Medical Imaging Analysis Report

I. Radiological Findings

Based on the provided MRI sequences of the knee (sagittal, axial views, etc.) and the arrow-marked areas, the following observations are noted:

• An abnormal signal is present in the quadriceps fat pad located above the patella and behind the quadriceps tendon. On T2-weighted images, it shows high signal intensity suggesting edema or effusion.
• A localized signal change is observed near the distal attachment of the quadriceps tendon adjacent to the patella, presenting as mild thickening or high signal intensity, consistent with tendinitis (tendinopathy).
• No obvious loose bodies or large joint effusion are seen. The joint capsule and cartilage surfaces appear generally normal, and there is no clear evidence of meniscal tear or fracture.
• No distinct rupture or markedly increased abnormal signal is observed in the ligament structures (cruciate ligaments, collateral ligaments, etc.).

II. Potential Diagnoses

Based on the imaging findings and the patient’s clinical history of anterior knee pain, the following diagnoses or differential diagnoses are considered:

1. Quadriceps Fat Pad Impingement Syndrome
   Reason: MRI shows edema in the anterior superior fat pad, consistent with the patient’s reported anterior knee pain.
2. Quadriceps Tendon Insertional Tendinitis or Tendinopathy
   Reason: Signal changes at the distal attachment of the quadriceps tendon, concurrently appearing with the fat pad changes, often correlate with pain in the same region.
3. Patellofemoral Cartilage Degeneration or Patellofemoral Pain Syndrome
   Reason: A common cause of anterior knee pain; however, no obvious cartilage or patellar malalignment abnormalities are observed here, so it remains a differential diagnosis.
4. Patellar Tendinitis
   Reason: Another common cause of anterior knee pain; however, the most prominent changes in this case are located on the quadriceps tendon side, with no significant patellar tendon abnormalities.

III. Final Diagnosis

Considering the patient’s age, symptoms, SLE history (current literature does not suggest a direct link between SLE and anterior superior fat pad edema), and imaging findings (marked edema in the quadriceps fat pad and inflammatory changes in the distal quadriceps tendon), the most likely diagnosis is:

“Quadriceps Fat Pad Impingement Syndrome and Quadriceps Tendon Insertional Tendinitis (Tendinopathy).”

If uncertainties remain, further clinical examination, ultrasound evaluation, or minimally invasive arthroscopic assessment may be considered.

IV. Treatment Plan and Rehabilitation

Based on the aforementioned diagnosis and the patient’s condition, a comprehensive treatment strategy may be considered as follows:

1. Conservative Treatment:
   • Rest and avoidance of excessive flexion and weight-bearing: Reduce activities that contribute to fat pad impingement and tendon overuse.
   • Local ice application: 2–3 times a day, 15–20 minutes each time, to alleviate local inflammation and edema.
   • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): May be taken orally or applied topically under physician guidance for short-term pain relief.
   • Physical Therapy: Complement with modalities (e.g., ultrasound therapy, low-frequency electrical stimulation) to reduce local inflammation and promote recovery.
2. Rehabilitation Training (FITT-VP Principle):
   • Type: Focus on strengthening and stretching exercises for the quadriceps and patellofemoral joint surrounding muscles, along with core and lower-limb stability training.
   • Frequency: 3–4 times per week, gradually increasing as symptoms improve.
   • Intensity: Begin with low-intensity isometric or low-resistance exercises, such as straight leg raises or seated knee extensions, and progressively increase resistance.
   • Time: Start with 10–15 minutes in divided sets (e.g., 2–3 sets), gradually increasing to about 30 minutes.
   • Mode: Begin with pain-free isometric quadriceps contractions, then incorporate small-angle isotonic exercises and functional activities in later stages.
   • Progression: As pain and swelling subside, appropriately increase the training intensity and range of motion, such as shallow squats or resistance band exercises. Advanced exercises (kneeling or deeper squats) can be introduced under the guidance of a rehabilitation specialist.
3. Other Treatment Options:
   • If there is no significant improvement with conservative management, local injection therapy (e.g., corticosteroid injection) may be considered. However, it should be performed cautiously after ruling out infection or other joint pathologies.
   • In rare cases where severe structural lesions coexist, arthroscopic surgery may be considered to relieve mechanical impingement of the fat pad or repair tendon injuries.
4. Special Considerations:

   Given the patient’s history of Systemic Lupus Erythematosus (SLE), attention should be paid to how autoimmune factors may affect soft tissue healing. Training should be progressive and within tolerance, with regular follow-up to monitor joint function and any new symptoms.

V. Disclaimer

The above report is a reference analysis based on the currently provided patient information and imaging data. It does not replace an in-person consultation or professional medical advice. In case of severe discomfort or any change in condition, please seek prompt medical attention and follow the guidance of a specialist.