Wk 4, Case 4 - Review

Patient History
55-year-old man with left lateral and medial knee pain after walking up and down stairs.

Findings
Menisci:

Medial Meniscus: Chronic trizonal radial tear of the posterior meniscal root with slight meniscal body partial extrusion related to altered hoop tether. No displaced or flipped fragment.

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: Incidental 0.9 x 0.7 cm inferior pretibial multiloculated ganglion cyst. Diffusely thickened and swollen infrapatellar plica and superolateral edema consistent with chronic patellofemoral maltracking.

Articulations:

Patellofemoral Compartment: Low-grade trochlear dysplasia with mild trochlear groove insufficiency. Dysplastic Wiberg 3 patella with broad flat lateral facet and an elongated partially covered odd facet. Borderline TT-TG distance measuring 1.6 cm. No patella Alta or Baja. Full-thickness flap-like fissures at the patellar ridge and medial patellar facet with subtle underlying reactive osteoedema. Low-grade trochlear chondromalacia.

Medial Compartment: Smooth intermediate-grade chondral loss seen at the medial aspect of the medial femoral condyle and tibial plateau weight-bearing surfaces. No full-thickness or penetrating chondromalacia.

Lateral Compartment: Unremarkable.

General:

Bones: Unremarkable.

Effusion: Small to moderate-sized suprapatellar effusion with diffuse reactive capsular synovitis.

Baker’s Cyst: Moderate-size gastrocnemius-semimembranosus cyst measuring 6.7 x 2.8 x 1.4 cm and evidence for partial dehiscence (small amount of extravasated fluid at the inferior aspect of the gastrocnemius semimembranosus bursal cyst). No evidence for extension into the popliteal fossa. No neurovascular bundle compression.

Loose Bodies: None.

Soft tissue and Neurovascular: Unremarkable.

Conclusion
1.Chronic trizonal radial tear posterior root medial meniscus with associated intermediate-grade chondromalacia involving the weight-bearing surfaces of the medial tibial plateau and femoral condyle.
2.Partially dehisced gastrocnemius-semimembranosus bursal cyst (Baker’s cyst).
3.Focal full-thickness chondral fissures of the mid patella apex and inferomedial patellar facet with subtle underlying reactive osteoedema.