The Not-So-Minor Laceration

Evaluating Periarticular Wounds in a Sliding Injury

Authors: Michael Kelleher, MD, Anna Waterbrook, MD, CAQ-SM

Introduction and Case Presentation:

Case: A 24-year-old softball player with no significant past medical history presents to the emergency department (ED) after sustaining a large laceration to the left knee during a softball game. She was attempting to slide feet first into second base when she accidentally landed on her flexed knee. She immediately felt a tearing sensation and noted significant pain with a visible wound around her left knee. She did not attempt to bear weight and was transported via EMS. She denies any numbness, tingling, or prior injury to the affected limb.

Exam: There is a large 15cm x 3cm x 3cm full-thickness laceration over the left anterior knee with visible muscle and bone. Range of motion is intact with full flexion/extension. Extensor mechanism intact. (-) Lachman’s, anterior/posterior drawer. Varus/valgus stressed without laxity. Strength is 5/5 and SILT. Dorsalis pedis and posterior tibial pulses 2+ bilaterally.

DDx:

• Full-thickness laceration
• Quad/Patellar tendon rupture.
• Traumatic arthrotomy
• Ligamentous vs tendon injury
• Long bone fracture
• Patellar fracture
• Joint dislocation