Crossing the Physeal Plate: Is it Crossing your Mind?

Purpose or Learning Objective: The spectrum of physeal pathologies around the knee joint in the pediatric age group ranges from developmental and growth disorders, traumatic derangement, inflammation, infection, and diffuse marrow disorder to neoplasm. This study evaluated and presented the imaging features of a range of observed abnormalities involving the physeal plate.

Methods or Background: A retrospective review of all magnetic resonance imaging (MRI) scans performed on the knee in the pediatric age group (0–16 years) in the past 10 years was conducted. The disease processes involving the distal femoral and proximal tibial physeal plate were evaluated and included in the study.

Results or Findings: MRIs of 210 patients (123 male; 87 female), mean age: 11.4 years) were assessed. Of the 210 patients, 56 (26%) had pathologies involving the physeal plate. A total of 38 patients showed pathologic involvement: 10 were infections, 7 were traumatic/stress induced, 2 were metabolic, 7 were neoplastic, and 12 were bony/fibrous bars. Lastly, 18 were focal periphyseal edema zone around the growth plate, likely representing early stages of physiologic physeal closure.

Conclusion: MRI of the knee joint in the pediatric age group is an excellent modality to look for the wide spectrum of growth plate involvement. These pathologies range from more common ones, such as physeal bars, osteomyelitis, or neoplasm, to less common ones like metabolic pathologies. An understanding of the pathophysiologic conditions involving the physeal plate can increase diagnostic accuracy, enabling radiologists to anticipate future growth disturbances and thus ensure timely and appropriate intervention.

Publication History

Article published online:
22 May 2024