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Physeal Widening in the Knee Due to Stress Injury in Child Athletes

Tal Laor1, Eric J. Wall2 and Louis P. Vu2,3

1 Department of Radiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH 45229-3039.
2 Department of Orthopedic Surgery, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039.
3 Present address: Department of Orthopedic Surgery, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013.


Figure 1
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  		Fig. 1A —15-year-7-month-old boy who is football place kicker. Frontal radiograph of right knee shows broad band of physeal widening of lateral aspect of distal femoral physis (arrow).

 

Figure 2
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  		Fig. 1B —15-year-7-month-old boy who is football place kicker. Coronal fast spin-echo proton density-weighted image (TR/TE, 2,500/11) with fat saturation of right knee shows broad area of lateral physeal widening of distal femur (arrow). Signal is isointense to that of rest of physis.

 

Figure 3
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  		Fig. 1C —15-year-7-month-old boy who is football place kicker. Frontal radiograph obtained 3 months after immobilization of knee shows near complete resolution of physeal widening.

 

Figure 4
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  		Fig. 2 —Sagittal conventional spin-echo T2-weighted image (TR/TE, 2,500/80) of right knee of 8-year-1-month-old boy who plays football. There is widening of posterior portion of medial tibial physis (solid arrow) with signal iso- to slightly hyperintense to that of rest of physis (dotted arrow).

 

Figure 5
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  		Fig. 3A —14-year-6 month-old male soccer player. Coronal fast spin-echo proton density-weighted image (TR/TE, 2,500/12) with fat saturation of right knee shows discrete area of isointense physeal widening (arrow) of proximal fibula.

 

Figure 6
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  		Fig. 3B —14-year-6 month-old male soccer player. Coronal gradient-echo image (2D multiplanar; 300/13; 20° flip angle) shows lateral distal femoral physeal widening (arrow).

 

Figure 7
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  		Fig. 3C —14-year-6 month-old male soccer player. Obtained 2 months after A and B, coronal gradient-echo image (2D multiplanar; 167/13; 20° flip angle) shows near complete resolution of physeal widening (arrow) after knee was kept at strict rest without immobilization.

 

Figure 8
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  		Fig. 4A —11-year-6 month-old girl who plays competitive tennis. Standing frontal radiograph of both knees shows physeal widening of both medial distal femoral physes and both medial proximal tibial physes. Lines have been drawn along axes of right femur and tibia to illustrate normal mild valgus alignment.

 

Figure 9
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  		Fig. 4B —11-year-6 month-old girl who plays competitive tennis. Coronal fast spin-echo proton density-weighted image (TR/TE, 4,000/34) with fat suppression of right knee. Widening of medial distal femoral and medial proximal tibial physes (arrows) shows signal that is isointense to rest of physes.

 

Figure 10
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  		Fig. 4C —11-year-6 month-old girl who plays competitive tennis. Standing frontal radiograph of both knees obtained 2 years after A, during which time child continued to play tennis intensely. There is relative varus alignment of both knees. Her physes have begun to fuse. She also developed bilateral tibial stress fractures and osteochondritis dissecans of both talar domes, not included on this image.

 

Figure 11
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  		Fig. 4D —11-year-6 month-old girl who plays competitive tennis. Frontal photograph of patient obtained 1 month before A shows she has normal alignment of her lower extremities.

 

Figure 12
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  		Fig. 4E —11-year-6 month-old girl who plays competitive tennis. Frontal photograph obtained 6 years after A shows relative varus alignment of her lower extremities.

 

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