Patient History
72M anterior pain with squatting
Findings
Cruciate ligaments: ACL and PCL are intact.
Medial compartment: Fraying of the outer edge of the posterior meniscal horn without frank meniscal tears. Focal penetrating chondral fissure with a tiny subchondral arthropathic cyst and nominal osteoedema at the anterolateral aspect of the medial femoral condyle (class 4 chondromalacia). No osteochondral defects. No osteoarthrosis. Intact medial collateral ligament.
Lateral compartment: Normal meniscus. No chondromalacia, osteochondral defects or osteoarthrosis. Intact lateral collateral ligament complex.
Anterior compartment: No patellofemoral dysplasia. Class 2 chondromalacia. No osteochondral defects or osteoarthrosis.
Proximal tibiofibular joint: Normal.
Extensor compartment: Mild tendinosis of the distal quadriceps tendon.
Severe confluent hypertrophic patellar tendinosis with interstitial splitting/delamination reaching the superficial fibers of the proximal patellar tendon.
Tiny traction enthesophytes of the anteroinferior patellar pole with a focal cortical breakthrough and diffuse reactive patellar osteoedema.
Patellar plate delamination with mild prepatellar bursitis. Diffuse reactive anterior soft tissue swelling.
Induration of the Hoffa's fat pad with diffuse edema.
Small joint effusion. No internal debris or free bodies.
Flexor compartment: Mild fluid distention of the gastrocnemius/semimembranosus bursa without dehiscence. The rest of the flexor mechanism and neurovascular bundle are normal.
No soft tissue masses.
Impressions
1. Severe confluent hypertrophic patellar tendinosis with interstitial splitting/delamination reaching the superficial fibers of the proximal patellar tendon in keeping with “jumper's knee”.
2. Tiny traction enthesophytes of the anteroinferior patellar pole with a focal cortical breakthrough and diffuse patellar osteitis.
3. Patellar plate delamination with mild prepatellar bursitis and diffuse reactive anterior soft tissue swelling.
4. Reactive edema in the Hoffa's fat pad. Small joint effusion.
