Morel-Lavallée Lesions in the Pediatric Patient: An Evaluation of Treatment With Interdisciplinary Clinical Management.

INTRODUCTION

Morel-Lavallée lesions (MLLs) are internal degloving injuries from traumatic shearing forces. Multiple pathways exist for treating MLLs, including surgery, percutaneous aspiration, sclerodesis, and conservative methods. These lesions differ between pediatric and adult patients in cause and location. There currently is limited data specific to treating pediatric and adolescent MLLs. Our goal was to review our recent experience with patient population, management strategy and patient outcomes for pediatric patients diagnosed with MLLs.

MATERIALS AND

METHODS

A retrospective review was conducted on patients ages 8-25 with documentation of an MLL in the electronic medical record between 2018 and 2024, with at least three months of available follow-up. Demographic information, lesion size and location, injury details, including injury-to-diagnosis time intervals, treatmzent across specialties, and patient outcomes, including documented resolution, were collected.

RESULTS

Eighty-three patients, with 87 total lesions (four with two lesions each), and a mean age 14.4 years (range 8-20 years), met study criteria. Seventy-four were trauma-induced MLLs (89.2%), consisting of sports injuries (n = 52, 70.3%), motor vehicle collisions and other trauma. Nine (10.8%) had no documented or identifiable traumatic mechanism. Forty-nine lesions were at the knee (56.3%). Seventy-two of 83patients (86.7%) were seen by an orthopedist during their treatment course, with the most common treatment being conservative management (n = 50, 69.4%). Of these, 7 patients (14%) required further treatment via interventional radiology (IR) or plastic/general surgery. Other orthopaedic treatments included conservative care with drainage and/or sclerotherapy (n = 11, 15.3%), surgery (n = 4, 5.6%), or no orthopaedic intervention (n = 7, 9.7%). Eleven patients (13.3%) were initially seen by IR or surgery and not orthopaedics. Only 15 patients (18.1%) had sufficient clinical/radiographic documentation to confirm lesion resolution, but of those, all demonstrated full resolution of their MLL.

DISCUSSION: Sports trauma was the most common cause of pediatric/adolescent MLLs, most often involving the knee. Most patients treated conservatively did not require further intervention. A multidisciplinary approach ensures appropriate care escalation. Improved follow-up could enhance both clinical outcomes and patient satisfaction. Understanding lesion factors' influence on treatment success can help guide future protocols.

KEY CONCEPTS: (1)Morel-Lavallée lesions in pediatric and adolescent patients most commonly occur due to sports injuries and most commonly involve the knee.(2)Conservative treatment including targeted compression was effective in the majority of cases and often avoided the need for invasive intervention.(3)Lesion recurrence and treatment escalation were uncommon when early conservative management was used.(4)A multidisciplinary treatment approach comprised of orthopaedics, interventional radiology, and plastic surgery can allow for individualized care.(5)Standardized follow-up and documentation are important for assessing long-term resolution and improving patient outcomes.

LEVEL OF EVIDENCE: Level IV (Case series).