Chondral Lesion of the Patella
Abstract
The patient was a 27-year-old man who was a recreational baseball player. He was referred to a physical therapist for a suspected medial meniscus injury following a right-sided lower extremity twisting injury sustained 3 weeks prior. Despite 4 weeks of physical therapist intervention, the patient was unable to successfully return to athletic activities. The patient was then referred to an orthopaedic surgeon, who ordered magnetic resonance imaging of his right knee, which revealed a focal full-thickness chondral lesion at the median patellar ridge.
J Orthop Sports Phys Ther 2012;42(3):291. doi:10.2519/jospt.2012.0404
The patient was a 27-year-old man who was a recreational baseball player. He was referred to a physical therapist for a suspected medial meniscus injury following a right-sided lower extremity twisting injury sustained 3 weeks prior. More specifically, the injury occurred when the cleats of his right athletic shoe became stuck while swinging a baseball bat from the right side of home plate. No diagnostic imaging had been completed following the injury.
At the time of the initial physical therapist evaluation, the patient's chief complaint was pain “underneath the kneecap.” By visual observation, infrapatellar swelling was noted and the patient had a normal gait. While there were no restrictions in knee range of motion, right quadriceps strength was diminished secondary to pain. Ligamentous and meniscal testing were negative. The patient's knee pain was also reproduced while stepping down from a 20.3-cm step.
Despite 4 weeks of physical therapist intervention, the patient was unable to successfully return to athletic activities. The patient was then referred to an orthopaedic surgeon, who ordered magnetic resonance imaging of his right knee, which revealed a focal full-thickness chondral lesion at the median patellar ridge (FIGURE 1).
A microfracture procedure was performed to address the chondral lesion. Subsequent magnetic resonance imaging at 6 weeks following surgery, which was performed to evaluate chondral recovery, revealed complete healing of the chondral lesion (FIGURE 2). The patient returned to full athletic activities without limitation at 14 weeks following surgery.
J Orthop Sports Phys Ther 2012;42(3):291. doi:10.2519/jospt.2012.0404
