MRI Interpretation and Treatment Plan

What This MRI Means

Your MRI shows a nondisplaced fracture in the upper inner part of your shin bone (proximal medial tibia) at the growth plate scar, combined with multiple minor soft-tissue injuries and patellar maltracking abnormalities that together explain your knee pain and swelling. 1

The key findings are:

Primary Injury (Most Significant)

Nondisplaced tibial fracture: A stress-type fracture at the old growth plate site measuring 2.1 cm, with surrounding bone marrow swelling but no displacement—this is the main source of your acute symptoms and requires protected weight-bearing 1

Secondary Soft-Tissue Injuries

Grade 1 MCL sprain: Mild injury to the medial collateral ligament on the inner knee—these heal well with conservative treatment in 4-6 weeks 2
Minor ACL sprain: Subtle signal changes in the anterior cruciate ligament without actual tearing—this represents mild strain or age-related changes that don't require surgery 1
Semitendinosus tendinosis: Low-grade strain at the hamstring tendon insertion with minimal inflammation 1

Biomechanical Abnormalities Contributing to Pain

Patella alta: Your kneecap sits higher than normal, which predisposes to maltracking and can cause anterior knee pain 3
Lateralized tibial tuberosity: The TT-TG distance of 2.6 cm indicates your tibial attachment point is shifted laterally (normal is <2.0 cm), contributing to abnormal kneecap tracking 3
Hoffa's fat pad impingement: Minor swelling in the fat pad beneath your kneecap, which is associated with the patellar maltracking 3

Treatment Plan

Phase 1: Fracture Protection and Acute Management (Weeks 0-6)

Immediate weight-bearing modification is essential to allow the tibial fracture to heal. 1

Protected weight-bearing: Use crutches with partial weight-bearing (touch-down to 50% body weight) for 4-6 weeks until fracture healing is confirmed 1
Knee immobilizer or hinged brace: Wear during ambulation for the first 2-3 weeks to protect the MCL and provide stability 2
Ice and elevation: Apply ice 15-20 minutes every 2-3 hours for the first week to reduce swelling 2
NSAIDs: Use as needed for pain control (avoid high doses that might impair bone healing) 2

Phase 2: Early Rehabilitation (Weeks 2-6)

Begin gentle range-of-motion exercises once acute pain subsides, typically after 1-2 weeks. 4

Quadriceps sets and ankle pumps: Start immediately to prevent muscle atrophy 4
Gentle knee flexion/extension: Progress from 0-90 degrees as tolerated, avoiding pain 4
Straight leg raises: Begin when you can perform a quadriceps set without lag 4
Hip strengthening exercises: Include side-lying leg raises and clamshells to address biomechanical contributors to patellar maltracking 4

Phase 3: Progressive Strengthening (Weeks 6-12)

Transition to full weight-bearing once follow-up radiographs confirm fracture healing (typically 6-8 weeks). 1

Knee-targeted exercise therapy: Progress to closed-chain exercises including mini-squats, step-ups, and leg press 4
Hip abductor strengthening: Continue aggressive hip strengthening as weakness contributes to patellar maltracking 4
Prefabricated foot orthoses: Consider if you have excessive foot pronation contributing to the biomechanical chain leading to patellar maltracking 4
Patellar taping or bracing: May help control symptoms related to patella alta and maltracking 4

Phase 4: Return to Activity (Weeks 12+)

Progress activity gradually based on pain response, with complete resolution of symptoms before returning to high-impact activities. 4

Graduated return protocol: Start with low-impact activities (cycling, swimming) before progressing to running or jumping 4
Running progression: If returning to running, begin with walk-run intervals at 30-50% usual pace, progressing by 1-2 minutes per session only if pain-free 4
Distance before speed: Build to 50% of pre-injury distance before introducing any speed work 4

Follow-Up Imaging and Monitoring

Obtain repeat knee radiographs at 6 weeks to confirm tibial fracture healing before advancing to full weight-bearing. 1

Clinical reassessment at 6-8 weeks: If no improvement with conservative treatment, consider repeat imaging to assess fracture healing and rule out other pathology 1
MRI is not routinely repeated unless new symptoms develop or there is failure to progress with appropriate rehabilitation 1

Critical Pitfalls to Avoid

Do not ignore the tibial fracture and focus only on the soft-tissue injuries—inadequate protection will delay healing and may lead to displacement. 1

Premature return to weight-bearing: Advancing too quickly before fracture healing can lead to displacement or delayed union 1
Focusing only on knee exercises without hip strengthening: This is a frequent error that leads to persistent patellar pain and treatment failure 4
Over-reliance on passive treatments: Emphasize active exercise therapy rather than depending solely on bracing, taping, or injections 4
Inadequate patient education: You must understand that the patellar maltracking findings represent biomechanical imbalances, not progressive joint destruction, and that consistent exercise is essential for long-term success 4
Ignoring persistent symptoms: If pain persists beyond 12 weeks despite appropriate treatment, reassess for complications or alternative diagnoses 1, 4

Prognosis

With appropriate protected weight-bearing and progressive rehabilitation, the tibial fracture should heal in 6-8 weeks, and the soft-tissue injuries should resolve within 4-6 weeks. 1, 2

MCL sprains: Grade 1 injuries heal well with conservative treatment, with full recovery expected in 4-6 weeks 2
Patellar maltracking symptoms: May persist if biomechanical factors are not addressed through sustained hip and knee strengthening exercises—over 50% of patients report persistent pain beyond 5 years when they fail to persist with exercise therapy 4
Long-term considerations: The patella alta and lateralized tibial tuberosity are anatomic variants that increase risk for recurrent patellar symptoms and may require ongoing attention to lower extremity biomechanics 3

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