Presentation
The patient presents with knee pain and limitation of motion. Negative trauma.
Patient Data
There is left knee osteoarthritis with medial joint space narrowing, tibial spine spurring, and developing osteophytes- Kellgren and Lawrence grade 2.
There is proximal and distal patella tendon enthesopathy.
There is an unusual, incidental, solitary, linear, streak-like, posteromedial tibial, medullary density straddling the meta diaphysis and minimally the epiphysis. This has benign features, with no cortical erosion, no associated soft tissue component, and no periosteal reaction.
Case Discussion
There is a mild degenerative change in the left knee, likely accounting for the patient's pain and presentation. Intrinsic abnormality of the ACL, PCL, and menisci cannot be excluded on plain films and hence an elective MRI is suggested especially should symptoms persist and progress.
There is an unusual linear, posteromedial density within the proximal tibial shaft with benign features as described above. The primary consideration is for osteopathia striata-like melorheostosis involving the tibial medulla. This is likely asymptomatic and incidental.
There is a noted clinical absence of any recent or past significant or trivial trauma. Aggressive lesions such as osteogenic sarcoma, osteoblastic metastases and lymphoma were considered unlikely. There is no clinical suspicion of a connective tissue disorder to suggest scleroderma. The patient has no systemic symptoms to suggest occult pulmonary pathology or an underlying malignancy.
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