Introduction: Pellet gunshot injuries occur quite frequently, especially among teenagers. Although conservative approaches to treatment are broadly accepted, such measures should account for any potential ramifications for the surrounding organs or other structures. Migration, infection, and limitation of proper functioning are hazards that should be weighed when evaluating the need for further steps. Case presentation: We report the case of a 25-year-old male, presented to our emergency department a few hours after incurring an airgun shot in the region of his right knee. Clinical examinations and a radiological assessment revealed the pellet to have struck in an extra-articular location, and indicated that the patient would be able to tolerate the injury with mild painkillers. However, after a few weeks the patient was experiencing limitations in joint movement, though the location of the pellet had not changed. This prompted major concern about the correct clinical pathway to follow in such cases – especially for patients who are athletes. Conclusion: Injury management for small pellet gunshots should not be as generalised as it is in the conservative approach. More individualised decision-making is required.