Medical Imaging Analysis Report

I. Imaging Findings

Based on the provided anteroposterior (AP) and frog-leg X-ray views of the pelvis, as well as MRI images, the following characteristic findings can be observed in the bilateral hip joints:

• Both proximal femoral epiphyses (femoral heads) appear to be abnormally positioned, showing a posterior-inferior displacement trend.
• The left side shows more pronounced displacement compared to the right side, presenting mild to moderate displacement, a widened growth plate, and an abnormal relationship between the epiphyseal margin and the superior border of the femoral neck (negative Klein line) on the left hip.
• Decreased epiphyseal height (relative to a normal side or standard reference values) suggests a possible structural abnormality or injury within the growth plate.
• On certain MRI sequences, there are notable signal changes in the corresponding region, potentially related to displacement and secondary inflammation or edema.

II. Potential Diagnoses

Considering the patient’s clinical presentation (8 weeks of knee and thigh pain, no trauma history, and prior growth hormone therapy) along with the imaging findings, the following potential diagnoses should be taken into account:

1. Slipped Capital Femoral Epiphysis (SCFE)
   Reason: SCFE commonly occurs in children or adolescents during a rapid growth phase, with risk factors including obesity and endocrine disorders (e.g., growth hormone therapy, hypothyroidism). Characteristic imaging features include posteroinferior displacement of the femoral epiphysis and a negative Klein line.
2. Legg-Calvé-Perthes Disease
   Reason: Most often seen in children aged 4–8, typically presenting with femoral head necrosis and collapse on imaging. Early stages can show changes in the density of the femoral epiphysis. Although it can present with hip or knee pain, the epiphyseal displacement seen in SCFE is not a feature of Perthes disease.
3. Metastatic Bone Disease or Infectious Lesions
   Reason: With a history of stem cell transplantation and other underlying conditions, one must consider bone marrow abnormalities, infection, or metastasis. However, X-rays and MRI do not indicate significant bone destruction or extensive lesions, making mechanical displacement more likely.

III. Most Likely Final Diagnosis

Taking into account the patient's age, symptoms (knee and thigh pain, possibly accompanied by a limp), previous growth hormone therapy, and radiological evidence of bilateral femoral heads slipping posteriorly and inferiorly along the growth plate, the most fitting diagnosis is bilateral Slipped Capital Femoral Epiphysis (SCFE).

If further assessment of lesion extent or stability is necessary, a more detailed MRI can clarify vascular supply and the specific nature of the growth plate damage. Monitoring blood tests (e.g., thyroid function) is advised to rule out related endocrine disorders.

IV. Treatment Plan and Rehabilitation Strategy

1. Treatment Approach
   • Weight-Bearing Restriction: Once diagnosed, weight-bearing should be immediately discontinued on the affected side(s). Crutches or a wheelchair may be used to minimize stress on the hip joints.
   • Surgical Intervention: In cases of poor stability or moderate-to-severe slips, internal fixation (e.g., screw placement through the growth plate) is usually required to prevent further slippage and reduce complications.
   • Medication Support: If endocrine disorders (e.g., thyroid issues, abnormalities related to growth hormone) are identified, coordination with an endocrinologist is recommended.
   • Postoperative Rehabilitation: The duration and progression of rehabilitation depend on the degree of slippage and the surgical technique. Follow medical advice on staged return to weight-bearing as appropriate.
2. Rehabilitation and Exercise Prescription

   Following a gradual progression and individualized strategy, rehabilitation should be supervised by specialized healthcare professionals:

   • Early Phase (0–6 weeks post-surgery or post-diagnosis):
     • Focus on protecting and maintaining the joint’s range of motion. Avoid excessive hip movement and weight-bearing.
     • Engage in gentle passive range-of-motion exercises and isometric muscle contractions to help preserve muscle strength and reduce adhesions.
   • Intermediate Phase (6–12 weeks):
     • Once partial weight-bearing is approved by the physician, initiate short-distance walking with assistive devices such as crutches.
     • Begin progressive resistance exercises aimed at core and hip musculature to stabilize the hip joint.
   • Late Phase (12 weeks and beyond):
     • Gradually transition to full weight-bearing ambulation. Low-impact activities like aquatic walking or cycling can be introduced.
     • In accordance with the FITT-VP principle, gradually increase exercise intensity, frequency, and duration to further enhance lower limb strength and joint stability.

V. Disclaimer

This report is based on existing medical history and imaging studies for reference purposes only. It should not be considered a substitute for an in-person consultation or professional medical diagnosis and treatment. The patient is advised to seek further evaluation and management from a specialist.