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A Case-Based
Approach
to Knee Pain
A Pocket Guide to Pathology,
Diagnosis and Management
Michelle Leong · Grant Cooper
Joseph E. Herrera
Peter Murphy Editors

123
A Case-Based Approach
to Knee Pain
Michelle Leong • Grant Cooper
Joseph E. Herrera • Peter Murphy
Editors

A Case-Based
Approach
to Knee Pain
A Pocket Guide to Pathology,
Diagnosis and Management
Editors
Michelle Leong Grant Cooper
Department of Rehabilitation Princeton Spine and Joint Center
Mount Sinai Hospital Princeton, NJ, USA
New York, NY, USA
Peter Murphy
Joseph E. Herrera Princeton Spine and Joint Center
Department of Rehabilitation Princeton, NJ, USA
Medicine
Mount Sinai Hospital
New York, NY, USA

ISBN 978-3-031-15355-6    ISBN 978-3-031-15356-3 (eBook)

https://doi.org/10.1007/978-3-031-15356-3

© The Editor(s) (if applicable) and The Author(s), under exclusive license to
Springer Nature Switzerland AG 2022
This work is subject to copyright. All rights are solely and exclusively licensed by
the Publisher, whether the whole or part of the material is concerned, specifically
the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting,
reproduction on microfilms or in any other physical way, and transmission or
information storage and retrieval, electronic adaptation, computer software, or by
similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service
marks, etc. in this publication does not imply, even in the absence of a specific
statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and
information in this book are believed to be true and accurate at the date of
publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with
regard to jurisdictional claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature

Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
For Mark, Sandy, Tommy, and
Riley
Michelle Leong
For Ana, Mila, Lara, Luka,
Twinkle, and Lili
Grant Cooper
Tara, Cassandra, and Dr.
Maheep Vikram
Peter Murphy
Foreword

Scabbed knees were a badge of honor of sorts during our elemen-

tary years; however, as a reader of this manuscript you most likely
are wondering what the mechanism of injury was, and whether it
warrants an x-ray given the evidence of trauma. We start our lives
weight-bearing directly onto our knees, progress to scrapes and
bruises, and then load them daily while allowing gravity to play
its role too—all proof that knees are quite resilient.
As clinicians who are faced with the increasing incidence of
knee pain (which plagued 25% of adults 20 years ago, with a sig-
nificant increase in incidence over the last two decades), it is
important to become familiar with the anatomy of this joint and
the pathologies that can combat its many structures. With the most
subtle of misaligned movements, one is at risk of disrupting the
many structures that both protect and make up the joint. It is not
just activity that causes this magnificent joint to become the cen-
ter of a chief complaint, but also the lack of activity proving to be
just as harmful. I am confident that as you read through the pages
of this manuscript, you will widen your knowledge and ability to
differentiate between affected structures in your patients and the
cause of their pathology. Through this case-based approach, you
will have a greater understanding of the appropriate workup and
treatment for the most common diagnoses associated with knee

vii
viii Foreword

pain. With the shared expertise of these authors, I am confident

that you will be better equipped to treat any patient to walk
through your door seeking your help in treating their resilient,
indispensable knees.

Icahn School of Medicine at Mount Sinai Mariam Zakhary

New York, NY, USA
Acknowledgments

Thank you to my coeditors for the opportunity to collaborate on

this book. Thank you to the Icahn School of Medicine at Mount
Sinai, Department of Rehabilitation and Human Performance, for
my valuable training in residency and fellowship. I have mentors
and friends for life. Thank you to my family and friends for all the
support.
Michelle Leong

It has been a pleasure to collaborate on this book. I want to first

thank my coeditors and all of the amazing authors who worked so
hard to make this book a reality. Thank you to my colleagues at
Princeton Spine & Joint Center for continuing to push, nurture,
and challenge me. And thank you to my family Ana, Mila, Lara,
Luka, Twinkle, and Lili for putting up with me when I disappear
into the study to write.
Grant Cooper

ix
x Acknowledgments

I would like to thank my amazing family, Sandra, Alex, Mikhayla,

and Andrew, for all of their continued love and support through
this journey. Thank you of course to my long-time friend, col-
league, and co-editor on this and so many other projects, Dr. Grant
Cooper. Thank you to all of our fantastic authors and other editors
who came together to make this book a success.
Joseph E. Herrera, DO, FAAPMR
Chair and Lucy G. Moses Professor
Department of Rehabilitation and Human Performance
Mount Sinai Health System
Director of Sports Medicine
Icahn School of Medicine at Mount Sinai
Interventional Spine and Sports Medicine Division
Department of Rehabilitation and Human Performance

I want to thank everyone who helped come together to make this

book possible. I am honored to be a part of this. A loving thank
you to my wife Tara and daughter Cassie. I’d also like to thank Dr.
Maheep Vikram whose mentorship through the years has been
invaluable.
Peter Murphy
Contents

1 Knee Anatomy����������������������������������������������������������������  1
Laurenie Louissaint and Aditya Raghunandan
2 Ligament Injuries���������������������������������������������������������� 21
Monica Gibilisco, Prathusha Maduri,
and Richard G. Chang
3 Meniscus Injuries ���������������������������������������������������������� 59
Amanda A. Kelly and Richard G. Chang
4 
Osteoarthritis of the Knee �������������������������������������������� 77
Aaron Bolds and Subhadra Nori
5 Patellofemoral Pathologies�������������������������������������������� 87
Caroline Varlotta and Ian O’Connor
6 Pediatric Knee Pain ������������������������������������������������������117
Esha Jain and Elinor Naor
7 Outpatient and On-Field Evaluation
of Sports Trauma in the Knee ��������������������������������������139
Dustin C. Buller, Esha Jain, and Alexis Colvin
8 Knee Fractures ��������������������������������������������������������������185
Seth Probert and Aditya Raghunandan

xi
xii Contents

9 Rheumatic
 and Infectious Causes
of Knee Pain��������������������������������������������������������������������203
Mark Riley and Michelle Leong
10 Knee
 Pain Case Studies ������������������������������������������������257
Daniel Weng, Caroline Lewis,
and Miguel Escalon

Index����������������������������������������������������������������������������������������327
Knee Anatomy
1
Laurenie Louissaint
and Aditya Raghunandan

Learning Objectives
• To recognize normal anatomy of the knee adapting a layered
approach.
• Understand the function of anatomical structures.

Introduction

Conceptually, the knee can be seen as being composed of two

joints: the tibiofemoral joint and the patellofemoral joint. The over-
all stability of the knee is dependent on static (cruciate and collat-
eral ligaments) and dynamic (hamstring muscles, extensor
mechanisms, and the popliteus muscle) stabilizers, muscle attach-
ment sites, menisci, the joint capsule, and the knee’s bony topogra-
phy. As we dive into its anatomy, readers will gain an understanding
of how all these structures reinforce the knee stability and function.

L. Louissaint (*)
Department of Human Performance and Rehabilitation, Icahn School of
Medicine, Mount Sinai Hospital, New York, NY, USA
A. Raghunandan
Department of Rehabilitation Medicine, Long School of Medicine at the
University of Texas Health Science Center at San Antonio,
San Antonio, TX, USA
e-mail: [email protected]

© The Author(s), under exclusive license to Springer Nature 1

Switzerland AG 2022
M. Leong et al. (eds.), A Case-Based Approach to Knee Pain,
https://doi.org/10.1007/978-3-031-15356-3_1
2 L. Louissaint and A. Raghunandan

The Anterior Knee

 nterior Knee Joints

A
The knee is a hinged capsular joint with three separate articulations:
the patellofemoral, medial, and lateral tibiofemoral joints (Fig. 1.1).

Femur

Patelia

Proximal
Gerdy’s
tibiofibular
tubercle
joint
Tibia Posterior
femoral
condyle
Tibial
tuberosity

Patellofemoral
articulation

Lateral
epicondyle
Adductor
tubercle
Tibiofemoral
articulation Gerdy’s
tubercle
Medial
epicondyle

Fig. 1.1 Bones of the knee: anterior and posterior view, side view medial and
lateral [3]
1 Knee Anatomy 3

The tibiofemoral joint is a hinge joint that aids in some of the knee’s
primary functions, such as transmission of body weight from the
femur to the tibia by allowing sagittal plane rotation and a small
degree of tibial axial rotation [1]. The medial and lateral femoral con-
dyles are the femur’s distal convex surfaces that articulate with the
tibia’s medial and lateral tibial plateau, respectively. The medial tibial
plateau has a concave articular surface while the lateral plateau has an
anteroposterior convexity. This topography accounts for the “screw-
home mechanism” or internal rotation of the femur, on the fixed tibia
as the knee approaches extension [2].
The patellofemoral joint, a gliding joint, is the articulation
between the patella and the femoral sulcus. The patella is the
body’s largest sesamoid bone. It has a concave superficial surface
and an articular surface with a vertical central ridge that separates
the medial and lateral facets which articulate with the femur. It
has a distal attachment to the deep layer of the patellar tendon and
a proximal attachment to the vastus intermedius [1].

Extensor Mechanism
The patellofemoral articulation is also referred to as the extensor
mechanism, which is composed of the quadriceps muscle group,
the patella, and the patellar tendon (Fig. 1.2). Disruption of any of
these components impedes a person’s ability to actively extend
the knee or resist passive flexion.
The quadriceps muscle group forms the primary motor unit
of the extensor mechanism. The rectus femoris merges with
vastus medialis obliquus, vastus medialis, vastus lateralis, vas-
tus lateralis oblique which terminate in an aponeurosis; these in
turn merge into the anterior-third joint capsule’s retinacular
layer that extends to form the quadriceps tendon attachment to
the patella [2]. The patellar tendon originates at the inferior
pole of the patella and inserts at the tibial tubercle, the distal
component of the extensor mechanism. Rectus femoris’ attach-
ment at the anterior inferior iliac spine allows it to also function
as a hip flexor. The quadriceps muscle group is innervated by
the femoral nerve (L2–L4) and receives vascular supply from
femoral artery [5].
4 L. Louissaint and A. Raghunandan

Quadriceps
muscle

Quadriceps
tendon

Femoral
groove

Patella
Medial
femoral condyle
Lateral
femoral condyle
Patellar
tendon

Anterior view of the knee Lateral view of the knee

Quadriceps Tendon

Patella

IllioTibial
band
Patellar
Tendon

Tibial
Tuberosity
Pes
Anserinus

Fig. 1.2 The extensor mechanism [4]

Other documents randomly have
different content
“That’s all, so cut along now, and remember, eleven
sharp. We’ve got a date for dinner, and I’m afraid we’re
going to be late as it is. So long, Charlie.”

“So long, Bill. So long, Chief.”

Charlie raced away, intent on the importance of his trust

and his two friends hurried toward the Palm Garden.

They found the Baron and his officers awaiting them in

the foyer of the restaurant. The Baron beamed approval
on their uniforms and introduced them to the members
of the group they had not already met. These
gentlemen each bowed from the waist and shook hands
with continental formality upon being presented. The
Baron spoke a few words, and then as the single stroke
of the ship’s bell clanged, the chief steward appeared in
the doorway.

“Dinner is served, Herr Captain.” 141

The Baron leading, they went into the restaurant. The

meal which they sat down to proved to be a long,
sumptuous affair of many courses. Every delicacy, in
and out of season, was served. Evidently the Baron
believed in living well—on other people. Both lads did
full justice to the banquet. Muffled strains of the ship’s
orchestra, hidden behind palms, lent gaiety to the
atmosphere, but could not cut through the rigid
formality of their companions’ demeanor.

It was after ten thirty by the time they left the table and
went out on deck. The stars were like jewels flashing in
the great inverted bowl of night. The dark water
gleamed quiet as a mill-pond, reflecting the slender
crescent of a new moon that had just appeared above
the horizon.
The Baron puffed a long cigar while he conversed at his
ease in a deck chair.

“This voyage,” he remarked complacently, watching the 142

red ash glow on the end of his cigar, “is becoming quite
a successful undertaking. A few more months and we
can well afford to retire, and go our own ways.”

“But surely, Herr Baron, you are not contemplating

ending this splendid venture?” It was the Chief Engineer
who spoke.

“We must not try providence too far, Bauer. To date, this
ship is a mystery to the world at large, it is true. But we
have already created some stir. Personally, I consider it
a positive compliment that the navies of the world are
seeking us out to destroy us!”

“It must,” Bill remarked, “afford you a good deal of

satisfaction, as well as profit, Baron.”

He was becoming restive. It was nearing eleven o’clock.

The cabin door was locked and Charlie could not get in.
But how to break away without arousing the Baron’s
suspicions, he could not see.

That gentleman puffed contemplatively for a moment or

two.

“Yes, you have it right, Mr. Bolton,” he observed at last. 143

“Pleasure and profit. Outside of the vast sums in money
and jewels we have taken from captured liners, you
perhaps do not realize that we have more than two
hundred very wealthy people as passengers. Their
ransoms, at the lowest estimate will run well over a
million dollars apiece. Yes, this is a most profitable
business, Mr. Bolton. But of course, a most dangerous
one. We must not practice it for too long a time.”

“Herr Baron,” Bill leaned forward in his seat, and smiled

his most engaging smile, “neither Chief Osceola nor I
have had the opportunity this evening to thank you for
your consideration in the matter of our cabin and the
uniforms you have provided us.”

“Yes, indeed, Baron,” Osceola seconded him and threw

the stub of his cigarette over the rail. “Very kind of you,
I must say.”

“Oh, do not mention it, my dear fellows.” The Baron was

joviality itself. “Those are small matters and easily
attended to.”

“But we appreciate your wish to make us comfortable.” 144

Bill rose, and Osceola followed his example. “And now,
sir, we will say good night. It has been a long day and a
busy one.”

“Good night, my young friends,” beamed von Hiemskirk.

“Pleasant dreams, and auf wiedersehn until tomorrow.”

Everyone stood up and saluted and the lads marched

off toward their cabin. Osceola was unlocking the door,
when a stealthy figure appeared from out the shadows
of a cross passage, and Charlie slipped into the room
with them.

“Gee, I thought you were never coming,” he said, as Bill

switched on the light.

“Sorry, Charles, so did we! Have you got any news?”

“Plenty, Bill. I—”

His words were cut short by a crash of gunfire from
above. For an instant they stood listening to the thunder
of the gun, then Bill broke their constrained silence.

“We’ll have to postpone our talk, Charlie, worse luck. 145

There’s something doing out there, all right, and it’s up
to the Chief and me to hustle up on deck pronto.”

Without further parley the three caught up their caps

and ran out of the cabin.

146
 Chapter XI
DANGEROUS BUSINESS

The lads encountered a crowd of nervous and excited

passengers on the stairs and were swept up with them
and out on deck. By common instinct the flow was
toward port. A few hundred yards away, the lights of a
steamer, parallel with them, could be discerned. Signals
were flashing, bells clanging, and the clamor of the
startled passengers pressing the rail was deafening.

Bill gripped Osceola’s arm. “Let’s get out of this

bedlam,” he shouted. “The skipper is sure to be on the
bridge—come along!”

Diving across the ship they ran forward on the opposite 147
deck and up the stair to the bridge. Baron von
Hiemskirk stood with a pair of night glasses trained on
the stranger across the water. Near him a group of
white uniformed ship’s officers conversed in whispers.
He lowered the binoculars as Bill and Osceola
approached and rendered them a stiff salute.

“Good evening again, gentlemen. Thank you for your

promptness. Chief Osceola, I want you and Lieutenant
Schneider to go aft and quiet that rabble. Explain to the
passengers that there is no cause for alarm. Tell them
also in my name that unless they go at once to their
cabins, they will be sent there forcibly.”

Osceola and the Lieutenant saluted and departed on

their errand.

“Now, gentlemen,” continued the Baron, “as several of 148

you already know, I have been aware for some time
that we were overhauling that ship we see out there.
Had she obeyed our signals and those of the Flying
Fish, there would have been no need to waste shell fire
on her. You will be interested to learn that she is the
Blake of Cardiff, loaded with twenty-five hundred tons of
coal—enough to keep us going for a week at good
speed, or two weeks at low speed. Tomorrow morning,
we will start coaling, and for the next few days, every
one of us will be especially busy. Those of you who are
not on duty, will please me by turning in at once, and
getting a good night’s rest. Good night, gentlemen.”

Back in his cabin, Bill undressed and got into bed. He

was lying there, with the lights burning, thinking over
the day’s events, when Osceola came in.

He tossed his cap on the lounge, and began to unbutton

his blouse. “Well, we got the sheep herded into their
respective barns. Did you find out anything about that
ship?”

Bill told him what the Baron had said. “Filthy business,
coaling,” he ended with a yawn.

“It will be interesting to find out how they work it at

sea, especially when we’ve got at least one warship on
our trail.”
“I don’t think the Baron’s worrying about the Stamford. 149
We’ve changed our course at least twice in the last few
hours. It’s a big ocean, Osceola.”

“Guess so. And some queer people on it. The noble

Baron makes me laugh. He’s probably the greatest thief
unhung, yet he purposely chatted with us and the other
officers after dinner, on the side of the deck away from
this collier, so that we would go to bed early and get a
good night’s rest.”

“He’s an odd beggar, all right,” yawned Bill. “Switch off

the light, and hop into that bed of yours, big boy, or I’ll
be talking in my sleep.”

A steward called them at five next morning. By five- 150

thirty they had dressed in uniform cap and dungarees,
breakfasted and were out on deck. The collier was now
steaming slowly alongside the big liner. The ships were
kept together by a hawser across the lips of the
Amtonia’s bows, supplemented by a few lines across her
poop; and a speed of two miles an hour was being
maintained by both vessels. This kept their noses
together. It also gave them a certain steadiness in the
choppy sea that ran this morning. Above all, it kept the
pirate ship constantly prepared, steamed up in
readiness to dash away in case an enemy cruiser
appeared. The lads noted that at each of the cables
which held the vessels together, a man was stationed,
ax in hand, to cut the strands should the emergency
arise.

Bill and Osceola soon found that preparations for

coaling on the high seas had already been made.
Through the decks of the Amtonia the carpenters had
cut large circular holes, one directly beneath the other.
In these openings, ship’s ventilator tubes were at that
moment being inserted. They were then spliced
together in such a manner that coal dumped on to the
deck merely had to be pushed into the tubes to slide
swiftly down into the bunkers.

Three temporary derricks had been erected, one fore, 151

another amidships, and one aft, all electrically equipped.
Bill was presently put in charge of the fore derrick, while
Osceola crossed over to the collier, where he helped to
superintend the loading of sacks and baskets with coal.
These when filled were transferred from the Blake’s
derricks to those of the liner, in midair. The coal was
then unloaded on the Amtonia’s deck and shoveled into
the tubes by the crew.

As the sun grew higher, the weather became

increasingly hotter. So hot was this work of coaling that
the men were soon working clad only in pantaloons, cut
short like boys’ trousers, or even in tights. There were
no feminine eyes about, for all passengers were being
kept below, so that occasionally the scanty loincloths
were cast aside and the men worked naked. Covered
from head to foot with sweat and coal dust, they soon
looked like gangs of negroes. The officers fared quite as
badly, for, though they were spared manual labor and so
did not discard their uniforms, they soon became as
grimy as the men and fully as uncomfortable.

Work was carried forward night and day, in alternate 152

watches. To Bill it became a nightmare of heat and
sweat and coal dust. The ship, usually so immaculate,
took on the appearance of a coalyard, and the fine black
dust filtered into even the remotest nooks and crannies.
When relieved of duty, the black counterpart of that
smart young Lieutenant Bolton would satisfy his hunger
at a buffet, get under a shower and then to bed. Here,
between coal dust coated sheets, he would snatch a
few hours sleep—then hurry above for his next trick at
the derrick. He began to find out that the life of an
officer aboard this pirate craft was not the bed of roses
it had first appeared to be. As Osceola worked and ate
and slept on board the Blake, the two saw nothing of
each other.

Late in the afternoon of the third day, the last of the

twenty-five hundred tons of coal was transferred and
shovelled down the chutes. Bill saw to the taking down
of his derrick and then went below to his cabin, thankful
that the dirty job had come to an end. He was getting
out of filthy clothes when Osceola walked in.

“Coolheavers ahoy!” he greeted. “I’m one black warrior, 153

if you ask me.”

“And I’ve had pleasanter jobs.”

“Oh, you’ve had a nice, comfortable deck to work on,”

returned the Chief, diving into the bathroom. “You’ve
nothing to complain about. I haven’t had these clothes
off since the day before yesterday! Been working down
in the hold of that collier at a temperature that blew the
top off our thermometer.” His voice was drowned by the
sound of the shower.

“That is tough! I missed you, old fellow. Where did you

sleep?”

“Where did I sleep!” spluttered the Chief. “Not in a

downy white bed like you—you son of luxury! I slept, or
rather, I tried to sleep in a ship’s hammock!”
Bill chuckled, and began to unlace his shoes. “Pretty
difficult to navigate until you get on to them. Hard to
get into—”

“Harder still to stay put when you’re once in the darned 154
thing! Gosh-all-hemlock, this water is sure a sweet, cool
dream, of Paradise! Let me tell you that my hammock
had to be slung between-decks—iron decks, at that.
Sleep! I’ve forgotten what it is. Every time I moved in
that hammock, the confounded thing dumped me onto
that dirty iron deck with a jar that nearly split my head!
Push that bell for a steward, please. I want food and
plenty of it, and I’m going to eat it in my comfortable
bed. Then, I’m going to sleep and sleep until tomorrow
morning.”

“Oh, no, you’re not,” said Bill.

“And who says so?”

“Have your supper, by all means, and have it in bed if

you like—but you and I have a date.”

“Date nothing! Keep it yourself. I’m only a poor Indian

pirate. Neither am I popular with first class passengers.”

“Perhaps not—but this date isn’t with a passenger.”

“Who then?” 155

“Have you forgotten the wireless operator?”

“Gosh! Do you have to pull that stunt tonight? I’m half

dead.”

“So are a few other people. That’s why I’m going to pull
it off tonight. Snap out of it, old man. The fortunes, if
not the lives of a lot of people depend on what we’re
able to accomplish.”

“Well, what are we going to do? You never have spilled

that plan of yours. Not to me, anyhow.” He came into
the cabin, drying himself with a bath towel.

“You order your chow,” suggested Bill. “If you haven’t

used all the hot water aboard ship, I want to get under
that shower myself. When I’m dressed and you’re in
your right mind, I’ve got to hunt up Charlie and see
what he’s found out. We’ll be back later and I’ll explain
the job in detail.”

He disappeared into the bathroom, closing the door 156

after him to cut short further argument. It was after
seven o’clock by the time Bill was dressed and ready to
go on deck. He knew that Charlie would be in the
passengers’ dining salon, and that was out of bounds
for the ship’s officers. So leaving Osceola attending to a
substantial dinner in bed, he went above to the Palm
Garden, where the officers’ mess was held.

It was not a talkative crowd at dinner that evening.

Every man at the table was dog tired and conversation
flagged in consequence. The meal with its many courses
seemed interminable to Bill. When at last it was over, he
excused himself, while the others were smoking cigars
and sipping liqueurs and went in search of young Evans.

Weary sailors were hard at work with hose and swabs

on the promenade deck, getting rid of the accumulated
grime of the coaling. Bill took a turn round to the
opposite side of the ship, where he encountered a
similar gang at work, but found no passengers about.
Charlie was not in the smoking room. Eventually he
found him, listening to the orchestra, which was playing
in the lounge.

Without appearing to recognize the youngster, he 157

caught his eye as he sauntered past, surreptitiously
crooked a finger and went down to his cabin. There he
found Osceola fast asleep in his bed, with all lights
burning. He was wondering whether he should wake
him then and there, or let him sleep, when Charlie softly
opened the door and entered.

Bill put a hand up for silence, and led him into the
bathroom. “Better let the poor Chief get some rest,” he
said, closing the door. “He’s been going it night and day
aboard that collier. He needs the sleep.”

“Well, I don’t, that’s a cinch! We’ve been kept off the

decks ever since you fellows started coaling, and sleep
was the only thing left to do. Say—did you see the Blake
go down?”

“No. I was sure they’d sink her, though, for the Baron 158
told me he was going to take her captain and crew
aboard the Amtonia and dispose of her as soon as we
got her coal. When did it happen?”

“Just before dinner—about quarter to seven.”

“I was cleaning up in here then.”

“Well, I got a peach of a view from the smoking room

windows, with Dad’s field glasses. They cut the ropes
and she drifted away from us. It wasn’t five minutes
later, when she gave a great lurch and went down bow
first. It certainly is a crime, the way the Baron sinks
good ships. I guess he had dynamite planted on board
just like he did with the Merrymaid.”
“Very likely. But there’s nothing we can do about it,
Charlie. Not yet awhile. But tell me, what have you
found out about that wireless room?”

“Well, since that first evening when we captured the 159

Blake, I haven’t been able to get up there. But I did
manage to get in soon after the gunfire that night. I
copped a couple of Dad’s cigars and gave ’em to the
guy who was on duty. These Heinies are a leadpipe
cinch to kid. He isn’t such a bad guy at that—showed
me the whole business—everything he had. I began to
think he’s a swell fellow even if he is a pirate. I got a
book on telegraphy out of the library and I’ve been
boning up on the Morse Code ever since. That and
sleeping. Say, I bet I could send a message now.
Receiving’s not so easy, though.”

“Never mind that—”

“But I’m sure I can, Bill—”

“All right—I believe you—but lay off it. I want the dope
first. How many operators does this ship run to? Did you
find that out?”

“Yep. There’s three of ’em.”

“How long are their watches?”

“Four hours each. But sometimes they’re on for eight

hours.”

“What do you mean?”

“Well, there are two on duty daytimes—”

“Never mind that either—I’m not interested in their
complete schedule. How many operators are in the
wireless room now?”

“Only one. He’s doing his trick from eight till midnight.” 160

“Good. Now we’re getting somewhere. How about from

midnight on?”

“Another guy comes on duty then.”

“For how long?”

“Till eight in the morning.”

“He’s alone all that time? Are you sure?”

“Yes. The other two lads relieve him then.”

“Do you know the operator who will go on at twelve

tonight?”

“Well, I’m not sure. They vary their watches, you know.”

“I suppose it doesn’t matter,” Bill said to himself. “Tell

me, is the door kept locked?”

“No, but they generally keep it shut.”

“Does the night operator sit facing it?”

“No. His back is toward the door.”

“Then that window in the wireless house must be to his

right when he’s sending or receiving?”

“Yes, and it’s sure to be open now.”

“Thanks, Charlie. You’ve done splendidly. Run along to 161
bed now. Osceola and I will attend to your friend later.”

Charlie’s face fell. “Aren’t you going to let me in on

this?” he pleaded. “Oh, Bill, gee—I did all the work and
you two are going to have all the fun!”

“Not much fun about it.” Bill grinned and was silent for a
minute. “Well, I reckon we can use you. But you must
remember that this is a very serious and dangerous
business, Charlie. If anything goes wrong, von
Hiemskirk is quite likely to have us shot out of hand.
You’ll have to obey orders to the letter, and take no
chances.”

“All right, Bill, of course, I will.”

“Okay. Then go to your cabin and turn in. And be back

here at one o’clock sharp.”

Charlie’s face was transformed with joy. “Thanks, Bill!”

“Run along now,” directed the older lad. “I’ve got a lot
to do before then. And be sure nobody sees you going
or coming.”

“They won’t!” promised the youngster. “Say, are we 162

going to shoot this operator?”

“Certainly not, you bloodthirsty wretch. None of us will

have guns. Neither Osceola nor I have one.”

“What are we going to do then?”

“Obey orders, kid. Get out of here now—I’m busy!”

163
 Chapter XII
THE JOB

When Charlie had gone, Bill glanced at his wrist watch.

It was just ten minutes to nine. With a sigh of
satisfaction, he picked up his cap. Then, snapping off
the electrics in the bathroom and the cabin, he, too,
went out.

It had been impossible for him to make preparations for 164

this venture of his since its inception at the beginning of
the week. As he went out on deck and forward toward
the bridge, he could hardly believe that no longer ago
than Monday morning, he had been flying his amphibian
north to New York, with Osceola as passenger. Then had
come the Merrymaid, and capture by these pirates, their
flying submarine and the raider, this huge liner whose
decks he was walking. That afternoon had come the
Orleans affair; in the evening the collier Blake had been
taken. Tonight, only Thursday. After the monotony of
three days’ coaling, the adventures of Monday seemed
far away, except when he stopped to realize that ever
since then he had had no leisure whatsoever to develop
his plan.

“Good evening, sir.” The guard at the foot of the stair

that led to the bridge saluted, and Bill came back to the
actual present with a start.

“Good evening, Schmidt.” He returned the man’s salute,

and recognized him as one of his derrick’s crew. “You
look so spick and span I didn’t know you at first glance.”

“Thank you, sir.” Schmidt smiled, keeping his rifle at

present. “And I feel a good bit more comfortable this
way, sir. Coaling is filthy work, Lieutenant.”

“Nothing dirtier.” Bill nodded and passed on up the

stairs.

Above he found Lieutenant Schneider pacing slowly up 165

and down. “Good evening,” said Bill. “Mind if I join you
for a few minutes?”

“I shall be honored, Herr Lieutenant,” returned the

officer. “An unlooked-for pleasure. A beautiful night, is it
not? But I surmised that like the rest of the mess you
turned in directly after dinner.”

“I admit I’m tired,” Bill went on chattily, “quite as tired

as the other chaps, after the grind of the last few days.
Chief Osceola was completely done up. Had his dinner
in bed, and I found him sound asleep when I went
below.”

“Don’t speak of bed,” grumbled the officer. “I wish I

were there now. It is just my luck to be on duty
tonight.”

“I found the cabin hot and stuffy, so I thought I’d come

up for a breath of air before turning in. Heading more to
northward, since we sank the Blake, I see.”
“Yes, the course is nor’nor’east now. Captain von
Hiemskirk is heading the ship for the transatlantic
passenger ship lane.”

“We don’t seem to be in any hurry, Lieutenant.” 166

“No, our speed is only sixteen knots. Everybody needs a

rest, and the Herr Baron, being a wise man, is saving
coal.”

“It sounds foolish of me, a ship’s officer, to admit it, but

I honestly have only the haziest idea of our position
now.”

“I don’t wonder at that,” laughed Schneider. “The way

we changed our course during the past week would
make a snake break its back. At noon today we were in
latitude 38 degrees north, longitude 62 degrees west—
and we aren’t far from there now at the rate we’ve been
steaming.”

“Mm—I thought we were much farther east,” remarked

Bill, and then changed the subject.

As he had now gained the information he wanted, he

chatted for ten minutes more with young Schneider,
then, wishing him good night, went below to his cabin.

Here he set the tiny alarm on his watch for twelve-thirty. 167
From the closet, he brought forth a civilian suit of his
own, and one of Osceola’s. These, together with two
pairs of tennis shoes and two soft felt hats that he
found in their bags, he placed on the lounge. Again he
dug into the bottom of a kit bag and pulled forth a coil
of rope, two monkey wrenches and a flashlight. Placing
these conveniently near the clothing, he began to
undress. Osceola still slept the sleep of exhaustion.
Without awaking him, Bill crept into his bed and turned
off the light.

It seemed but a moment or two later, though in reality

three hours had crept away, when the tinkle of his alarm
bell brought Bill back to a sleepy realization of the job
before him. He switched off the alarm and sat up in
bed. Osceola’s voice cut the throbbing drone of the
ship’s machinery.

“What’s the big idea?”

“Time to get on the job,” Bill murmured in a low tone. 168

“Had you forgotten it? Don’t turn on the light.”

“No, I hadn’t forgotten. You said something about

working out a plan of yours tonight. But can’t we put it
off for twenty-four hours? I’m bleary-eyed, I’m so tired.”

Bill got out of bed. “So is everybody else aboard this

packet. And that’s why we’re pulling it off tonight.”

He tossed Osceola’s clothes on to the chief’s bed.

“Here’s an old suit of yours—get into it.”

“Oh, if you say so—” yawned his friend. “What are we

going to do with those wrenches? Crack the Baron’s
safe?”

“What a pair of eyes you’ve got! I’d forgotten you could

see in the dark. No, you big galoot, this is not robbery
you’re in for now. We’re going to tie up the wireless
operator. I want to do some broadcasting on my own.”

“So that’s the way the wind blows!” Osceola, fully awake 169
now, was pulling on his trousers. “I have to hand it to
you, boy, when it comes to action—you act!”
“Come on—I know it’s risky business, but if we’re ever
going to break up this nest of pirates, we’ve got to have
help.”

“You’re going to wire our position to that cruiser who

was on our trail Monday?”

“And to whomever else it may concern—yes, that’s the

idea!”

Osceola grunted. “And what is the Herr Baron going to

be doing to us while the cruiser is trying to catch us?”

“Not a blooming thing, if the wireless man doesn’t spot

who we are. I’ve got a couple of handkerchiefs cut with
slits for eyeholes. We can drape them over our lovely
features just like real thugs, when we get on deck!”

“Swell!” responded his companion. “Gimme one of those

wrenches. I’m all set if you are.”

Bill glanced at the luminous dial of his watch. “We’ll give

him three minutes.”

“Give who three minutes?”

“Charlie’s coming with us.” 170

“What? Not that crazy kid! He’s sure to gum the show.”

“No, he won’t. And we need a lookout, Osceola. The

youngster worked like a hero, getting dope about the
wireless routine. I know it’s a responsibility to let him
take the risk—but the chap was so keen on being in at
the death—I simply hadn’t the heart to refuse him.”
“Well, so long as this is your party, I’ll say no more
about dragging Charlie into it. But I’d hate to be you if
his mother finds out what you’ve let him in for.”

A crack of light appeared under the door, and Charlie

opened it, slipped inside and closed the door behind
him.

“Here I am,” he whispered.

“Not really,” Osceola whispered back, “why, I thought it

was Christmas Eve and Santa Claus had come to fill my
stocking!”

“Try the other side of your bed when you get up next 171
time, Chief,” Charlie snickered. “Why the grouch? Don’t
lose your nerve. If anybody tries to hurt you, I’ll put salt
on his tail.”

Osceola laughed good-humoredly. “You young scamp, if

you don’t cut the comedy and do what you’re told
tonight, you’ll think you’ve had salt rubbed on yours,
along with the hiding you’ll get from me.”

“Thar she blows! thar she blows!” teased Charlie. “What

a whale of a guy you are, Chief!”

“Pipe down—both of you!” commanded Bill. “You make

more noise than an old maid’s tea party. What do you
want to do—wake up the ship?”

“Well, let’s shove off then,” said Charlie in a lower tone,

and started for the door.

Bill caught his arm. “Not that way,” he warned. “The

ports to this cabin are regular windows, and we’re going
out through them. There’s less chance of being seen.”
“Shall I lock the door?” asked Osceola.

“No. If we’re able to pull this off, it will be a case of 172

speed in getting back here. The door may be handier
then. Come on—mum’s the word. I’ll go first—”

He stepped onto the window seat. A moment later he

was through the broad porthole, and out on deck. Not a
soul was in sight. A nod to Osceola brought the Chief to
his side and they waited until Charlie reached the deck.

With Bill in the lead, they walked swiftly forward until

they came to the open stair leading up to the boat deck.
Motioning caution, Bill went silently up the rubber-
coated treads with the others close behind. He knew
that once above, they would be in plain sight of the
bridge. Therefore, before reaching the stairhead, he
dropped to his knees and crawled up to the deck level,
careful to keep his head below the skyline. Then,
turning back to Charlie, he drew the boy’s head close to
his lips.

“I want you to stay here!” he whispered. “If anyone 173

comes off the bridge and makes for this stair, run down
to the deck below and get out of his way. When he’s
gone, come back here. If anyone comes up the stair,
crawl into the shadow of that lifeboat. If you see
anybody at all going toward the wireless house, whistle
twice and beat it back to your cabin, no matter what
occurs. Got it clear, now?”

Charlie, tense with excitement and proud of the

responsibility given him, nodded mutely. Then he moved
to one side while Osceola slipped past him, to lie beside
Bill.
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