A 54-Year-Old Man

Abstract

A 54-year-old man was sent for a second opinion having presented 5 weeks previously complaining of right thigh pain for 2 weeks and then heard a pop from his knee which became acutely painful when he was walking. From then he had found it difficult to weight-bear and to straight leg raise. He had pain and tenderness superolateral to his patella. He had not sustained any injury. The pain was so severe that he was unable to move his knee. He had been placed in an extension knee orthosis and was using crutches. At presentation he was investigated and found to have a vastus intermedius tear on ultrasound, which was the working diagnosis. The pain had persisted, and he was really incapacitated, barely able to move his knee, and reluctant to remove his orthosis. He was on a plethora of drugs, including opiates, which were not controlling his pain.