A 20-year-old male collegiate football athlete reported a remarkably swollen elbow after direct contact with the ground. Initial radiographs and magnetic resonance imaging were negative for a fracture and soft tissue structural damage. After 2 weeks of conservative treatment, the athlete had no decrease in swelling and associated symptoms. He was diagnosed with a Morel-Lavallée lesion, later confirmed by diagnostic ultrasound imaging. The lesion was initially treated with compression therapy and cryotherapy to reduce swelling. Upon the final diagnosis the lesion was eventually incised, drained, and packed with iodoform sterile strips. It is hypothesized that many minor Morel-Lavallée cases are under- or misdiagnosed due to overlapping of signs and symptoms with other soft tissue traumas common in athletic populations. The procedures of this case can be utilized to optimize outcomes in future cases. While rare, Morel-Lavallée lesions can occur in athletic activities involving the upper extremity, and not solely crush injuries or traumatic and high-intensity accidents. This knowledge, along with the presented signs and symptoms, can give future healthcare professionals knowledge to include this diagnosis in their working differential diagnosis of injuries with similar presentations.
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Upper Extremity Morel-Lavallée Lesion in a Collegiate Football Player: A Case Report
Kyle Southall, Matt Price, and Courtney Wisler
Clinicians’ Attitudes, Perspectives, and Clinical Practices on Gait Retraining After Anterior Cruciate Ligament Reconstruction
Kyle Southall, Laura Vogtle, Harshvardhan Singh, Matthew P. Ithurburn, C. Scott Bickel, and Christopher P. Hurt
Introduction: It has been shown that 45%–85% of patients with anterior cruciate ligament reconstruction (ACLR) will have early-onset arthritis within 10–12 years following surgery. Over the past two decades, the amount of literature regarding ACLR, gait maladaptations after ACLR and their potential link to early-onset arthritis, and rehabilitation techniques has grown exponentially; however, long-term patient outcomes remain modest. Methods: To evaluate current clinicians’ attitudes, perspectives, and clinical practice approach for rehabilitation of patients following ACLR, a survey questionnaire was designed using the Delphi technique. Results: Of the 263 respondents, 84.4% (n = 226) reported that they believed gait training to be “Very” or “Extremely Important.” However, only 35.7% (n = 94) reported objectively measuring gait during ACLR rehabilitation. Of the total respondents, only 6.8% (n = 18) assessed gait during rehabilitation using two-dimensional or three-dimensional motion capture technologies. Discussion: Our results suggest that while gait evaluation was perceived as important, most respondents did not objectively measure gait metrics as a clinical outcome during ACLR rehabilitation. These findings provide a prospective rehabilitation target to potentially mitigate a known risk factor of early-onset arthritis (gait maladaptations) in individuals following ACLR.
