Subchondral insufficiency fracture of the knee and complex meniscal tear
Presentation
Left knee pain for several weeks, has worsened.
Patient Data
Diagonal subchondral fracture in the inferior aspect of the medial femoral condyle (MFC), accompanied by extensive adjacent bone marrow edema. No articular surface collapse.
Diagonal subchondral fracture in the middle aspect of the medial tibial plateau, accompanied by extensive adjacent bone marrow edema. No joint surface collapse.
Subtle abnormal signal from the covering cartilage in the middle aspect of the medial tibial plateau, without clear evidence of defined focal cartilaginous defect.
The cruciate and collateral ligaments appear normal.
Extensive radial tear in the posterior horn of the medial meniscus adjacent to the posterior meniscal root. Partially avulsed meniscal fragment anterior to the tear, measuring 7 mm in the sagittal plane and 5 mm in the craniocaudal plane. Additionally, component of diagonal tear along the width of the posterior horn, continuing into the body of the meniscus.
Small amount of intra-articular fluid, without creation of a popliteal cyst.
The lateral meniscus and the patellar cartilage are preserved, the extensor mechanism appears normal.
In summary:
SIFK of the MFC and medial tibial plateau
complex medial meniscal tear
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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