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<v ->This case is a 33 years old.

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She came to do an MRI.

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With anterior pain.

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She had a suspicion of chondromalacia.

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And as we can see here,

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there is a chondromalacia,

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some features, some edema,

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some irregularity of the cartilage.

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And she came to see what was this.

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She performed a MRI.

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We are looking for the images

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and we saw this kind of image that I didn't saw this before.

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I didn't remember to see this before.

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It looked like...

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something sclerotic surrounding the epiphysis area.

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I really didn't remember to see the image like this.

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But one of my fellows who had already...

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seen and studied a case. (chuckles)

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He told me and he showed me an article, from 2003,

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published in Skeletal Radiology,

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which cited this image's pattern

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in a case of growth arrest

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of the secondary ossification center of the epiphysis.

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This case is only to show

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it's like a differential diagnostic

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of chronic osteonecrosis.

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This is not osteonecrosis.

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This is really growth arrest of the secondary area.

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Let me show you what it means.

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This image is from the literature.

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That you can see this area.

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This area.

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We have this zone...

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This zone of a secondary ossification,

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or ossified epiphysis.

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And when you have any disease or any problem

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in the maturation of the bone, due local trauma,

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severe infection, malnutrition,

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no plank long-term immobilization.

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You can have a lesion of this...

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A provisional zone of ossification.

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Is this area, it's a blue marine area.

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And the radiography taken from the literature,

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I didn't have any image of this,

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you can see this sclerotic, surrounding exactly this area.

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Some authors...

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use the term...

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acrophysis.

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I never heard about.

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Usually the most common is to see the Harris line.

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The Harris line,

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as you can see in these images of x-ray and MRI.

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The Harris line is the most common,

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is the loss of conformation of the longitudinal trabecular

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with compaction in the horizontal layers

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and transversal layers.

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Transverse to the metaphysis area,

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which is called Harris line.

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This is a very nice case, I didn't saw an image,

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and I put like this image because it's very curious.

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It should be a differential diagnosis

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on chronic osteonecrosis.

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<v ->I wanna make a comment about it because I've seen this.

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And what's interesting about it.

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First of all, it gives you an idea exactly how bones grow.

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You know, for example, if you see growth arrest

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in the vertebral bodies,

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you'll know that most of the growth

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of the vertebral body is anterior and lateral,

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and not posterior.

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The other interesting thing about it

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is the fat within the smaller bone

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is always higher signal, you know.

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And I've always wondered about that.

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But it's always got more pure fat it seems like...

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Like in there.

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And then the one other thing is...

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that some people say they shouldn't be called

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growth arrest lines,

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because this is deposited with recovery of the growth,

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after the arrest.

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So some people call these growth recovery lines,

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not growth arrest lines.

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But this is a beautiful example.

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I've often seen the changes, mostly in the patella,

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but in your case, you know,

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they're dramatic in the femur and tibia.

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They're just... that's a beautiful, beautiful place.