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The MRI images demonstrate focal abnormal signal changes and marked thinning of the lateral aspect of the patellar articular cartilage with fraying, fissuring and marked contour irregularity with evidence of moderate subchondral bone reactive changes that appear hypointense on T1 and hyperintense on PDFS, and marked thinning of the articular plate. Appearances are consistent with chondromalacia patella grade 4 according to the modified Outerbridge grading system.