Imaging Findings

From the lateral X-ray of the knee joint, the lower pole of the patella (at the patellar tendon attachment near the patella) shows an irregular calcification or ossification. Mild swelling is observed in the adjacent soft tissue. Overall, there is no obvious discontinuity of bone integrity, the patella maintains a generally normal shape, and there is no apparent narrowing of the joint space.

Possible Diagnoses

Based on the patient’s age, clinical symptoms, and imaging findings, the following differential diagnoses are considered:

• Sinding-Larsen-Johansson Disease (traction apophysitis of the inferior pole of the patella): Common in adolescents aged 10-14, especially active boys. On imaging, irregular ossification or calcification can be seen at the inferior pole of the patella. Clinically, there is pain and tenderness at the lower pole of the patella.
• Osgood-Schlatter Disease (tibial tubercle apophysitis): Also a traction apophysitis but primarily involves the tibial tubercle, where the patellar tendon attaches to the tibia. Pain and bony changes occur at the tibial tubercle. If the child has pain at the tibial tubercle and corresponding imaging findings, this should be considered, but in this case, the imaging findings involve the inferior pole of the patella.
• Patellar Tendinopathy or Patellar Tendonitis: Often related to overuse from repetitive activities, but simple soft tissue lesions usually do not show local ossification markers on X-ray.
• Avulsion Fracture of the Inferior Pole of the Patella: Usually seen after acute trauma. If there were obvious bone fragments or discontinuity of the patella, this would be a consideration. However, such features are not shown in this film.

Final Diagnosis

Taking into account the imaging findings, the patient's age, clinical symptoms, and the typical features of traction apophysitis, the most likely diagnosis is:

Sinding-Larsen-Johansson Disease (traction apophysitis of the inferior pole of the patella).

This is a self-limiting benign condition that usually resolves within a few months to about a year as skeletal maturity progresses.

Treatment Plan and Rehabilitation

The mainstay of treatment is conservative management, aiming to relieve the patient’s symptoms and ensure normal bone growth:

• Rest and Activity Modification: Avoid excessive flexion-extension of the knee joint and high-impact activities such as running and jumping that increase stress at the patellar attachment. The use of an elastic knee brace or supportive device may help.
• Pain Relief and Anti-inflammatory Measures: Depending on the severity of pain, non-steroidal anti-inflammatory drugs (NSAIDs) or basic analgesics can be used. Local ice application (following the RICE principle) can also reduce pain and swelling.
• Physical Therapy and Strength Training: Once acute pain subsides, exercises to stretch and strengthen the quadriceps and hamstrings can be introduced to maintain or improve knee joint stability.

FITT-VP Principle for Progressive Rehabilitation:

• Frequency: 2-3 times per week initially, which can be increased to 3-4 times per week as symptoms improve.
• Intensity: Begin with low to moderate intensity, such as low-resistance or low-impact exercises (e.g., wall sits or static holds). If pain is well-controlled, gradually increase the training load.
• Time: Start with about 15-20 minutes per session, including warm-up and cool-down. Gradually increase to 30 minutes based on tolerance and symptom control.
• Type: Emphasize low-impact aerobic activities (such as swimming or cycling) combined with targeted strengthening (quadriceps, hamstrings, etc.).
• Volume & Progression: Increase exercise duration or intensity progressively as tolerated. If significant pain or discomfort occurs, reduce load or pause as needed.

Example (Weekly Training Schedule):

• Weeks 1-2: Focus on isometric quadriceps exercises, wall sits, and low-intensity cycling for around 15 minutes each session.
• Weeks 3-4: Introduce gentle patellar stretching exercises for about 20 minutes per session, gradually including moderate-intensity strength training.
• Week 5 and Beyond: If pain is controlled and continues to improve, slowly increase sessions to 30 minutes and add core, balance, and coordination training.

Disclaimer

This report is a reference analysis based on the currently provided history and imaging data and does not replace an in-person clinical examination or professional medical advice. In case of any further questions or changes in condition, please consult a qualified healthcare provider.