Patient History
72-year-old male with extreme posterior knee pain with no known injury
Findings
Cruciate Ligaments: ACL and PCL with mild mucoid degeneration. Otherwise, intact.
Central Compartment: Diffuse synovitis with tibial eminence spurring and multifocal chondral erosions with subchondral arthropathic cysts along the notch floor.
Medial Tibiofemoral Compartment: Class 2-3 chondromalacia. No osteochondral defects. No osteoarthrosis. Meniscal fraying without meniscal tears. Intact medial collateral ligament. Mild swelling along the deep crural fascia with nominal tibial collateral bursitis.
Lateral Tibiofemoral Compartment: Class 2-3 chondromalacia. No osteochondral defects. Complex macerated tear of the anterior meniscal horn which is partially extruded into the gutter and a thin and delicate radial/flap undersurface tear of the posterior horn and body.
Proximal Tibiofibular Joint: Mild osteoarthrosis with penetrating chondral fissure and subchondral arthropathic cyst formation.
Posteromedial Corner: Mild to moderate insertional tendinosis of the semimembranosus tendon.
Posterolateral Corner: Severe infiltrative tendinosis at its insertion on the popliteal hiatus with a punched-out cortical erosion and synovitis. The fibular collateral ligament, biceps femoris, arcuate ligament and popliteofibular ligament are intact.
Extensor Mechanism: Severe diffuse hypertrophic infiltrative tendinosis with peritendinitis and interstitial splitting of the mid to distal quadriceps tendon and the entire patellar tendon.
Flexor Mechanism: Nominal fluid distention of the gastrocnemius and semimembranosus bursa without dehiscence. The neurovascular bundle is unremarkable.
Traction enthesophyte with cortical erosion of the inferior patellar vertical ridge.
Patellar plate delamination with severe prepatellar bursitis and diffuse anterior soft tissue swelling.
Small to moderate joint effusion with reactive synovitis. No conspicuous internal debris or free bodies.
Diffuse periarticular soft tissue swelling.
Impressions
1. Crystal deposition arthropathy of the right knee (gout).
2. Marked severe infiltrative hypertrophic tendinosis with peritendinitis and interstitial splitting of the mid to distal quadriceps tendon and the entire patellar tendon.
3. Patellar plate delamination with severe prepatellar bursitis.
4. Severe infiltrative tendinosis of the popliteus with a punched-out cortical erosion and synovitis at its insertion on the popliteal hiatus.
5. Small to moderate joint effusion with reactive synovitis.
6. Diffuse periarticular soft tissue swelling.
7. Generalized lateral femorotibial class 2-3 chondromalacia.
