Intended for healthcare professionals

Endgames Spot Diagnosis

A typical sign on a plain knee radiograph

BMJ 2016; 355 doi: (Published 23 November 2016) Cite this as: BMJ 2016;355:i6021
  1. Paul T P W Burgers, orthopaedics,
  2. Peter H C Den Hollander, orthopaedics
  1. Department of Orthopaedic Surgery, Medical Center Haaglanden, The Hague, Netherlands
  1. Correspondence to P T P W Burgers p.burgers{at}

A healthy 23 year old football player presented a couple of hours after an episode of trauma to his left knee. When running, he had turned to the right while keeping the left foot fixed to the ground (external rotation-valgus stress). He had not heard or felt a pop or a click, but afterwards he was not able to bear weight. Immediate swelling occurred and the pain was localised medially. A radiograph was obtained (fig 1).

Fig 1


What abnormality is shown on the radiograph and what condition is it associated with?


A lateral femoral notch sign or sulcus sign (red line) …

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