The Morel-Lavallée Lesion as a Rare Differential Diagnosis for Recalcitrant Bursitis of the Knee: Case Report and Literature Review

Abstract

A 72 year-old-male was referred to our institution with recalcitrant prepatellar bursitis. The injury was sustained after striking his right knee against a post whilst horse riding 9 months ago. Previous treatments included repeated aspiration and excision of the bursa with elastic compression bandaging. A diagnosis of a Morel-Lavallée internal degloving injury was made, and the lesion was satisfactorily managed by an internal quilting procedure to eliminate the potential dead space. A review of the literature reveals 29 published reports of Morel-Lavallée lesions with sufficient information for inclusion. These came from 14 separate countries with a total of 204 lesions in 195 patients. The most common anatomical location was the greater trochanter/hip (36%), followed by the thigh (24%) and the pelvis (19%). Most were managed surgically with evacuation of the haematoma and necrotic tissue followed by debridement, which was often repeated (36%). Conservative treatment with percutaneous aspiration and compression bandaging was the next most common treatment (23%). The knee was the fourth most common region affected (16%), and only 3 other lesions in the literature have been managed with a quilting procedure.

Imaging Features of Morel-Lavallée Lesions

“…Less commonly reported locations include the lumbosacral region, the abdominal wall (usually related to prior abdominoplasty), the calf, periscapular region, scalp, arm, and hand [21117], which is in line with our observations. The following locations were reported in a literature review of 204 ML lesions from 29 articles: greater trochanter 37%; thigh 20.1%; pelvis (other than trochanteric area) 18.6%; knee 15.7%; lumbosacral 3.4%; abdominal 1.5%; calf/lower leg 1.5%; head (subgaleal) 0.5%; and not specified 2.0% [18]. …”

The importance of morel-lavallee lesion in medicolegal evaluation: a case report

“…In a review by Vanhegan et al, 204 lesions were defined in 29 articles and lesion distributions; trochanter major/hip 30.4%; thigh 20.1%; pelvis 18.6%; knee 15.7%; gluteal region 6.4%; lumbosacral 3.4%; abdominal 1.5%; calf/lower leg 1.5%; head 0.5%; and not specified 2.0% were defined [10]. In this presented case the lesion is defined in the lower leg region where it is rarely seen.…”

An unusual cause of haemorrhagic shock from a subcutaneous haematoma: a Morel-Lavallée lesion

“…The literature describes different methods to treat this injury. (1)(2)(3)(5)(6)(7)(8) While some authors suggest open surgical debridement, (2,3,5) others have described alternative forms of treatment such as compressive bandaging, (6,7) percutaneous drainage, (6,7) and injection of sclerosing agents. (8) Lin et al (6) successfully treated a patient with echo-guided percutaneous aspiration coupled with the application of a compressive bandage over the haematoma site.…”

“…(1)(2)(3) The result of this lesion is bleeding into the subcutaneous tissue plane, which then causes the development of a haematoma. We herein report the unusual occurrence of a Morel-Lavallée lesion presenting with haemorrhagic shock in a 20-year-old man following a worksite accident.…”