50-year-old male with decreased range of motion status post VMO repair (8/12/15) complicated by infection and surgical I&D (8/24/2015). Please note that exam is slightly limited due to patient motion.MENISCI: There is attenuation of the posterior horn of the medial meniscus that may in part reflect partial meniscectomy. There is, however, an irregular, somewhat jagged contour of the femoral articular surface of the medial meniscus at the body/posterior horn junction, suspicious for tearing. Mildly increased signal intensity within the posterior horn and body of the medial meniscus likely represents additional intrasubstance degeneration. The anterior horn root appears to be attached to a subcentimeter ossicle which may reflect prior trauma, but we cannot say with certainty whether this ossicle attaches to the medial tibial plateau.There is increased signal within the inner third of the body of the lateral meniscus which appears to extend to the tibial articular surface, likely representing a tear. There is also fraying of the undersurface of the lateral meniscus posterior horn.ARTICULAR CARTILAGE AND BONE: There is patchy edema within the medial and lateral femoral condyles extending to the articular surface and to a lesser degree within the proximal tibial meta-epiphysis and medial aspect of the patella. This is nonspecific but could represent bone contusions in the correct clinical setting. There is full-thickness articular cartilage loss along the far medial aspect of the patella. There is full-thickness cartilage degeneration along the weightbearing portions of the lateral femoral condyle and lateral tibial plateau adjacent to the posterior horn of the lateral meniscus. There may be full-thickness cartilage loss along the medial femoral condyle above the posterior horn of the meniscus on coronal T2 weighted images, however this is not confirmed on sagittal sequences.LIGAMENTS: Increased signal intensity within the proximal fibers of the lateral collateral ligament proper may represent prior degeneration or tearing. The biceps femoris and iliotibial band are intact. The MCL is intact. The ACL and PCL are intact.EXTENSOR MECHANISM: There is thickening of the quadriceps tendon which likely represents a combination of prior injury, tendinosis and prior surgery including VMO repair. Heterogeneous low and intermediate signal intensity tissue deep to the distal fibers of the VMO likely represents a combination of scar tissue and perhaps chronically torn tendon. Low signal intensity scar tissue extends from beneath the VMO along the anterior aspect of the suprapatellar pouch and also along the superior margin of Hoffa's fat pad to the ACL and anterior horn of the lateral meniscus. There is an additional intermediate signal intensity within the subcutaneous fat anterior to the extensor mechanism, also likely representing scar tissue. The patellar tendon appears normal.ADDITIONAL
1.Postsurgical changes of VMO repair and scar tissue within the joint (arthrofibrosis) as well as along the anterior aspect of the extensor mechanism as described above.2.Patchy edema-type signal within the femoral diaphysis and proximal tibia is of uncertain etiology and significance. This distribution would be atypical for red marrow but could conceivably represent prior bone contusions. Marrow infection is considered less likely.3.Probable medial and lateral meniscal tears as described above.4.Cartilage degeneration and other findings as described above.