Traumatic Articular-Bursal Fistula in a Collegiate Football Player

A collegiate football player suffered a direct blow to the distal quadriceps mechanism, resulting in a partial tear of the vastus medialis obliquus. Over time, he began to develop activity-related swelling of his prepatellar bursa. By 6 weeks after his injury, an area of swelling the size of a golf ball would rapidly develop with just 5 minutes of quadriceps exercises. Swelling would diminish within a few hours of rest. A magnetic resonance imaging examination suggested a fistula track from the articular space through the vastus medialis obliquus into the prepatellar bursal area. When prolonged rest did not improve his symptoms, he was taken to surgery. Arthroscopic visualization confirmed a traumatic fistula between the articular space and the prepatellar bursa, allowing free egress of fluid. A spinal needle was used to localize the fistula tract to allow this to be identified for an open, layered suture closure. An area of traumatic chondrosis on the medial side of the patella with loose chondral flaps was also debrided as the probable “fluid generator.” The patient enjoyed a full recovery and was back to playing college football 10 weeks after surgery.