Right knee contracture status post ACLR. Evaluate right knee for chondromalacia of medial femoral condyle 18 month status post microfracture. Scar tissue? Some sequences are limited by patient motion artifact. There are postoperative changes of anterior cruciate ligament reconstruction and microfracture of the medial femoral condyle. Thick bandlike low signal intensity extends from the inferior pole of the patella through Hoffa's fat pad indicating extensive scarring, extending to the anterior horns of both the medial and lateral menisci.MENISCI: As stated above, scar tissue extends to the anterior horn of the medial meniscus. The medial meniscus is otherwise unremarkable. Scar tissue also extends to the anterior horn of the lateral meniscus. There is intermediate to high signal intensity within the anterior horn of the lateral meniscus compatible with intrasubstance degeneration. This signal extends through the peripheral fibers of the anterior horn of the meniscus into the adjacent soft tissues representing extrusion of mucoid material. I do not see definite extension to either the tibial or femoral articular surfaces.ARTICULAR CARTILAGE AND BONE: Multiple small foci of subchondral signal abnormality are seen within the weightbearing portion of the medial femoral condyle, presumably representing the site of prior microfracture. There is edema within the adjacent bone marrow, of questionable significance. Cartilage overlies the microfracture site, and while I see no discrete fluid-filled defect, the cartilage is heterogeneous with foci of increased signal intensity that may reflect degeneration or simply relatively immature cartilage following microfracture. Overall, the thickness of the microfracture cartilage is similar to that of the adjacent native cartilage although it may be slightly thinned along the posterior medial aspect of the microfracture site. I see no fluid-filled defect within the tibial articular cartilage. The articular cartilage of the lateral femoral condyle is within normal limits. Focal increased signal intensity within the articular cartilage of the medial facet of the patella indicates focal degeneration.LIGAMENTS: The anterior cruciate ligament reconstruction graft appears intact although possibly slightly thinned at its femoral entry point. There are small cysts within the medial aspect of the lateral femoral condyle anterior to the graft and I cannot exclude the possibility of graft impingement. There is a laminar appearance of the posterior cruciate ligament that may reflect degeneration or prior injury. The medial collateral ligament appears normal. The lateral collateral complex appears normal. EXTENSOR MECHANISM: The quadriceps tendon appears normal. The patellar tendon appears slightly thickened which may reflect mild tendinosis or prior surgery.ADDITIONAL
1.Extensive scarring of Hoffa's fat pad with extension to the anterior horns of the medial and lateral menisci.2.Anterior cruciate ligament reconstruction with slight thinning of the ligament at its femoral entry point and small cysts anterior to the graft in the adjacent femur; while these findings may not be of any current clinical significance, I cannot exclude the possibility of graft impingement.3.Surgical changes of medial femoral condyle microfracture with edema in the adjacent bone marrow and heterogeneity of signal of the overlying cartilage that is nonspecific and may reflect degeneration or immaturity of microfracture cartilage.4.Degeneration of the anterior horn of the lateral meniscus and other findings as above.