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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
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Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
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For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Practice Cases
Worklist 1
10 topics, 17 min.
Practice Cases
Worklist 2
10 topics, 21 min.
Practice Cases
Worklist 3
10 topics, 28 min.
Practice Cases
Worklist 4
10 topics, 19 min.
Practice Cases
Worklist 5
10 topics, 43 min.
0:00
This patient is 62 years old.
0:03
There is chronic pain in the clinical
0:06
history with non trauma.
0:09
And the main finding that we see is the presence
0:13
of chondromalacia.
0:15
There is tricompartmental chondromalacia,
0:18
which is more so involving
0:21
the lateral compartment.
0:22
So we see areas of full-thickness chondral denudation
0:27
that translate as changes
0:30
in the subchondral bone marrow,
0:33
bright on fluid sensitive sequence here on proton density,
0:39
intermediate signal intensity.
0:41
And we can see how there are focal,
0:44
very subtle indentations in the subchondral plate
0:48
that are allowing for this
0:50
subcondylar cystic change to happen.
0:52
So, this is great for outer bridge chondral injury
0:58
where the cartilage is completely lost.
1:01
We have full thickness fissuring and we have
1:04
these very extensive areas of marrow edema.
1:08
If we look on the axial images,
1:10
we can see here that there is complete
1:13
denudation of the subchondral plate.
1:15
There's no cartilage at all anymore
1:18
in this lateral patellar facet.
1:21
There is exposure of the subcondylar plate.
1:23
And we have here also subcondylar cystic changes
1:27
at the level of the patellar apex.
1:29
So tricompartmental, patellofemoral,
1:33
lateral femoral condyle,
1:35
and there was also change in the surface of the
1:39
cartilage in the medial femorotibial compartment
1:43
with a focal partial thickness condyle defect in
1:46
the central weight bearing portion
1:48
of the medial femoral condyle.
1:50
All this combined, give us the diagnosis
1:54
of tricompartmental chondromalacia,
1:57
which is the main cause of the patient's symptoms.
Wk 2, Case 1 - Review
HIDEInteractive Transcript
0:00
This patient is 62 years old.
0:03
There is chronic pain in the clinical
0:06
history with non trauma.
0:09
And the main finding that we see is the presence
0:13
of chondromalacia.
0:15
There is tricompartmental chondromalacia,
0:18
which is more so involving
0:21
the lateral compartment.
0:22
So we see areas of full-thickness chondral denudation
0:27
that translate as changes
0:30
in the subchondral bone marrow,
0:33
bright on fluid sensitive sequence here on proton density,
0:39
intermediate signal intensity.
0:41
And we can see how there are focal,
0:44
very subtle indentations in the subchondral plate
0:48
that are allowing for this
0:50
subcondylar cystic change to happen.
0:52
So, this is great for outer bridge chondral injury
0:58
where the cartilage is completely lost.
1:01
We have full thickness fissuring and we have
1:04
these very extensive areas of marrow edema.
1:08
If we look on the axial images,
1:10
we can see here that there is complete
1:13
denudation of the subchondral plate.
1:15
There's no cartilage at all anymore
1:18
in this lateral patellar facet.
1:21
There is exposure of the subcondylar plate.
1:23
And we have here also subcondylar cystic changes
1:27
at the level of the patellar apex.
1:29
So tricompartmental, patellofemoral,
1:33
lateral femoral condyle,
1:35
and there was also change in the surface of the
1:39
cartilage in the medial femorotibial compartment
1:43
with a focal partial thickness condyle defect in
1:46
the central weight bearing portion
1:48
of the medial femoral condyle.
1:50
All this combined, give us the diagnosis
1:54
of tricompartmental chondromalacia,
1:57
which is the main cause of the patient's symptoms.
Report
Patient History
62-year-old female with left knee pain, ongoing for several years. No known injury. No history of surgery.
Findings
MENISCI:
Medial meniscus: Diminutive appearance of the medial meniscus, with pseudoextrusion of the meniscal body, but no traumatic tear or evidence of root ligament injury.
Lateral meniscus: Chronic inner edge fraying of the lateral meniscus posterior horn and posterior body, without traumatic or communicating tear.
LIGAMENTS:
Anterior cruciate ligament: Intact.
Posterior cruciate ligament: Intact.
Medial collateral ligament: Intact.
Lateral collateral ligament/complex: Intact.
Posterolateral corner structures: Intact.
Posteromedial corner structures: Intact.
EXTENSOR MECHANISM:
Patellar tendon: Intact. Mild prepatellar soft tissue swelling, without focal bursitis or degloving injury.
Distal quadriceps tendon: Intact.
Medial patellofemoral ligament: Intact.
Medial and lateral patellar retinacula: Intact.
Hoffa’s/Infrapatellar fat pad: Unremarkable.
ARTICULATIONS:
Patellofemoral compartment: Patella alta, with lateral tilt of the patella, but no evidence of subluxation or dislocation injury. Full-thickness chondral loss of the lateral patellar facet, patellar apex, and lateral trochlea, with multifocal penetrating osteochondral erosions of the upper pole patellar apex and lateral trochlea, hypertrophic spurring of the peripheral lateral facet, and mild spurring of the lateral trochlear ridge; findings suggestive of lateral patellar pressure syndrome. Moderate to severe chondral thinning of the medial patellar facet and medial trochlea.
Medial femorotibial compartment: Moderate to severe chondral thinning of the medial femoral condyle and tibial plateau weight-bearing surfaces with mild joint line spurring, but no penetrating erosion or reactive osteoedema.
Lateral femorotibial compartment: Moderate chondral thinning of the lateral femorotibial weight-bearing surfaces, with mild bony remodeling of the femoral condyle notch aspect secondary to femorotibial shift, and penetrating erosions and reactive osteoedema of the lateral tibial spine secondary to abutment with the femoral condyle. Mild joint line spurring.
GENERAL:
Bones: No acute or traumatic bony injury, macro- or microfracture. Femorotibial shift present.
Effusion: Small to moderate-sized joint effusion.
Muscle: Mild tendinopathy and peritendinitis of the distal semimembranosus insertion. No traumatic muscle tear or injury. No volumetric muscle atrophy.
Neurovascular: Intact.
Baker’s/Bursal cyst: Partially dehisced gastrocnemius-semimembranosus bursal cyst, measuring 4.6 cm in craniocaudal height.
Intra-articular/Loose bodies: None.
Conclusion
1. Tricompartmental Kellgren-Lawrence grade 2-3 osteoarthritis, most severe in the lateral patellofemoral compartment, with lateral patellar pressure syndrome, grade 4 chondromalacia, penetrating chondromalacic erosions, and peripheral spurring.
2. Grade 3 and 4 weight-bearing chondromalacia within the medial and lateral femorotibial compartments, most prominent of the lateral tibial spines and femoral condyle notch aspect.
3. Inner edge fraying of the lateral meniscus posterior horn, without traumatic tear. No traumatic medial meniscus tear.
4. Partially dehisced gastrocnemius-semimembranosus bursal cyst.
Case Discussion
Faculty
Omer Awan, MD, MPH, CIIP
Associate Professor of Radiology
University of Maryland School of Medicine
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
Jenny T Bencardino, MD
Vice-Chair, Academic Affairs Department of Radiology
Montefiore Radiology
Edward Smitaman, MD
Clinical Associate Professor
University of California San Diego
Tags
Musculoskeletal (MSK)
MRI
Knee
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