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<v Dr. de Abreu>So we have, that's a knee...

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62 year old male.

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When we look at this knee, what can we see?

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We can see cartilage loss.

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Lot of loss here, we have bone to bone here.

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We have diffused grade four cartilage, con and CBO plateau.

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We have... we don't see the ACL.

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We see the PCL attached to a bone fragment.

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Very large bone fragment here.

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We see also femoral anterior OA, and also lots

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of cartilage with osteophytes and large joint effusion.

1:03

So rapidly, we are in front of

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a case of open compartmental OA.

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Okay, but what do we have here that cause attention also?

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We have this connection of fluid here, at the poster part

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of the joint and the, we can see a low signal

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of this synovial contour, and a little bit

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the low signal also at the super patella pouch.

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And this will raise the question if we could have

1:50

a synovial tumor together with that, because we know

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hemosyderin deposit is typically of a synovial tumor,

2:01

but what can give us a clue about what is going on?

2:07

So we have open compartmental advanced osteopetrosis,

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We have here this evulsion,

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this large bone fragment evulsion from the PCL.

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So probably what we had in this case was a large arthrosis.

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So we have a secondary OA, post traumatic, and the arthrosis

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chronically with deposit hemosyderin on

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the synovial membrane.

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So that's why in this case, we are seeing

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this low signal at the Synovial membrane, okay?

2:56

So let's see the axial T2 fat-sat.

3:05

Okay, so Don, this is the, the other case you wanna

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comment about it?

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<v Dr. Resnick>No, I agree with your diagnosis,

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but I can tell you that one of

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the possibilities that would be considered is,

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depending on the history, if in fact

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the patient did not recall exactly when

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there was a evulsion fracture from

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the PCL neuropathic osteoarthropathy is

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in the differential of something that looks like this.

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But if they recall the injury

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then I agree with you a hundred percent post

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traumatic osteoarthritis would be the diagnosis there.

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And it's kind of a nice example of how bad

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and extensive these synovial abnormalities may become.