 Good morning everyone. I'm Dr. Somya Uppalpatti, finally a resident from Mericity Institute of Medical Sciences, Thelungana. My topic is association between subcutaneous nephar thickness and conral Malaysia Patilla on MRI knee in a rural population. Conral Malaysia Patilla refers to softening and degeneration of the articular cartilage of the Patilla, which is characterized by thinning, ulcerations, conral defects and subcontral erosion changes. It is one of the common causes of anterior knee pain in adolescents and young girls. Traumatic causes such as chronic overuse, malalignment, Patilla position and prior dislocations that caused biomechanical and physical alterations in Patilla have been attributed to it. MRI has emerged as a reliable and accurate modality in the diagnosis of conral Malaysia Patilla due to its non-invasive nature and refinements and sequences that allow detailed soft tissue and cartilage imaging. Studies showed obesity as a risk factor for Patilla femoral osteoarthritis. In the study, we evaluate the association between subcutaneous nephar thickness as an indirect marker of obesity and conral Malaysia Patilla on MRI. The main objective of the study is to evaluate the association between subcutaneous nephar thickness as an indirect marker of obesity and conral Malaysia Patilla on MRI knee. This was a retrospective study conducted on 120 patients who presented to orthopedic OPD with anterior knee pain and were referred to Department of Radiology for further investigations. Patients underwent knee MRI on 1.5 test valve using a dedicated knee coil. The study was conducted at MediCity Institute of Medical Sciences from Jan 2019 to April 2021. Inclusion criteria. Patients with anterior knee pain and without any history of trauma or prior knee surgeries are included in this study. After meeting the inclusion criteria, MRI images are evaluated for the presence or absence of conral Malaysia Patilla and graded according to the modified outer bridge classification. Subcutaneous nephar thickness is measured at the level of maximum Patilla cartilage thickness on the medial aspect of the knee on axial T2 weighted images. So the measurements are taken from the medial skin surface of the knee joint to the posterior aspect of the medial femoral conduct. The square test was applied to the study to evaluate the association between subcutaneous nephar thickness and conral Malaysia Patilla. Here is an axial T2 weighted image which is showing the subcutaneous nephar thickness measurement. Modified outer bridge grading of conral Malaysia Patilla. On fast saturated proton density MR sequences, they're divided into four grades. Grade 0 is normal. Grade 1 cartilage signal abnormality but appears architecturally intact. Grade 2 surface frame or focal defects involving less than 50 percentage of cartilage thickness. Grade 3 defects involving more than 50 percentage of the cartilage thickness without bone edema. Grade 4 full thickness cartilage defect or loss with associated bone marrow edema. Here are the proton density fat saturated images. This is grade 0 where there is a normal articular cartilage without any defects or signal abnormality. This is a grade 1 where there is a hyper intense signal in the articular cartilage without any defect. Grade 2 where there is a focal defect of the cartilage which is less than 50 percentage of the cartilage thickness. Grade 3 where the defect is more than 50 percentage of the cartilage thickness. Grade 4 where there is a full thickness stare with adjacent bone marrow edema. The study included 120 patients with the age group of 15 to 59 years. The mean age of the patients with conral Malaysia Patilla was 39 years. Conral Malaysia Patilla were present in 28 patients out of which 13 were men and 15 were women. There was no evidence of conral Malaysia Patilla in 92 patients. The means up here in a sneer fat thickness in the study group was 2 centimeters plus or minus 0.7. Out of 28 patients with conral Malaysia Patilla there were 17.8 percentage with grade 1, 25 percentage with grade 2, 21.4 percentage with grade 3 and 35.7 percentage with the grade 4 changes. Majority of the study group showed grade 4 changes comprising of 35.7 percentage. The sex distribution of the patients with different grades of conral Malaysia Patilla. Higher grades of conral Malaysia Patilla and thicker means up to a sneer fat thickness were seen predominantly in females when compared to the males. In this bar diagram we can see the grades of conral Malaysia Patilla are more predominantly seen in females when compared to the males. The majority of conral Malaysia Patilla changes are seen involving the medial facet of the Patilla in about 75 percentage of the patients followed by involvement of later Patilla facet in about 20 percentage and a small minority involving both the facets. Mean subcutaneous sneer fat thickness in normal knees and different grades of conral Malaysia Patilla. In grade 0 that is in normal individuals the mean subcutaneous sneer fat thickness is 2 centimeters plus or minus 0.7 and in grade 1 changes the mean subcutaneous sneer fat thickness is 2.2 centimeters plus or minus 0.5. In grade 2 changes the mean subcutaneous sneer fat thickness is 2.8 plus or minus 0.2 centimeters. In grade 3 it is 2.8 plus or minus 0.7 centimeters and in grade 4 it is 3.2 centimeters plus or minus 1.8. Mean subcutaneous sneer fat thickness showed proportional increase with higher grades of conral Malaysia Patilla and highest in patients with grade 4 changes. Here is an axial T2 weighted image of the right knee showing the subcutaneous sneer fat thickness which is 3.9 centimeters. TD Facet image of the same patient showed articular cartilage defect with bone marrow edema suggest to have grade 4 conral Malaysia Patilla. The chi-square test applied to the study showed a strong association between subcutaneous sneer fat thickness and grades of conral Malaysia Patilla with significant p-value. Higher grades of conral Malaysia Patilla were present in women compared to men with correspondingly increased subcutaneous sneer fat thickness. Hereby concluding conral Malaysia Patilla is a common condition seen in young individuals with anterior knee pain. Subcutaneous sneer fat thickness as a macrophobicity was strongly associated with the presence and severity of conral Malaysia Patilla on MRI. Thus emphasizing the role of obesity as a predisposing factor in the development of conral Malaysia Patilla and early diagnosis of the same on MRI. Coming to the discussion, conral Malaysia Patilla is a common cause of anterior knee pain in young adolescents, usually diagnosed in MRI of knee and has frequently by arthroscopic evaluation. MRI is shown to be superior to the clinical symptoms and physical examination in diagnosing conral Malaysia Patilla with cross-sectional images providing new insight regarding risk factors which cannot be obtained by radiographic evaluation. The spectrum of pathological changes that occur within the cartilage can range from mild cartilage softening edema, fissuring, progressing to the full thickness cartilage loss and ultimately leading to the development of osteoarthritis. Conral Malaysia Patilla is much more common nowadays than was initially thought. In the present study, conral Malaysia Patilla was seen in 23.3% of the study group of which 35.7% were diagnosed with a grade 4 changes with associated bone marrow edema. The association of obesity and conral Malaysia Patilla has been recognized but poorly established. Few studies show that obesity and increased fat mass were both associated with more cartilage defects in the knee. Bentham demonstrated abnormalities in the knee articular cartilage in a population of 20 children and adolescents who were morbidly obese. Our results support these studies by demonstrating the strong association between subclinus knee fat thickness as a macrophobicity with the presence and severity of conral Malaysia Patilla on MRI. It is important to diagnose early stages of conral Malaysia Patilla on MRI and arthroscopic evaluation as they may be reversible, particularly in obese patients who may benefit from weight reduction programs. The main drawback in this study is since it was a retrospective study, BMI, weight of the patient could not be obtained. However, the use of subclinus knee fat thickness as a macrophobicity, although not an accurate reflection of BMI, showed a positive association with severity of conral Malaysia Patilla. Here are my references. Thank you.