Acute Knee Injury During Professional Basketball Tournament In A 'Bubble' Setting

HISTORY: A 30 year-old professional male basketball athlete experienced sharp left knee pain after planting extended leg with knee in slight flexion during an abrupt defensive movement in a game. He immediately fell down holding left knee due to intense pain. Pain was ‘relieved’ after knee was placed in extension, but reported knee feeling ‘weird’. Prior to injury, athlete reported history of left patellar tendinitis 2 years prior treated conservatively, lack of strengthening program for 4 months in 2020 due to COVID pandemic, intense pre-bubble preparations consisting of 2-a-day full court basketball sessions, and a strenuous game schedule during the ‘bubble’. Prior left knee X-Ray remarkable for Patella Alta. He was treated for right patellar tendinitis and adductor strain during the bubble. He also suffered a suspected left knee contusion in a game 3 days prior that was gradually improving towards the day of injury. PHYSICAL EXAMINATION: Anterior left knee swelling and indentation on initial inspection. No tenderness to palpation on anterior knee after physician placed knee in extension. Able to perform left knee flexion, but markedly limited knee extension and mobility during walking. Further Inspection revealed indentation in below patella with knee flexion. Quadriceps contraction revealed anterior tilting of inferior pole of patella. Unable to perform straight leg raise test due to difficulty lifting knee. Negative Lachman’s, Valgus and Varus Stress Tests. DIFFERENTIAL DIAGNOSIS: Patellar Tendon Rupture, Patellar Dislocation, ACL Tear. TEST AND RESULTS: Diagnostic Ultrasound remarkable for hypoechoic region at proximal patellar tendon at insertion suggestive of discontinuity of the tendon. MRI confirmed full thickness tear of patellar tendon. FINAL WORKING DIAGNOSIS: Left Patellar Tendon Tear TREATMENT AND OUTCOMES: Left knee initially placed in full extension with ‘medial’ pull of patella due to initial suspicion of patellar dislocation. Athlete then immobilized in full extension until follow up with Orthopaedic Surgeon. Underwent left patellar tendon repair within 1 week of injury. Acute rehabilitation course consisted of immobilization of brace at 30 degrees with gradual range of motion exercises, light quadriceps strengthening and pain management modalities.