Wk 2, Case 2, Knee MR - Review

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Report

Patient History

75F status post fall, pain.

Findings

The ACL and PCL are intact.

Medial compartment: Contusion microtrabecular fractures in the nonweightbearing surface of the medial femoral condyle. A 4 cm, thin and delicate, trizonal cleavage tear involving the posterior horn and body of the medial meniscus which is displaced into the medial gutter due to loss of tether. Disruption of the meniscotibial and meniscofemoral ligaments. Class 2-3 chondromalacia. No osteochondral defects. No osteoarthrosis. Intact medial collateral ligament.

Lateral compartment: Nondisplaced microtrabecular fracture of the lateral tibial plateau reaching the posterior weightbearing surface. No osteochondral defects. No chondromalacia. Avulsion or chip “Segond” fracture at the attachment of the posterior iliotibial band fibers and anterior oblique band of the fibular collateral ligament (FCL). Disruption of the arcuate ligament and of the meniscocapsular fibers. Low-grade sprain of the popliteus myotendinous junction. The rest of the FCL, biceps tendon and popliteofibular ligament are intact. Lateral meniscocapsular separation with detachment of the meniscopoplieteal fascicles.

Anterior compartment: No chondromalacia, osteochondral defects or osteoarthrosis. Medial patellofemoral ligament and lateral patellar retinaculum are intact.

Large joint effusion or hemarthrosis without internal debris or free bodies.

Moderate sprain at the origin of the lateral gastrocnemius.

Mild distal quadriceps tendinosis with traction enthesophyte at its insertion on the anterosuperior patellar pole. Normal patellar tendon.

Induration of the infrapatellar plica with edema in the Hoffa's fat pad. Patella baja.

The rest of the flexor compartment and neurovascular bundle are unremarkable.

Impressions

1. Nondisplaced microtrabecular fracture of the lateral tibial plateau reaching the posterior weightbearing surface accompanied by an avulsion or chip fracture at the attachment of the posterior fibers of the iliotibial band and anterior oblique band of the fibular collateral ligament (FCL) in keeping with a “Segond fracture.”

2. Posterolateral corner injury consisting of disruption of the arcuate ligament, the meniscocapsular fibers, low-grade sprain of the popliteus myotendinous junction and a moderate sprain at the origin of the lateral gastrocnemius. The rest of the FCL, popliteofibular ligament and biceps tendon are intact.

3. A 4 cm, thin and delicate, trizonal cleavage tear involving the posterior horn and body of the medial meniscus which is displaced into the medial gutter due to loss of tether.

4. Disruption of the meniscotibial and meniscofemoral ligaments.

5. Lateral meniscocapsular separation with detachment of the meniscopoplieteal fascicles.

6. Large joint effusion or hemarthrosis without internal debris or free bodies.

7. Patella baja and maltracking.

Case Discussion

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Gitanjali Bajaj, MD

Assistant Professor

University of Arkansas for Medical Sciences

Edward Smitaman, MD

Clinical Associate Professor

University of California San Diego

Brian Y. Chan, MD

Assistant Professor of Musculoskeletal Radiology

University of Utah

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Wk 2, Case 2, Knee MR - Review