Abstract
The present report concerns a 23-year-old woman who sustained an injury to her right knee while playing 10-pin bowling on a Nintendo Wii video game console. She presented to our orthopaedic outpatients clinic 3 months later with history and examination findings suggestive of a medial meniscal tear, which was confirmed by MRI scan. She underwent arthroscopic partial medial meniscectomy and made an uneventful recovery.
BACKGROUND
Meniscus tear is one of the most common injuries of the knee, and is caused by axial loading with rotational force.1 It has been reported that meniscus injuries accounted for 12% of all football knee injuries in high school injury survey in the USA.2 The mechanism of meniscus injury is more frequently related to contact injury than non-contact injury.3
To date, meniscus injury from playing video games has not been reported, and 10-pin bowling causing knee injuries has similarly not been reported
CASE PRESENTATION
A 23-year-old woman was referred to our outpatient clinic with a 3-month history of right knee pain following an injury sustained while playing 10-pin bowling on a Nintendo Wii video game console. The injury was sustained in the delivery stride. She experienced immediate pain and her knee swelled up overnight; she was unable to carry on with her day to day activities and presented with pain and tenderness over the medial aspect of her knee, which had been present ever since the initial injury.
On examination she had mild effusion of her right knee, mild quadriceps wasting, tenderness along the medial joint line and a full range of motion. A modified McMurray compression test was positive on the medial side. Her anterior cruciate ligament was clinically intact and similarly there was no increased laxity on testing the collateral ligaments.
INVESTIGATIONS
The radiographs were normal. A MRI scan confirmed the diagnosis of a tear in the medial meniscus, as seen in fig 1.
Figure 1.
A. Far medial sagital image of the right knee demonstrating a complex tear of posterior horn of medial meniscus extending to the posterior and medial surfaces. B. T1 mid-sagital image of the right knee in a 16-year-old girl demonstrates a displaced parrot beak fragment from the posterior horn and body within the intercondylar notch just inferior to the posterior cruciate ligament.
DIFFERENTIAL DIAGNOSIS
Medial meniscus injury, knee contusion.
TREATMENT
The patient underwent an arthroscopy at which a displaced parrot beak tear of posterior horn of medial meniscus was found and a partial medial menisectomy was performed. The remainder of her knee was normal (fig 2).
Figure 2.
A. Arthroscopy right knee: top two arthroscopic pictures show displaced parrot beak tear of medial meniscus. B. Following partial meniscectomy.
OUTCOME AND FOLLOW-UP
The patient recovered uneventfully, and was seen at the clinic at 6 and 12 week intervals; she is doing very well and her knee is pain free.
DISCUSSION
Meniscus injury is one of the most common injuries among young adults, occurring most often while participating in contact sports. To sustain an injury to the meniscus the patient usually has to have axial loading with rotation force going through the knee, and to develop that from just playing a video game is not a common injury. This patient was playing a bowling game on the Nintendo Wii console that uses motion-sensing controllers rather than the more traditional joypad type controller; consequently she was performing the same movement as you would do in a real-life bowling game. Wii-related meniscus injury has not been reported in literature to date; although there have been two case reports of “Wii knee”, they were lateral patella dislocation with medial patellofemoral ligamentous damage and a large femoral osteochondral fracture4,5
The Nintendo Wii is a widely used video games system with new games coming out regularly. It is similar to other video games consoles, but the physical involvement is greater with Wii games because of the unique control system.
It has been reported in the literature for many years that video games can cause injuries like contact sports, such as tendon and ligaments injuries; some terms used are Wiitis,6 Playstation thumb7 and Nintendenitis.8
In our case, we report that meniscus injury can be caused by Wii video games and not just sports that involve physical contact. This case can therefore be added to the other Wii injuries already reported in the literature.
LEARNING POINTS
Meniscus injury can happen without being involved in a contact sport.
Suspicion of meniscus injury should be raised even with unusual mechanisms of injury.
Video games are not completely “safe” games and can cause real physical injury.
Footnotes
Competing interests: None.
Patient consent: Patient/guardian consent was obtained for publication.
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