Background: There are multiple causes of posterior knee pain and radicular symptoms. A symptomatic fabella is a rare cause but should be considered in the differential diagnosis.
Purpose: Physicians should consider a symptomatic fabella as a diagnosis when common treatments for posterior knee pain have not alleviated the symptoms.
Study design: Case report.
Methods: Review of clinical documentations of an orthopedist, physiatrist, physical therapist, 2 primary care sports medicine physicians, and the surgical report of an orthopedist.
Results: It took time and resources including several referrals and imaging modalities to make a final diagnosis.
Conclusion: Symptomatic fabellae are an uncommon finding but should be considered in the differential diagnosis with an athlete with posterior knee pain.
Clinical relevance: Considerable time and resources were used to ultimately diagnose and treat a NCAA Division 1 athlete. Surgical excision was required of a sesamoid bone that is present in 30% of individuals.