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Wk 2, Case 5 - Review

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Okay,

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the history on this one is 28-year-old

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with anterior knee pain.

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Query, meniscus tear.

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Okay, stay with the same theme.

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Axial.

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Patellar shape, pretty good.

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Trochlear groove, pretty good.

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Lateral ridge, pretty good.

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Medial ridge, pretty good.

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Medial peripatellar plica, present.

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Not uncommon.

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That's normal.

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Medial retinaculum, superficial.

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And Medial Patellofemoral ligament,

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a little bit laminated,

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a little bit thickened,

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but still present.

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Lateral retinaculum, present.

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Popliteal fossa, normal.

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MCL, visible.

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Popliteus tendon and the popliteus hiatus, visible.

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And here's your fibular collateral ligament,

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which will combine with the biceps

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to form the conjoint.

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There is your oblique popliteal ligament,

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which forms the capsule in the midline

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and connects to the other side.

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Let's look at our sagittal now,

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keeping with our same theme,

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axial to sagittal,

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we go to the sagittal.

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Menisci, normal.

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Anterior cruciate, normal.

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Posterior cruciate, normal.

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A little bit of induration of

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the retropatellar space.

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Very common in young individuals due to maltracking.

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And the major finding,

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look for the swelling is here.

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This case is all about what's going

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on on the front end.

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This patient has delamination of the prepatellar plate,

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which is the contiguation or continuation of

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the rectus femoris fibers of the quadriceps

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over the top of the patella.

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Much like you have the

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rectus abdominis fibers continuing over

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the top of the synthesis pubis.

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But these fibers have detached.

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This is actually a four or five layered structure

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with at least three and sometimes four bristle

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layers, which we don't often think about.

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This patient has delaminated the prepatellar plate.

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The treatment is conservative.

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This is probably something

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you haven't seen before.

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It's important to comment on the status

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of the quadriceps, normal.

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The status of the patellar tendon, normal.

Report

Patient History
28-year-old man with knee pain. Query meniscus tear.

Findings
Menisci:

Medial Meniscus: Intact.

Lateral Meniscus: Intact.

Ligaments:

Anterior Cruciate Ligament: Intact.

Posterior Cruciate Ligament: Intact. Mildly lax and slightly swollen proximally.

Medial Collateral Ligament: Intact.

Lateral Collateral Ligament: Intact.

Posterolateral Corner Structures: Intact.

Extensor Mechanism:

Patellar Tendon: Intact and unremarkable.

Distal Quadriceps Tendon: Intact quadriceps tendon. Extensive prepatellar plate delamination with surrounding high signal edema and thickened edematous prepatellar bursa. No bursal effusion.

Medial Patellofemoral Ligament: Intact.

Medial and Lateral Patellar Retinacula: Slightly thickened lateral patellar retinaculum. Slightly lax medial patellar retinaculum.

Hoffa Fat Pad: Mild edema within the superolateral aspect of Hoffa’s fat pad, suggesting a degree of lateral patellar impingement.

Articulations:

Patellofemoral Compartment: Wiberg type 2 patella. No trochlear dysplasia. Mild lateral patellar tilt. No patellar subluxation. Normal TT-TG distance mesuring 1.0cm. Preservation of the patellofemoral cartilage.

Medial Compartment: Normal.

Lateral Compartment: Normal.

General:

Bones: Normal.

Effusion: None.

Baker’s Cyst: None.

Neuovascular: Normal.

Loose Bodies: None.

Conclusions
1. Extensive prepatellar plate delamination with surrounding active inflammation and prepatellar bursitis.

2. Patellar tendon-lateral femoral condyle friction syndrome (Hoffa fat pad impingement syndrome) related to patellofemoral maltracking.

3. No meniscus tear.

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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