Intended for healthcare professionals

Endgames Spot Diagnosis

Knee pain after a fall

BMJ 2018; 360 doi: (Published 22 March 2018) Cite this as: BMJ 2018;360:k775
  1. Abhiram R Bhashyam, orthopaedic surgery resident1,
  2. Michael J Weaver, attending orthopaedic surgeon2
  1. 1Harvard Combined Orthopaedics Residency Program, Boston, MA, USA
  2. 2Brigham and Women’s Hospital, Department of Orthopaedic Surgery, Boston, MA, USA
  1. Correspondence to AR Bhashyam abhashyam{at}

A 69 year old man slipped in the snow and presented with swelling and pain in the left knee. On examination, he could not extend his knee and had a palpable, visible indentation on the surface of his distal anterior thigh, above the patella. It was not an open injury and he did not have substantial tension in the overlying skin. There was no neurovascular deficit. A radiograph was obtained (fig 1). What is the diagnosis?

Fig 1

Lateral radiograph of the left knee


Intra-articular patella dislocation with quadriceps tendon rupture.


The lateral radiograph of the knee shows that the left patella has dislocated around its horizontal axis and its articular surface is facing inferiorly. The upper pole of the patella is engaged in the intercondylar groove of the femur. The …

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