MRI of the
.knee joint

DR.ABD-ELLAH NAZER. MD
INDICATIONS
 Knee joint complaint
• Pain

• Trauma

• Swelling

• Osteoarthritis


Suspected
Examination]
• Inflammation...
Protocol of examination
 Axial T1 localizer

 Sagittal T1, PD, T2
 Coronal gradient echo,
STIR
 If contrast is injecte...
How to know the pulse sequence?!

T1

T2

Gradient

STIR
Items to be evaluated
 Menisci (medial & lateral)
 Ligaments
- Cruciate (ACL, PCL)
- Collateral
- Retinacular
 Tendons ...
Meniscus
Medial meniscus
 Semilunar - shaped
Posterior horn wider,
longer,
taller
than
anterior horn
Posterior horn tig...
Lateral meniscus
 C- shape
 Posterior and anterior horns are symmetric
 Anterior horn may be hypo plastic,
extremely th...
B

A

C

B

A

C
Lateral meniscus
Medial meniscus
.Medial

and lateral meniscus
.Medial and lateral meniscus
Patellar retinacular ligaments
Collateral
Ligaments
Proton density coronal image shows the normal
medial collateral ligament as a thin, taut, well-defined,
low-signal structu...
Coronal and sagittal proton density image
demonstrating the normal lateral collateral
ligament in its entirety, from the f...
Meniscal
Lesions

Degeneration
 Tear
 Cyst
Discoid
Type I

Normal

Type II

Simple Tear

Complex Tear
Types of Meniscal degeneration
Grade I
 Grade II
 Meniscal fraying

Tear
 Grade 11 degeneration

 Grade 1 degeneration
Meniscal degeneration with free edge fraying
Meniscal degeneration with free edge fraying
Types of Meniscal Tears

Simple
 Complex
 Special types

Simple Meniscal Tears
Horizontal
 Vertical
 Radial

Horizontal tear
Horizontal tear
Horizontal tear
Vertical tear
Occurs typically in the outer 1/3 of
the posterior horn or body of the
meniscus
[rare in the anterior horn]
Vertical
tear
Vertical tear
Radial tear
[ Vertical tear of the free edge of the meniscus [ Root tear

Ghost meniscus
If there is no history of
Meniscal surgery and
the posterior horn is
absent near the
intercondylar notch

Ghost meniscus
Special Meniscal Tears
Flap
 Bucket handle
 MC separation

[ Flap tear [Oblique
Should have tow components , horizontal and
Vertical common in the medial meniscus
[Flap tear [Oblique
Bucket handle tear
[Small sized posterior horn [ sagittal
[Medially displaced fragment[ coronal
[Double PCL sign [ sagittal
Bucket Handel tear
Bucket Handel tear
Bucket Handel tear , Lateral meniscus

Flipped meniscus : Double Delta Sign
Flipped meniscus : Double Delta Sign
Flipped meniscus : Double Delta Sign
Flipped meniscus : Double Delta Sign
MENISCOCAPSULAR SEPARATION
Post-traumatic contusion
of the lateral femoral and
tibial condyles
Discoid meniscus
.Dysplastic meniscus with loss of normal semi lunar shape
.or more coverage of the tibial plateau 50%
Men...
Discoid meniscus
Discoid meniscus
Meniscal cyst
A Cyst extending from a meniscal tear
Common sites : Anterior horn LM , Posterior horn MM
Meniscal cyst
Meniscal
cyst
Ligamentous
Lesions


ACL

 PCL
 Collateral
 Retinacular
Anterior cruciate ligament
Anterior cruciate ligament
MRI shows the normal
linear low signal intensity
ACL adjacent to the
lateral bony wall of the
upper intercondylar
notch (a...
Anterior cruciate ligament

Posterior cruciate ligament
Anterior cruciate ligament injury
Primary signs [ In the ligament ]

In
te

rc

on
d

yl
a

r

ro
of

Total discontinuity
...
Anterior cruciate ligament injury
Anterior cruciate ligament injury
Normal ACL
Normal ACL

Non visualization of the ACL with a cloud of edema and hemorrhage
Anterior cruciate ligament injury

Secondary signs [ Outside the ligament ]
•
•
•
•
•
•
•
•

Blumensaat angle sign.
Bone c...
.Negative Blumensaat angle
.Positive Blumensaat angle
.ACL Graft with negative Blumensaat angle
The probability of an
ACL tear is very high
if both such bone
bruises are present,
only slightly lower if
the tibial bone ...
Anterior tibial translocation
”Anterior tibial translocation with” uncovered meniscus sign
Segond fracture
An elliptical vertically 3x10mm bone
fragment parallel to the lateral tibial
cortex, about 4mm distal to t...
Segond fracture in
patient with ACL tear.
T1- weighted coronal
MRI shows a small, lowsignal elongated
fracture fragment th...
ACL injury
ve+
PCL LINE SIGN
PCL redundancy as a secondary sign of ACL tear. This is a relatively
unreliable secondary sign of ACL tear.
Partial ACL tear
 Common about 10-43% of ACL tears
 Suboptimal accuracy of MRI
 Subtle 1ry and 2ry signs
 Focal angula...
Partial ACL tear

T1-weighted sagittal
MRI shows a normalappearing ACL.

T1-weighted sagittal MRI
image immediately
adjace...
Partial ACL tear
Partial ACL tear with thickening, angulations and abnormal bright signal
. inside. The tibial and femoral attachment is pr...
.Partial ACL tear with thickening and abnormal bright signal inside
.Partial ACL tear with diffuse thickening and abnormal signal inside
Chronic ACL Tear





Fragmented ACL [ common finding ]
Absent bone edema and contusions
Empty notch sign
ACL attached...
Empty notch sign

ACL tear on axial image showing nonvisualization of the anterior
cruciate ligament (ACL) in the upper in...
Chronic ACL tear, empty notch sign. T1-weighted
coronal MRI shows fat in the lateral intercondylar notch,
ACL is absent. T...
ACL Degeneration




Intra ligamentous cyst
May be mistaken for a tear
Arthroscopic decompression
Intercondylar notch cyst










1% of knee MRIs
Usually an incidental finding
Painful if erodes the bone
Post-t...
Intraligamentous ganglion cyst
Posterior cruciate ligament






The major stabilizer of the knee
Uniform low signal , no striations
Twice strong as ...
Proton-dense sagittal image demonstrates the normal
tibial insertion of the PCL. The insertion site is a
vertically inclin...
Posterior cruciate ligament



PCL injuries represent about 12% of knee injuries
Combined PCL injuries represent 97%
Wit...
NORMAL PCL

MR FINDINGS
Increased signal due to hemorrhage and edema
Diffuse enlargement of PCL

TORN PCL
COMPLETE PCL TEAR
An enlarged, intermediate signal
(obviously torn) PCL
NORMAL PCL

AVULSION TEAR
• Involves the tibial insertion
• Retracted bone fragment
• Bone marrow edema at avulsion site
•...
AVULSION PCL TEAR
AVULSION PCL TEAR
PARTIAL PCL TEAR
PD sagittal image shows partial tear
of the midsubstance of the PCL. The
normal ligament of Humphrey (small
arrow) is visu...
Collateral ligaments
MCL is about 8-11 cm
LCL is about 5-7 cm
Isolated injuries are rare,
usually with ACL and MM
Collateral ligaments
GRADING SYSTEM
Grade I : microscopic tear
Grade II :partial tear
Grade III : complete tear

Grade I,I...
Proton density coronal image
shows the normal medial
collateral ligament as a thin,
taut, well-defined, low-signal
structu...
Coronal and sagittal proton density image
demonstrating the normal lateral collateral
ligament in its entirety, from the f...
Grade I medial
collateral ligament tear
with surrounding
edema (straight arrows)
on a T2WI Note the
normal thickness and
s...
.Grade 1 sprain of the medial collateral ligament
.Grade 11 sprain of the medial collateral ligament
months after 7
conservative treatment

Grade II medial collateral ligament tear seen on a coronal
proton density image sho...
Grade II medial collateral ligament tear seen on a coronal T1 and
STIR images showing slight thickening of the medial coll...
.Grade 111 tear of the MCL
Grade III medial
collateral ligament
tear on a coronal fast

spin-echo T2-weighted
image demonstrates a
disrupted ligament...
Acute grade III tear with a folded ligament (arrow) and
surrounding edema on a coronal proton density image.
Acute tear of the proximal
portion of the lateral collateral
ligament is seen on this coronal
proton density image (white
...
Grade III
MCL tear with
retraction
Grade III MCL
tear with
abnormal
signal and
edema
.Grade 111 tear of the LCL
Ilio-tibial band syndrome. Distal tendon of IT fascia and insert at gerdy,s
.tubercle of the tibia. It occur in runner, cy...
(Pre-patellar bursitis.(housemaid bursitis
.Backer and Pes anserine cyst
Patellar and
quadriceps tendons
Patellar tendons
Complete tear of the patellar tendon with ACL tear
Complete tear of the patellar tendon with ACL tear
Partial tear of the patellar tendon
Lateral pressure syndrome





Thickening of the lateral retinaculum
Lateral knee pain
Obese, athletic patients
May be...
Patella alta








Sequlae of
patellofemoral
dysplasia
Lengthening of the
infrapatellar tendon
May be associated wit...
Patella Baja




Poliomyelitis
Achondroplasia
JRA
Hyaline cartilage
Hyaline cartilage
T2*

MT

Hyaline cartilage
Articular cartilage
MT

STIR
Chondromalacia patellae
Degeneration of the hyaline cartilage
Anterior knee pain in young adults

Four stages
Signal abnor...
Chondromalacia patella
Chondromalacia patella
Chondromalacia patella
Loose bodies
• Read with plain films
• Low signal fragments
Synovial osteochondromatosis
Loose bodies
Synovial osteochondromatosis
Metaplasia of subsynovial soft tissues
[Affects any joint [ knee , hip , elbow
Age incidence ...
Synovial chondromatosis
Synovial chondromatosis
Lipoma arborescens
Rare
Idiopathic
Fatty synovial infiltrations forming
variable sized villous projections
within
the join...
Lipoma
arborescens

Lipoma arborescence
Pigmented villo-nodular synovitis
 Idiopathic
 Monoarticular disease 1% incidence
 Hypertrophic synovial masses with he...
PIGMENTED VELLONODULAR
SYNOVITIS
PIGMENTED VILLONODULAR SYNOVITIS
PIGMENTED VILLONODULAR SYNOVITIS
VERSUS LIPOMA ARBORESCENS
Pigmented
villonodular
synovitis
POPLITEAL CYST
Fluid in the bursa which is usually
communicating with the joint space
Other names
Baker’s cyst
Gastrocnemi...
Medial plica syndrome
 Inflamed synovial plica causing pain , crepitus

and pseudolocking
 Often in adolescents and athl...
PLICA SYNDROME
Medial plica Syndrome
Osteochonddritis dissecans
 Osteochondral fragment in a typical location
 Young male
 Lateral aspect of the medial femo...
Osteochondritis Dissecans
Osteochondritis Dissecans along the medial femoral condyle
OSTEOCHONDRITIS DISSECANS
Red marrow recon version / marrow
lesion
Bone marrow contusion
Migratory osteoporosis
Bone infarcts
 Serpigenous lesions in the bone marrow
 Variable in size [ Chinese figures ]
 Double line sign is diagno...
BONE INFARCTS
BONE INFARCTS
BONE INFARCTS
Enchondroma
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  1. 1. MRI of the .knee joint DR.ABD-ELLAH NAZER. MD
  2. 2. INDICATIONS  Knee joint complaint • Pain • Trauma • Swelling • Osteoarthritis  Suspected Examination] • Inflammation • Tumors pathology [previous
  3. 3. Protocol of examination  Axial T1 localizer  Sagittal T1, PD, T2  Coronal gradient echo, STIR  If contrast is injected [ Axial, Sagittal ,coronal T1 WIs ]
  4. 4. How to know the pulse sequence?! T1 T2 Gradient STIR
  5. 5. Items to be evaluated  Menisci (medial & lateral)  Ligaments - Cruciate (ACL, PCL) - Collateral - Retinacular  Tendons ( Quadriceps, Pattelar)  Bones  Synovial effusion Where?! Sagittal PD Coronal. Sagittal,cornal and axial. Coronal Axial Sagittal PD Sagittal T1& T2 Sagittal T2
  6. 6. Meniscus Medial meniscus  Semilunar - shaped Posterior horn wider, longer, taller than anterior horn Posterior horn tightly attached to the capsule
  7. 7. Lateral meniscus  C- shape  Posterior and anterior horns are symmetric  Anterior horn may be hypo plastic, extremely thin  Discoid meniscus and meniscal cysts more common
  8. 8. B A C B A C
  9. 9. Lateral meniscus
  10. 10. Medial meniscus
  11. 11. .Medial and lateral meniscus
  12. 12. .Medial and lateral meniscus
  13. 13. Patellar retinacular ligaments
  14. 14. Collateral Ligaments
  15. 15. Proton density coronal image shows the normal medial collateral ligament as a thin, taut, well-defined, low-signal structure extending from the medial femoral epicondyle to the medial tibial metaphysis
  16. 16. Coronal and sagittal proton density image demonstrating the normal lateral collateral ligament in its entirety, from the femoral condyle origin to the fibular head insertion.
  17. 17. Meniscal Lesions Degeneration  Tear  Cyst Discoid
  18. 18. Type I Normal Type II Simple Tear Complex Tear
  19. 19. Types of Meniscal degeneration Grade I  Grade II  Meniscal fraying 
  20. 20. Tear
  21. 21.  Grade 11 degeneration  Grade 1 degeneration
  22. 22. Meniscal degeneration with free edge fraying
  23. 23. Meniscal degeneration with free edge fraying
  24. 24. Types of Meniscal Tears Simple  Complex  Special types 
  25. 25. Simple Meniscal Tears Horizontal  Vertical  Radial 
  26. 26. Horizontal tear
  27. 27. Horizontal tear
  28. 28. Horizontal tear
  29. 29. Vertical tear Occurs typically in the outer 1/3 of the posterior horn or body of the meniscus [rare in the anterior horn]
  30. 30. Vertical tear
  31. 31. Vertical tear
  32. 32. Radial tear [ Vertical tear of the free edge of the meniscus [ Root tear Ghost meniscus
  33. 33. If there is no history of Meniscal surgery and the posterior horn is absent near the intercondylar notch Ghost meniscus
  34. 34. Special Meniscal Tears Flap  Bucket handle  MC separation 
  35. 35. [ Flap tear [Oblique Should have tow components , horizontal and Vertical common in the medial meniscus
  36. 36. [Flap tear [Oblique
  37. 37. Bucket handle tear
  38. 38. [Small sized posterior horn [ sagittal [Medially displaced fragment[ coronal [Double PCL sign [ sagittal
  39. 39. Bucket Handel tear
  40. 40. Bucket Handel tear
  41. 41. Bucket Handel tear , Lateral meniscus Flipped meniscus : Double Delta Sign
  42. 42. Flipped meniscus : Double Delta Sign
  43. 43. Flipped meniscus : Double Delta Sign
  44. 44. Flipped meniscus : Double Delta Sign
  45. 45. MENISCOCAPSULAR SEPARATION
  46. 46. Post-traumatic contusion of the lateral femoral and tibial condyles
  47. 47. Discoid meniscus .Dysplastic meniscus with loss of normal semi lunar shape .or more coverage of the tibial plateau 50% Meniscal body segment seen in 3 or more sagittal images
  48. 48. Discoid meniscus
  49. 49. Discoid meniscus
  50. 50. Meniscal cyst A Cyst extending from a meniscal tear Common sites : Anterior horn LM , Posterior horn MM
  51. 51. Meniscal cyst
  52. 52. Meniscal cyst
  53. 53. Ligamentous Lesions  ACL  PCL  Collateral  Retinacular
  54. 54. Anterior cruciate ligament
  55. 55. Anterior cruciate ligament
  56. 56. MRI shows the normal linear low signal intensity ACL adjacent to the lateral bony wall of the upper intercondylar notch (arrow). The normal ACL moves away from the wall and diverges into multiple fascicles on more distal images.
  57. 57. Anterior cruciate ligament Posterior cruciate ligament
  58. 58. Anterior cruciate ligament injury Primary signs [ In the ligament ] In te rc on d yl a r ro of Total discontinuity Abnormal signal Abnormal configuration Abrupt angulation Wavy appearance Abnormal axis
  59. 59. Anterior cruciate ligament injury
  60. 60. Anterior cruciate ligament injury
  61. 61. Normal ACL
  62. 62. Normal ACL Non visualization of the ACL with a cloud of edema and hemorrhage
  63. 63. Anterior cruciate ligament injury Secondary signs [ Outside the ligament ] • • • • • • • • Blumensaat angle sign. Bone contusions [Pivot- shift bruises ] Anterior translocation of the tibia Uncovered meniscus sign Avulsion fracture of the tibial insertion Segond fracture 70-100% with ACL tear PCL buckling Hyperextension ACL tear with ." "kissing bone bruises PCL line sign
  64. 64. .Negative Blumensaat angle
  65. 65. .Positive Blumensaat angle
  66. 66. .ACL Graft with negative Blumensaat angle
  67. 67. The probability of an ACL tear is very high if both such bone bruises are present, only slightly lower if the tibial bone bruise is present in isolation, and still slightly lower with an isolated femoral bone bruise of this appearance.
  68. 68. Anterior tibial translocation
  69. 69. ”Anterior tibial translocation with” uncovered meniscus sign
  70. 70. Segond fracture An elliptical vertically 3x10mm bone fragment parallel to the lateral tibial cortex, about 4mm distal to the plateau. Best seen on AP or tunnel radiographic views association with ACL tear 100% -75
  71. 71. Segond fracture in patient with ACL tear. T1- weighted coronal MRI shows a small, lowsignal elongated fracture fragment that is parallel to the lateral tibia. The association of Segond fractures with ACL tears approaches 100%.
  72. 72. ACL injury
  73. 73. ve+ PCL LINE SIGN
  74. 74. PCL redundancy as a secondary sign of ACL tear. This is a relatively unreliable secondary sign of ACL tear.
  75. 75. Partial ACL tear  Common about 10-43% of ACL tears  Suboptimal accuracy of MRI  Subtle 1ry and 2ry signs  Focal angulations  Focal increase T2 signal [non specific ]  Single bundle sign Sagittal MRI shows an abruptly angulated mid-ACL (arrow) .A wavy or sharply angulated appearance is abnormal.
  76. 76. Partial ACL tear T1-weighted sagittal MRI shows a normalappearing ACL. T1-weighted sagittal MRI image immediately adjacent to the previous image shows a partially disrupted ACL
  77. 77. Partial ACL tear
  78. 78. Partial ACL tear with thickening, angulations and abnormal bright signal . inside. The tibial and femoral attachment is preserved
  79. 79. .Partial ACL tear with thickening and abnormal bright signal inside
  80. 80. .Partial ACL tear with diffuse thickening and abnormal signal inside
  81. 81. Chronic ACL Tear     Fragmented ACL [ common finding ] Absent bone edema and contusions Empty notch sign ACL attached to PCL
  82. 82. Empty notch sign ACL tear on axial image showing nonvisualization of the anterior cruciate ligament (ACL) in the upper intercondylar notch A large knee effusion and a Baker cyst are noted incidentally.
  83. 83. Chronic ACL tear, empty notch sign. T1-weighted coronal MRI shows fat in the lateral intercondylar notch, ACL is absent. This is a frequent MRI appearance of a chronic ACL tear after resolution of acute edema and hemorrhage.
  84. 84. ACL Degeneration    Intra ligamentous cyst May be mistaken for a tear Arthroscopic decompression
  85. 85. Intercondylar notch cyst         1% of knee MRIs Usually an incidental finding Painful if erodes the bone Post-traumatic chronic partial cruciate ligament tear with internal degeneration More common in the ACL Oval , rounded may be multilocular Rim enhancement if inflamed Arthroscopic drainage Cruciate ligament cyst
  86. 86. Intraligamentous ganglion cyst
  87. 87. Posterior cruciate ligament     The major stabilizer of the knee Uniform low signal , no striations Twice strong as the ACL The menisco-femoral ligaments are intimately related to PCL. They connect the posterior horn of the lateral meniscus to the medial femoral condyle Ligament of Humphrey anterior to PCL Ligament of Wrisberg posterior to PCL
  88. 88. Proton-dense sagittal image demonstrates the normal tibial insertion of the PCL. The insertion site is a vertically inclined posterior to the articular surface.
  89. 89. Posterior cruciate ligament   PCL injuries represent about 12% of knee injuries Combined PCL injuries represent 97% With ACL 65% With MCL 50% With MM 30% TYPES OF PCL INJURES Complete tear 40% Partial tear 55% Avulsion tear 7%
  90. 90. NORMAL PCL MR FINDINGS Increased signal due to hemorrhage and edema Diffuse enlargement of PCL TORN PCL
  91. 91. COMPLETE PCL TEAR
  92. 92. An enlarged, intermediate signal (obviously torn) PCL
  93. 93. NORMAL PCL AVULSION TEAR • Involves the tibial insertion • Retracted bone fragment • Bone marrow edema at avulsion site • The actual PCL may be normal
  94. 94. AVULSION PCL TEAR
  95. 95. AVULSION PCL TEAR
  96. 96. PARTIAL PCL TEAR
  97. 97. PD sagittal image shows partial tear of the midsubstance of the PCL. The normal ligament of Humphrey (small arrow) is visualized better because it is adjacent to the high signal intensity edema of the torn PCL. PARTIAL PCL TEAR
  98. 98. Collateral ligaments MCL is about 8-11 cm LCL is about 5-7 cm Isolated injuries are rare, usually with ACL and MM
  99. 99. Collateral ligaments GRADING SYSTEM Grade I : microscopic tear Grade II :partial tear Grade III : complete tear Grade I,II and isolated grade III are treated conservatively, while grade III tears associated with ACL tears are treated by repairing ACL only
  100. 100. Proton density coronal image shows the normal medial collateral ligament as a thin, taut, well-defined, low-signal structure extending from the medial femoral epicondyle to the medial tibial metaphysis
  101. 101. Coronal and sagittal proton density image demonstrating the normal lateral collateral ligament in its entirety, from the femoral condyle origin to the fibular head insertion.
  102. 102. Grade I medial collateral ligament tear with surrounding edema (straight arrows) on a T2WI Note the normal thickness and signal of the medial collateral ligament and continued close apposition to the femoral and tibial cortices.
  103. 103. .Grade 1 sprain of the medial collateral ligament
  104. 104. .Grade 11 sprain of the medial collateral ligament
  105. 105. months after 7 conservative treatment Grade II medial collateral ligament tear seen on a coronal proton density image shows slight thickening of the medial collateral ligament and separation from the underlying cortices. Bone marrow edema of the lateral tibial plateau is seen due to valgus stress
  106. 106. Grade II medial collateral ligament tear seen on a coronal T1 and STIR images showing slight thickening of the medial collateral ligament and separation from the underlying cortices.
  107. 107. .Grade 111 tear of the MCL
  108. 108. Grade III medial collateral ligament tear on a coronal fast spin-echo T2-weighted image demonstrates a disrupted ligament that is thickened and retracted with surrounding edema (black arrow).
  109. 109. Acute grade III tear with a folded ligament (arrow) and surrounding edema on a coronal proton density image.
  110. 110. Acute tear of the proximal portion of the lateral collateral ligament is seen on this coronal proton density image (white arrow). Note the associated grade II medial collateral ligament tear.
  111. 111. Grade III MCL tear with retraction
  112. 112. Grade III MCL tear with abnormal signal and edema
  113. 113. .Grade 111 tear of the LCL
  114. 114. Ilio-tibial band syndrome. Distal tendon of IT fascia and insert at gerdy,s .tubercle of the tibia. It occur in runner, cyclists, football players and weight lifter
  115. 115. (Pre-patellar bursitis.(housemaid bursitis
  116. 116. .Backer and Pes anserine cyst
  117. 117. Patellar and quadriceps tendons
  118. 118. Patellar tendons
  119. 119. Complete tear of the patellar tendon with ACL tear
  120. 120. Complete tear of the patellar tendon with ACL tear
  121. 121. Partial tear of the patellar tendon
  122. 122. Lateral pressure syndrome     Thickening of the lateral retinaculum Lateral knee pain Obese, athletic patients May be associated with chondromalacia
  123. 123. Patella alta     Sequlae of patellofemoral dysplasia Lengthening of the infrapatellar tendon May be associated with chondromalacia Length of patellar tendon/ length of patella > 1.3
  124. 124. Patella Baja    Poliomyelitis Achondroplasia JRA
  125. 125. Hyaline cartilage
  126. 126. Hyaline cartilage
  127. 127. T2* MT Hyaline cartilage
  128. 128. Articular cartilage
  129. 129. MT STIR
  130. 130. Chondromalacia patellae Degeneration of the hyaline cartilage Anterior knee pain in young adults Four stages Signal abnormalities Ulceration [ fraying , partial or full thickness defects ] Reactive bone changes [ edema , cyst formation , sclerosis ] Osteoartheritic changes
  131. 131. Chondromalacia patella
  132. 132. Chondromalacia patella
  133. 133. Chondromalacia patella
  134. 134. Loose bodies • Read with plain films • Low signal fragments Synovial osteochondromatosis
  135. 135. Loose bodies
  136. 136. Synovial osteochondromatosis Metaplasia of subsynovial soft tissues [Affects any joint [ knee , hip , elbow Age incidence 40 years M:F=2:1 FINDINGS Widening of the joint space Bone erosions Intra articular loose bodies Secondary osteoartheritic changes cartilage formation
  137. 137. Synovial chondromatosis
  138. 138. Synovial chondromatosis
  139. 139. Lipoma arborescens Rare Idiopathic Fatty synovial infiltrations forming variable sized villous projections within the joint capsule commonly in the supra- patellar pouch Associated with joint effusion Painless swelling Treatment by synovectomy
  140. 140. Lipoma arborescens Lipoma arborescence
  141. 141. Pigmented villo-nodular synovitis  Idiopathic  Monoarticular disease 1% incidence  Hypertrophic synovial masses with hemosiderin     laden macrophages bone erosions Intermediate signal in T1 and low signal in T2 with enhancement after contrast injection Typical location posterior to Hoffa’s fat pad Painless swelling , pain with progressive disease Treatment by synovectomy
  142. 142. PIGMENTED VELLONODULAR SYNOVITIS
  143. 143. PIGMENTED VILLONODULAR SYNOVITIS
  144. 144. PIGMENTED VILLONODULAR SYNOVITIS VERSUS LIPOMA ARBORESCENS
  145. 145. Pigmented villonodular synovitis
  146. 146. POPLITEAL CYST Fluid in the bursa which is usually communicating with the joint space Other names Baker’s cyst Gastrocnemius/semimembranosus bursa
  147. 147. Medial plica syndrome  Inflamed synovial plica causing pain , crepitus and pseudolocking  Often in adolescents and athletics  No measurement for plica thickness Four types of plica Suprapatellar 90% Medial 15 -30% Infrapatellar Lateral [ rare]
  148. 148. PLICA SYNDROME
  149. 149. Medial plica Syndrome
  150. 150. Osteochonddritis dissecans  Osteochondral fragment in a typical location  Young male  Lateral aspect of the medial femoral condoyle  Variable sized fragment attached or detached  Criteria of unstable fragment Large size more than 1cm Fluid between the fragment and donor bone Cystic changes at the donor site Enhancement of the separation line
  151. 151. Osteochondritis Dissecans
  152. 152. Osteochondritis Dissecans along the medial femoral condyle
  153. 153. OSTEOCHONDRITIS DISSECANS
  154. 154. Red marrow recon version / marrow lesion
  155. 155. Bone marrow contusion
  156. 156. Migratory osteoporosis
  157. 157. Bone infarcts  Serpigenous lesions in the bone marrow  Variable in size [ Chinese figures ]  Double line sign is diagnostic [peripheral hyperintense with hypointense inner border on T2  CAUSES POSTTRAUMATIC STEROIDS COLLAGEN DISEASES ALCOHOLISM PANCREATITIS SPONTANEOUS
  158. 158. BONE INFARCTS
  159. 159. BONE INFARCTS
  160. 160. BONE INFARCTS
  161. 161. Enchondroma
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