![]() Prior to the start of surgery, bone marrow aspirate was harvested from the left posterior superior iliac crest and whole blood was drawn intravenously. This example highlights the difficulty in repairing radial tears as there is a significant gap (white arrow, up) and approximation of the two tissues must be restored for successful repair.Įxamination under anesthesia of the right knee revealed complete grade III ACL and LCL tears. Complex radial tear of the posterior horn of the lateral meniscus (white circle) with significant meniscal extrusion. C) Coronal view demonstrating wavy appearance and thickening of LCL (white arrow, right), indicative of a complete tear this was confirmed on clinical exam. B) Posteromedial tibial bone bruise, indicative of secondary sign for posterolateral corner injury (white arrow). A) Sagittal view demonstrating complete tear of the ACL (white arrow, right) with increased anterior tibial translation as a secondary sign of ACL injury (white arrow, left) and floating appearance of lateral meniscus (black arrow). MRI appearance of grade III tears of the anterior cruciate ligament (ACL) and lateral collateral ligament (LCL) and radial tear of lateral meniscus. Neurovascular exam revealed mild decreased sensation throughout the common peroneal nerve distribution with intact motor function. The proximal tibiofibular joint had increased anteroposterior motion at 90 degrees of knee flexion compared to the contralateral limb. The dial test was 1 + at 30 degrees of knee flexion with rotation occurring from the anterolateral tibia. The athlete's posterior cruciate ligament (PCL) and medial collateral ligament (MCL) were stable with a negative posterior drawer and a negative valgus stress test. Ligamentous exam revealed a 3 + Lachman's test with a soft endpoint, 3 + pivot shift, and 3 + varus stress test at 30 degrees. Right knee flexion was limited to 90 degrees due to swelling and pain. Right knee extension was 7 degrees of hyperextension compared to 3 degrees of hyperextension on the left knee. She was tender to palpation along the medial and lateral joint lines. Patellar mobility was two quadrants medially and laterally with no crepitation appreciated. Upon examination, there was moderate effusion and swelling globally around the right knee. Her left knee had a previous anterior cruciate ligament (ACL) reconstruction performed three years prior. She denied any previous history of injury to her right knee. Her chief complaint was right knee pain and instability. She presented to the orthopedic clinic three days following her skiing injury. The patient provided informed consent for this case report. She began to experience immediate anterolateral knee pain with an associated knee effusion. She described a noncontact mechanism at the time of injury which included deep knee flexion with a varus force. The athlete sustained an acute right knee injury during a competitive skiing event (giant slalom). This case report describes a 28-year-old female who is an alpine skier on the U.S.
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