Neoplastic and Non-neoplastic Bone Lesions of the Knee

Abstract

Numerous anatomical variants are described around the knee, many of which look like bony lesions, so it is important to know them to avoid unnecessary complementary tests and inadequate management. Likewise, several alterations in relation to normal development can also simulate bone lesions.

However, numerous pathologic processes frequently affect the knee, including traumatic, inflammatory, infectious, and tumor pathology. Many of these entities show typical radiologic features that facilitate their diagnosis. In other cases, a correct differential diagnosis is necessary for proper clinical management.

Despite the availability of increasingly advanced imaging techniques, plain radiography is still the technique of choice in the initial study of many of these pathologies. This article reviews the radiologic characteristics of tumor and nontumor lesions that may appear around the knee to make a correct diagnosis and avoid unnecessary complementary radiologic examinations and inadequate clinical management.

Keywords

knee - bone lesions - tumors - normal variant - developmental disorder

Publication History

Article published online:
20 May 2024

• References

• 1 Mhuircheartaigh JN, Lin YC, Wu JS. Bone tumor mimickers: a pictorial essay. Indian J Radiol Imaging 2014; 24 (03) 225-236
• 2 van Holsbeeck M, Vandamme B, Marchal G, Martens M, Victor J, Baert AL. Dorsal defect of the patella: concept of its origin and relationship with bipartite and multipartite patella. Skeletal Radiol 1987; 16 (04) 304-311
• 3 Johnson JF, Brogdon BG. Dorsal effect of the patella: incidence and distribution. AJR Am J Roentgenol 1982; 139 (02) 339-340
• 4 Snoeckx A, Vanhoenacker FM, Gielen JL, Van Dyck P, Parizel PM. Magnetic resonance imaging of variants of the knee. Singapore Med J 2008; 49 (09) 734-744
• 5 Narváez J, Narváez JA, Clavaguera MT, Gil M, Sánchez-Márquez A, Nolla-Solé JM. Dorsal defect of the patella: an uncommon cause of knee pain. Arthritis Rheum 1996; 39 (07) 1244-1245
• 6 Mellado JM, Salvadó E, Ramos A, Camins A, Saurí A. Dorsal defect on a multi-partite patella: imaging findings. Eur Radiol 2001; 11 (07) 1136-1139
• 7 Augusto ACL, Goes PCK, Flores DV. et al. Imaging review of normal and abnormal skeletal maturation. Radiographics 2022; 42 (03) 861-879
• 8 Laloo F, De La Hoz Polo M, Haque S. Imaging pitfall in the pediatric knee: irregular epiphyseal ossification at the femoral condyle. J Belg Soc Radiol 2021; 105 (01) 84
• 9 Resnick D, Greenway G. Distal femoral cortical defects, irregularities, and excavations. Radiology 1982; 143 (02) 345-354
• 10 Suh JS, Cho JH, Shin KH. et al. MR appearance of distal femoral cortical irregularity (cortical desmoid). J Comput Assist Tomogr 1996; 20 (02) 328-332
• 11 Sconfienza LM, Albano D, Messina C, Gitto S, Mariani PP, Zappia M. Imaging of anatomical variants around the knee. Semin Musculoskelet Radiol 2023; 27 (02) 198-205
• 12 Tscholl PM, Biedert RM, Gal I. Cortical desmoids in adolescent top-level athletes. Acta Radiol Open 2015; 4 (05) 2058460115580878
• 13 Levine AH, Pais MJ, Berinson H, Amenta PS. The soleal line: a cause of tibial pseudoperiostitis. Radiology 1976; 119 (01) 79-81
• 14 Greenspan A. Bone island (enostosis): current concept—a review. Skeletal Radiol 1995; 24 (02) 111-115
• 15 Kransdorf MJ, Peterson JJ, Bancroft LW. MR imaging of the knee: incidental osseous lesions. Magn Reson Imaging Clin N Am 2007; 15 (01) 13-24
• 16 Guillin R, Moser T, Koob M. et al. Subperiosteal hematoma of the iliac bone: imaging features of acute and chronic stages with emphasis on pathophysiology. Skeletal Radiol 2012; 41 (06) 667-675
• 17 Yumoto T, Joko R, Yamakawa Y, Yamada T, Naito H, Nakao A. Subperiosteal hematoma of the iliac bone: an unusual cause of acute hip pain after a fall. Am J Case Rep 2018; 19: 1083-1086
• 18 Verma R, Singh J. Magnetic resonance imaging in stress fractures: making a correct diagnosis. Indian Journal of Musculoskeletal Radiology 2022; 4: 1-12
• 19 Ecklund K. Sports-related injuries of the pediatric musculoskeleton: lower extremity. In: Hodler J, Kubik-Huch RA, von Schulthess GK. eds. Musculoskeletal Diseases 2021–2024: Diagnostic Imaging. Cham, Switzerland: Springer; 2021. Chapter 19
• 20 Fayad LM, Kawamoto S, Kamel IR. et al. Distinction of long bone stress fractures from pathologic fractures on cross-sectional imaging: how successful are we?. AJR Am J Roentgenol 2005; 185 (04) 915-924
• 21 Fredericson M, Bergman AG, Hoffman KL, Dillingham MS. Tibial stress reaction in runners: correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995; 23: 472-481
• 22 Jacobson JA, Girish G, Jiang Y, Sabb BJ. Radiographic evaluation of arthritis: degenerative joint disease and variations. Radiology 2008; 248 (03) 737-747
• 23 Tanaka H, Araki Y, Yamamoto H, Yamamoto T, Tsukaguchi I. Intraosseous ganglion. Skeletal Radiol 1995; 24 (02) 155-157
• 24 Makino A, Pascual-Garrido C, Rolón A, Isola M, Muscolo DL. Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. Knee Surg Sports Traumatol Arthrosc 2011; 19 (03) 408-411
• 25 Jaramillo D. Infection: musculoskeletal. Pediatr Radiol 2011; 41 (Suppl. 01) S127-S134
• 26 Lee YJ, Sadigh S, Mankad K, Kapse N, Rajeswaran G. The imaging of osteomyelitis. Quant Imaging Med Surg 2016; 6 (02) 184-198
• 27 Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004; 364 (9431): 369-379
• 28 van der Naald N, Smeeing DPJ, Houwert RM, Hietbrink F, Govaert GAM, van der Velde D. Brodie's abscess: a systematic review of reported cases. J Bone Jt Infect 2019; 4 (01) 33-39
• 29 Davies AM, Hughes DE, Grimer RJ. Intramedullary and extramedullary fat globules on magnetic resonance imaging as a diagnostic sign for osteomyelitis. Eur Radiol 2005; 15 (10) 2194-2199
• 30 Desimpel J, Posadzy M, Vanhoenacker F. The many faces of osteomyelitis: a pictorial review. J Belg Soc Radiol 2017; 101 (01) 24
• 31 Grey AC, Davies AM, Mangham DC, Grimer RJ, Ritchie DA. The ‘penumbra sign’ on T1-weighted MR imaging in subacute osteomyelitis: frequency, cause and significance. Clin Radiol 1998; 53 (08) 587-592
• 32 Murray RO, McCredie J. Melorheostosis and the sclerotomes: a radiological correlation. Skeletal Radiol 1979; 4 (02) 57-71
• 33 Sonoda LI, Halim MY, Balan KK. Detection of extensive melorheostosis on bone scintigram performed for suspected metastases. Clin Nucl Med 2011; 36 (03) 240-241
• 34 Panagopoulos A, Tatani I, Kourea HP, Kokkalis ZT, Panagopoulos K, Megas P. Osteolytic lesions (brown tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna and radius: a case report. J Med Case Rep 2018; 12 (01) 176
• 35 Yamauchi R, Ohshika S, Ono H, Saruga T, Ogawa T, Ishibashi Y. Diagnosis and treatment of brown tumor in the femur induced by parathyroid carcinoma: a case report. Case Rep Oncol 2022; 15 (03) 1074-1080
• 36 Douis H, Saifuddin A. The imaging of cartilaginous bone tumours. I. Benign lesions. Skeletal Radiol 2012; 41 (10) 1195-1212
• 37 Murphey MD, Choi JJ, Kransdorf MJ, Flemming DJ, Gannon FH. Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation. Radiographics 2000; 20 (05) 1407-1434
• 38 Engel H, Herget GW, Füllgraf H. et al. Chondrogenic bone tumors: the importance of imaging characteristics [English, German]. Rofo 2021; 193 (03) 262-275
• 39 Walden MJ, Murphey MD, Vidal JA. Incidental enchondromas of the knee. AJR Am J Roentgenol 2008; 190 (06) 1611-1615
• 40 Gómez-León N, Galán-González I, Moreno-Casado MJ. et al. Chondroid tumors: review of salient imaging features and update on the WHO classification. Curr Probl Diagn Radiol 2023; 52 (03) 197-211
• 41 Altay M, Bayrakci K, Yildiz Y, Erekul S, Saglik Y. Secondary chondrosarcoma in cartilage bone tumors: report of 32 patients. J Orthop Sci 2007; 12 (05) 415-423
• 42 Afonso PD, Isaac A, Villagrán JM. Chondroid tumors as incidental findings and differential diagnosis between enchondromas and low-grade chondrosarcomas. Semin Musculoskelet Radiol 2019; 23 (01) 3-18
• 43 Patel A, Davies AM, Botchu R, James S. A pragmatic approach to the imaging and follow-up of solitary central cartilage tumours of the proximal humerus and knee. Clin Radiol 2019; 74 (07) 517-526
• 44 Varma DG, Ayala AG, Carrasco CH, Guo SQ, Kumar R, Edeiken J. Chondrosarcoma: MR imaging with pathologic correlation. Radiographics 1992; 12 (04) 687-704
• 45 Murphey MD, Walker EA, Wilson AJ, Kransdorf MJ, Temple HT, Gannon FH. From the archives of the AFIP: imaging of primary chondrosarcoma: radiologic-pathologic correlation. Radiographics 2003; 23 (05) 1245-1278
• 46 Logie CI, Walker EA, Forsberg JA, Potter BK, Murphey MD. Chondrosarcoma: a diagnostic imager's guide to decision making and patient management. Semin Musculoskelet Radiol 2013; 17 (02) 101-115
• 47 Frank RM, Chalmers PN, Cole BJ, Gitelis S. Osteoid osteoma of the intercondylar notch: an uncommon cause of knee stiffness. J Knee Surg Rep 2015; 1: 2-7
• 48 Huang AJ. Radiofrequency ablation of osteoid osteoma: difficult-to-reach places. Semin Musculoskelet Radiol 2016; 20 (05) 486-495
• 49 Murphey MD, Robbin MR, McRae GA, Flemming DJ, Temple HT, Kransdorf MJ. The many faces of osteosarcoma. Radiographics 1997; 17 (05) 1205-1231
• 50 Yarmish G, Klein MJ, Landa J, Lefkowitz RA, Hwang S. Imaging characteristics of primary osteosarcoma: nonconventional subtypes. Radiographics 2010; 30 (06) 1653-1672
• 51 Nguyen JC, Baghdadi S, Pogoriler J, Guariento A, Rajapakse CS, Arkader A. Pediatric osteosarcoma: correlation of imaging findings with histopathologic features, treatment, and outcome. Radiographics 2022; 42 (04) 1196-1213
• 52 Brader P, Abramson SJ, Price AP. et al. Do characteristics of pulmonary nodules on computed tomography in children with known osteosarcoma help distinguish whether the nodules are malignant or benign?. J Pediatr Surg 2011; 46 (04) 729-735 Published correction appears in J Pediatr Surg 2011;46(8):1685
• 53 Böhm P, Kröber S, Greschniok A, Laniado M, Kaiserling E. Desmoplastic fibroma of the bone. A report of two patients, review of the literature, and therapeutic implications. Cancer 1996; 78 (05) 1011-1023
• 54 Vanhoenacker FM, Hauben E, De Beuckeleer LH, Willemen D, Van Marck E, De Schepper AM. Desmoplastic fibroma of bone: MRI features. Skeletal Radiol 2000; 29 (03) 171-175
• 55 Antonescu CR, Erlandson RA, Huvos AG. Primary fibrosarcoma and malignant fibrous histiocytoma of bone—a comparative ultrastructural study: evidence of a spectrum of fibroblastic differentiation. Ultrastruct Pathol 2000; 24 (02) 83-91
• 56 Verbeke SL, Bovée JV. Primary vascular tumors of bone: a spectrum of entities?. Int J Clin Exp Pathol 2011; 4 (06) 541-551
• 57 Cao L, Wen JX, Han SM. et al. Imaging features of hemangioma in long tubular bones. BMC Musculoskelet Disord 2021; 22 (01) 27
• 58 Wenger DE, Wold LE. Malignant vascular lesions of bone: radiologic and pathologic features. Skeletal Radiol 2000; 29 (11) 619-631
• 59 Mascard E, Gomez-Brouchet A, Lambot K. Bone cysts: unicameral and aneurysmal bone cyst. Orthop Traumatol Surg Res 2015; 101 (1, Suppl): S119-S127
• 60 Restrepo R, Zahrah D, Pelaez L, Temple HT, Murakami JW. Update on aneurysmal bone cyst: pathophysiology, histology, imaging and treatment. Pediatr Radiol 2022; 52 (09) 1601-1614
• 61 Gutierrez LB, Link TM, Horvai AE, Joseph GB, O'Donnell RJ, Motamedi D. Secondary aneurysmal bone cysts and associated primary lesions: imaging features of 49 cases. Clin Imaging 2020; 62: 23-32
• 62 Murphey MD, Nomikos GC, Flemming DJ, Gannon FH, Temple HT, Kransdorf MJ. From the archives of AFIP. Imaging of giant cell tumor and giant cell reparative granuloma of bone: radiologic-pathologic correlation. Radiographics 2001; 21 (05) 1283-1309
• 63 Chakarun CJ, Forrester DM, Gottsegen CJ, Patel DB, White EA, Matcuk Jr GR. Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics 2013; 33 (01) 197-211
• 64 Biermann JS. Common benign lesions of bone in children and adolescents. J Pediatr Orthop 2002; 22 (02) 268-273
• 65 Jordanov MI. The “rising bubble” sign: a new aid in the diagnosis of unicameral bone cysts. Skeletal Radiol 2009; 38 (06) 597-600
• 66 Noordin S, Allana S, Umer M, Jamil M, Hilal K, Uddin N. Unicameral bone cysts: current concepts. Ann Med Surg (Lond) 2018; 34: 43-49
• 67 Mik G, Arkader A, Manteghi A, Dormans JP. Results of a minimally invasive technique for treatment of unicameral bone cysts. Clin Orthop Relat Res 2009; 467 (11) 2949-2954
• 68 Kransdorf MJ, Moser Jr RP, Gilkey FW. Fibrous dysplasia. Radiographics 1990; 10 (03) 519-537
• 69 Kushchayeva YS, Kushchayev SV, Glushko TY. et al. Fibrous dysplasia for radiologists: beyond ground glass bone matrix. Insights Imaging 2018; 9 (06) 1035-1056
• 70 Chang CY, Garner HW, Ahlawat S. et al. Society of Skeletal Radiology—white paper. Guidelines for the diagnostic management of incidental solitary bone lesions on CT and MRI in adults: bone reporting and data system (Bone-RADS). Skeletal Radiol 2022; 51 (09) 1743-1764
• 71 Eyzaguirre E, Liqiang W, Karla GM, Rajendra K, Alberto A, Gatalica Z. Intraosseous lipoma. A clinical, radiologic, and pathologic study of 5 cases. Ann Diagn Pathol 2007; 11 (05) 320-325
• 72 Milgram JW. Intraosseous lipomas. A clinicopathologic study of 66 cases. Clin Orthop Relat Res 1988; (231) 277-302
• 73 Propeck T, Bullard MA, Lin J, Doi K, Martel W. Radiologic-pathologic correlation of intraosseous lipomas. AJR Am J Roentgenol 2000; 175 (03) 673-678
• 74 Jung JY, Jee WH, Hong SH. et al. MR findings of the osteofibrous dysplasia. Korean J Radiol 2014; 15 (01) 114-122
• 75 Kahn LB. Adamantinoma, osteofibrous dysplasia and differentiated adamantinoma. Skeletal Radiol 2003; 32 (05) 245-258
• 76 O'Sullivan GJ, Carty FL, Cronin CG. Imaging of bone metastasis: an update. World J Radiol 2015; 7 (08) 202-211
• 77 Bertoni-Salateo R, de Camargo B, Soares F, Chojniak R, Penna V. Solitary plasmocytoma of bone in an adolescent. J Pediatr Hematol Oncol 1998; 20 (06) 574-576
• 78 Bhagavathi S, Fu K. Primary bone lymphoma. Arch Pathol Lab Med 2009; 133 (11) 1868-1871
• 79 Mulligan ME, McRae GA, Murphey MD. Imaging features of primary lymphoma of bone. AJR Am J Roentgenol 1999; 173 (06) 1691-1697
• 80 Hoover KB, Rosenthal DI, Mankin H. Langerhans cell histiocytosis. Skeletal Radiol 2007; 36 (02) 95-104
• 81 Starkebaum G, Hendrie P. Erdheim-Chester disease. Best Pract Res Clin Rheumatol 2020; 34 (04) 101510
• 82 Mosheimer BA, Oppl B, Zandieh S. et al. Bone involvement in Rosai-Dorfman disease (RDD): a case report and systematic literature review. Curr Rheumatol Rep 2017; 19 (05) 29
• 83 Dorfman HD, Czerniak B. Ewing's sarcoma and related entities. In: Dorfman HD, Czerniak B. eds. Bone Tumors. St. Louis, MO: Mosby; 1998: 607-663
• 84 Murphey MD, Senchak LT, Mambalam PK, Logie CI, Klassen-Fischer MK, Kransdorf MJ. From the radiologic pathology archives: Ewing sarcoma family of tumors: radiologic-pathologic correlation. Radiographics 2013; 33 (03) 803-831
• 85 Eggli KD, Quiogue T, Moser Jr RP. Ewing's sarcoma. Radiol Clin North Am 1993; 31 (02) 325-337