P3.245: Morel-Lavallée Lesions in the Pediatric Patient: An Evaluation of Treatment Progression with Interdisciplinary Clinical Management

Background: Morel-Lavallée lesions (MLLs) are degloving injuries resulting from traumatic shearing forces. Multiple pathways exist for treating MLLs, including surgical management, percutaneous aspiration, chemical sclerodesis, and conservative nonsurgical methods. These lesions present differently in pediatric and adult patients, both in cause and location. There currently is no evaluated algorithm specific to pediatric and adolescent MLLs. Our goal was to describe the patient population, treatment pathways and associated outcomes of pediatric and adolescent MLLs to better characterize the presentation and management of these injuries.

Methods: Retrospective chart review was conducted on patients aged 8-25 years treated for a MLL with at least three months of elapsed time under treatment from January 1, 2018, to September 31, 2024. Patient demographic information, lesion location, injury details, treatment modalities utilized by orthopedics, interventional radiology, plastic and general surgery, and patient outcomes regarding lesion recurrence and resolution data were collected.

Results: 84 patients met study criteria; of those, 74 had trauma-induced MLLs (88.1%), consisting of sports-related injuries (70.3%); the majority occurred during wrestling, soccer, and biking/ATV riding (each n=9, 17.3%), followed by motor vehicle accidents (17.6%) and miscellaneous trauma (12.2%). 10 patients experienced atraumatic onset of their MLL without an acute inciting event. 88 lesions in total were characterized, most commonly at the knee (56.8%), thigh (17.0%) and shin (9.1%). 73/84 patients (86.9%) were seen by an orthopedist during their treatment, with the most common treatment modality used being conservative management, consisting of targeted compression and/or additional conservative treatment, such as immobilization, weight bearing restrictions, and physical therapy referral (n=49, 67.1%). Of these, 6 patients (12.2%) required further treatment via IR or plastic/general surgery. Other treatment by orthopedics included a combination of conservative treatment and drainage and/or sclerotherapy (n=14, 19.2%), surgery (n=3, 4.1%), or no direct orthopedic intervention (n=7, 9.6%). 11 patients (13.1%) were initially seen by IR or surgery and not orthopedics. Only 15 patients (17.9%) had sufficient clinical or radiographic documentation to confirm the status of lesion resolution. Of these patients, however, 100% demonstrated full lesion resolution.

Conclusion: Traumatic sports injuries were the most prevalent mechanism of Morel-Lavallée lesion formation, and the most common location of MLLs was at the knee. Most patients receiving conservative management did not further obtain IR or surgical treatment. Collaboration among specialties can ensure that patients’ treatment progression is most conducive to their needs. Maximizing patient follow-up to ensure resolution and prevent recurrence could allow for improved outcomes both from a clinical and patient satisfaction standpoint. Characterizing the current treatment progressions for pediatric and young adults presenting with MLLs and understanding the influence of patient and lesion characteristics can allow clinicians to provide the most effective treatment pathways.