Immediate Swelling After Trauma to the Knee

Abstract

A 26-year-old otherwise healthy male presents to the clinic with right knee pain after a skiing accident 3 days ago. The patient landed awkwardly after attempting a jump. He experienced immediate right knee pain necessitating ski patrol to bring him down the mountain. The patient reports hearing a “popping” noise when landing. Shortly after he noticed swelling around his knee, but he was still able to bear weight on his leg. Today in clinic, the patient is able to ambulate with a single crutch on a slightly flexed knee without the knee buckling. On physical exam, a large effusion is present over his anterior knee. There is mild warmth and tenderness to palpation around the medial joint line. Muscle compartments in the leg are soft and pulses are 2+. Neurologic exam reveals normal motor and sensory function distal to the knee. The patient is able, but hesitant, to perform active or passive knee range of motion secondary to pain. There is increased knee laxity of 1 cm when an anterior force is applied to the tibia at 30° and 90°. There is no laxity with varus or valgus stress applied to the knee. Compression and axial rotation across the knee joint while extending it from a fully flexed position produces neither pain nor a palpable or audible snap.