Subchondral insufficiency fracture of the knee and complex meniscal tear

Case contributed by Yaïr Glick
Diagnosis certain

Presentation

Left knee pain for several weeks, has worsened.

Patient Data

Age: 65 years
Gender: Female

Diagonal subchondral fracture in the inferior aspect of the medial femoral condyle (MFC), accompanied by extensive adjacent bone marrow edema. No articular surface collapse.

Case Discussion

Worsening pain in the left knee, present for several weeks. Treated with an intra-articular NSAID injection to no avail. Walks with a limp, full range of motion. Significant tenderness over the medial meniscus. X-ray study (not available) - no evidence of osteoarthrosis. Referred for knee MRI to assess for avascular necrosis (AVN) of the middle femoral condyle (MFC).

MRI showed subchondral insufficiency fracture of both the MFC and the medial tibial plateau, plus a complex medial meniscal tear in-between, which may have developed earlier than the fractures.

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