Presentation
Left knee pain and stiffness. History of polyarthropathy treated with high dose steroids and biologics.
Patient Data
Sclerotic band through the left knee medial tibial condyle. Small knee joint effusion.
Marked bone marrow edema signal through the medial tibial condyle with associated periosteal edema. Centrally in the edema, there is an incomplete T1 low signal fracture line. Overlying cartilage is intact. No tibial plateau depression.
Horizontal oblique meniscal tear at the body and posterior horn. Lateral meniscus is intact.
No ligamentous injury. Mild ACL mucoid degeneration characterized by high PDFS signal and thickening
No knee joint effusion. Anteromedial knee subcutaneous edema.
Case Discussion
This case is an example of an insufficiency fracture of the knee visible on x-ray with florid changes on the MRI. Given long-term steroid use, the patient may have osteoporosis, which is a risk factor for insufficiency fractures.
In this case, the meniscal tear may be incidental, particularly as the fracture is deeper than a typical subchondral insufficiency fracture and the meniscal tear of the body rather than the root.
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