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A little athlete with a tender knee

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Patient Details & Clinical History


An 11 year old male is referred from the orthopedist for an MRI evaluation of his left knee. He complains diffuse mild pain to the knee joint, since a hit on the lateral aspect, during soccer training 1 month ago. Range of motion of the right knee is normal. He is a physically active kid and plays soccer regularly. He has no significant previous medical history.

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MRI
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Coronal PD FS

Coronal T1

MRI of the knee has been performed @ 1.5T using a knee surface coil in three orthogonal planes including PD, PD FS and T1 weighted sequences.

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MRI
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Coronal PD FS

Coronal T1

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MRI
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Coronal PD FS

Coronal T1

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MRI
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Coronal PD FS

Coronal T1

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MRI
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Coronal PD FS

Coronal T1

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MRI
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Coronal PD FS

Coronal T1

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MRI
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Coronal PD FS

Coronal T1

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MRI
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Coronal PD FS

Coronal T1

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MRI
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Coronal PD FS

Coronal T1

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MRI
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Coronal PD FS

Coronal T1

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MRI
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Coronal PD FS

Coronal T1

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MRI
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Coronal PD FS

Coronal T1

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MRI
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Coronal PD FS

Coronal T1

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MRI
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Coronal PD FS

Coronal T1

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MRI
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Coronal PD FS

Coronal T1

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MRI

Sagittal PD

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MRI

Sagittal PD

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MRI

Sagittal PD

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Sagittal PD

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Sagittal PD

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Sagittal PD

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Sagittal PD

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Sagittal PD

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Sagittal PD

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Sagittal PD

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Sagittal PD

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Sagittal PD

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Sagittal PD

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Sagittal PD

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Sagittal PD

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Sagittal PD

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Relevant images
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Coronal PD FS

Coronal T1

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Relevant images

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Sagittal PD

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Imaging Findings
An area of periphyseal edema is present at the level of the lateral distal femoral physis. No other significant imaging findings are observed.

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Differential diagnosis (DDX)


Focal edema to the distal femoral physis related to prior injury. Focal edema to the distal femoral physis related to normal physeal fusion. Bone marrow edema localized to and surrounding the distal femoral physis related to infection.

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Diagnosis Please

?
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Final Diagnosis

Focal Peryphiseal Edema aka FOPE

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What is FOPE
FOPE (Focal Peryphiseal Edema) is a focal physeal alteration. Is a focal bone marrow edema pattern centered at the physis of the distal femur, proximal tibia, or proximal fibula that extends into the adjacent metaphysis and epiphysis. A painfull knee is its clinical manifestation. The cause of this appearance is unknown. It may be a manifestation of normal skeletal maturation (physiologic physeal fusion).

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FOPE
Has been reported to occur in young athletes in 75% of the cases (Zbojniewicz AJR 2011). This finding may also be accidental in asymptomatic adolescents that undergo a knee MRI. Is therefore to be considered an early stage of physiologic physeal fusion. It should not be mistaken for an abnormality and requires no invasive diagnostic procedure, and does not need imaging followup.

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References
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Focal Periphyseal Edema (FOPE) zone on MRI of the adolescent knee: a potentiallypainful manifestation of physiologic physeal fusion? Zbojniewicz AM, Laor T. American Journal of Roentgenology 2011; 197: 998 1004. MRI of the Pediatric Knee. Pai DR, Strouse PJ. American Journal of Roentgenology 2011; 196: 101927. MR Imaging Insights into Skeletal Maturation: What Is Normal? Laor T, Jaramillo D. Radiology 2008; 250: 2838.

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