Dr Resnick
Long before any recent attention to the fat pads cited by you and Avneesh, in fact 40 years ago, one of the giants in skeletal radiology, Peter Cockshott, investigated the cause of femoral erosion in persons with patellofemoral arthritis, as in your case. I attach an abstract of his article as I cannot get the original. The classic teaching at that time was that the anterior femoral erosion was related to bone-on-bone contact with the patella in extension of the knee but he and his associates suggested it was increased pressure in the suprapatellar pouch. In fact, on one occasion, he showed me a case in which the femoral erosion began after a patellectomy. All of this was long before MRI and the interest in the anterior fat pads of the knee. We stand on the shoulders of giants.
Roar Pederson
I have seen several different/maybe related changes in femur in this area. There seems to be vessels entering the femur from anterior beneath the fat pad, and sometimes these vessels are dilated and seem to anastomose with vessels on the posterior side, sometimes with a lot of surrounding edema, and quite often bony changes at the anterior cortex – thickening, erosion, and oven OO in the same area. I feel this is sometimes a busy spot, but what is the reason for these changes?
Me
It was described long ago in xray literature that remodeling of femur is a sign of severe / long standing patellofem impingement. I read it in 1996 in David Sutton’s book. He had a lateral view of xr showing it
Best!
AC
Avneesh Chhabra, M.D. M.B.A.
Professor Radiology & Orthopedic Surgery
Chief, Division of Musculoskeletal Radiology
UT Southwestern Medical Center, Dallas, Tx
5373 Harry Hines Blvd.
Dallas, Tx-75390-9178
Office: 214-648-2122
avneesh.chhabra
