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Knee Capsule Strain

Posterior Knee Capsule Strain In A Football Player Preparing For The Pro-Combine


A 23-year-old black male elite football player running back was preparing for the Pro-Combine through strength and conditioning.  The medical and surgical histories were benign and the patient was without pain, discomfort or knee pain prior to a broad jumping task.  The player performed a 10-foot broad jump landing favoring his left knee in a hyperflexed position with his buttocks almost touching the ground.


In order to recover from the jump, the patient utilized his left leg to extend himself and in the process externally rotated his knee as he fell forward.  The patient experienced immediate discomfort in the posterior lateral aspect of the knee.  He avoided any further broad jumping but participated in a generalized conditioning program that day.  In the evening, the patient had increasing pain and minimal swelling the posterior area behind the knee.


In addition he had difficulty extending his knee to horizontal as well as externally rotating his knee.  In the morning, the patient awoke with difficulty extending the knee due to tightness, stiffness and pain with extension and external rotation of the knee.


On examination, the primary finding was tenderness to deep palpation along the midline of the distal femur in between the medial and lateral condyles.  The tenderness extended a distance of three inches from midline of the distal femur toward the proximal tibia. 


Additional pain on palpation was noted posteriorly in the distal femur adjacent to the lateral condyle.  There was no notable joint swelling.  The tests for meniscus as well as the anterior and posterior cruciate were negative for any significant laxity or tears.


The patient had full range of motion but pain in the last ten degrees of knee extension.  With the knee flexed, external rotation reproduced the pain; however, internal rotation caused only mid soreness.  There was no Baker’s cyst noted posteriorly.


The assessment was a posterior capsule strain that had the following functional limitations:

1.  Resistance to full extension

2.  Resistance against external rotation of the knee with pain along the oblique popliteal ligament.


The primary diagnosis for this individual was a posterior meniscofemoral ligament strain and a very minor posterior cruciate ligament strain.


The most common mechanism of injury was hyperextension combined with external rotation of the knee.  This presentation seems to be classic for a superficial posterior capsule ligament sprain without derangement of any internal structures within the knee joint proper.


Patient was instructed to participate in active range of motion, stretching, anti-inflammatories, cold, ice and rest of three days prior to returning to activities of hyperextension and external rotation of the knee.  The patient recovered through the conservative treatment and had no further sequela to the problem.



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