J. S., male, age 50, has suffered with a swollen knee joint for several years; this has gradually grown worse, and was extremely painful on motion. He was incapacitated for work, and was compelled to rest heavily on his cane while walking. There was no history of traumatism, syphilis or tuberculosis.
Examination revealed a knee much larger than its companion, with an obliteration of the patellar folds. Fluctuation was present. The patella was very movable, due to the presence of fluid within the joint; no pain on manipulation. The patient could flex his leg to a right angle; this movement was accompanied by a "meaty" crepitus, not the form of crepitation, however, commonly felt in a diseased joint; in other words, a sensation was transmitted on palpation, as if some soft substance were present within the joint. This crepitation became more marked as the flexion increased. The skiagraph revealed a shadow