Patient History
22M right knee pain with motion
Findings
The anterior collateral and posterior collateral ligaments are intact.
Anterior Compartment: Patellofemoral dysplasia, with Wiberg 3 appearance of the patella and a flat Dejour type B trochlea. Moderate osteoarthrosis. Generalized chondral blistering with multifocal areas of full-thickness penetrating chondral erosions and fissures more conspicuous along the lateral patellar articular facet and lateral trochlea with subchondral arthropathic cyst formation in keeping with class 4 chondromalacia.
Diffusely scarred medial patellofemoral ligament (MPFL) with evidence of previous surgical repair with screws at the origin of the non weight bearing surface of the medial femoral condyle and at the MPFL insertion on the hypoplastic medial patellar articular facet.
The lateral patellar retinaculum appears also scarred but otherwise intact.
Increased tibial tuberosity to trochlear groove distance (TT-TG) of 2cm (normal <1.5cm).
Induration of the infrapatellar plica with edema in the Hoffa's fat pad.
Medial Compartment: No meniscal tears. No chondromalacia or osteochondral defects. No osteoarthrosis. Intact medial collateral ligament.
Lateral Compartment: No meniscal tears. Class 2 chondromalacia. No osteochondral defects. Kellgren Lawrence grade 2 osteoarthrosis. Intact lateral collateral ligament complex.
Extensor Components: Moderate distal quadriceps tendinosis. Insertional tendinosis of the posterior and proximal fibers of the patellar tendon at the site of its origin at the inferior pole of the patella with diffuse patellar tendinosis and hypertrophic interstitial delamination distally. Chronic apophysitis at its insertion on the tibial tuberosity with fragmentation and no associated osteitis.
Flexor Compartment: Unremarkable.
No soft tissue masses or cysts.
Trace joint effusion without internal debris or free bodies.
Normal neurovascular bundle.
Impressions
1. Moderate insertional tendinosis of the posterior and proximal fibers of the patellar tendon with hypertrophic interstitial delamination/tear tracking distally. Findings in keeping with a forme fruste of “jumper's knee.”
2. Chronic apophysitis with fragmentation of the tibial tuberosity at the insertion of the distal patellar tendon representing sequela of Osgood-Schlatter disease.
3. Patellofemoral dysplasia with Wiberg 3 appearance of the patella and a flat Dejour type B trochlea. Increased tibial tuberosity to trochlear groove distance (TT-TG) of 2cm.
4. Diffusely scarred MPFL with evidence of previous surgical repair likely from prior lateral dislocation.
5. Patellar maltracking with edema in the Hoffa's fat pad with infrapatellar impingement.
