Femoral trochlear dysplasia with tibial eminence fracture and chronic ACL tear

Case contributed by Dr Nafisa Shakir Batta

Presentation

Pain at knee joint, aggravated on walking

Patient Data

Age: 35
Gender: Male

Axial images reveal that the trochlear surface of  femoral condyle appears dyplastic with short sulcal depth, decreased medial facet length, lateralised patella, edematous medial retinaculum, scarring at medial patellofemoral ligament and articular cartilaginous edema & subchondral cyst at lateral undersurface of patella : findings consistent with femoral trochlear dysplasia with chronic lateral patellar instability

Coronal images show cortical breech at tibial eminence suggesting a depressed fracture extending in a posteromedial to anterolateral plane. Surprisingly no marrow edema is seen indicating a chronic pathology.

The ACL is mildly thickened and anteriorly bowed relative to the expected normal  taut, Blumensaats parallel morphology, hence suggstive of lowgrade partial thickness tear involving predominantly the posterolateral fibres.

The quadriceps and infrapatellar tendon show fibrillar morphology with insertional edema. Some interstitial edema is seen at the meniscofemoral deep attachment of MCL  with minimal fluid in the lateral recess of the suprapatellar pouch.

Case Discussion

This case reveals a medley of findings

  • femoral trochlear dysplasia
  • chronic lateral patellar instability
  • partial low grade ACL tear
  • insertional tendinosis at quadriceps and infrapatellar tendon
  • fracture of tibial eminence
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Case Information

rID: 24784
Case created: 12th Sep 2013
Last edited: 7th Dec 2016
Inclusion in quiz mode: Included

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