Tibial plateau fatigue fractures

Case contributed by Nick Tarasov


Presents with acute bilateral knee pain after extensive running.

Patient Data

Age: 40 years
Gender: Male

Left knee

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

Right knee


Findings on MRI of the right knee almost fully match those of the left side, but bone marrow edema is more pronounced at the medial aspect of the tibial plateau.

Case Discussion

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

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