Intended for healthcare professionals

Endgames Spot Diagnosis

A man with knee pain after a fall

BMJ 2017; 359 doi: (Published 16 November 2017) Cite this as: BMJ 2017;359:j5053
  1. Tobenna J Oputa, ST3 trauma and orthopaedics1,
  2. Ronnie Davies, ST8 trauma and orthopaedics2
  1. 1East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, UK
  2. 2Central Manchester University Hospitals, Manchester, UK
  1. Correspondence to T Oputa Tobi{at}

A 47 year old man presented with a painful swollen right knee after a fall down stairs. On examination, his right knee was swollen, and there was infrapatellar tenderness, a palpable defect inferior to the patella, and a large effusion on palpation. He was unable to raise his leg or extend his knee. A radiograph of the knee was taken (fig 1). What sign can be seen on this radiograph and what diagnosis is it suggestive of?

Fig 1

Lateral radiograph of the right knee


Short answer

Patella alta (high riding patella) suggestive of a patellar tendon rupture.


Patellar tendon rupture has an annual incidence of 0.68% …

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