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Patellar Contusion
From WikiSM
Contents
Other Names
- Patella contusion
- Patellar bruise
Background
- This page refers to contusions and bruises of the Patella
- Patella Fracture is discussed separately
History
Epidemiology
- Common in pediatrics
- One study estimated 29.1% of knee injuries seen in the ED were "knee contusions" in the pediatric population[1]
- Note that "knee contusion" included all comers, not specifically patella
- It was more common in males (31.8%) than females (22.8%)
- Moustaki found 43.5% of kids with knee injury were diagnosed with "knee contusion"[2]
- The most common etiology was fall or direct impact while playing at home or the playground
Pathophysiology
- General
- Bone bruises/ contusions should be thought of as radiographically occult bone injuries
- Etiology
- Direct blunt trauma to the patella during sport
- Common culprits include minor falls during play or sport
Associated Conditions
Risk Factors
- Unknown
Differential Diagnosis
- Fractures
- Dislocations & Subluxations
- Patellar Dislocation (and subluxation)
- Knee Dislocation
- Proximal Tibiofibular Joint Dislocation
- Muscle and Tendon Injuries
- Ligament Pathology
- Arthropathies
- Bursopathies
- Patellofemoral Pain Syndrome (PFPS)/ Anterior Knee Pain)
- Neuropathies
- Other
- Bakers Cyst (Popliteal Cyst)
- Patellar Contusion
- Pediatric Considerations
- Patellar Apophysitis (Sinding-Larsen-Johnansson Disease)
- Patellar Pole Avulsion Fracture
- Tibial Tubercle Avulsion Fracture
- Tibial Tuberosity Apophysitis (Osgood Schalatters Disease)
- Proximal Tibial Metaphyseal Fracture
- Proximal Tibial Physeal Injury
Clinical Features
- History
- Patients should be able to describe the trauma
- Primarily complain of pain, swelling
- Physical Exam: Physical Exam Knee
- Erythema, prepatellar swelling may be present
- Tenderness along point of contact
- Fluctuance suggest prepatellar bursitis
- Extensor mechanism should be intact despite pain
- Range of motion is intact, effusion typically absent
- Special Tests
Evaluation
- Clinical decision rules
- Consider Pittsburgh Decision Rule (PDR)
- Consider Ottawa Knee rule (OTR)
Radiology
- Standard Radiographs Knee
- Findings
- By definition will be normal
- Bipartite Patella
- Can be mistaken for a fracture
MRI
- Not typically indicated
Ultrasound
- Not typically indicated
- May be used in lieu of radiographs to evaluate patella and extensor mechanism
Classification
- Not applicable
Management
Nonoperative
- Activity modification guided by pain
- Consider PRICE therapy
- Patient does not routinely need immobilization
- Medications: Acetaminophen, NSAIDS
- If Prepatellar Bursitis is concomitant
- Consider Knee Compression Sleeve
Operative
- There are no surgical indications for this injury
Rehab and Return to Play
Rehabilitation
- No specific rehabilitation program exists
Return to Play/ Work
- Most patients will have symptom resolution in 1-3 weeks
- Can return to play along that timeline
Complications and Prognosis
- Patellar contusion is a self limiting injury
- Expect full return to play after symptoms resolve
See Also
- Internal
- External
- Sports Medicine Review Knee Pain: https://www.sportsmedreview.com/by-joint/knee/
References
- ↑ Gage, Brett E., et al. "Epidemiology of 6.6 million knee injuries presenting to United States emergency departments from 1999 through 2008." Academic emergency medicine 19.4 (2012): 378-385.
- ↑ Moustaki, M., et al. "Home and leisure activities and childhood knee injuries." Injury 36.5 (2005): 644-650.
Created by:
John Kiel on 8 July 2021 13:45:48
Authors:
Last edited:
4 October 2022 15:56:42
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