Reason: Right knee pain and swelling, history of ACL reconstruction 2008, microfracture and meniscectomy, evaluate for meniscus tear, healing of microfracture, new chondral injury History: Right knee pain MENISCI: There is deformity and abnormal signal intensity of the posterior horn and body of the medial meniscus that appears similar to that seen on the prior studies when accounting for technical differences which likely represents a combination of postoperative changes, degeneration, and chronic tearing. The anterior horn appears relatively preserved. There is increased signal intensity within the lateral meniscus indicating intrasubstance degeneration as well as a possible tiny horizontal tear along the undersurface of the posterior horn near its free edge.ARTICULAR CARTILAGE AND BONE: There is delamination of the articular cartilage of the lateral facet of the patella immediately lateral to the median eminence. There is additional thinning and degeneration of the articular cartilage of the patella; the articular cartilage along the medial facet is perhaps slightly thicker than on the prior examination, which may reflect the sequela of prior microfracture, but this is equivocal. There is progression of cartilage degeneration of the medial compartment with a large area along the posterior aspect of the weightbearing surfaces devoid of articular cartilage. There is mild edema within the underlying subchondral bone. There has also been progression of full-thickness degeneration of the articular cartilage of the lateral compartment, particularly adjacent to the posterior horn of the meniscus. There has been progression of tricompartmental osteophytes.LIGAMENTS: The intra-articular portion of the ACL graft seen on the prior study is no longer evident likely representing a tear. The PCL appears thickened likely representing mucoid degeneration. The MCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL
1. Progression of osteoarthritis as described above.2. Nonvisualization of the intra-articular portion of the ACL graft presumably representing rupture.3. Deformity and signal abnormality of the medial meniscus likely represents a combination of prior surgery, degeneration, and chronic tearing.4. Degeneration and perhaps a small horizontal tear of the lateral meniscus.5. Joint effusion, Baker's cyst, and other findings as described above.