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A 30-year-old woman with acute knee injury
  1. Suzanne Witjes1,
  2. Tammo H Pels Rijcken2,
  3. Cor P van der Hart3
  1. 1Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands
  2. 2Department of Radiology, Tergooi Hospitals, Hilversum, The Netherlands
  3. 3Department of Orthopaedic Surgery, Bergman Clinics, Naarden, The Netherlands
  1. Correspondence to Suzanne Witjes, Department of Orthopaedic Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; suzanne.witjes{at}gmail.com

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Question

A 30-year-old woman was admitted to our hospital with acute knee pain after she had fallen while downhill skiing. In this fall she went through a typical valgus trauma with external rotation in the right knee, in which she observed a direct pain and popping sensation. At the scene of the accident the knee was cooled directly and a pressure bandage was applied. One day later she presented at the out-patient clinic. The patient was able to bear weight on the right knee and pain was not a major problem. There was no locking, but she complained of giving-way. On inspection, a large effusion was present. On physical examination valgus stress was painful and tenderness of the medial collateral ligament was present. Range of motion was only slightly limited due to pain and effusion. Lachman sign was positive in comparison with the contralateral side. The conventional lateral knee radiograph showed an abnormal deep depression in the lateral femur condyle (figure 1A).

Figure 1

Lateral radiograph of the right knee shows a lateral condyle sulcus of 3 mm, which is abnormally deep (solid arrow). The normal central depression on the medial condyle (dashed arrow) can be observed anterior to the traumatic depression in the lateral condyle (A). The solid white line in (B) represents the Blumensaat intercondylar line. The method of measuring the depth of the sulcus is also shown in (B): a line drawn tangentially across the lower articular surface of the lateral femur forms the reference line. The depth of the sulcus (normal <1.5 mm) is measured perpendicular to this line at the deepest point.

What is this indentation on the lateral femoral condyle and what causes it?

Answer

Additional MRI showed a prominent bone contusion at the location of the radiographically visible depression in the lateral femur condyle (figure 2). Remarkably, also …

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