for a traumatic haemarthrosis of the knee includes injuries to the anterior cruciate ligament (ACL), patella instability, fracture or osteochondral injury, and occasionally a peripheral meniscus tear.  This case illustrates the need to carefully evaluate a player who presents with rapid knee swelling as this history suggests a significant knee injury.  A careful clinical assessment is always needed.  X-rays are frequently normal and should not falsely reassure the medical team. In most cases MRI is indicated for further investigation.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

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Le traumatisme du GENOU doit être pris au serieux quelque soit la forme.lorsque le trauma survient au cours d une activité sportive le médecin du sport doit imposer au sportif l arrêt de toute activité et lui faire comprendre qu’ en continuant à jouer il s exposé à des dégâts. Le conduire en clinique pour examen. L examen du GENOU se repose. 1 sur le test de laterite( LLI- LLE et MENISQUE) 2 Tiroir. 3 Les ligaments croisés.. S il y’a un epanchement quelque minute apres(HEMARTHROSE) il faut faire une ponction evacutrice pour soulager le sportif. Demander en urgence une… Lire la suite »