56-year-old female with skiing injury, twisted knee, evaluate, MCL, patella, ACL MENISCI: Again seen is a horizontal cleavage tear of the posterior horn and body of the medial meniscus extending to the tibial articular surface, appearing similar to the prior exam. Globular and linear signal abnormality within the body and posterior horn of the lateral meniscus also appears similar to the prior exam and is compatible with intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: Increased signal intensity within the articular cartilage of the lateral facet of the patella likely represents full-thickness degeneration with cyst formation in the underlying subchondral bone. This was present on the prior exam. There is focal, new full-thickness degeneration of the articular cartilage along the median eminence along with multiple additional new partial thickness clefts. The tibiofemoral articular cartilage appears relatively intact.There is edema within the anterolateral aspect of the medial patella and within the lateral aspect of the lateral femoral condyle likely representing contusions from recent transient patellar dislocation. The cortex along the anteromedial patella appears discontinuous, which may represent a small avulsion fracture.There is flattening of the femoral trochlea superiorly, indicating dysplasia. Slight lateral tracking of the patella relative to the center of the trochlea is noted. The Insall-Salvati ratio measures 1.4, indicating mild patella alta. The tibial tubercle to trochlea groove distance measures 16 mm, which is borderline elevated, not accounting for tilt of the knee within the scanner.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. There is thickening and edema within the medial patellar retinaculum at its patellar attachment, likely representing a tear. The posterior fibers of the medial patellar retinaculum are also not well visualized which could indicate a chronic tear, but this is equivocal.ADDITIONAL
1. Findings compatible with recent transient patella dislocation including what we suspect is a small avulsion fracture of the medial patella and injury to the medial patellar retinaculum as described above.2. Femoral trochlear dysplasia, slight patella alta, and slightly increased tibial tubercle to trochlea groove distance.3. Hemarthrosis.4. Progression of articular cartilage degeneration of the patella.5. Horizontal cleavage tear of the medial meniscus appearing similar to the prior exam.