Physeal injury in a skeletally immature male athlete

A 12-year-old skeletally immature male athlete presented for evaluation with acute bilateral knee pain. Initial radiographs revealed subtle lucency of the medial proximal tibial physis and MRI was recommended. On MRI, broad-based intravasation of the physis into the proximal femoral and tibial physes was observed. This represented physeal widening, a phenomenon that has been observed in skeletally immature athletes presenting for acute knee pain. While such changes to the physis may be quite prominent on MRI, conventional radiographic findings may be much more subtle. As many causes of chronic knee pain in this population are managed with active rehabilitation, a high index of suspicion for this diagnosis in the presence of physeal abnormalities may warrant evaluation with MRI. The literature suggests this pathology will resolve with rest, but, if weight-bearing activities are continued, there is a risk for significant growth abnormalities.