1447 - Unique Case of Chronic Knee Pain in a Patient with Severe Posttraumatic Osteophytosis and Osteoarthritis

The patient complains of 2 month history of worsening knee pain after a fall. He has history of chronic pain in the knee due to a traumatic Motor Vehicle Accident in the 1970s, at which time he required reconstructive surgery. After his surgery, he was able to function without significant limitations until this presentation. History and physical exam findings were notable for pain, tenderness to medial joint space, and decreased active and passive range of motion on knee flexion. X-rays were obtained in clinic which demonstrated severe osteophytosis and sclerosing around his hardware as well as osteoarthritis in the joint space. The patient was initially managed with medication and physical therapy which provided no relief. He then underwent ultrasound-guided corticosteroid injection to the knee which provided 2 weeks of >50% relief. Next the patient underwent ultrasound-guided visco-supplementation injection to the knee which provided 50% relief for over 6 weeks.

Discussions:

The posttraumatic changes in the patient’s knee posed unique challenges in managing his pain. The osteoarthritis was severe enough to limit the patient’s range of motion; which, in turn, limited his ability to participate in physical therapy. The osteophytosis and sclerosis around surgical hardware limited surgical options due to surgical complexity. Despite these challenges, the patient experienced a notable reduction in knee pain with visco-supplementation injection.

Conclusions:

This case highlights unique posttraumatic imaging findings in the knee that limited treatment options for the patient’s chronic pain. Further investigation could explore additional treatment options for knee osteoarthritis specifically in patients with posttraumatic changes.