A 28-year-old male semiprofessional basketball player presented to our orthopaedic practice with pain proximal and lateral to the left knee joint. He was treated for a tibial shaft stress fracture with tibial intramedullary nail (IMN) fixation 1 year prior at an outside hospital. He first noticed pain proximal and lateral to the left knee 2 weeks after surgery, and it persisted for the entire year. He had no complaints of pain in other joints and he denied any history of trauma since surgery. X-ray images taken during initial evaluation at our clinic showed no evidence of fractures, appropriate position of hardware, and presence of heterotopic bone at the proximal TFJ (Figure 1(a)). We ordered a CT scan to further evaluate the heterotopic bone and rule out implant problems including screw breakage, loosening, or prominent position. The CT scan demonstrated that the implant was properly positioned with no protruding or loosening screws (Figures 1(a)-1(d)). We posited that the implant likely had little to no impact on the patient's pain. The scan also displayed no acute fracture consistent with the patient's reported level of pain (Figures 1(a)-1(e)). However, it showed that the drill for the proximal locking screw may have penetrated through the tibia and into the fibula (Figure 1(d)). It also revealed proximal tibiofibular synostosis immediately distal to the proximal TFJ joint (Figures 1(a)-1(e)) aligned with the bone reaming along the drill path (Figure 1(d)). Following a literature review and a discussion with our patient, we decided to proceed with nonoperative management. The patient declined a steroid injection. The patient's knee pain resolved without intervention, and he was able to return to playing semiprofessional basketball. At 13 months postoperation, he reported intermittent, mild pain on the medial side of the knee while playing basketball, but this did not limit his participation. At the final follow-up 16 months postoperation, he reported no pain.