Patient History
Bilateral knee pain in a 28-year-old man.
Findings
Menisci:
Medial Meniscus: Intact.
Lateral Meniscus: Intact.
Ligaments:
Anterior Cruciate Ligament: Intact.
Posterior Cruciate Ligament: Intact.
Medial Collateral Ligament: Intact.
Lateral Collateral Ligament: Intact.
Posterolateral Corner Structures: Intact.
Posteromedial Corner Structures: Intact.
Extensor Mechanism:
Patellar Tendon: Intact.
Distal Quadriceps Tendon: Intact.
Medial Patellofemoral Ligament: Intact.
Medial and Lateral Patellar Retinacula: Thickened lateral retinaculum. Lax medial retinaculum.
Hoffa’s Fat Pad: Superolateral Hoffa’s fat pad edema with subjacent thickening and induration of the infrapatellar plica.
Articulations:
Patellofemoral Compartment: Borderline shallow trochlear groove. Mildly dysplastic Wiberg 2 patella. Patellar lateralization and tilt noted. Diffuse grade 3-4 medial patellar facet chondromalacia, with focal penetrating osteochondral erosions involving the mid medial patellar facet. Lateral patellar facet and trochlear cartilage relatively preserved. Mild osteophytic spurring of the upper and lower pole of the patella.
Medial Compartment: Tiny subchondral pseudocyst anteromedial aspect tibial condylar rim. Otherwise unremarkable.
Lateral Compartment: Normal.
General:
Bones: Early osteophytic spurring of the upper and lower pole of the patella. Tiny subchondral pseudocyst anteromedial aspect medial tibial condylar room. Otherwise unremarkable.
Effusion: Large knee joint effusion with diffuse florid synovitis insinuating into capsular recesses, consistent with known history of psoriatic arthritis.
Baker’s Cyst: None.
Loose Bodies: None.
Soft tissue and neurovascular: Normal. Intact popliteal neurovascular bundle.
Conclusion
1. Active knee joint arthrosynovitis with large knee joint effusion and synovial reaction, compatible with provided history of psoriatic arthritis.
2. Moderate grade chondromalacia patellae, including diffuse grade 3-4 medial patellar chondromalacia with small focal penetrating erosions.
3. Secondary signs of patellar maltracking, on background of lateral patellar tilt and lateralization, and low grade patellar and femoral trochlear dysplasia.
