Case 2, presented by Robert G. Marx, MD, MSc, FRCSC, and Aaron Daluiski, MD describes a 18-year-old high school quaterback playing in his final game prior to starting his collegiate baseball career on a scholarship who was tackled in the open field. He had his left foot planted and his knee gave way. Referred for consultation by his local orthopedic surgeon one month after the injury, and generally in excellent health, the patient was 6’ 4’’ and weighed 225 pounds. MRI demonstrated obvious bi-cruciate disruption. There was avulsion of the long head of the biceps and iliotibial band. The structures of the posterior lateral corner were torn, including the fibular collateral ligament and popliteus tendon (Figure 1). The patient was taken to the operating room for anterior and posterior cruciate ligament as well as posterolateral corner reconstruction, including biceps tendon repair by one surgeon (RGM). During the same procedure, another surgeon (AD) performed neurolysis of the common peroneal nerve. The peroneal nerve was extremely scarred to the surrounding tissue and extensive, meticulous common peroneal neurolysis was performed. The patient was immobilized in full extension and non-weight bearing for four weeks, followed by physical therapy, range of motion exercises and progressive weight bearing as tolerated. At 6 months, he began to have early return of peroneal motor function, specifically dorsiflexion. One year after surgery, he had normal, symmetrical peroneal eversion strength with slight weakness of dorsiflexion power on the left. Sensation on the dorsal aspect of the foot was improved, but not quite normal. One year after surgery the patient began fielding and batting practice, with excellent left knee stability and function. At 16 months following surgery he returned to baseball competition, playing his usual position, first base, for his college team (Figure 4).
Read full case details in Volume 5, Issue 3 of Grand Rounds - Complex Cases.
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