Patient History
Right anterior and patella pain. Sharp pain from crepitus. Instability and weakness. Occasional feverish. Increased pain with weight, ascending and descending stairs, kneeling and squatting. All since 30 years. Fractured right knee 12 years old. Realigned right patella. 1 injection.
Findings
Cruciate ligaments: ACL and PCL are intact.
Anterior compartment: Patellofemoral dysplasia, with Wiberg [3] appearance of the patella and a flat Dejour type [B] trochlea. Severe osteoarthrosis with large osteophyte spurring more conspicuous at the lateral patellar articular facet. Class 4 chondromalacia with generalized chondral plate delamination and multifocal penetrating chondral fissures and erosions with underlying subchondral arthropathic cyst formation along the entire lateral patellar articular facet, patellar vertical ridge and lateral femoral condyle, surrounded by nominal osteoedema.
The medial patellofemoral ligament AND lateral patellar retinaculum appear intact.
Medial compartment: Enclosed degenerative fraying of the posterior horn and body of the meniscus without tears. Kellgren-Lawrence grade 2 osteoarthrosis. Class 1-2 chondromalacia. No osteochondral defects. Intact medial collateral ligament.
Lateral compartment: Intact meniscus. Kellgren-Lawrence grade 2 osteoarthrosis. Class 1-2 chondromalacia. Osteochondral defects. Intact lateral collateral ligament complex.
Extensor compartment: Mild distal quadriceps tendinosis. Evidence of prior tibial tuberosity transfer with surgical screws at the distal patellar tendon attachment.
Borderline increased tibial tuberosity to trochlear groove (TT-TG) distance which measures 1.5cm in length. No patellar tendinosis.
Borderline patella alta with an Insall-Salvati ratio 1.5cm.
Flexor compartment: Normal. Unremarkable neurovascular bundle. No bursal cysts.
Small joint effusion without internal debris or free bodies.
No soft tissue masses.
Impressions
1. Patellofemoral dysplasia with Wiberg 3 appearance of the patella and a flat Dejour type B trochlea.
2. Findings result in excessive lateral pressure syndrome with severe anterior compartment osteoarthrosis and class 4 chondromalacia mostly involving the lateral patellar articular facet, patellar vertical ridge and lateral femoral condyle.
3. Evidence of prior tibial tuberosity transfer with surgical screws at the distal patellar tendon attachment. Borderline increased tibial tuberosity to trochlear groove (TT-TG) distance which measures 1.5 cm in length. Borderline patella alta with an Insall-Salvati ratio of 1.5cm.
4. Enclosed degenerative fraying of the posterior horn and body of the medial meniscus without tears.
5. Kellgren-Lawrence grade 2 osteoarthrosis of the medial and lateral compartments.
6. Posteromedial recess 4mm osseous body.
