Reason: Left medial sided knee pain, hx lateral tibial plateau fx, evaluate for cause of pain History: above ARTICULAR CARTILAGE AND BONE: There is a comminuted intra-articular fracture of the proximal tibia. The fracture predominantly involves the lateral tibial plateau with downward sloping of the plateau posteriorly, resulting in approximately 1 cm of depression relative to the level of the medial tibial plateau. The fracture also extends in a sagittal plane into the anterior portion of the medial tibial condyle, but we see no depression or displacement of the medial condyle. There is signal abnormality within the articular cartilage overlying the posterior half of the lateral tibial plateau likely representing a combination of degeneration and tearing. The articular cartilage of the lateral femoral condyle appears relatively intact. We see no fluid-filled defects of the articular cartilage of the medial tibial plateau. Although the articular cartilage of the medial femoral condyle appears intact, there is subchondral edema within the weightbearing portion of the medial femoral condyle, which is associated with plaque-like low signal intensity along the subchondral bone plate. This is nonspecific and could reflect pre-existing degenerative changes, a healing impaction/stress fracture, or mild osteonecrosis. Other than mild superficial fraying of the articular cartilage along the medial facet of the patella, the patellofemoral articular cartilage appears normal.MENISCI: There is poorly defined increased signal intensity along the inferior aspect of the posterior horn of the medial meniscus indicating an undersurface tear involving both the central and peripheral portions of the meniscus. In addition, the body of the medial meniscus appears attenuated which may represent additional fraying or tearing. There is a 5 mm poorly defined low signal intensity focus along the medial aspect of the medial tibial plateau beneath the periphery of the body of the medial meniscus which may represent a small extruded meniscal fragment. The anterior horn appears intact. The anterior horn and body of the lateral meniscus appear intact. The majority of the posterior horn appears intact, although there is increased signal intensity within the root of the posterior horn extending to the superior margin of the meniscus which could represent partial-thickness tearing. The popliteomeniscal fascicles are also indistinct with intermediate signal intensity immediately posterior to the posterior horn of the lateral meniscus which may represent scar tissue.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The distal patellar tendon is slightly thickened with intrasubstance foci of high signal intensity likely reflecting tendinosis and perhaps interstitial tearing.ADDITIONAL
1. Comminuted intra-articular fracture of the proximal tibia with depression of the posterior aspect of the lateral tibial plateau and extension of the fracture into the medial tibial condyle as described above.2. Subchondral edema of the medial femoral condyle is nonspecific, but could reflect pre-existing degenerative changes, healing impaction/stress fracture, or mild spontaneous osteonecrosis.3. Medial meniscus tear as described above with possible displacement of a small flap of meniscal tissue into the medial gutter.4. Other findings as described above.