Surgical Procedure for Osteophyte Impingement of the Quadriceps Tendon: A Case Report.

INTRODUCTION

Osteophytes associated with knee osteoarthritis can irritate surrounding soft tissues and cause pain and mechanical symptoms. Although impingement of the medial collateral ligament and popliteus tendon has been reported, symptomatic osteophyte impingement of the quadriceps tendon is rare, and no reports describe its surgical treatment.

CASE REPORT: An 82-year-old Asian man presented with several years of left knee pain accompanied by a snapping sensation during knee flexion. The pain did not occur during gait. Physical examination revealed tenderness at the superolateral aspect of the patella, and painful snapping occurred between 90° and 120° of knee flexion. Radiographs demonstrated advanced knee osteoarthritis (Kellgren-Lawrence grade 4) with multiple osteophytes. Computed tomography (CT) identified an osteophyte at the lateral femoral trochlea corresponding to the site of tenderness. Magnetic resonance imaging showed signal intensity changes at the site of the osteophyte. Based on the clinical findings and imaging results, the pain was diagnosed as quadriceps tendon impingement caused by the osteophyte. After several months of unsuccessful conservative treatment, including quadriceps exercises and analgesics, arthroscopic osteophyte resection was performed. Arthroscopy revealed a cord-like structure continuous with the quadriceps tendon that contacted the osteophyte during flexion. Both the osteophyte and the contacting soft-tissue structure were resected until the impingement was eliminated. Postoperatively, the snapping and pain resolved immediately. CT confirmed adequate resection of the anterolateral osteophyte. At the 6-month follow-up, the patient remained symptom-free.

CONCLUSION

Osteophyte Impingement of the Quadriceps Tendon is a rare cause of knee pain. Arthroscopic osteophyte resection can provide effective symptom relief when conservative treatment fails.