0:01

<v ->Another case,

0:02

is a little bit similar

0:04

but with different images.

0:08

He's 31 years old, male,

0:10

patients start with diffused pain in the left knee,

0:14

predominantly in the lateral region

0:17

of the left knee, after running.

0:21

Let me put the images in XL plain.

0:24

He complains pain in the lateral area of the knee.

0:30

Let me put here, the sagital_t2 images

0:34

as we can see here better.

0:37

When you take a look in the images,

0:39

we can see the edema between the inner tibia band.

0:43

It's a friction or surcharge,

0:47

of the inner tibia band.

0:50

This syndrome, probably one of the cause of the pain.

0:55

But when we look for the bone

0:59

we can see this dots, this punctate image,

1:03

punctuate edema.

1:05

This is a very different aspect.

1:08

Also, we can see,

1:13

my small lesion

1:15

of the mid lateral meniscus.

1:18

As you can see, here our biplanar lesion,

1:21

horizontal and vertical lesion,

1:24

But if a very small cyst

1:27

but it's a chronic lesion,

1:29

we cannot, we don't see any unstable fragment.

1:32

We don't see acute sign of meniscal lesion.

1:40

The patient stay in rest,

1:43

did physiotherapy,

1:45

and he was doing better.

1:49

But few days,

1:53

she had the same problem in the right side.

1:57

Let me put the images of the right side.

2:00

In fact, this patient, they didn't put rest.

2:04

He begins to run again

2:06

and she felt the same kind of pain

2:11

from the other side.

2:12

And when you look the MRI,

2:15

you look for the images.

2:18

It looked like the polka dot signs.

2:22

I just learned this, the polka dot sign.

2:27

It's but in this side,

2:31

we cannot see any lesion

2:35

of the meniscus, cartilage, ligaments,

2:38

and we can see everything is normal.

2:41

There is no iliotibial band friction.

2:45

Means this kind of edema is really a early stress reaction

2:51

and could give symptoms of pain in the patients.

2:56

It means in my reports, usually when I see

3:00

this kind of edema I put in my reports,

3:04

like a stress reaction

3:06

because we can avoid

3:09

a really stress fracture,

3:11

if we can call the doctor,

3:13

if we can speak with the patient

3:15

about the initial phase

3:19

of this stress reaction.

3:23

This patient came back few months later to do a new MR.

3:29

And I can show you the result.

3:32

This is the,

3:34

the right side, the left side.

3:36

I put the images,

3:40

let put the images, this is sagital_t2,

3:43

sagital_t2.

3:46

And let me put the actual images here,

3:49

and the actual images here.

3:54

You can see the complete resolution,

3:57

the complete resolution of the edema

4:00

without any symptoms in the site.

4:04

The only thing that he changed after this time,

4:11

he felt problem in his meniscus.

4:13

And if you look, the meniscus is more degenerated

4:17

then rupture is

4:20

enlarged in the cyst.

4:22

There is a synovial inflammation.

4:24

There is a perineural cyst.

4:26

There is a inflammation of the synovial,

4:28

surrounded the meniscus.

4:30

But the bone edema is complex, but reversible,

4:34

as you just show for us.

4:37

This is a good case to show the evolution

4:40

of this kind of edema.

4:41

But the most important for me is

4:43

if you have a patient with this kind of edema

4:48

put in your report as an initial stress reaction,

4:52

'cause the patient should stop the exercise

4:57

to avoid to have a true stress fracture.

5:00

Usually in one month with rest

5:03

they are completely solve this kind of

5:06

this pattern of edema.

5:07

Any comments Don?

5:10

<v ->No, I'm just curious in these cases,

5:12

were they all cross training

5:15

or were they other sports?

5:18

<v ->Runners, Runners.

5:21

<v ->Okay, yeah, and I guess majority lower extremity knee,

5:27

probably?

5:28

<v ->Yeah, all of them.

5:30

I have some cases in the distal tibia,

5:33

very similar of this

5:36

but in the knee, it's very, very common.

5:38

It's very common.

5:39

Sometimes you see usually in my experience,

5:43

the edema comes from the posterior and central part.

5:47

Let me put the image here.

5:51

the edema that comes usually from the area

5:54

where the vessels getting in the bone,

5:57

in the posterior part of the bone,

5:59

in the central and posterior part

6:01

of the metaphyseal distal femur.

6:05

<v ->Yeah, they're really nice cases,

6:07

that's terrific.