Wk 2, Case 1 - Review

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.