Left patella excision and knee reconstruction in April 2016 for malignant giant cell tumor, restaging Again seen are surgical changes of the knee including patellar resection and soft tissue reconstruction. The medial head of the gastrocnemius has been transposed as a flap along the anteromedial aspect of the proximal tibia. This graft is contiguous with a reconstructed extensor mechanism which can be traced to its insertion on the tibial tuberosity distally and the quadriceps tendon proximally. The reconstructed tendon appears thickened with heterogeneous increased signal on short TE sequences, which may represent degeneration or tendinosis but this appears similar to the prior examination and there is no evidence of a full-thickness tear.There is mild thickening and enhancement of the skin of the knee. Additionally, there is bandlike enhancing tissue traversing the subcutaneous fat of the knee which likely represents scarring. Heterogeneous enhancement of the reconstructed extensor tendon is noted with additional amorphous enhancement anterior to the biceps femoris muscle. Although it is impossible to exclude small tumoral deposits, this changes appears improved from the prior examination and likely represent scarring as there is no dominant focus of nodular enhancement to confirm recurrence.Metallic susceptibility artifact is seen along the anterior tibial tuberosity. There is a moderate-sized joint effusion with mild enhancement of the synovium indicating synovitis. The underlying bone marrow is of normal signal. There is diffuse edema of the subcutaneous fat which also appears improved from the prior exam.Although not tailored for the evaluation of the internal structures of the knee, the menisci and collateral ligaments appear intact.
Redemonstration of surgical changes relating to soft tissue reconstruction of the knee. Again seen is amorphous enhancement of the surrounding soft tissues but this has decreased from the prior examination and likely represents improving inflammation. Again, there is no dominant nodular focus of enhancement to suggest residual or recurrent disease although small tumoral deposits cannot entirely be excluded.