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ABSTRACT |
Monday, May 1, 10:00 AM–12:00 PM
Abstracts 001–012
Moderators: Hilary R. Umans, MD and Derek R. Armfield, MD
10:00 AM
001. MR Findings of Extruded Medial Menisci Correlated with Arthroscopy MR Findings of Extruded Medial Menisci Correlated with Arthroscopy
Magee T.H.*; Radiology, Neuroskeletal Imaging, Merritt Island, FL.
Address correspondence to T.H. Magee (tmageerad{at}cfl.rr.com)
Objective: Meniscal extrusion (greater than 3-mm extension beyond the tibial margin) has been described on previous studies as having a high index of association with meniscal root tears. These previous studies were limited by a lack of exact arthroscopic correlation. We correlated MR exams with meniscal extrusions greater than 3 mm beyond the tibial margin and correlated MR findings with arthroscopic findings.
Materials and Methods: A retrospective review of 300 consecutive knee MR exams was performed. All patients had a complete MR exam performed on a 3 Tesla GE MR. MR exams were reviewed for medial meniscal extrusion greater than 3 mm from the tibial margin.
Results: Forty two of the MR exams demonstrated medial meniscal extrusion greater than 3 mm from the tibial margin. Thirty three of these patients had meniscal degeneration, complex tear or a large radial tear involving the meniscal root on arthroscopy. Nine of these patients had no meniscal tear demonstrated on arthroscopy despite MR findings consistent with degenerative tearing at the meniscal root using currently accepted MR criteria for such. Four of the nine arthroscopy reports indicated there was no evidence of medial subluxation of the meniscus. All nine of these patients were fifty years or greater in age.
Conclusion: There may be a subset of patients in which the meniscal root is stretched rather than torn. Additionally there may be some dynamic subluxation of the meniscus resulting in intermittent extrusion. This is not evident on static MR images but is evident on arthroscopy. Medial meniscal extrusion in patients greater than age 50 may be a significant source of false positive readings of meniscal tears on MR examinations as compared with arthroscopy.
002. MRI Analysis of Patellar and Femoral Rotation During Upright, Weight-Bearing Knee Flexion
Epstein N.J.1*; Besier T.F.2; Draper C.E.2; Yoon K.3; Fredericson M.3; Beaupre G.S.3; Delp S.L.2; Gold G.E.1; 1. Radiology, Stanford University School of Medicine, Stanford, CA; 3. Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA; 2. Bioengineering, Stanford University School of Medicine, Stanford, CA.
Address correspondence to N.J. Epstein (nepstein{at}stanford.edu)
Objective: The purpose of this study was to assess patellar and femoral rotation during weight-bearing knee flexion in patients with patellofemoral pain (PFP) and in asymptomatic controls.
Materials and Methods: Forty subjects (23 with PFP and 17 healthy controls) were scanned upright at 30 degrees of knee flexion in loaded and unloaded conditions. MR scanning was performed in a 0.5-T GE Signa SP open scanner (GE Healthcare, Milwaukee, WI) using a custom back support. This device enabled subjects to sit on a small seat while in the unloaded state and in a loaded state when the seat was removed. A 3D fast spoiled gradient echo (SPGR) sequence was employed to obtain 2-mm contiguous sagittal plane images of the subject's patellofemoral joint. Each scan took 2:13 min using the following parameters: TR = 33 ms, TE = 9 ms, flip angle = 45°, NEX = 1, field of view = 20 cm x 20 cm, matrix dimensions = 256 x 160, interpolated to 256 x 256. Axial images were acquired by re-formatting the source images. Image slices of 2 mm were taken perpendicular to the patellofemoral articulation at the level of the intercondylar eminence. Images were analyzed using MAT-LAB (Mathworks, Inc., Natick, MA). We compared the change in patellar rotation (PR) and femoral rotation (FR) relative to the image plane from non-weight bearing to weight bearing.
Results: Both PFP and control subjects showed variability in the change of femoral and patellar rotation from non-weight-bearing to weight-bearing. Fifty-two percent (21/40) of subjects had a change in the PR of < 5 degrees while forty-eight percent (19/40) had a change in PR of > 5 degrees (range 5–12). Fifty-five percent (22/40) had a change in the FR < 5 degrees while forty-five percent (18/40) had a change > 5 degrees (range 5–15). There was no difference detected in the direction or amount of rotation between control and PFP patients.
Conclusion: No prior studies have analyzed the effects of upright weight-bearing on patellofemoral rotation during flexion. Our data indicate that femoral and patellar rotation are affected by weight-bearing in both controls and subjects with PFP. These results suggest that unloaded radiographic analysis may not be sufficient to demonstrate these changes.
003. The MR Appearance of PCL Tears: New Observations
Rodriguez W.1*; Helms C.A.1; Vinson E.N.1; Toth A.P.2; Higgins L.D.2; 1. Radiology, Duke University Medical Center, Durham, NC; 2. Orthopaedic Surgery, Duke University Medical Center, Durham, NC.
Address correspondence to W. Rodriguez (willpower95{at}yahoo.com)
Objective: The posterior cruciate ligament (PCL) has become an increasingly popular subject of orthopaedic research and debate. With improved techniques in imaging and the increasing recognition of multi-ligament knee injuries, injury to the PCL is diagnosed more frequently. There is little in the literature regarding the appearance of the torn PCL on MRI. The purpose of this study is to describe the MR appearance of surgically proven acute PCL tears and to emphasize previously unreported signs.
Materials and Methods: The preoperative MR exams of 36 patients with surgically proven PCL tears were retrospectively reviewed by two MSK-trained radiologists. The PCL was assessed for thickness in the sagittal plane and for its relative signal intensity on fat-suppressed proton density (PDW) and T2-weighted (T2W) images. Note was made of avulsion from the tibia or femur and of associated injuries in other ligaments. In a separate cohort, 200 consecutive knee MR exams without a known PCL injury were retrospectively evaluated for PCL thickness in the sagittal plane.
Results: In the patients with acute PCL tears, the average PCL thickness in the sagittal plane was 9.8 mm (range of 6–15 mm), with 34/36 (94%) measuring greater than 6 mm. In the cohort of 200 patients without PCL injury, only 8 (4%) had PCL thickness in the sagittal plane greater than 6 mm. Acute PCL tears also demonstrated intermediate to near fluid signal intensity on the sagittal PDW images. In most cases, the T2W images demonstrated intermediate or low signal intensity within the PCL, with only 3/36 (8%) demonstrating fluid signal within the substance of the ligament on T2W images. In 30/36 (83%) cases, the signal intensity of the PCL on T2W images was lower than that on PDW images. Few PCL tears were isolated, with only 3/36 (8%) cases with no other ligamentous injuries. 2/36 (5%) cases showed an avulsion of the PCL from the tibia, and 5/36 (14%) showed avulsion from the femoral attachment.
Conclusion: The typical appearance of an acute PCL tear on MRI includes thickening greater than 6 mm as measured in the sagittal plane, seen in 94% of the cases in this series. Most of the acutely torn posterior cruciate ligaments demonstrated intrasubstance intermediate signal intensity on the PDW and T2W images, with lower signal intensity on the T2W images. Avulsion from the tibia or femur is a relatively uncommon finding. Discontinuity of the PCL is not a typical feature. Recognition of these findings will improve our ability to preoperatively diagnose PCL tears.
004. The Determination of Patellar Malalignment and Associated Soft Tissue Abnormalities with MR Imaging
O'Brien S.D.1*; Vinson E.N.1; Helms C.A.1; Garrett W.E.2; Wittstein J.R.2; 1. Radiology, Duke University Medical Center, Durham, NC; 2. Orthopedic Surgery, Duke University Medical Center, Durham, NC.
Address correspondence to S.D. O'Brien (seth_obrien_1999{at}yahoo.com)
Objective: Patellar malalignment is a common cause of anterior knee pain. Although there are reports of using various modalities to determine patellar malalignment, to our knowledge there are no studies investigating the use of MRI to evaluate both patellar malalignment and soft tissue abnormalities associated with excessive lateralization of the patellar tendon insertion.
Materials and Methods: The preoperative knee MRI exams of 13 patients with patellar malalignment requiring surgical medialization of the distal patellar tendon insertion were retrospectively evaluated by two musculoskele-tal-trained radiologists in consensus. We assessed the degree of lateralization of the distal patellar tendon insertion relative to the position of the center of the trochlear groove on axial images. We noted associated findings of edema in the superolateral aspect of Hoffa's fat, lateral patellar cartilage abnormalities, and lateral trochlear cartilage abnormalities. As a control population, the degree of distal patellar tendon insertion lateralization was assessed in 34 consecutive knee MRI exams in which there was no lateral patellofemoral cartilage abnormalities or superolateral Hoffa's fat edema.
Results: In the control population, the distal patellar tendon inserted an average of 11.3 mm (range 4.1 to 24.3 mm) lateral to the level of the trochlear groove. In the patients who eventually underwent patellar tendon medialization, the distal patellar tendon inserted an average of 19.3 mm (range 10.4 to 34.1 mm) lateral to the trochlear groove. 10/13 (76.9%) of these studies demonstrated edema in the superolateral aspect of Hoffa's fat, 7/13 (53.8%) demonstrated lateral patellar facet cartilage abnormalities, and 7/13 (53.8%) demonstrated lateral trochlear groove cartilage abnormalities. 12/13 (92.3%) demonstrated either edema in the superolateral aspect of Hoffa's fat or lateral patellofemoral cartilage abnormalities.
Conclusion: The degree of lateralization of the distal patellar tendon insertion is easily assessed on axial MR images, and is consistently increased in patients requiring medialization of the distal patellar tendon due to excessive lateral patellofemoral pressure, compared with a control population. Associated soft tissue abnormalities, including edema in the superolateral aspect of Hoffa's fat and lateral patellofemoral cartilage abnormalities, are commonly present in these patients and are also easily assessed by MRI.
005. Analysis of the Posterior Cruciate Ligament of the Knee in Ultrasound – Anatomical and Clinical Study. Diagnostic Value of PCL's Thickness and Bowing Ratio
Dzianach M.P.1*; Piontek T.2; Owczarski T.3; Czwojdzinski A.4; Siwinski D.5; Sosnowski P.1; Juszkat R.1; 1. Department of Radiology, University of Medical Sciences, Poznan, Poland; 2. Paediatric Orthopaedic Clinic, University of Medical Sciences, Poznan, Poland; 3. Department of Orthopaedic Surgery, Orthopaedic Hospital, Poznan, Poland; 4. Department of Paediatric Orthopaedics and Traumatology, Postgraduate Medical Education Centre, Warsaw – Otwock, Poland; 5. Department of Orthopaedic Surgery, MSWiA Hospital, Poznan, Poland.
Address correspondence to M.P. Dzianach (marcin.dzianach{at}sk4.am.poznan.pl)
Objective: To describe the sonographic appearance of entire length of the posterior cruciate ligament using curvilinear transducer. To analyze diagnostic value of the PCL parameters (thickness and bowing ratio).
Materials and Methods: Five studies of fresh amputated knee specimens were performed. Eye visible contrast agent was injected into the regions of origin and insertion of the PCL under sonographic guidance. Then knee was dissected to expose PCL and deposit of contrast inside. The second part of the study consisted of prospective evaluation of 50 asymptomatic volunteers and 216 patients with suspicion of the cruciate ligament injury. Both the affected and contralateral asymptomatic PCL were scanned in longitudinal plane with curvilinear transducer. Thickness of the proximal and distal part and the curvature of PCL bow (PCL bowing ratio) were assessed. All patients underwent arthroscopy considered as a gold standard.
Results: Cadaveric study showed the feasibility of the entire length of PCL in ultrasound evaluation. In cohort study average values of PCL thickness in proximal/distal part and bowing ratio were as follows: 4,7 mm/5,3 mm/3,7 – volunteers (n = 100), 4,8 mm/5,5 mm/3,8 – patients with injuries of structures other than cruciates (n = 50), 11,2 mm/10,6 mm/3,2 – with acute PCL injury (n = 12), 9,2 mm/10,3 mm/3,2 – with chronic PCL injury (n = 14), 4,5 mm/5,4 mm/3,3 – with acute ACL injury (n = 85), 4,5 mm/5,1 mm/2,8 – with chronic ACL injury (n = 51). There was no statistical difference between thickness and bowing ratios of the right and left PCLs of the volunteer cohort. Statistically significant difference between PCL thickness of cohorts with injured PCL and the other cohorts was assessed. The same was between PCL thickness of affected and contralateral asymptomatic knees of injured PCL cohorts. When the cutoff thickness was more than 9 mm (in one or both parts of ligament), sensitivity was 100% and specificity 99% for the recognition of the acute PCL injury and 86% and 99%, respectively, for the chronic one. There was statistically significant difference between PCL bowing ratios of chronic injured ACL cohort and volunteers or non-cruciate-injured knee cohorts. When the cutoff PCL bowing ratio was less than 2,9, sensitivity was 82% and specificity 93%.
Conclusion: High-resolution sonography provides good quality image of the PCL eligible for measurements. Thickness of the ligament arise significantly only in case of PCL injury. PCL bowing ratio is a valuable support in sonographic diagnosis of chronic ACL injury.
006. Incidence of Meniscal Root Injuries in Patients with Non-displaced Tibial Plateau Fractures
Yun J.H.*; Clement J.P.; Bredella M.A.; Palmer W.E.; Kassarjian A.; Radiology, Massachusetts General Hospital, Boston, MA.
Address correspondence to J.H. Yun (jyun1{at}partners.org)
Objective: To analyze the incidence of meniscal root injuries in patients with non-displaced tibial plateau fractures.
Materials and Methods: MR studies performed in 2004 showing non-displaced tibial plateau fractures were analyzed retrospectively. Patient information including age, sex, mechanism of injury, and surgical correlation was obtained. The presence of meniscal, ligamentous, myotendinous, and cartilaginous injuries was recorded. Attention was given to the presence of meniscal root injury defined as meniscal tear involving the central 1 cm of the posterior meniscal attachment.
Results: 21 patients had medial tibial plateau fractures (MTPF), and 11 patients had lateral tibial plateau fractures (LTPF). In female patients with MTPF, 14 of 15 (93%) had medial meniscal injury (MMI), 10 (67%) of which involved the meniscal root, and 2 of 15 (13%) had lateral meniscal injury (LMI). In female patients age > 60 with MTPF, 9 of 9 (100%) had MMI, 7 (78%) of which involved the meniscal root, and 4 of these 9 (44%) had popliteus myotendinous injury. In patients with LTPF, 4 of 11 (36%) had MMI, 1 (9%) of which involved the meniscal root, and 4 of 11 (36%) had LMI. Only 1 of 17 (6%) knee radiographs of patients with MR evidence of non-displaced tibial plateau fractures showed evidence of fracture, while 10 of 17 (59%) showed degenerative changes.
Conclusion: Radiographically occult medial tibial plateau fractures, particularly those in older women, have a high incidence of medial meniscal root injury and popliteus myotendinous injury.
007. Arthroscopic Validation of Three Radiographic Grading Scales of Osteoarthritis of the Tibiofemoral Joint
Kijowski R.*; Blankenbaker D.; Stanton P.; Fine J.; De Smet A.; Radiology, University of Wisconsin Hospital, Madison, WI.
Address correspondence to R. Kijowski (rkijowski{at}mail.radiology.wisc.edu)
Objective: Radiographic grading scales are commonly used in epidemiologic and clinical studies to define the presence and estimate the severity of osteoarthritis (OA) of the tibiofemoral joint (TFJ). However, no prior study has compared the ability of these grading scales to define the presence and estimate the severity of articular cartilage degeneration within the TFJ. Thus, this study was performed to correlate the radiographic grade of OA using the Kellgren-Lawrence, Ahlback, and Brandt grading scales with the actual degree of articular cartilage degeneration within the TFJ in patients with chronic knee pain.
Materials and Methods: The study group consisted of 125 patients with symptomatic OA of the TFJ. All patients had standing AP radiographs of the knee performed prior to arthroscopic knee surgery. Each articular surface of the TFJ was graded at arthroscopy. Two radiologists retrospectively reviewed the knee radiographs without knowledge of the arthroscopic findings to determine the presence and severity of OA of the TFJ joint using the Kellgren-Lawrence, Ahlback, and Brandt grading scales. Correlation coefficients describing the relationship between the grade of OA and the severity of articular cartilage degeneration were calculated for each grading scale.
Results: The Kellgren-Lawrence, Ahlback, and Brandt grading scales could not define the presence of OA in 26 (20%), 69 (55%), and 26 (20%) of the 125 patients in the study group respectively. The correlation coefficients for the Kellgren-Lawrence, Ahlback, and Brandt grading scales were 0.49, 0.41, and 0.56, respectively. The differences between the correlation coefficients for the Kellgren-Lawrence and Ahlback grading scales and the correlation coefficients for the Brandt and Ahlback grading scales were statistically significant (p < 0.05).
Conclusion: The Kellgren-Lawrence and Brandt grading scales were equally effective at defining the presence and estimating the severity of articular cartilage degeneration within the TFJ. However, these grading scales did not define the presence of OA in a large number of patients with the disease and had only a moderately strong correlation with the actual degree of articular cartilage degeneration within the TFJ. The results ofour study suggest that more sensitive imaging methods than knee radiographs are needed to define the presence and estimate the severity of OA of the TFJ joint in epidemiologic and clinical studies.
008. Does Marathon Running Cause Acute Lesions of the Knee? Evaluation with MR Imaging
Schueller-Weidekamm C.*; Schueller G.; Uffmann M.1; Bader T.R.; Department of Radiology, Medical University of Vienna, Vienna, Austria.
Address correspondence to C. Schueller-Weidekamm (claudia.schueller-weidekamm{at}meduniwien.ac.at)
Objective: To investigate whether running a marathon causes acute alterations of menisci, cartilage, bone marrow, ligaments, or joint effusions, which could be evaluated by magnetic resonance imaging (MRI).
Materials and Methods: Twenty-two non-professional marathon runners underwent MRI of the knee before and immediately after running a marathon. Lesions of menisci and cartilage (5-point scale), bone marrow, ligaments (3-point scale), joint effusion, and additional findings were evaluated. Information on running experience, training, and prior injuries was obtained.
Results: Before the marathon, grade 1 lesions of the menisci were found in eight subjects, and grade 2 lesions in five runners, respectively. An increase in the severity of meniscal lesions from grade 1 to grade 2 was found in one runner after running. Grade 1 cartilage lesions were found in three runners, and grade 2 lesions in one runner, all of which remained unchanged after the marathon. Bone marrow edema was present in three runners and grade 1 anterior cruciate ligament lesions were seen in two runners before and after the marathon. Joint effusions were present in 13 runners in the pre-run scans, slightly increased in four runners after the marathon, and newly occurred in 1 runner after the marathon. There was no statistically significant difference (p > 0.05) in the presence or severity of lesions in runners with a higher training level and more running experience compared to runners with a lower training level.
Conclusion: The evaluation of lesions of the knee with MRI shows that marathon running does not cause severe, acute lesions of cartilage, ligaments, or bone marrow of the knee in well-trained runners. Minor lesions, such as joint effusions or increased intrameniscal signal alterations are frequent findings in runners and can be intensified by running a marathon.
009. Posterior Horn Lateral Meniscal Tears Simulating Meniscofemoral Ligament Attachment after ACL Tear
Park L.*; Jacobson J.A.; Jamadar D.A.; Caoili E.; Kalume-Brigido M.; Wojtys E.; Radiology, University of Michigan, Ann Arbor, MI.
Address correspondence to L. Park (lspark{at}umich.edu)
Objective: In our clinical practice, we have noted apparent far lateral attachment of the meniscofemoral ligament (MFL), hypothesized as representing a type of meniscal tear associated with ACL tear. This study evaluates MFL attachment and association with posterior horn lateral meniscus (PHLM) tears.
Materials and Methods: Consecutive arthroscopy reports from 1/1/04
– 9/1/04 (excluding 
) were reviewed. Subjects were included in
the study if the PHLM and ACL were evaluated and described as normal or torn
at arthroscopy, if the patient did not have prior meniscal or ACL surgery, and
if the subject had a routine MRI examination. Two fellowship-trained
musculoskeletal radiologists reviewed the 95 sagittal intermediate-weighted
spin echo MRI sequences (3 mm slice thickness, 0.5 mm gap) from 96 patients.
The presence of MFL (Humphrey and/or Wrisberg) was recorded, as well as the
number of MR images lateral to the PCL where the MFL was identified as
structure separate from the PHLM. Subjects were excluded if no MFL was present
(2), if the MR images were of suboptimal quality (3), or if there was
additional signal abnormality involving the superior or inferior articular
surface of the PHLM not continuous with a MFL (36), leaving 54 subjects in the
final study group. The number of images where a distinct MFL was identified
was compared to the presence of PHLM and ACL tear at arthroscopy using
Fisher's exact test.
Results: Of the 54 subjects, 21 had ACL tears, 5 of which had PHLM tears. At MRI, MFL consisted of Humphrey (27), Wrisberg (15), or both (12). The ligament of Humphrey inserted on average 0.9 consecutive images (range 0 – 3) lateral to the PCL in subjects without a PHLM tear, and on average 4.6 (range 0 – 8) with a PHLM tear. The ligament of Wrisberg inserted on average 3.1 consecutive images (range 1 – 8) lateral to the PCL in subjects without a PHLM tear, and 4.5 (range 4 – 5) with a PHLM tear. Using 4 images as a threshold, there was a significant association between PHLM tear and 4 or more consecutive images a MFL was identified lateral from the PCL (p = 0.0097). There was a significant association between ACL tear and this type of PHLM tear (p = 0.0064).
Conclusion: Apparent lateral extension of a MFL should be considered as a possible PHLM tear, especially in the setting of ACL tear. In the absence of PHLM tear, the ligament of Humphrey normally inserts within 3 images lateral to the PCL.
011. Cyst-like Structures in the Tibial Plateau: MR in Osteoarthritic Specimen with Histological and Anatomical Correlation
Pouders C.1,2*; De Maeseneer M.1; Van Roy P.1; De Mey J.2; Clarys JP.1; 1. Experimental Anatomy, Vrije Universiteit Brussel, Brussels, Belgium; 2. Radiology, Vrije Universiteit Brussel, Brussels, Belgium; 3. Radiology, University of Michigan, Ann Arbor, MI.
Address correspondence to C. Pouders (caroline.pouders{at}vub.ac.be)
Objective: To determine the mechanism and histological characteristics of cyst-like changes of the tibial plateau in association with osteoarthritis.
Materials and Methods: MR images were obtained in 45 tibial plateaus harvested from patients undergoing total knee replacement. MR imaging sequences included SE T1and FFE T2 and were obtained on a 1.5 T clinical system. MR images and specimens were analyzed for presence of interspinous and subchondral cyst-like changes (low signal intensity on T1, high on T2). Selected specimens were frozen and cut into sections corresponding to the MR images. After decalcification, Weigert's hematoxylin, trichrome and alcian bleu stains were performed.
Results: Cyst-like areas were common in the subchondral bone, both in the weight bearing surfaces and in or at the interspinous region. Macroscopic findings showed cystic cavities. Microscopic findings were compatible with a pseudocyst containing fragments of necrotic bone. No epithelial lining was seen, and the cysts were lined by fibrous scar tissue.
Conclusion: Histological findings of cyst-like MR changes in the tibial plateau show evidence of pseudocysts, with a fibrous lining, and containing necrotic bone fragments suggestive of previous avascular necrosis due to compressive or avulsive stress on the subchondral bone or the interspinous region.
012. Anterior Fat Pad Edema of the Knee: Patterns and Partners
Wallach A.*; Umans H.; Radiology, Jacobi Medical Center, Bronx, NY;
Address correspondence to A. Wallach (adamwallach{at}yahoo.com)
Objective: To compare and contrast patterns of fat pad edema in the anterior knee and define significant associated abnormalities.
Materials and Methods: This is a retrospective review of 610 sequential knee imaging examinations obtained utilizing a 1.5T MR unit between 1/1/03 and 9/8/05 at our institution. We evaluated: presence/pattern of knee fat pad edema, patellofemoral malalignment, patella alta, patellar tendon abnormality, chondromalacia patellae, trochlear abnormalities, effusion, marrow edema and fracture. Four discrete subsets were defined: isolated Hoffa's fat pad edema (17), superolateral Hoffa/prefemoral fat pad edema (26), quadriceps fat pad edema (27), and absence of fat pad edema. Associated findings for each fat pad edema group were compared with findings in the other 3 subsets.
Results: Results were calculated using the Fisher exact test. Statistically significant (p < 0.05) associations were 1) Hoffa's fat pad edema positively correlated with abnormality of the femoral trochlea 2) Edema in the superolateral Hoffa/prefemoral pattern negatively correlated with effusion and acute fracture, and positively correlated with chondromalacia patellae and abnormality of the femoral trochlea. In this group 46%, 42% and 23% of knees had patella alta, patellar malalignment and patellar tendon abnormalities, respectively. 3) Quadriceps fat pad edema was not significantly associated with any other abnormality.
Conclusion: The different subsets of fat pad edema patterns appear to be distinct entities inasmuch as they are associated with different abnormalities. Superolateral Hoffa/prefemoral fat pad edema is significantly associated with chondromalacia patella, femoral trochlear abnormality, patellar malalignment, patellar tendon abnormality and patella alta. Isolated Hoffa's fat pad edema is significantly associated with trochlear abnormalities. Quadriceps fat pad edema alone has no significant associated findings.
* Will present paper
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