Unusual Morel-Lavallee lesion of the knee region in an elderly patient

Abstract

The Morel-Lavallee lesion (MLL) of the knee region has been described in the Orthopaedic literature, and all of those were fit and healthy young participants sustaining sports-related trauma to the knee. We describe a case of an elderly woman, on aspirin and prophylactic clexane, who sustained a low-energy injury to the right knee and developed an MLL of the knee region. A delayed recognition, led to the persistence of the MLL as a diffuse haematoma, which subsequently became colonised with methicillin-resistant We discuss the management of a case and highlight the importance of early identification and management of MLL of the knee region. Further evidence needs to be collected about MLL lesions in elderly, frail patients who are anticoagulated, and have increased risk of falls. This cohort of patients is more vulnerable to bleeding and infection than a fit, young adult population.

Endoscopic Resection of Chronic Morel–Lavallée Lesion of the Knee

“…It results from highenergy shearing forces, wherein the skin and subcutaneous tissue are separated from the underlying fascia. 1,2 Disruption of bridging blood and lymphatic vessels leads to a collection of fluid in the plane created as a result of the injury. The fluid collection is frequently colonized during the incipient bacteremia that can follow a polytrauma.…”

“…In this scenario, the skin can draw supply via the dermal and subcutaneous vascular plexus, but the risk of ischemic injury is increased. 2,3 Decreased cutaneous sensation often is associated with the skin over the area of degloving because of shearing injury to the cutaneous nerves. 4 MLLs tend to occur in regions with relatively firm and immobile deep fascia, most often around the peritrochanteric or peripelvic region and the lower limb.…”

“…Although MLLs in the pelvis and hips have been well described, their occurrence in the knee region has been reported. 2,3,[5][6][7] Overall, about 15.7% of MLLs occur in the knee region. 6 In the majority of cases, MLLs spontaneously resolve; however, in those that don't, granulation tissue is thought to become organized into a pseudo-capsule preventing the resorption of fluid.…”