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Anterior Knee pain
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Re: Anterior Knee pain - January 6, 2005 6:05:00 AM
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UTDC
Posts: 221
Joined: December 21, 2003
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Army,
Good case. A well demarcated, benign appearing ovoid lesion is visible within the tibia. Off the top of my head, the differentials are giant cell tumor, fibrous dysplaysia, anyresmal (sp!)bone cyst and a number of other benign processes. He needs further imaging and a referral.
Jeff
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Re: Anterior Knee pain - January 6, 2005 3:33:00 PM
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jma
Posts: 2310
Joined: August 24, 2000
From: NY
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Hello,
See an ovid round growth at the medial tibia distal lateral to the tibial tubercles. On the lower lateral x-ray, can also see a clearing transparency on the tibia as well. I agree, further imaging and a referral as well.
JMA
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Re: Anterior Knee pain - January 10, 2005 8:09:00 PM
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Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
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The radiologist called this a nonossified fibroma. All other structres were read normal.
I remember when I was a new therapist and would see these; I would tend to get all worked up over nothing and when I reported these to the physician, he would make note of it but nothing was done. I would think in this case a call to the physician would be in order.
Fibroxanthoma, nonossifying fibroma (NOF), fibrous cortical defect (FCD), and less commonly, benign fibrous histiocytoma, have all been used interchangeably in the radiology literature.
Fibroxanthoma and FCDs are nonaggressive fibrous lesions of bone that are distinguished from one another historically by their size and natural history. Both are considered developmental defects and nonaggressive. They were first described by Lichtenstein and Jaffe in 1942 and they typically occurred within the metaphysis of growing long tubular bones in children, most commonly about the knee. Controversy continues regarding the correct terminology (as noted above) and etiology of these lesions.
Currently, the distinction between FCD and fibroxanthoma is based on the size and natural history. FCDs are asymptomatic, small, (less than 3 cm), eccentrically located, metaphyseal cortical defects; most of these spontaneously disappear. However, some evolve and enlarge into fibroxanthomas. Conversely, fibroxanthomas (greater than 3 cm) are larger, eccentric, intramedullary lesions that abut the cortex; they have a typical, superficial, scalloping pattern in the adjacent cortex.
Anatomy: Approximately 90% of cases of both lesions involve the tubular long bones. Common sites include the femur (most commonly the distal femoral metaphysis [38%]), the proximal and distal tibia (43%), and the knee (55%); most lesions occur around the knee. The tibial diaphysis is involved in only 10% of cases. The fibula is affected in 8-10% of cases, as noted in one series at the Armed Forces Institute of Pathology (AFIP). Both fibroxanthoma and FCDs are uncommon in the upper extremity; however, of those reported in the literature, 8% were in the humerus, and both radial and ulnar lesions were rare. Less common sites include the innominate bone, clavicle, skull, scapula, mandible, and small bones of the hands and feet.
< Message edited by David Adamczyk -- August 20, 2007 8:27:46 PM >
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Alex Brenner, PT, MPT, OCS
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Re: Anterior Knee pain - January 11, 2005 7:51:00 AM
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chiroortho
Posts: 655
Joined: February 18, 2004
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Army,
This is a good case. One factor to mention would be to include Ewing's in the differential. Although the NOF shown here is clearly benign in appearance, Ewing's sarcoma is very common in this age group, and particularly common in the tibia, with symptoms of knee pain.
When I first saw the radiograph I was happy to see that the tumor did not violate the cortex, an encouraging sign that the tumor was benign. However, in a young man with atraumatic knee pain and a lucency on his films, I would make sure that he sees the ortho surgeon post haste.
Thank you for your efforts in providing case studies for review.
Greg
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Greg Priest, DC, DABCO
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