Developmental defects of the distal femoral metaphysis.

Knee Lesion in a 62-year-old Woman

“…It typically occurs between the ages of 3 to 17 years, with a peak incidence at 10 to 15 years, and has been reported in 11.5% of boys and 3.6% of girls [21]. At epiphyseal closure, the irregularity decreases in size and often disappears, although it may persist into adulthood [7,9,13,20,27], as documented in one report in a 57-year-old man [17]. Suh et al [23] also found distal femoral cortical irregularities in 44 of 100 knee MRIs (mostly adults) and divided them into concave (four cases with cortical concavity), convex (36 cases with cortical convexities), and divergent (four cases with wide and split cortex).…”

“…Suh et al [23] also found distal femoral cortical irregularities in 44 of 100 knee MRIs (mostly adults) and divided them into concave (four cases with cortical concavity), convex (36 cases with cortical convexities), and divergent (four cases with wide and split cortex). The lesion is often asymptomatic, producing no palpable mass, pain, or swelling and has a benign course [8,9,16,19]. Consequently, they are frequently an incidental finding when radiographs are reviewed for unrelated conditions or knee trauma as in our patient [7,9].…”

“…The lesion is often asymptomatic, producing no palpable mass, pain, or swelling and has a benign course [8,9,16,19]. Consequently, they are frequently an incidental finding when radiographs are reviewed for unrelated conditions or knee trauma as in our patient [7,9].…”

“…Some [21] consider it a developmental anomaly while others consider it an earlier phase of the more common fibrocortical defect [4,7]. Most lesions can be related to chronic traction or avulsive injury at the insertion of the extensor aspect of the adductor magus [2,5,9,14,20] or to the origin of the medial head of the gastrocnemius [7,17,20,23,26] and plantaris muscles [7]. Some authors, however, have not found tendinous attachments at this location [4,21,27].…”

“…A proximal humeral lesion at the insertion of the pectoralis major has been described as a ''ringman's shoulder,'' occurring primarily in gymnasts [10]. The femoral lesion is best demonstrated radiographically with the knee in 20°to 45°of external rotation [9]. The involved area is typically 1 to 2 cm in length, occasionally with reactive bone formation extending into the soft tissue [9].…”