CASE
An 11-year-old boy was referred to our orthopedic practice after injuring his left knee at football practice. The patient explained that he was hit from behind and fell on his flexed knees. The following day, he was evaluated at a local emergency department (ED). Radiographs revealed no fractures, and the patient's mother was advised to give him OTC NSAIDs for pain and to bring him to the orthopedic clinic if his symptoms did not improve.
The patient was brought to our clinic 3 days after the injury. He complained of increased pain and had a swollen knee. He reported that his symptoms were exacerbated with activity.
Physical examination The patient walked with a “toe touch” gait with a noticeable limp. His left knee was bruised and swollen, and its range of motion (ROM) was –15 degrees extension to 100 degr
ees flexion. He had a 2+ joint effusion, which was mildly tense and moderately painful. The ligament stress tests revealed pain but no instability. There was tenderness on palpation in the popliteal region and along the medial and lateral aspects of the supracondylar femur at the attachment points for the medial and lateral collateral ligaments. His skin was pink and warm, and he had strong, bounding dorsalis pedis and posterior tibial pulses. The ankle-brachial indices were more than 1.0 bilaterally. ROM in the hip and ankle was normal.
Imaging The ED radiographs were read as normal. Radiographs of the nonaffected right knee taken in our office also revealed no abnormalities. However, when they were compared against each other, the irregularity seen in Figure 1 was noted.
WHAT IS YOUR DIAGNOSIS?
• Pellegrini-Stieda disease
• Supracondylar femoral physeal fracture
• Osteochondral defect
• Ostoeochondroma