HISTORY: Division 1 Basketball player with h/o patella femoral sydrome left knee improved after therapy, now with anterior right knee pain for 3 months. Felt pain with jumping, but denied specific trauma. Initially treated with conservative therapy for patellar tracking problems. Straight Leg Raises, Terminal Knee Extensions, and quad sets. There were some compliance issues with therapy. Symptoms continued and patient then had an acute onset of worsening anterior knee pain while playing basketball. Remembers feeling some type of “pop”. Evaluated by team physician - xrays were obtained. PHYSICAL EXAMINATION: Initially pain over patella, medial discomfort. Possible trace effusion per trainer. After acute injury: moderate effusuion, medial and lateral patella tenderness, tenderness over medial patella ligament, + apprehension test. Normal valgus/varus stress, no laxity with ACL/PCL, normal medial and lateral compartment loading tests. DIFFERENTIAL DIAGNOSIS: Patella subluxation/dislocation; chondromalacia patella, infrapatella bursits, bipartite patella with tendinitis, stress fracture, patella fracture. TEST AND RESULTS: Plain film Xrays, Bone Scan, CT scan. FINAL WORKING DIAGNOSIS: Midpole transverse patella fracture TREATMENT AND OUTCOMES: Surgical treatment - ORIF patella.