Pain in the back of the knee after basketball injury.

Patient

Q: My daughter 17, hurt her knee during a basketball game. She did not have pain that told her exactly when it happened.(not bad enough to to override the adrenialine of the game). We think she collided with another girl but she is very rough during a game, falling, diving, etc. She could not straighten it all the way without pain. Could not lift her leg while sitting (bent or straight) without pain. She could not step off of her leg while walking without pain. She limped for a couple of days. She has pain in the back of the left knee on the outside. She did not practice basketball at school for 4 days but played a game 7 days after the injury. Practiced all last week and played 3 out of 4 games this weekend. So this will be the 14th day with pain. What is wrong with her knee?

Doctor

A:    Typically the pain behind the knee with flexion (bend knee)- extension is the most common presentation of the Patellofemoral Syndrome, which is produced by an impairment affecting the patella and femur joint, in the case of your daughter, the previous injury might have caused ,besides the direct blow, an unbalanced muscle pull that produced excessive pressure or leverage forces on the patellofemoral joint surfaces. Patellofemoral syndrome is common in US especially among young and active persons. The suggested strategy should be: strengthening and stretching the main muscle of the thigh: quadriceps, to restore the muscle balance around the knee joint, for this is indicated physical therapy for 6 to 8 weeks, using ice packs at the end of the game or  exercise routine to decrease pain and swelling. The use of a soft knee braces helps to control patella position and restrict full knee flexion which is good to ease the pain. Also, and very important, the activities or sports that require frequent squatting must be avoided until the pain is under control. If after carefully follow all these conservative measures, she continues feeling pain and having any degree of limitation to flexion or extension, I strongly recommend her a reassessment by a orthopedic surgeon this time with imaging studies.

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