Focal Periphyseal Edema: Are We Overtreating Physiologic Adolescent Knee Pain?

Abstract

The goals of this study were to (1) introduce the MRI phenomenon of focal periphyseal edema (FOPE) to the orthopaedic community and (2) describe characteristic features and clinical outcomes of a small series of adolescents with FOPE lesions about the knee. The inclusion criterion was the presence of activity-related knee pain and periphyseal edema on T2-weighted MRI. Exclusion criteria were skeletal maturity, history of traumatic knee injury, and the presence of other knee abnormalities. Participants completed the Short Form 10 and Pediatric International Knee Documentation Committee (pedi-IKDC) outcome assessments. Four patients (average age, 13.7 years) with atraumatic activity-related knee pain and FOPE lesions were retrospectively identified. At follow-up (average, 15.8 months), all patients reported the ability to participate in physical activities at the desired level. The mean pedi-IKDC score was 71.2. With supportive treatment, patients with FOPE were able to return to sport, although they had lower-than-average outcome scores. Increased awareness and understanding of this clinical entity are necessary for provision of effective, cost-efficient care to patients with FOPE.

Whole body magnetic resonance imaging in healthy children and adolescents

“…This finding is suggested to present early stages of physiologic physeal closure [7] which implies that also physes in other locations may be involved. FOPE has been reported to be a non-traumatic cause of pain [7,36,37]. In accordance with previous publications, the highest number of FOPEs were in the adolescent age-group [7], but we also found FOPElike lesions in younger children.…”

Focal Periphyseal Edema (FOPE) Zone: A Possible Cause of Unexplained Knee Pain In Adolescents. A Case Report and Literature Review.

“…2,7 All reports suggest conservative treatment by activity restriction, physiotherapy and mild analgesics etc, and did not recommend any invasive intervention as in most cases the symptoms resolved over time. However some reports 6,8 have suggested that FOPE associated knee pain may not be clinically benign as shown by decreased ped-IKDC scores compared to matched peers and persistent activity related knee pain greater than one year after diagnosis. In the case we presented the patient still has symptoms of pain six months after the initial diagnosis.…”

“…Zbojniewicz et al 1 Beckmann et al 2 Bochmann et al 3 Bai et al 4* Sakamoto et al 5 Giles et al 6 Ueyama et al 7 Spiers et al 8 Frohlich et al 9 Runner, dancer, basketball, soccer, tennis, volleyball, track athletic, off road bicycling, baseball, football, horseback riding, golf. Softball, dancer, basketball.…”

“…The pain subsided after four weeks of the onset. Gilles et al 6 retrospectively identified four patients, three females and one male, with MRI findings consistent with FOPE. All 4 reported atraumatic, activity-related knee pain.…”

“…Since their initial case series of 12 patients there have been several other reports. [2][3][4][5][6][7][8][9] We present a case with a FOPE zone finding on MRI scan in an adolescent male and reviewed published reports to find out what we know about this condition so far.…”