VCOM Research Day Program Book 2023

Medical Student Research Case Reports

03 A Case of Focal Periphyseal Edema in a Young Male Athlete

Madeline Marshall, OMS III; Everett Wilson, DO; Christopher John, MD Corresponding author: mmarshall@vcom.edu

Edward Via College of Osteopathic Medicine- Virginia Campus Carilion Clinic Department of Family Medicine, Carilion Clinic Department of Orthopedic Surgery

Focal Periphyseal Edema (FOPE) Zones were first described in medical literature around 2011 and described as a benign MRI finding in adolescents. Continued uncertainty around the origin and future impact of FOPE Zones are still being discussed in current literature. This case displays the progression from onset to diagnosis to treatment and resolution of symptoms which helps add valuable data to the growing investigation of this rare MRI finding. We present a 14-year-old male football player who presented to the orthopedic surgery clinic with 3 weeks of left knee pain. The patient suffered a hyperextension injury to the left knee approximately 1 year prior during the previous football season, and otherwise has no significant past medical history or surgical history. Since that injury, he dealt with intermittent pain in the knee which had limited his athletic performance but was manageable with supportive care. However, this pain progressed and became present with simple movements like stretching, jumping, and knee flexion, and limping was noted on primary assessment in the orthopedic surgery clinic. The pain was described as a dull ache radiating throughout the knee joint, with localization

to the anterior aspect of the knee. From initial presentation to his last follow up, this patient’s care followed a 44-day timeline. On primary assessment, there was tenderness to palpation on the left medial tibial plateau, without edema or limb malalignment, and x-ray imaging was unremarkable. Given normal imaging despite continued pain, further diagnostic testing with a left knee MRI was performed. In the interim, the patient was advised against playing football, and against any strenuous lower extremity activity with no limitations on upper body training. On day 13 of the patient’s care timeline, he underwent an MRI which showed a zone of focal periphyseal edema involving the left proximal tibial physis. On follow-up assessment, the patient had continued medial knee pain despite lower extremity rest. After consultation with pediatric orthopedics, continued cessation of strenuous lower extremity activity for another 4 weeks was recommended. On day 44 of the patient’s care timeline, the patient presented to the clinic with complete resolution of left knee pain. Examination was negative for pain over the

medial tibial plateau, limb malalignment, or edema. Range of motion testing was intact, he was able to perform a deep squat, could squat jump without pain, and tolerating light jogging for the past few weeks. Given the patient's ability to tolerate activity without pain, there were no indications for repeat imaging, and the patient was cleared to return to full activity without restrictions. Most studies show a major predominance in females having FOPE zones over males, but this case could contribute further to the epidemiologic understanding of FOPE zones and could further grow the data on the typical presentation and progression of this rare diagnosis.

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