Continued right knee pain 6 months status post microfracture of patella, trochlea and medial femoral condyle. No improvement with surgery, physical therapy, injections. Evaluate healing of microfracture. MENISCI: The anterior horn and body of the lateral meniscus appear more attenuated on the current study that on the prior study which I suspect reflects interval partial meniscectomy, although I cannot entirely exclude the possibility of progression of attritional tearing. Persistent enlargement of the peripheral aspect of the body of the lateral meniscus may reflect displaced meniscal tissue in the lateral gutter, but this appears similar to that seen on the prior study. The posterior horn appears slightly attenuated, likely reflecting prior meniscectomy, appearing similar to the prior study.There is blunting of the anterior horn of the medial meniscus that appears similar to that seen on the prior study and may represent an old tear or partial meniscectomy. The signal abnormality seen within the anterior horn of the medial meniscus on the prior study, however, is less prominent on the current study which may reflect interval surgery. The remainder of the medial meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the patella lateral to the median eminence that appears more pronounced on the current study than on the prior study. There is also a full-thickness cleft through this degenerated cartilage, best seen on the sagittal images, that was not clearly evident on the prior study. I see no underlying bone marrow signal abnormality. Heterogeneity of the articular cartilage of the femoral trochlea centrally appears to have progressed when compared with the prior study, which may reflect interval surgery; however, there remain near-full-thickness/full-thickness clefts of the articular cartilage. Underlying bone marrow signal intensity is normal. Focal signal abnormality within the articular cartilage of the medial femoral condyle just posterior to the anterior horn of the meniscus with mild degenerative edema type signal in the underlying subchondral bone appears similar to that seen on the prior study, compatible with focal cartilage degeneration. The previously seen focus of full-thickness cartilage degeneration along the posterior aspect of the lateral femoral condyle with degenerative signal abnormality in the underlying subchondral bone is less pronounced on the current study on the prior study; however, there is new focal delamination of the articular cartilage of the lateral femoral condyle just above the free edge of the posterior horn of the lateral meniscus.LIGAMENTS: The anterior cruciate ligament graft appears intact. The previously seen presumably bioabsorbable anchor in the tibia is now partially replaced with fluid signal intensity. Signal abnormality within the marrow along the femoral tunnel appears similar to the prior study and is of doubtful significance. Intermediate signal intensity seen along the anterior aspect of the graft on the prior study is no longer evident, perhaps due to interval surgery. The posterior cruciate ligament appears intact. The medial collateral ligament appears intact. The lateral collateral ligamentous complex appears intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL
1.Tricompartmental cartilage degeneration as described above, with most of degenerative foci showing progression or no change when compared with the prior study.2.Meniscal abnormalities as described above that I suspect reflect prior meniscectomy; I see no definite new or recurrent tear.3.Anterior cruciate ligament reconstruction and other findings as described above.