Chondromalacia of the fabella

Chondromalacia ANDRESGRISOLIA,M.D.,

of the Fabella

Wadsworth, Kansas, AND W. W. BARTELS, M.D., Lincoln, Nebraska

From tbe Orthopedic Service, Veterans Hospital, Grand Island, Nebraska.

or standing. He aIso noticed an inabiIity to straighten the Ieft knee. PhysicaI examination reveaIed: One and a haIf inches of atrophy of the Ieft thigh as compared to the right; Iimitation of extension of the left knee to 160 degrees and fIexion to 65 degrees; exquisite tenderness to paIpation on the insertion of the IateraI head of the left gastrocnemius muscIe. Roentgenograms (Fig. I) reveaIed a 2 by I cm., ovoid and mottled left fabella, with aIternating radioIucent and opaque areas. There was no fabeIIa on the right side.

Administration

of the fabeha are uncommon. Osteochondritis [3]* impingement [6] and fractures [4-5J have been reported. However, a survey of the literature discloses a tota of onIy six cases of chondromalacia of the fabella [r-2]. This case is reported because of the rare incidence of the lesion, and to demonstrate the compIete recovery which fohows excision of the diseased sesamoid. ESIONS

L

CASE

REPORT

H. W. F., a thirty-nine year old, white, married, maIe farmer was admitted to this hospita1 on December 2, 1957. He stated that in August 1957, pain in the Ieft popIitea1 region had deveIoped. There was no history of trauma. The pain graduaIIy increased and became particuIarIy severe on waIking

FIG. 2.

FIG. r. Roentgenogram fabella. American

Journal

FIG. 3. Low power photomicrograph of specimen. New cartiIage surrounds degenerating cartilage.

of right knee showing mottIed

of Surgery.Volume 08,

November,

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Operative specimen.

760

Chondromalacia On December 5 the fabelIa was excised. It was found directly under the attachment of the IatcraI head of the gastrocnemius muscIe. Examination of the gross specimen (Fig. 2) showed a disc shaped piece of tissue measuring 2 by 3 by I .5 cm., with many small, granular nodules protruding from its lateral surface. The media1 surface was smooth and glistening. Microscopic examination (Fig. 3) shoned many areas of new cartilage being developed irregularIy, most of them in the external surface of the specimen. There were many smaI1 areas of degenerating cartilage enmeshed and surrounded by the new cartilage. The patient recovered uneventfuIIy. On the setond postoperative day, ambuIation and an active exercise program were started, and he was discharged on December 16, 1957. At re-evaluation

of the Fabella four months later, the patient had no complaints and the range of motion of the Ieft knee was normal. REFERENCES GOLDENBERG, K.

R. and WILD, E. L. Chondromalacia fabella. J. Bone ~7 Joint Surg., 34-A: 689 ,690, Ig5.z GOLDENBERG, R. R. Chondromalwiu fabrllw. Bull. Hosp. Joint Dis., 17: 35 -47, 1956. LE POUTRE, C. Sesamoid douIoureaux. Guerison par l’extirpution. Rear. d’ortbop., 16: 234 246, rgzg. LEVOUVTZ, R. S. and KL.ETSCRKA, I I. D. Fracture of the I’abeIla. Report of a case. J. Bone O- Joint Surg.,

” 6.

37-A: 876-877; 1955. J. Fracture of sesamoid bones. A report of two cases. Am. J. Surg., 18: 507. jog, 1032.

SAGEL,

TAILLARD, W. Les syndromes douloureaux du genou assocics a unc lesion de la “ fabella.” Rez,. Chir. Ortbop., 43: rzg -136, 1957.