A 51-year-old man reported with complaints of recent onset of left knee pain. He had sustained a displaced comminuted fracture of his left patella following a fall 15 months ago. Modified tension band wiring with cerclage wiring was successfully performed, and the patient was recovering well. He was well for the last 14 months and returned to his job without any pain or functional disability. However, he started experiencing deep-seated pain within the left knee with restriction of movements for the last 4 weeks. There was no recent history of any fall or trauma to the left knee. Clinical examination of the left knee revealed no patella or joint line tenderness but pieces of wires were palpable percutaneously. There was no effusion and the cruciate and collateral ligaments were intact; there was no neurovascular deficit. There was no extensor lag and knee extension power was normal. The range of motion of the knee was painfully restricted.\nRadiographs of the left knee revealed a united fracture patella with broken cerclage wire (). The inferio-medial segment of the broken cerclage wire was found to have migrated into the posterior compartment of the knee joint and hooked anteriorly at the base of anterior cruciate ligament.\nThe patient underwent surgery for removal of the patella wires. Fluoroscopic examination before surgery revealed the posterior part of wire had shifted its position with anterior part of it still hooked with anterior cruciate ligament. An arthroscopic examination of the knee was done through the standard anteromedial and anterolateral portal. Any structural damage including chondral lesion due to wire migration was not found, a migrated piece of wire was found embedded at the base of anterior cruciate ligament, going toward posterior compartment of knee through medial side of notch, which was removed (). We used intraoperative fluoroscopy (), before finishing the arthroscopic examination of knee, which demonstrated that, there was no remaining piece of wire in posterior compartment of knee. The rest of the broken wires were removed via a midline anterior knee incision along the old scar. The patella was stable after complete removal of the wires, indicating union of the rest of the fragments.\nThe patient was discharged the next morning and his wounds healed at 2 weeks. Complaints of knee pain resolved completely following the surgery, and the patient was able to resume work at 2 weeks.
A 60-year-old woman presented to us with pain over medial aspect of right knee joint. The pain was non radiating. The pain was relieved by rest and was exacerbated by squatting and sitting cross legged. The patient had difficulty in climbing stairs. On physical examination there was tenderness along the medial aspect of knee joint and a curved scar mark was present over the anterior aspect of knee joint (). While history taking the patient told us that she had a patella fracture around 4 years back which was treated by open reduction and internal fixation and she subsequently underwent implant removal 2 years back. The patient had full range of motion (ROM) at knee joint (Figs. , ) and moderate pain was observed on medial side while flexing and extending knee joint. There was no history of any recent trauma to knee joint. A provisional diagnosis of osteoarthritis knee joint was made and weight bearing standing antero-posterior and lateral x-rays ofleft knee joint were ordered. On X-rays it was found that multiple pieces of broken circlage wire were present around knee joint and one piece had migrated posteriorly (). On examination patient did not had distal neurovascular deficit and patients pain was not related to these broken pieces, rather it was due to degenerative changes in the knee joint. It is believed that the surgeon who did implant removal removed only the K wires leaving behind the circlage wires which broke into multiple pieces over the passage of time due to the repeated stresses at knee joint. Patient was advised to undergo total knee replacement along with subsequent removal of broken hardware as potential undue complications can occur because ofbroken hardware in the form of damage to neuro vascular structure due to migration of pieces posteriorly. It was also explained to the patient that cases have been reported where broken pieces migrate to heart and sternum and produce life threatening complications. However, patient refused to undergo any type of surgery. she was warned and told to be alert whenever the nature of her pain changes or she experiences new onset of symptoms which is different in character from the pain she is experiencing now and was kept on regular follow up.