Osteochondritis dissecans of the medial femoral condyle with a MCL tear and radial tear of the PHMM

Case contributed by Mohammad A. ElBeialy
Diagnosis almost certain

Presentation

14 years old karate player with sport-induced knee pain for the last 12 days.

Patient Data

Age: 14 years.
Gender: Male
  • a peripheral radial tear is seen as an oblique band of increased signal intensity within the posterior horn medial meniscus with disruption of both articular surfaces. 
  • intact anterior horn medial meniscus and lateral menisci.
  • a small osteochondral lesion of the lateral aspect of medial femoral condyle is seen with subchondral edematous marrow changes demonstrating low T1 and high PD FS / STIR signal intensity.
  • no articular disruption or loose fragment.
  • high grade partial thickness tear of the tibial attachment of the medial collateral ligament.
  • intact lateral collateral ligament and cruciate ligaments.
  • minimal joint effusion. 
  • marrow edema signal of the lateral femoral condyle and posterior tibial plateau with patchy area of low T1 and high STIR signal.

Case Discussion

This case shows a constellation of findings in knee trauma: 

  • peripheral radial tear of the PHMM. 
  • medial femoral condyle osteochondritis dissecans (OCD) with subchondral edematous marrow signal as well as marrow edema signal of the lateral femoral condyle and posterior tibial plateau.
  • high grade partial thickness tear of the medial collateral ligament.
  • minimal joint effusion.

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