Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at UIC Library of Health Sciences on June 26, 2014. For personal use only. No other uses without permission. Copyright © 2013 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
[
musculoskeletal imaging
FIGURE 1. Lateral (left) and anterior-to-posterior view (right) knee radiographs. Although a large suprapatellar joint effusion was seen (arrow), the osseous structures, soft tissues, and joints were otherwise unremarkable.
]
FIGURE 2. Proton density–weighted magnetic resonance image (sagittal view) demonstrating disruption of the posterior cruciate ligament (arrow).
Isolated Posterior Cruciate Ligament Injury KATHLEEN GLENESK, PT, DPT, Arvin Sports Physical Therapy Clinic, Keller Army Community Hospital, West Point, NY. BRIAN T. FOGARTY, MD, Keller Army Community Hospital, West Point, NY. RICHARD B. WESTRICK, PT, DPT, DSc, OCS, SCS, US Army-Baylor University Doctoral Residency in Sports Physical Therapy, West Point, NY.
T
he patient was a 19-year-old male cadet at a military academy who was evaluated by a physical therapist in a direct-access capacity for a chief complaint of right knee pain and giving way after falling onto his right knee while snow sledding at a high rate of speed 2 weeks earlier. He reported feeling a pop in his right knee at the time of the injury and complained of immediate right knee pain and swelling that increased over the next 2 days after injury, which limited his ability to perform required military and athletic training activities. Visual observation revealed moderate
right knee effusion and an antalgic gait. Range of motion for the right knee was 10° to 120°. Although there was a positive posterior drawer test and a positive posterior sag sign for the right knee, other ligamentous testing was normal. Pain was noted with the McMurray test, and the right knee was diffusely tender to palpation. Knee radiographs were ordered by the physical therapist,1 which demonstrated a large suprapatellar joint effusion (FIGURE 1). The osseous structures, soft tissues, and joints were otherwise unremarkable. Due to concern for a posterior cruciate ligament injury and to assess for concom-
itant injury, magnetic resonance imaging was ordered,2 which revealed disruption of the posterior cruciate ligament without injury to surrounding tissues (FIGURE 2). Following consultation with an orthopaedic surgeon, it was determined that the patient would be managed nonoperatively.3 Following 6 weeks of physical therapist intervention, the patient was able to begin participation in required military and athletic training activities and to eventually return to full, unrestricted activity at 4 months following injury. t J Orthop Sports Phys Ther 2013;43(10):759. doi:10.2519/ jospt.2013.0418
References 1. A merican College of Radiology. ACR Appropriateness Criteria: acute trauma to the knee. Available at: http://www.acr.org/Quality-Safety/Appropriateness-Criteria/ Diagnostic/~/media/ACR/Documents/AppCriteria/Diagnostic/AcuteTraumaKnee.pdf. Accessed May 15, 2013. 2. H ash TW. Magnetic resonance imaging of the knee. Sports Health. 2013;5:78-107. http://dx.doi.org/10.1177/1941738112468416 3. S helbourne KD, Clark M, Gray T. Minimum 10-year follow-up of patients after an acute, isolated posterior cruciate ligament injury treated nonoperatively. Am J Sports Med. 2013;41:1526-1533. http://dx.doi.org/10.1177/0363546513486771 The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the US Army Medical Department, the US Army, or the US Department of Defense.
journal of orthopaedic & sports physical therapy | volume 43 | number 10 | october 2013 |
43-10 Imaging-Glenesk.indd 1
759
9/18/2013 2:33:33 PM
[
musculoskeletal imaging
FIGURE 1. Lateral (left) and anterior-to-posterior view (right) knee radiographs. Although a large suprapatellar joint effusion was seen (arrow), the osseous structures, soft tissues, and joints were otherwise unremarkable.
]
FIGURE 2. Proton density–weighted magnetic resonance image (sagittal view) demonstrating disruption of the posterior cruciate ligament (arrow).
Isolated Posterior Cruciate Ligament Injury KATHLEEN GLENESK, PT, DPT, Arvin Sports Physical Therapy Clinic, Keller Army Community Hospital, West Point, NY. BRIAN T. FOGARTY, MD, Keller Army Community Hospital, West Point, NY. RICHARD B. WESTRICK, PT, DPT, DSc, OCS, SCS, US Army-Baylor University Doctoral Residency in Sports Physical Therapy, West Point, NY.
T
he patient was a 19-year-old male cadet at a military academy who was evaluated by a physical therapist in a direct-access capacity for a chief complaint of right knee pain and giving way after falling onto his right knee while snow sledding at a high rate of speed 2 weeks earlier. He reported feeling a pop in his right knee at the time of the injury and complained of immediate right knee pain and swelling that increased over the next 2 days after injury, which limited his ability to perform required military and athletic training activities. Visual observation revealed moderate
right knee effusion and an antalgic gait. Range of motion for the right knee was 10° to 120°. Although there was a positive posterior drawer test and a positive posterior sag sign for the right knee, other ligamentous testing was normal. Pain was noted with the McMurray test, and the right knee was diffusely tender to palpation. Knee radiographs were ordered by the physical therapist,1 which demonstrated a large suprapatellar joint effusion (FIGURE 1). The osseous structures, soft tissues, and joints were otherwise unremarkable. Due to concern for a posterior cruciate ligament injury and to assess for concom-
itant injury, magnetic resonance imaging was ordered,2 which revealed disruption of the posterior cruciate ligament without injury to surrounding tissues (FIGURE 2). Following consultation with an orthopaedic surgeon, it was determined that the patient would be managed nonoperatively.3 Following 6 weeks of physical therapist intervention, the patient was able to begin participation in required military and athletic training activities and to eventually return to full, unrestricted activity at 4 months following injury. t J Orthop Sports Phys Ther 2013;43(10):759. doi:10.2519/ jospt.2013.0418
References 1. A merican College of Radiology. ACR Appropriateness Criteria: acute trauma to the knee. Available at: http://www.acr.org/Quality-Safety/Appropriateness-Criteria/ Diagnostic/~/media/ACR/Documents/AppCriteria/Diagnostic/AcuteTraumaKnee.pdf. Accessed May 15, 2013. 2. H ash TW. Magnetic resonance imaging of the knee. Sports Health. 2013;5:78-107. http://dx.doi.org/10.1177/1941738112468416 3. S helbourne KD, Clark M, Gray T. Minimum 10-year follow-up of patients after an acute, isolated posterior cruciate ligament injury treated nonoperatively. Am J Sports Med. 2013;41:1526-1533. http://dx.doi.org/10.1177/0363546513486771 The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the US Army Medical Department, the US Army, or the US Department of Defense.
journal of orthopaedic & sports physical therapy | volume 43 | number 10 | october 2013 |
43-10 Imaging-Glenesk.indd 1
759
9/18/2013 2:33:33 PM
