Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of left knee pain following a high-energy trauma/hyperextension injury. Reports immediate posterior knee pain, swelling, and a subjective feeling of instability. Denies neurovascular compromise. Mechanism of injury consistent with a direct blow to the proximal tibia with the knee in flexion (dashboard injury).
Clinical Examination Findings
Left knee examination reveals significant posterior sag sign. Posterior Drawer test is positive (Grade III, >10mm) with a soft endpoint. Quadriceps active test confirms posterior tibial translation. Lateral and medial collateral ligaments are stable. Neurovascular status intact distally with palpable dorsalis pedis and posterior tibial pulses.
Treatment Protocol
Initial management includes RICE protocol (Rest, Ice, Compression, Elevation). Immobilization in a hinged knee brace locked in full extension for 2-4 weeks to allow for posterior capsular healing. Non-weight bearing or toe-touch weight bearing with crutches as tolerated. Referral to physical therapy for quadriceps-strengthening exercises. Surgical reconstruction to be considered upon follow-up.