Unusual presentation of more common disease/injury

Wii knee revisited: meniscal injury from 10-pin bowling

Sami M Almedghio¹, Odisseas Shablahidis², Winston Rennie³, Robert U Ashford⁴

¹ University Hospitals of Leicester NHS Trust, Orthopaedics, Infirmary Square, Leicester, Leicestershire, LE1 5WW, UK
² University Hospitals of Leicester, Trauma and Orthopaedics, Leicester General Hospital, Gwendolen Road, Leicester, Leicestershire, LE5 4PW, UK
³ Leicester Royal Infirmary, Radiology, Infirmary Square, Leicester, Leicestershire, LE1 5WW, UK
⁴ University Hospitals of Leicester NHS Trust, Orthopaedics, Leicester General Hospital, Gwendolen Road, Leicester, Leicestershire, LE5 4PW, UK

Correspondence to:
Sami M Almedghio, salmedghio{at}yahoo.com

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.

---

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

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.

The radiographs were normal. A MRI scan confirmed the diagnosis of a tear in the medial meniscus, as seen in fig 1.

View this figure (81K): in this window | in a new window | PowerPoint for Teaching   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.

 

Medial meniscus injury, knee contusion.

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).

View this figure (100K): in this window | in a new window | PowerPoint for Teaching   Figure 2 A. Arthroscopy right knee: top two arthroscopic pictures show displaced parrot beak tear of medial meniscus. B. Following partial meniscectomy.

 

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.

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 fracture^4,5

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.

Competing interests: None.

Patient consent: Patient/guardian consent was obtained for publication.

1. Keene, GS. Key topics in orthopaedic trauma surgery. Oxford, UK: Bios Scientific Publishers, 1999.
2. Stocker, B, Nyland, J, Caborn, D, et al. Results of Kentucky high school football knee injury survey. J Ky Med Assoc 1997; 95: 458–64.[Medline]
3. Dick, R, Ferrara, MS, Agel, J, et al. Descriptive epidemiology of collegiate men’s football injuries: national collegiate athletic association injury surveillance system, 1988–1989 through 2003–2004. J Athl Train 2007; 42: 221–33.[Medline]
4. Robinson, RJ, Barron, DA, Grainger, AJ, et al. Wii knee. Emerg Radiol 2008; 15: 255–7.[CrossRef][Medline]
5. Hirpara, KM, & Abouazza, OA. The "Wii knee": a case of patellar dislocation secondary to computer video games. Injury Extra 2008; 39: 86–7.[CrossRef]
6. Bonis, J. Acute Wiiitis. N Engl J Med 2007; 356: 2431–2.[Free Full Text]
7. Karim, SA. Playstation thumb - a new epidemic in children. S Afr Med J 2005; 95: 412.[Medline]
8. Macgregor, DM. Nintendonitis? A case report of repetitive strain injury in a child as a result of playing computer games. Scott Med J 2000; 45: 150.[Medline]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?