This case is interesting because edema along the wound channel, left after old direct puncture of the nail is sustained for more than 40 years. Possibly there is a chronic inflammation around traumatic channel because of irritating effect of small foreign particles. Also there is a defect in the femoral cartilage, at the first impression was attributed to patellofemoral osteoarthritis due to patella baja (or patella infera), which is known to be a predisposition to patellofemoral joint overload with osteoarthritis development.