Often in sports and other recreational activities, knee injuries occur frequently. Most of them can be recognized through thorough history and examination. Sometimes physical examination can be misleading. For example, a seperation or fracture of the distal femoral epiphysis may appear to be valgus instability due to a medial collateral ligament sprain.
When dealing with adolescent athletes the athletic trainers and therapists who work with them should have a high degree of suspicion when evaluating knee sprains. In an immature knee the physis isn't nearly as strong as the ligaments. Therefore rather than the rupture of the ligaments, the external forces acting on the knee will most likely cause failure of the epiphyseal plate.
Since the valgus force serves as the proximal attachment site for the cruciate ligaments, posterior capsule, and medial collateral ligament, the distal femoral epiphysis is most susceptible. The physis is distal to the medial collateral ligament's attachment site since the proximal tibial epiphysis is a lot less prone to injury. The more common avulsion fractures of the proximal tibial epiphysis typically involve the distal attachments of the crusiate ligaments. These fractures are usually marked the same hemarthrosis as the cruciate ligament ruptures.
Deformity and leg length discrepancy can occur if physeal fracures are not recognized early and treated properly. Although the serious ones are easy to recognize the subtle serperations or fractures can be a lot harder to recognize. These fractures are not accurately detected using the standard AP and lateral views, so stress views or MRI are usually recommended. The MRI is used most since it does not place further stress on the fractured epiphysis.