Ortho Dx: Severe pain, inability to bear weight on the knee - Clinical Advisor

Ortho Dx: Severe pain, inability to bear weight on the knee

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A 56-year-old patient presented to the emergency department with severe pain in his right leg and inability to bear weight after falling up the stairs. The patient denied any history of knee pain or functional loss before the fall.

Radiographs were taken and were reported as normal without acute fractures by the attending radiologist.

The ED physician reported a difficult exam secondary to pain, and positive exam findings of a joint effusion and inability to bear weight.

The patient was sent home from the ED with a knee immobilizer and crutches, instructed to weight bear as tolerated, and to follow up with orthopedics in one week.

Patella alta, a joint effusion, and changes in the soft tissue shadows (suggestive of an attenuated quadriceps tendon) are evident on the lateral radiograph (figure 1), leading to a high index of suspicion for a patella tendon rupture. According to...

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Patella alta, a joint effusion, and changes in the soft tissue shadows (suggestive of an attenuated quadriceps tendon) are evident on the lateral radiograph (figure 1), leading to a high index of suspicion for a patella tendon rupture.

According to the Insall-Salvati ratio, the length of the patella tendon (measured from the inferior pole of the patella to the tibial tubercle insertion) should be approximately equal to the length of the patella (measured from the superior to inferior pole). However, variations to this 1:1 ratio have been mentioned in radiographic literature (0.74-1.50). 

A patella tendon rupture is suspected when the length of the patella tendon appears significantly greater than the length of the patella.

Dagan Cloutier, MPAS, PA-C, practices in a multispeciality orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).

This has been brought to you in partnership with the Journal of Orthopedics for Physician Assistants

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