Abstract
Objective
To document the first report of intra-articular, non-weight-bearing, impaction fractures of the lateral femoral condyle.
Materials & methods
Institutional Review Board and Regional Ethics Committee approval for this study was obtained and patient informed consent deemed unnecessary. We prospectively documented all potential cases of non-weight-bearing posterior subchondral impaction fractures of the femoral condyles diagnosed on magnetic resonance imaging (MRI) of the knee performed at our institution between January 2006 and December 2011. The cases were reviewed and discussed by three experienced musculoskeletal radiologists and only cases satisfying pre-defined MRI criteria were included.
Results
Sixteen cases of intra-articular impaction fractures in a posterior, non-weight-bearing area of the lateral femoral condyle were diagnosed in patients with a mean age of 40. Eight were associated with recreational sports activities and 4 with repeated kneeling. There were no fractures documented in the non-weight-bearing aspect of the medial femoral condyles. Proposed underlying mechanisms for development of this type of fracture are presented.
Conclusion
Awareness, along with a high level of suspicion, that non-specific knee pain, especially in patients involved in athletic activities, could be due to intra-articular impaction fractures of the non-weight-bearing posterior aspect of the lateral femoral condyle is essential and MRI is the mainstay of diagnosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
DeFranco M, Recht M, Schils J, Parker RD. Stress fractures of the femur in athletes. Clin Sports Med. 2006;25:89–103. ix.
Drabicki R, Greer W, DeMeo P. Stress fractures around the knee. Clin Sports Med. 2006;25:105–15.
Boden B, Speer K. Femoral stress fractures. Clin Sports Med. 1997;16(2):307–17.
Lafforgue P, Daumen-Legré V, Clairet D, Daver L, Acquaviva PC. Insufficiency fractures of the medial femoral condyle. Rev Rhum Engl Ed. 1996;63(4):262–9.
Milgrom C, Chisin R, Margulies J, et al. Stress fractures of the medial femoral condyle. J Trauma. 1986;26(2):199–200.
Davies M, Cassar-Pullicino VN, Darby AJ. Subchondral insufficiency fractures of the femoral head. Eur Radiol. 2004;14(2):201–7.
Muthukumar T, Butt SH, Cassar-Pullicino VN. Stress fractures and related disorders in foot and ankle: plain films, scintigraphy, CT and MR imaging. Semin Musculoskelet Radiol. 2005;09(3):210–26.
Legroux Gerot I, Demondion X, Louville AB, Delcambre B, Cortet B. Subchondral fractures of the femoral head: a review of seven cases. Joint Bone Spine. 2004;71(2):131–5.
Ikemura S, Yamamoto T, Motomura G, Nakashima Y, Makawari T, Iwamoto Y. MRI evaluation of collapsed femoral heads in patients 60 years old or older: Differentiation of subchondral insufficiency fracture from osteonecrosis of the femoral head. Am J Roentgenol. 2010;195(1):W63–8.
Yildirim M, Gursoy R, Varoglu E, Oztasyonar Y, Cogalgil S. 99 M Tc-MDP bone SPECT in evaluation of the knee in asymptomatic soccer players. Br J Sports Med. 2004;38(1):15–8.
Mink JH, Deutsch AL. Occult cartilage and bone injuries of the knee: detection, classification, and assessment with MR imaging. Radiology. 1989;170(3 Pt1):823–9.
Milgrom C, Giladi M, Stein M, et al. Stress fractures in military recruits: a prospective study showing an unusually high incidence. J Bone Joint Surg Br. 1985;67(5):732–5.
Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, MacIntyre JG. Stress fractures in athletes: a study of 320 cases. Am J Sports Med. 1987;15(1):46–58.
Anderson MW, Greenspan A. Stress fractures. Radiology. 1996;199(1):1–12.
Clement DB, Ammann W, Taunton JE, et al. Exercise-induced stress injuries to the femur. Int J Sports Med. 1993;14(6):347–52.
Rajendran K. Mechanism of locking at the knee joint. J Anat. 1985;143:189–94.
Pinskerova V, Johal P, Nakagawa S, et al. Does the femur roll-back with flexion? J Bone Joint Surg Br. 2004;86(6):925–31.
Nakagawa S, Kadoya Y, Todo S, et al. Tibiofemoral movement 3: full flexion in the living knee studied by MRI. J Bone Joint Surg Br. 2000;82(8):1199–200.
Sofka CM. Imaging of stress fractures. Clin Sports Med. 2006;25(1):53–62.
Wall J, Feller J. Imaging of stress fractures in runners. Clin Sports Med. 2006;25(4):781–802.
Iwamoto J, Takeda T. Stress fractures in athletes: review of 196 cases. J Orthop Sci. 2003;8(3):273–8.
Zazryn TR, Finch CF, McCrory P. A 16 year study of injuries to professional kickboxers in the state of Victoria, Australia. Br J Sports Med. 2003;37(5):448–51.
Gartland S, Malik MHA, Lovell ME. Injury and injury rates in Muay Thai kick boxing. Br J Sports Med. 2001;35(5):308–13.
Krivickas LS. Anatomical factors associated with overuse sports injuries. Sports Med. 1997;24(2):132–46.
Niva H, Kiuru J, Haataja R, Pihlajamäki H. Fatigue injuries of the femur. J Bone Joint Surg Br. 2005;87(10):1385–90.
Conflicts of interest
The authors declare that they have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Depasquale, R., Fotiadou, A., Kumar, D.S. et al. Subchondral impaction fractures of the non-weight-bearing portion of the lateral femoral condyle. Skeletal Radiol 42, 177–185 (2013). https://doi.org/10.1007/s00256-012-1492-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-012-1492-4