Painful Lateral Knee Condyle Bone Marrow Edema after Treatment with Lateral Wedged Insole

Abstract

A 50-yr-old man arrived at our department for a rehabilitation prescription after a right knee medial collateral ligament sprain. Magnetic resonance imaging showed medial collateral ligament partial rupture and medial femoral condyle increased signal intensity indicating bone edema. After treatment, the patient still complained of weight-bearing knee medial compartment pain. A lateral wedged insole was prescribed to decrease medial compartment compression forces. Initial response to insole use was good, but soon after, the patient complained of severe worsening knee pain. On examination, the lateral joint line and condyle palpation were tender. Insole use discontinuation was recommended, and another magnetic resonance imaging scan was performed. It showed an high T2-weighted signal intensity, representing bone marrow edema comprising a volume of 5 x 5 x 4.5 cm of lateral femoral condyle. Discontinuation of orthosis use relieved the pain, and the edema disappeared. To our knowledge, lateral femoral condyle painful bone marrow edema after lateral wedged insole use has not been previously described. The findings of this case report indicate that lateral wedged insole prescription should be carefully evaluated.

Bone Marrow Edema Pattern around the Knee on Magnetic Resonance Imaging Excluding Acute Traumatic Lesions

“…8,9 Orthotics may also alter weightbearing, which can result in an asymptomatic or painful BME pattern on MRI that disappears after discontinuation of the orthosis. 10 Chronic tension on ligamentous structures including the cruciate and collateral ligaments may produce a BME pattern at the attachment sites of the ligaments to the bone. These findings can be incidental or may be associated with mucoid degeneration of the ligaments.…”