Arthroscopic removal of multiple foreign bodies in the knee: A case report

We report the uncommon case of knee arthroscopic removal of multiple bullet pellets. A 25-year-old male professional footballer was admitted with left knee swelling, pain, and limitation of movement following a gunshot injury. Radiographs revealed multiple pellets in and around the left knee, each measuring about 5 mm in diameter. There were several pellets in the subcutaneous, intramuscular, and intra-articular parts of the left knee. The pellets were metallic, contraindicating magnetic resonance imaging to assess intra articular structures. He was booked for an urgent knee arthroscopy and the pellets were retrieved, and the other vital intra articular structures were examined. Three 5 mm diameter spherical bullet pellets were removed from the joint cavity. The synovial membrane was debrided, and the knee lavaged. Recovery was satisfactory with no complications. The patient was discharged to physiotherapy and followed up at 3 and 6 months after surgery. Foreign bodies in the knee are not uncommon; however, the presence of multiple bullet pellets is rare, especially in the index case of a sportsman. Its removal can be challenging, even arthroscopically. Such a procedure can result in severe complications, such as infections and joint deformities. The decision to use the arthroscopic approach requires careful deliberation regarding the status of the patient vis-a-vis the available skill and experience of the managing team.