Lateral Meniscus Tear with Grade 1 Lateral Collateral Ligament Sprain
Objective:
Informing of a 21-year-old female, senior, NCAA division three college
basketball player who acquired a lateral meniscus and later collateral ligament
(LCL) sprain on her left knee during pre-season scrimmage. Mechanism came from
an awkward twisting landing from going after a jump ball.
Background:
In women athletes, most twisting mechanisms of the knee can lead to an
anterior cruciate ligament (ACL) rupture. In this case however, the twisting
mechanism upon landing has caused a grade 1 LCL sprain and lateral meniscus tear.
Different Diagnosis:
Lateral collateral ligament sprain, meniscus tear, IT band friction syndrome,
and subluxation of patella.
Treatment:
Patient was given crutches for the weekend and a full rehabilitation program
was given to regain full extension of knee before returning to play.
Uniqueness:
While most female basketball player injuries from a mechanism of twisting
knee while landing result in ACL ruptures, the following case study focuses on a
lateral meniscus tear with a grade 1 LCL sprain. This patient also has had previous
surgery of a complete ACL rupture five years ago on the same knee.
Conclusion:
In conclusion, the following case study presents the diagnoses, treatment,
and rehabilitation process of a female basketball player with a grade 1 LCL sprain
and lateral meniscus tear with previous history of an ACL rupture.
Key Words:
Lateral Meniscus, Lateral Collateral Ligament, Knee Injury, College Athlete
Abstract
The knee joint functions to support the body weight and to shorten and
lengthen the lower limb (1). The knee is a hinge joint with many major structures
running through it, such as, the anterior cruciate ligament (ACL), the lateral
collateral ligament (LCL), and the meniscal cartilage; all of which will be further
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explained in this report. The National Collegiate Athletic Association (NCAA) has
gathered statistics over a three year period…showing that women suffered anterior
cruciate ligament injuries more often than men, nearly 4 times as often in
basketball, 3 times as often in gymnastics, and nearly 2 and a half times as often in
soccer (2). This is mainly because of the woman’s increased Q angle. The Q angle is a
measure of the angle between the quadriceps muscle on the front of the thigh and
the patellar tendon at the knee (2). This angle is greater in women because of their
ability to have a child and leaves them more susceptible to mainly ACL, as well as
other knee injuries. And between the two menisci, the medial menisci has a much
higher incidence of injury that does the lateral meniscus (3).
In this case report, I would like to present a senior NCAA division 3
basketball player who suffered a Grade 1 LCL sprain and lateral meniscus tear who
has a previous history of a complete rupture and surgical repair of her ACL in the
same knee. With this injury, I will explain the diagnosing process along with her
rehabilitation process and how return to play was determined.
Case Report
A 21-year-old, senior, NCAA division 3 women’s basketball player was
competing in a pre season scrimmage when she went up for a rebound and came
down, landing awkwardly, twisting her left leg. She limped a few steps before taking
a knee and coming off the court. We performed a quick evaluation to determine
whether or not she could return to play. She described moderate pain on her left
lateral knee but nothing really severe. No clicking or swelling was present at the
time. She showed full range of motion (ROM) and full functionality through jumping
and cutting so we allowed her to return to play. After the game we iced and told her
to come in tomorrow before practice for another look at the injured knee.
The next day before practice she came in for us to take another look at it. She
complained hours after the game, her knee had some swelling and had some
instances of clicking, and a little pain with going up and down steps. We had prior
knowledge of her previous ACL rupture and surgery on that same knee about five
years before. She described her pain as a 6 and like a radiating pain. She also stated
that ice made it feel slightly better.
During the observation process, we noticed her left knee was slightly more
swollen then her right. No discoloration was present, nor were there any sighs of
obvious deformities. We had her stand up and demonstrate her walk for us and she
displayed an obvious limp. No forefoot varus or valgus was present when observing
her gait. Neither was there any genuvalgum, genuvarum, or genurecravartum.
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Moving to ROM, both actively and passive flexion of the knee was full without
pain. When we moved to extension however, she could not extend fully and had
some pain. Resistive also had the same results.
There was no neurological test or manual muscle test done because of no
complaints of numbness or tingling so we went straight to special test. First test
done was a Varus Stress test where she had slight pain when performed and the
same results when performed at 30 degrees. We also had her grab her lay down
supine and had her grab her leg and have her heel touch her side (Bartilozzi Test)
and she had pain in her lateral joint line. Other test such as Varus Stress Test,
McMurray’s Test, and Apley’s Compression/Distraction test were performed but all
had negative results.
From these factors we determined it was a Grade 1 LCL sprain and lateral
meniscus tear. I believe this because the clicking, pain with stairs, positive bartilozzi
test, and unable to gain full extension lead me to believe it’s a torn lateral meniscus.
And her mechanism, location of pain, and positive varus stress test points toward a
grade 1 LCL sprain. We began exercises to start with extension and fitted her with
crutches to use for the weekend. She was kept out of practice until she regained full
extension and had no more limping.
Her exercises consisted of warming up ten minutes on the bike, then she
would do straight leg raises with no weight for the first day; three sets of ten. Next,
would be passive extension; four sets of thirty. Finally, standing knee flex; three sets
of ten. We would then ice her knee after. The following day her swelling had went
down so we added a five pound ankle weight to her straight leg raises and standing
knee flex. We also added a new exercise where she laid flat with her knee on the
edge of the table with the five-pound weight on her ankle. We continued this for
three more days until she regained full extension.
We then gave her a LCL tape job for more stability and had her perform some
functional test to determine whether or not she could return to play. We had her do
a box drill where she would sprint up, shuffle to her right, back pedal, and then
shuffle to her left a few time; She had no complaints. We then had her do some
sprinting. Finally we had her do some jumping lay-ups on each side of the net and
had no complaints. We allowed her to return to practice with the limitations of no
scrimmaging yet and she would continue to come in for treatment. After practice
she felt fine with her limitations and the following practice was able to return fully
with no limitations.
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Discussion
With injuries like these, it’s very important to gain full range of motion.
Sports Science Orthopedic Clinic explains, “The ultimate goal of ACL reconstructive
surgery is to provide dynamic stability while maintaining full range of motion.” (4)
But that can go for any injury that looses ROM. If ROM is lost in the knee and never
regained, it will cause limping due to leg discrepancy, which can then lead to more
and more problems caused my your kinetic chain thrown of by not having full ROM.
With this athlete in particular, it’s important to know the history of the injury to
make sure her previous ACL reconstruction wasn’t upset and that the LCL and
lateral meniscus heal properly.
Conclusion
In conclusion, I’ve shown you a 21-year-old female, senior, NCAA division
three college basketball player who acquired a lateral meniscus and later collateral
ligament (LCL) sprain on her left knee from coming down awkwardly in a twisting
motion. I’ve also provided you with the systematic evaluation process and how we
diagnosed, treated, and got her back to 100%. The main thing I’ve learned from this
case study is how to rehab properly to regain full range of motion and the proper
things the look for during a functional test for the athlete to return to play.
References:
1.Clarkson, Hazel M. Musculoskeletal Assessment. Philadelphia, PA:
Lippincott Williams and Wilkins; 1989
2. Physical Therapy Corner: Knee Injuries and the Female Athlete. 2007.
Available At: http://www.nismat.org/ptcor/female_knee
3. Prentice, William E. Principles of Athletic Training. New York: McGraw
Hill; 2011
4. The Sports Science Orthopedic Clinic: Reconstructive Surgery. 2011.
Available At: http://www.ssoc.co.za/acl-injuries.html
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