Back to Basics: A Case of Traumatic Knee Pain

Back to Basics: A Case of Traumatic Knee Pain

By Dr. Ozair Rizvi, MD

A 45 year-old male with no medical history presents with Right knee pain after a mechanical fall causing him to land onto his right knee. Exam reveals moderate swelling and tenderness. He is unable to extend the knee.

X-ray shows:














Diagnosis: Patella Alta

What is it?

Superior displacement of the patella due to disruption of the tendon attaching the patella to the tibial tubercle.


  • Tensile overload of the extension mechanism
  • Most commonly occurs with the knee in a flexed position
  • Local steroid injection associated with increased risk of spontaneous rupture


  • Pain, greatest in infrapatellar region
  • Swelling of the knee due to hemarthrosis
  • Popping sensation
  • Difficulty weight-bearing

Physical exam

  • High-riding patella
  • Hemarthrosis and ecchymosis
  • Localized tenderness
  • Reduced ROM of knee (impaired knee extension and weight bearing) due to pain
  • Possibly a palpable gap below the inferior pole of the patella


  • If partial tear with intact extensor mechanism, likely nonoperative management with immobilization in full extension (knee splint).
  • If complete tear and loss of extensor mechanism, requires orthopaedics consult and possible operative repair.



Chen SK, Lu CC, Chou PH, et al. Patellar tendon ruptures in weight lifters after local steroid injections. Arch Orthop Trauma Surg 2009; 129:369.