Fast Bowler's knee - anteromedial articular impingement

To describe a series of impingement lesions found on the anterior aspect of the medial femoral condyle in international cricketers.

Seven international level fast bowlers presented to our clinic with knee pain in the lead leg between 2005 and 2013. The mean age of the patients was 26.7 years (20-29 years). In all patients a careful history and examination was undertaken followed by appropriate investigations. Conservative management and arthroscopic surgery were performed on these cases. We aimed for a pain free quiet knee with resolved oedema on MRI and return to sport.

MRI images showed oedema in the medial femoral condyle in all patients and 4 patients also had associated cartilage loss. These 4 patients underwent arthroscopic surgery whereas the other 3 were less symptomatic and were managed conservatively. All patients returned to international cricket at an average of 6 months in the non-operative group and 8 months in the operative group.

Anterior impingement of the anteromedial femoral condyle can be a potentially serious lesion in the fast bowler. A strong index of suspicion regarding this lesion has to be exercised when a fast bowler attends with knee pain and effusion.