NFL: it may happen any given Monday

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Patient Details & Clinical History

A 28 year old NFL player is referred from the team orthopedist for an MRI of the left knee after trauma occurred during a game. He complains of knee stiffness and pain, along with marked medial swelling. A prior US shows a medial sided superficial fluid collection and a prior X-Ray demonstrates no skeletal injuries (US and X-Ray studies not available) .

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Diagnosis Please

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Arterial Phase Axial View

In the next slide the final diagnosis

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The Correct Diagnosis is: Acute Morel-Lavallee lesion of the knee

associated with lateral femoral condyle and lateral patellar contusion as a consequence of a high-speed sport impact.
Maurice Morel-Lavalle described this entity in 1853 as a closed degloving injury of the soft tissues of the hip and pelvis. Such lesions have been reported in the soft tissues adjacent to the greater trochanter, lower back, and buttock regions. Morel-Lavallee lesion (MLLs) are fluid collections localized at interface between the subcutaneous fat and fascia. MLLs can also occur about the knee and have been described in the orthopedic and sports medicine literature. It is imposrtant to distinguish Morel-Lavallee lesions from simple prepatellar bursitis. MLLs are a result of a blunt tangential force which separates the hypodermis from the underlying fascia and do not represent an inflammatory process. The hemolymphatic supply fills the perifascial plane with blood, lymph and necrotic fat. Granulation tissue usually surrounds the lesion and may be organized into a fibrous pseudocapsule which prevents reabsorption of fluid. MRI appearance differs from acute to chronic lesions. With chronic lesions presenting features of organized collections. Simple compression and rest should suffice to treat most lesions. Larger ones may require drainage. Aggressive treatment is usually avoided and less invasive treatment preferred including serial percutaneous aspirations and suction drainage. Refractory cases may also be treated with sclerodesis (talc or doxycycline).

Selected References:

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Borrero CG, Maxwell N, Kavanagh E. MRI findings of prepatellar Morel-Lavalle effusions. Skeletal Radiol 2008; 37: 4515. Tejwani SG, Cohen SB, Bradley JP. Management of Morel-Lavallee Lesion of the Knee: Twenty-Seven Cases in the National Football League. American Journal of Sports Medicine 2007; 35: 11627.