Wk 3, Case 1 - Review

Patient History
17 year old boy complaining of the knee “giving out” and medial, lateral and posterior knee pain after playing basketball. Query meniscal tear.

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: Intact.

Hoffa’s Fat Pad: Focal superolateral Hoffa’s fat pad edema consistent with patellar tendon-lateral femoral condyle friction syndrome related to patellofemoral maltracking.

Articulations:

Patellofemoral Compartment: Dysplastic patella with short medial facet and an elongated concave odd facet that is partially covered with cartilage. Low-grade trochlear dysplasia with slightly insufficient trochlear groove (Dejour type A). Mild patella Alta with an Insall-Salvati ratio of 1.5. Normal TT-TG distance measuring 1.1cm. A full-thickness chondral defect at the patellar ridge and lateral patellar facet. No underlying chondral plate penetration or subchondral edema.

Medial Compartment: Old healed osteochondritis dissecans involving the posterolateral aspect of the medial femoral condyle. Overlying cartilage slightly thickened but intact.

Lateral Compartment: Normal.

General:

Bones: Mild stress-related osteoedema or contusion involving the mid patella. Incidental mildly dysplastic wide intercondylar notch.

Effusion: Small suprapatellar effusion.

Baker’s Cyst: None.

Loose Bodies: 5 mm chondral body within the lateral aspect of the suprapatellar recess effusion. A possible 3 mm chondral body within the knee joint effusion between the medial facet and the medial trochlea inferiorly. Both chondral fragments are likely to arise from the lateral patella chondral defects

Soft tissue and Neurovascular: Normal.

Conclusion
1.Full-thickness chondral defects/fractures at the patellar ridge and lateral patellar facet without underlying subchondral plate penetration. 5 mm and 3 mm chondral fragments within the superolateral joint space effusion and adjacent to the medial facet patellofemoral articulation.

2.Dysplasia: Chronic patellofemoral maltracking on a background of low-grade trochlear dysplasia (Dejour A) and patellar dysplasia with evidence for patellar tendon-lateral femoral condyle friction syndrome.

3.Old healed osteochondritis dissecans medial femoral condyle as described above.

4.No internal derangement or meniscus tear.