[

musculoskeletal imaging

FIGURE 1. Axial proton density magnetic resonance image, with fat saturation of the right knee demonstrating a focal full-thickness chondral lesion at the median patellar ridge (orange arrow), with subchondral marrow edema (white arrow) and a small- to moderate-sized joint effusion.

FIGURE 2. Axial proton density magnetic resonance image, with fat saturation of the right knee 6 weeks following microfracture treatment of the chondral lesion at the median patellar ridge seen in FIGURE 1. Complete healing of the chondral lesion (orange arrow) as well as decreased subchondral marrow edema are seen. A small- to moderate-sized joint effusion is noted.

Chondral Lesion of the Patella

IAN M. LEAHY, PT, DPT, Orthopedic Resident, University of Southern California, Division of Biokinesiology & Physical Therapy, Los Angeles, CA. CHRISTOPHER M. POWERS, PT, PhD, FACSM, FAPTA, Associate Professor and Director, Program in Biokinesiology; Co-Director, Musculoskeletal Biomechanics Research Lab, University of Southern California, Division of Biokinesiology & Physical Therapy, Los Angeles, CA.

he patient was a 27-year-old man who was a recreational baseball player. He was referred to a physical therapist for a suspected medial meniscus injury following a right-sided lower extremity twisting injury sustained 3 weeks prior. More specifically, the injury occurred when the cleats of his right athletic shoe became stuck while swinging a baseball bat from the right side of home plate. No diagnostic imaging had been completed following the injury. At the time of the initial physical therapist evaluation, the patients chief complaint was pain underneath the

kneecap. By visual observation, infrapatellar swelling was noted and the patient had a normal gait. While there were no restrictions in knee range of motion, right quadriceps strength was diminished secondary to pain. Ligamentous and meniscal testing were negative. The patients knee pain was also reproduced while stepping down from a 20.3-cm step. Despite 4 weeks of physical therapist intervention, the patient was unable to successfully return to athletic activities. The patient was then referred to an orthopaedic surgeon, who ordered magnetic resonance imaging of his right knee,

which revealed a focal full-thickness chondral lesion at the median patellar ridge (FIGURE 1). A microfracture procedure was performed to address the chondral lesion. Subsequent magnetic resonance imaging at 6 weeks following surgery, which was performed to evaluate chondral recovery, revealed complete healing of the chondral lesion (FIGURE 2). The patient returned to full athletic activities without limitation at 14 weeks following surgery. t J Orthop Sports Phys Ther 2012;42(3):291. doi:10.2519/jospt.2012.0404

journal of orthopaedic & sports physical therapy | volume 42 | number 3 | march 2012 |

291