Pain. Evaluate MPFL graft, cartilage MENISCI: There is mild increased signal intensity within the inner fibers of the posterior horn of the medial meniscus likely representing fraying of the free edge. There is also blunting of the free edge of the body of the medial meniscus with mild medial extrusion of the body that appears to progressed when compared with the prior study. The anterior horn appears intact, and I see no fluid-filled or otherwise unstable meniscal tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness fissuring of the articular cartilage of the medial facet of the patella that is new when compared with the prior study. There is adjacent superficial tearing of the articular cartilage that extends to the median eminence. The articular cartilage of the lateral facet appears relatively intact. There is thinning of the articular cartilage of the medial facet of the femoral trochlea that has progressed when compared with the prior study. The articular cartilage of the lateral facet appears relatively intact. There are rounded foci of signal abnormality within the subchondral bone of the weightbearing portion of the medial femoral condyle. I do not know whether these represent degenerative cysts or sites of prior microfracture. Edema extends superiorly from these rounded foci. The articular cartilage overlying these subchondral foci is thinned, with a near full-thickness defect noted just above the free edge of the posterior horn of the medial meniscus. There is also thinning of the articular cartilage of the medial tibial plateau which is new when compared with the prior study. There is mild heterogeneity of the signal of the articular cartilage of the lateral tibial plateau suggesting mild degeneration, particularly beneath the posterior horn of the lateral meniscus. There are small tricompartmental osteophytes.LIGAMENTS: The anterior cruciate ligament appears intact. The posterior cruciate ligament appears slightly elongated, perhaps due to old trauma, but otherwise intact. The superficial band of the medial collateral ligament appears intact. The lateral collateral ligament complex appears intact. There is a medial patellofemoral ligament graft, the posterior fibers of which contain intermediate signal intensity suggesting degeneration, but I see no full-thickness rupture. EXTENSOR MECHANISM: The patient has undergone a tibial tuberosity transfer. The distal patellar tendon appears thickened and is traversed by a linear focus of high signal intensity. I suspect this represent a combination of tendinosis and postsurgical changes, perhaps with focal insertional tearing. The proximal patellar tendon and the distal quadriceps tendon appear intact.ADDITIONAL
1.Surgical changes of MPFL graft, with intermediate signal intensity in the posterior fibers of the graft suggesting degeneration.2.Surgical changes of tibial tuberosity transfer with increased signal intensity in the distal patellar tendon suggesting tendinosis and perhaps focal insertional tearing.3. Overall progression of osteoarthritis/cartilage degeneration, particularly within the lateral patellofemoral joint, as described above.