Patient History
28-year-old male with right knee pain and inability to bend the knee after work related injury where patient hit the knee on work equipment. No history of surgery.
Findings
ACL and PCL are intact.
Medial compartment: Full-thickness tear of the proximal tibial collateral ligament and contributing fibers from the origin of the medial popliteofibular ligament (MPFL) associated with superficial medial collateral ligament bursitis and edema along the deep cruciate fibers. Also, disruption of contributing fibers from the posterior oblique ligament (POL) and insertional tendinosis of the semimembranous tendon. No meniscal tears; however, there is disruption of the meniscofemoral and meniscotibial ligaments. No meniscal extrusion. No osteochondral defects, chondromalacia or osteoarthrosis.
Lateral compartment: Nondepressed subchondral contusion fracture at the outer weightbearing portion of the lateral femoral condyle measuring 0.6 cm in depth, 1.2 cm in width and 1.4 cm in anteroposterior dimension. It is surrounded by severe confluent osteoedema. No osteochondral defects, chondromalacia or osteoarthrosis. The lateral meniscus is normal. The lateral collateral ligament complex is intact.
Anterior compartment: Disruption of the most medial fibers of the MPFL. The MPFL attachment in the patella are intact. The lateral patellar retinaculum is intact. No patellofemoral dysplasia. No chondromalacia, osteochondral defects or osteoarthrosis.
Proximal tibiofibular joint: Normal.
Extensor mechanism: Quadriceps and patellar tendons are normal.
Flexor mechanism: Mild disruption of a tiny gastrocnemius/semimembranosus bursal cyst inferiorly near the semimembranous attachment. The rest of the flexor compartment and neurovascular bundle are intact.
Moderate joint effusion/hemarthrosis without internal debris or free bodies.
Normal-appearing lymph node posterior to the distal femur metadiaphysis.
Periarticular soft tissue swelling.
Impression
1. Right knee valgus mechanism of injury with a nondepressed subchondral contusion fracture at the outer weightbearing portion of the lateral femoral condyle measuring 0.6 cm in depth.
2. Posteromedial corner injury consisting of a full-thickness tear of the proximal tibial collateral ligament and contributing fibers at the origin of the MPFL associated with superficial medial collateral ligament bursitis; disruption of contributing fibers from the POL and disruption of the meniscofemoral and meniscotibial ligaments without meniscal tears.
3. Moderate joint effusion/hemarthrosis without internal debris or free bodies with periarticular soft tissue swelling
