Medical Analysis Report

Imaging Findings

An expansile cystic lesion is observed in the metaphyseal region of the proximal right femur. The surrounding cortex is thin but remains intact. The lesion is well-demarcated, appearing radiolucent or cystic internally, without a distinct trabecular pattern. No significant reactive sclerosis is noted. The surrounding soft tissue shows no evident swelling or abnormal calcification. Currently, no obvious pathological fracture lines are detected, but attention should be paid to the stability of the adjacent structures.

Potential Diagnoses

1. Simple Bone Cyst (Unicameral Bone Cyst): Commonly seen in children and adolescents, usually located in the metaphysis of long bones. Radiographically, it presents as a well-defined expansile radiolucent lesion with a thin but typically intact cortex. This is consistent with the patient's age and imaging features.
2. Aneurysmal Bone Cyst: May also appear as an expansile cystic lesion but often exhibits septations or varying densities of hemorrhage; in this case, there is a lack of obvious septation or layered features.
3. Fibrous Dysplasia: Can show cystic changes but often demonstrates a “ground-glass” appearance and small internal fragments. This does not coincide fully with the imaging findings here.

Considering the patient’s age, the location, and the typical imaging presentation, the primary consideration is a Simple Bone Cyst.

Final Diagnosis

Based on the patient’s young age, clinical symptoms (pain radiating to the hip and knee), X-ray findings (“expansile cystic lesion with a thin cortex”), and common sites reported in the literature, the most likely diagnosis is Simple Bone Cyst. If there is still doubt, MRI or pathologic biopsy can be performed for further confirmation.

Treatment Plan and Rehabilitation Program

Treatment Strategy

• Conservative Treatment: If the lesion is relatively small and symptoms are mild, observation may be considered. Avoid strenuous activities to reduce the risk of pathological fracture.
• Surgical Intervention: For larger cysts or those with a high risk of pathological fracture, curettage (scooping out the cyst) followed by bone grafting or the use of bone substitutes can be considered. In some cases, corticosteroid injections are attempted.

The decision to proceed with surgery depends on the lesion’s size, the patient’s symptoms, and the degree of skeletal maturity. Close follow-up is necessary to monitor changes in the lesion and the risk of fracture.

Rehabilitation / Exercise Prescription

Since the lesion is located in the proximal femur, excessive weight-bearing and high-impact activities should be avoided. Under the guidance of a professional rehabilitation therapist, lower limb function should be gradually restored. A step-by-step protocol (based on the FITT-VP principle) can be considered:

1. Initial Stage:
   • Frequency (F): 2–3 times per week with low-intensity exercises.
   • Intensity (I): Limit weight-bearing activities; use crutches or a walker to reduce load.
   • Time (T): 10–15 minutes per session of light exercises, including range-of-motion training in a supine or seated position.
   • Type (T): Primarily non-weight-bearing or low-load activities, such as seated leg raises, passive joint movements, and low-resistance band exercises.
   • Progression (P): Gradually increase duration and load as long as the condition remains stable and pain is tolerable.
2. Consolidation Stage:
   • Frequency (F): 3–4 times per week.
   • Intensity (I): Gradually increase bodyweight exercise and light resistance training, still avoiding high-impact movements.
   • Time (T): 15–30 minutes each session, depending on pain tolerance and strength recovery.
   • Type (T): Include isometric exercises for the quadriceps and hamstrings in a seated or supine position, along with core stability exercises.
   • Progression (P): Once local pain subsides or diminishes and muscle strength improves, transition from partial to full weight-bearing exercises.
3. Strengthening Stage:
   • Frequency (F): 3–5 times per week.
   • Intensity (I): With appropriate support or bracing, progressively work on single-leg standing exercises, squats, and similar functional movements.
   • Time (T): Approximately 30–45 minutes per session, incorporating strength and coordination training.
   • Type (T): Gradually introduce low-impact aerobic activities (e.g., elliptical, stationary cycling) and increase resistance based on individual conditions.
   • Progression (P): Monitor pain and rehabilitation assessment indicators. If symptoms improve and bone structure is stable, further return to normal exercise routines.

Throughout the rehabilitation process, keep the following points in mind:

• All exercises should be performed without significant pain. If severe pain or swelling occurs, stop immediately and seek evaluation.
• Monitor bone density and structural recovery. Imaging follow-up may be necessary to assess cyst recurrence or fracture risk.
• Adjust exercise intensity and formats on an individual basis. Avoid blindly increasing the load.

Disclaimer

This report serves only as a reference analysis and does not replace in-person medical consultation or professional physician advice. If any doubts arise or symptoms worsen, please seek medical attention promptly.