Unique Muscle Strain Masquerading as an Intraarticular Ligamentous Knee Injury in a Female, Collegiate Basketball Player

Edward Rosero, Christiana Care Health System Department of Sports Medicine. edjrosero@gmail.com. (Sponsor: Kristopher Fayock) HISTORY: 19-year-old female, collegiate basketball player was referred to the sports medicine clinic by the athletic training office. One-day prior, she reported posterior knee pain and inability to fully bear weight immediately after hyperextending her knee while running. She denies feeling a “pop” or a “click.” Several hours after the injury she developed knee swelling and lost ability to fully extend her knee. She denies any paresthesias in the leg. PHYSICAL EXAMINATION: Examination in the office was significant for a right knee effusion and pain along the medial aspect of the knee along medial collateral ligament and medial joint line. Pain was reproducible with valgus stress. Range of motion testing revealed a 15-degree extension lag. Ligamentous instability testing was equivocal secondary to pain. DIFFERENTIAL DIAGNOSIS: Medial collateral ligament sprain Medial meniscal tear Anterior cruciate ligament sprain Patella or Quadriceps tendon strain Intraarticular loose body Hamstring strain TEST RESULTS: MRI of the right knee revealed a moderate strain of the semimembranosus muscle and tendon along the distal aspect of the knee and mild strain of the patellar tendon at the attachment to the lower pole of the patella. FINAL WORKING DIAGNOSIS: Moderate semimembranosus strain and mild patella tendon strain. TREATMENT AND OUTCOMES: Referred for Orthopaedic evaluation, who recommended knee immobilizer and rehabilitation with emphasis on increasing range of motion. Non-steroidal anti-inflammatory medication for pain. After 2 weeks of rehabilitation, she was able to pass all functional tests and was cleared to start non-contact drills and progress activity as tolerated