Differential Diagnosis for 29-year-old Female with Knee Pain and Swelling
- Single most likely diagnosis:
- Meniscal tear: Given the patient's history of ACL repair and recent trauma from playing soccer, a meniscal tear is a common complication, especially with rough play. The symptoms of medial knee pain, swelling, and limited range of motion are consistent with this diagnosis.
- Other Likely diagnoses:
- Ligament sprain: Although the patient does not recall twisting her knee, the rough play could have caused a ligament sprain, which would explain the pain, swelling, and limited mobility.
- Osteoarthritis flare-up: The patient has moderate osteoarthritis in the medial compartment of the knee, and the recent trauma could have triggered a flare-up, exacerbating her symptoms.
- Contusion or bruising: A direct blow to the knee during rough play could have caused a contusion or bruising, leading to pain, swelling, and limited mobility.
- Do Not Miss diagnoses:
- Septic arthritis: Although the patient denies fever, chills, or fatigue, septic arthritis is a potentially life-threatening condition that requires prompt diagnosis and treatment. The presence of a suprapatellar joint effusion increases the suspicion for this condition.
- Osteonecrosis: The patient's history of ACL repair and recent trauma increases the risk of osteonecrosis, which can be a devastating condition if left untreated.
- Rare diagnoses:
- Stress fracture: Although less likely, a stress fracture could occur, especially if the patient has a history of overuse or repetitive stress on the knee.
- Pigmented villonodular synovitis (PVNS): This rare condition is characterized by inflammation and overgrowth of the synovial tissue, which could cause pain, swelling, and limited mobility. However, it is a less common condition and would require further evaluation to diagnose.