Suprapatellar fat-pad impingement:mri findings Poster No.: C-1672 Congress: ECR 2017 Type: Scientific Exhibit Authors: A. Arslan, S. Ulus, S. A. Kara, O. SAYG#L#; istanbul/tr Keywords: Trauma, Diagnostic procedure, MR, Extremities DOI: 10.1594/ecr2017/C-1672 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 12
Aims and objectives The anterior knee has three fad pads; *Anterior suprapatellar (quadriceps) *Posterior suprapatellar (prefemoral or supratrochlear) *Infrapatellar (Hoffa) fad pads Suprapatellar fat-pad, located on the patella base,is triangular in shape. Suprapatellar fatty tissue would increase in size and signal intensity in theacute phase of suprapatellar fat pad impingement (SPFP) syndrome. The purpose of this study was to evaluate the other magnetic resonance imaging (MRI) findings along with the SPFP syndrome, to describe the prevalence and clinical features of suprapatellar fat-pad edema. Page 2 of 12
Methods and materials 5700 patients, reviewed retrospectively SPFP edema (+) 304 patients Chondromalacia Patellofemoral joint morphology normal, lateral subluxation, lateral tilt Synovial effusion, synovitis MCL tear, ACL tear Quadriceps femoral tendinitis, patellar tendinitis Medial - lateral meniscal tear or degeneration Hoffa edema, soft tissue edema Osteoarthritis Baker cyst Clinical complaint anterior knee pain, meniscal pain or nonspecific pain Data were analysed with Pearson's Correlation Coefficient. Page 3 of 12
Images for this section: Fig. 1: The patient was referred to our clinic due to anterior knee pain; isolated SPFP impingement. Radiology, Acibadem University School of Medicine, Acibadem Fulya Hastanesi - Istanbul/TR Page 4 of 12
Fig. 2: Isolated SPFP impingement Radiology, Acibadem University School of Medicine, Acibadem Fulya Hastanesi - Istanbul/TR Page 5 of 12
Fig. 3: T2 FS-sagittal image grade IV chondromalacia with SPFP edema. Radiology, Acibadem University School of Medicine, Acibadem Fulya Hastanesi - Istanbul/TR Page 6 of 12
Results The prevalence - 5.3% (304 patients) 48% in males, 52% in females 209 patients on 1.5 Tesla 95 patients on 3 Tesla 65 patients - osteoarthritis 21.3 % 45.4 % normal 9.2 % grade I chondromalacia 7.9 % grade II chondromalacia 14.5 % grade III chondromalacia 24 % grade IV chondromalacia.(figure III) Patellofemoral joint morphology 77 % normal 19.7 % lateral subluxation 3.3 % tilt Clinical symptoms 44 anterior knee pain 14.5 % 16 meniscal pain 5.2 % 244 non-specific pain 80.3 % 60.9 % synovial effusion 35.2 % quadriceps femoral tendinitis Page 7 of 12
26.3 % medial meniscal tear 10.2 % Hoffa edema 9.9 % soft tissue edema 8.9 % isolated SPFP impingement (figure I-II) We observed positive relation age - osteoarthritis (r=0.4660, p<0.05) age - patellar chondromalacia (r=0.5198, p<0.05) lateral subluxation - tilt in patellofemoral joint (r=0.3171, p<0.05) Page 8 of 12
Images for this section: Fig. 7: pd-fs-aksiyal image, Hoffa edema and Baker cyst with SPFP edema. Radiology, Acibadem University School of Medicine, Acibadem Fulya Hastanesi - Istanbul/TR Page 9 of 12
Conclusion The most common MRI findings with SPFP syndrome are synovial effusion andquadriceps femoris tendinitis. Limitations There are several limitations to this study Retrospective Lack of histopathologic correlation Clinical complaint evaluation was subjective Page 10 of 12
Personal information Aydan Arslan, M.D. Department of Radiology, Acibadem University School of Medicine, Istanbul/TR; arslanaydan@gmail.com Sila Ulus, M.D., Assistant Prof. Department of Radiology, Acibadem University School of Medicine, Istanbul/TR; silaulus@hotmail.com Simay Altan Kara, M.D., Prof. Department of Radiology, Acibadem University School of Medicine, Istanbul/TR; simay.kara@acibadem.edu.tr Ozlem Saygili, M.D., Prof. Department of Radiology, Acibadem University School of Medicine, Istanbul/TR; ozlem.saygili@acibadem.com.tr Page 11 of 12
References 1.Ahmet Bas, Onur Tutar, Inanc Yanik, Cesur Samanci. Quadriceps fat-pad impingement syndrome: MRI findings. BMJ Case Reports 2012; doi:10.1136/bcr-2012-007643 2.Khaled Aly Matrawya, Abdel Aziz El-Nekeidyb, Akram Al-Dawodyc. MRI features of some uncommon causes of painful knee Alexandria Journal of Medicine Volume 50, Issue 2, June 2014, Pages 149-157 3.Nikolaos Tsavalas1 Apostolos H. Karantanas. Suprapatellar Fat-Pad Mass Effect: MRI Findings and Correlation With Anterior Knee Pain AJR 2013; 200:W291-W296 4.Nogah Shabshin Mark E. SchweitzerWilliam B. Morrison. Quadriceps fat pad edema: significance on magnetic resonance images of the knee Skeletal Radiology May 2006, Volume 35, Issue 5, pp 269-274 5. Roth C, Jacobson J, Jamadar D et-al. Quadriceps fat pad signal intensity and enlargement on MRI: prevalence and associated findings. AJR Am J Roentgenol. 2004;182 (6): 1383-7. 6.Rosse C, Gaddum-Rosse P. Hollinshead's textbook of anatomy. Lippincott Williams & Wilkins. (1997) ISBN:0397512562. Page 12 of 12