Tibial plateau fatigue fractures

Case contributed by Dr Nick Tarasov

Presentation

Presents with acute bilateral knee pain after extensive running.

Patient Data

Age: 39
Gender: Male
MRI

Left knee

There is slight anterior displacement bony fragment from left tibial plateau, best seen on sagittal images. There are foci  both T1 and STIR signal hyperintensity localized at inferior portion of patellar tendon, depicting its strain. Extensive bone marrow oedema at the proximal tibial epimetadiaphysis best vizualized on STIR sequences, less on T1 and T2 as hypo-isointense signal characteristics. Medial femoral condyle minimal subchondral defects is also seen. Minimal joint effusion. Cruciate and collateral ligaments as well as menisci seems unremarkable.

MRI

Right knee

Findings revealed by MRI of another knee almost fully matches with same at left side, but bone marrow oedema is more pronounced at medial part of tibial plateau.

Case Discussion

Almost symmetric bilateral knee findings are consistent with chronic Osgood-Schlatter disease. Extensive bone marrow oedema at both tibial plateau reflects trabecular microdamage (fatigue fractures as a subtype of stress-fractures). 

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Case information

rID: 39100
Case created: 19th Aug 2015
Last edited: 11th Jan 2017
Inclusion in quiz mode: Included

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