Femoral trochlear dysplasia with tibial eminence fracture and chronic ACL tear

Axial images reveal that the trochlear surface of  femoral condyle appears dyplastic with short sulcal depth, decreased medial facet length, lateralized 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 fibers.

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.