Case Study

Case Studies  

1- Knee Injury 

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. 

Studies and Results:

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)

Neutrophils <25% (WNL) 

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 

Diagnostic Analysis  

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. 

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