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A 52-year-old woman with diabetes and a known cancer complained of non-traumatic knee pain for two weeks duration. Her initial radiographs and clinical findings were inconclusive. However, subsequent work-up including bone scan and MRI suggests an insufficiency fracture of the left tibial plateau. Tibial plateau fractures may directly extend to the articular surfaces of the weight-bearing joint. Insufficiency fracture of the tibial plateau is a rare diagnosis. Delayed diagnosis can cause persistent knee pain and can lead to deformity of the joint. A high index of suspicion and appropriate imaging greatly assist in an early diagnosis and in minimizing major morbidity.