STUDY PROCEDURE
MRI of the left knee is obtained without administration of intravenous contrast as per routine protocol.

FINDINGS
Collateral ligaments: The MCL is intact. Trace fluid is noted along its medial aspect. The lateral collateral ligament complex is intact.

Cruciate ligaments: Intact.

Menisci: Moderate intrasubstance signal is present involving the anterior horn, body and posterior horn of the medial meniscus without a tear. There is moderate intrasubstance signal involving the body, posterior horn and anterior horn of the lateral meniscus without a definite tear. There is no para meniscal cyst.

Extensor mechanism: Intact.

Osseous structures: There is no acute fracture. There is no acute marrow edema. There is no focal osseous lesion. It is no acute osteochondral lesion. Prominent tricompartmental marginal osteophyte formation is noted. The medial and lateral patellar retinaculum are intact.

Cartilage: Chondromalacia patella is noted with full-thickness chondral loss involving the lateral patellar facet cartilage, measuring 2.3 cm. There is diffuse high-grade chondral loss throughout the medial patellar facet cartilage. High-grade chondral loss is noted throughout the trochlear cartilage with full-thickness chondral denidation involving the superior lateral trochlear cartilage measuring 1.6 cm. There is moderate chondral thinning involving the central weightbearing surface of the medial femoral condyle and the medial tibial plateau. Full-thickness chondral defect is noted involving being central to posterior lateral femoral condyle cartilage measuring 1.2 cm.

Miscellaneous: The Hoffa's fat pad is preserved. There is a small size joint effusion. The popliteal vessels are unremarkable. The musculature about the knee remains normal in signal characteristics. Multiloculated popliteal cyst is noted, measuring 6.8 cm x 1.3 cm x 1.1 cm.

IMPRESSION
1. There is severe intrasubstance signal involving the anterior horn, body and posterior horn of the lateral meniscus without a definite meniscal tear yet identified. The patient may be at risk for impending/close flap tear.

2. Moderate intrasubstance signal is present involving the body and posterior horn of the medial meniscus without a definite tear.

3. Intact collateral and cruciate ligaments. Prominent tricompartmental marginal osteophytosis is noted.

4. Grade 4 chondromalacia patella is noted with full-thickness chondral loss involving the lateral patellar facet cartilage, measuring 2.3 cm. There is diffuse high-grade chondral loss throughout the medial patellar facet cartilage. High-grade chondral loss is noted throughout the trochlear cartilage with full-thickness chondral denudation involving the superior lateral trochlear cartilage measuring 1.6 cm.

5. Near full-thickness chondral defect is noted involving the central to posterior lateral femoral condyle cartilage measuring 1.2 cm.

6. Chondromalacia is noted in the medial compartment of the knee with moderate chondral thinning involving the central weightbearing surface of the medial femoral condyle and the medial tibial plateau.

7. Note is made of a multiloculated popliteal cyst, measuring 6.8 x 1.3 x 1.1 cm. Small size knee joint effusion is also present.

Upon review, what would be your suggestion for treatment?