Case 04 - 70 year old female with knee pain
Case 4: 70 year old female with one month of worsening right knee pain. No history of trauma.
- This injury pattern looks very similar to the last two cases with prominent marrow edema throughout the medial femoral condyle and a low intensity fracture line undercutting the medial femoral cartilage.
- Given the atraumatic history, this is an example of a subchondral insufficiency fracture.
- The marrow edema is visible but the fracture line is hard to see on axial images.
- Once a subchondral fracture is identified, there are several important features to characterize for the surgeon: the size and location of the lesion, as well as the appearance of the overlying cartilage; the cartilage is best seen on proton density images and in this case, the cartilage adjacent to the fracture appears normal for age.
- It is also important to check for evidence of instability, which is indicated by fluid-signal adjacent to the fracture or frank displacement of the fracture fragment.
Findings such as in this case warrant a call to the referring physician and treatment with non-weight bearing to allow the fracture to heal without complications.
Accession: CL0038
Study description: MR KNEE RIGHT
Case discussion: