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An 11-year-old boy complains of 4 weeks of medial knee pain that began while playing tennis. Examination shows reproduction of pain with internal rotation of the tibia during extension of the knee, and relief of pain with tibial external rotation. A radiograph and MRI is shown in Figures A and B. Which of the following is the most appropriate initial treatment?
Arthroscopic removal of fragment
Arthroscopic open reduction and internal fixation
Arthroscopic microfracture drilling
Non-weight bearing for 6-8 weeks
Full weight bearing with avoidance of athletic acticity
Select Answer to see Preferred Response
A 10-year-old boy has atraumatic, progressive right knee pain for 2 months. He denies fevers or mechanical knee symptoms. His exam is completely normal and symmetric to his left knee. Radiographs of the right knee demonstrate open growth plates and a well circumscribed 1x1cm area of sclerotic subchondral bone with a radiolucent halo separating this area from his femoral epiphysis. MRI is shown in Image A. What is the best initial treatment plan?
Arthroscopic reduction and fixation
An 11-year-old boy presents with recurrent knee effusions and discomfort with athletic activity. A radiograph of the knee is shown in Figure A. What is the most important determinant of a successful outcome with nonoperative treatment?
Weight of the patient
Presence of open physes
Location of the lesion within the knee
A history of trauma to the affected joint
Which area of the knee is most likely to be affected by a juvenile osteochondritis dissecans (JOCD) lesion?
Lateral aspect of the medial femoral condyle
Lateral aspect of the lateral femoral condyle
Medial aspect of the lateral femoral condyle
Medial facet of the patella
Lateral facet of the patella
Which of the following factors is the best predictor of successful non-operative management of an osteochondritis dissecans lesion in the knee?
Open femoral physis
Location in the knee
High signal behind the lesion on MRI
Articular cartilage thickness
Body mass index
HPI - During sports activities (basketball) a 17 years old male injured his left knee. He came to my office two weeks later.
How would you treat this patient initially?
HPI - 12 month history of pain worse in the last 2 month. Manual worker. occasional amateur soccer player. no history of trauma
What would your next step in management be?
HPI - 19 year old male football player, Had a atraumatic knee injury June 30,2014, while doing a sudden extension of the knee. He refers pain below the knee cap, when doing flexion and extension. He doesnt tolerate a flexion above 30°. MRI from June 30, 2014 showed a chondrol fracture (see image). He was initially treated with a knee splint, rest, for 4 weeks. After that he was allowed to walk without the splint, open chain excercise, he still have pain while flexing knee over 30°. New MRI shows that the the chondral fracture seems to be still unstable.
What should I do next?