Lipoma arborescens

Case contributed by Dr Bruno Di Muzio

Presentation

Chronic instability. Previous history of anterior cruciate ligament rupture.

Patient Data

Age: 50-year-old

Left knee radiographs

Modality: X-ray

Changes of early osteoarthritis are present in both the knee and patellofemoral joints. Signs of joint effusion. 

MRI Left knee

Modality: MRI

Moderately large joint expansion with an effusion and quite marked synovial proliferation containing fat deposits consistent with lipoma arborescence.

The anterior cruciate ligament shows chronic tear of its posterolateral bundle, the anteromedial bundle is intact. Posterior cruciate ligament is intact. Medial and lateral collateral ligaments are intact. Medial and lateral menisci are intact.

There is irregular loss of articular cartilage over both the medial and lateral femoral condyles more marked over the lateral femoral condyle with some irregular loss of cartilage of the lateral tibial plateau. Minimal marginal osteophytes of the femoral condyles and tibial plateau with a central osteophyte of the lateral femoral condyle.

Quadriceps tendon and patellar ligament show integrity and normal signal. Full thickness cartilage loss in both facets of the patellofemoral articulation, with subchondral cyst formation.

A bursal cyst emerges posteriorly into the popliteal fossa medial to the medial head of the gastrocnemius muscle. Popliteus tendon sheath is expanded with synovitis and fluid. Posterolateral and medial corners tendons are intact. 

Case Discussion

This case illustrates features suggesting tricompartmental osteoarthritis, more marked in the patellofemoral joint and lateral knee compartment. There is also lipoma arborescens that is most likely related to the osteoarthritis or to a chronic inflammatory condition. Findings of a chronic partial tear of the ACL (posterolateral bundle).

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Case Information

rID: 46413
Case created: 4th Jul 2016
Last edited: 18th Jul 2016
Tag: rmh
Inclusion in quiz mode: Included

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