Question: Hello,

My wife had an acute ACL reconstruction done in XXXXXXX 2014 following which her recovery was not good. She had difficuly achiveing full range wit lot of stiffness.She developed fixed flexion deformity of about 40 degrees. Finally MRI revealed arthrofibrosis post which she had another surgery in November 2014 to release the fibrosis.Now five months post that her range has improved though flexion deformity degree persits and she still has pain, swelling. Another problem was locking of the knees when she is mad eto do exercises for terminal extension. Another MRI was done and the findings area as below:. Please guide us if there is any reason for worry. Thanks :-
MRI RIGHT KNEE JOINT

Protocols: Sagittal PD and PDFS sequences. Coronal PDFS sequence. Axial PDFS sequence

OBSERVATIONS:

Medial meniscus: Posterior horn shows low grade intrameniscal signal changes, not communicating with articular surface.

Lateral Meniscus: No tear.

Anterior cruciate ligament: Evidence of ACL reconstruction noted. The reconstructed ACL graft is intact.
Few susceptibility artefacts are noted along the ACL graft.

Posterior cruciate ligament: No tear.

Medial collateral ligament: No tear.

Lateral collateral ligament: No tear.

Biceps femoris and ileo tibial tract: are normal.

Bone:
-     Evidence of ACL reconstruction with femoral / tibial tunnels noted. The graft screws are in-situ.
-     Patella and proximal fibula are normal.

Joint: Mild joint effusion.

Articular cartilage:
1.     Medial compartment: No significant thinning or erosions.
2.     Lateral compartment: No significant thinning or erosions.
3.     Patello femoral compartment: Subtle fissuring of cartilage noted along the medial and lateral facets.

Popliteal fossa: No focal lesions.

Infra patellar Hoffa’s fat pad:
-     Postero-superior part of the Hoffa’s fat pad appears oedematous with fibrotic bands and fat stranding. This zone of fibrosis and oedematous fat measures 2 cms (AP) x 0.8 cms (cranio-caudal) dimensions.
-     Small susceptibility artefact is noted in the interspace between Hoffa’s fat pad and lateral femoral condyle (? Significance).

Periarticular soft tissues are normal.


IMPRESSION:

     Evidence of ACL reconstruction with intact ACL graft.

     Fibrosis with co-existing oedema in the postero-superior part of Hoffa’s fat pad.

     Small susceptibility artefact in the interspace between Hoffa’s fat pad and lateral femoral condyle (? Significance).

     Early changes of chondromalacia patellae.

     Low grade intrameniscal signal changes in the posterior horn of medial meniscus.