Skip to main content
SpringerLink
Log in

Lateral femoral condyle insufficiency fractures: imaging findings, demographics, and analysis of outcomes

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To describe imaging characteristics and demographics of lateral femoral condyle insufficiency fractures (LFCIFs) and identify characteristics associated with progression to epiphyseal collapse.

Materials and methods

A retrospective review of 105 consecutive patients with LFCIF was performed (mean age 58.1 years) after excluding post-traumatic and pathological fractures. Lesion size and location, presence of bone marrow edema–like signal, soft tissue edema, chondrosis grade, and meniscus pathology were documented. Demographics were recorded from the electronic patient record. Follow-up MRI and/or radiographs were evaluated for healing/stability or progression to epiphyseal collapse. Bone mineral density was assessed from dual-energy x-ray absorptiometry (DEXA) scans and/or radiographs.

Results

Fifty-six female and 49 male subjects were included. Female subjects were older at presentation (60.5 versus 56.3 years, p = .02). A total of 61.7% of the subjects with available DEXA and/or radiographs had osteopenia/osteoporosis. The central weight-bearing (61%) and outer condyle (54.3%) were most involved. High-grade chondrosis was present in ≥ 1 compartment in 70.5% including 42% in the lateral compartment. A total of 67.6% had ≥ 1 meniscus tear with similar frequency of medial and lateral tears (47.6% versus 41%). Bone marrow edema–like signal was present in all cases; soft tissue edema was present in 83.8%. Fifty-three subjects had available follow-up MRI (n = 24) and/or radiographs (n = 29). Increased age, fracture dimensions, presence of medial meniscus tears, and high-grade patellofemoral chondrosis were associated with progression (p ≤ .05).

Conclusion

LFCIFs are associated with meniscus tears, high-grade chondrosis, and osteopenia/osteoporosis with more global knee pathology present when compared with medial femoral condyle insufficiency fracture. Increased age, medial meniscus tears, fracture dimensions, and high-grade patellofemoral chondrosis were associated with progression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Gorbachova T, Amber I, Beckmann NM, Bennett DL, Chang EY, Davis L, et al. Nomenclature of subchondral nonneoplastic bone lesions. Am J Roentgenol. 2019;213(5):963–82.

    Article  Google Scholar 

  2. Lecouvet FE, van de Berg BC, Maldague BE, Lebon CJ, Jamart J, Saleh M, et al. Early irreversible osteonecrosis versus transient lesions of the femoral condyles: prognostic value of subchondral bone and marrow changes on MR imaging. AJR Am J Roentgenol. 1998;170(1):71–7.

    Article  CAS  PubMed  Google Scholar 

  3. Viana SL, Machado BB, Mendlovitz PS. MRI of subchondral fractures: a review. Skelet Radiol. 2014;43(11):1515–27.

    Article  Google Scholar 

  4. Gourlay ML, Renner JB, Spang JT, Rubin JE. Subchondral insufficiency fracture of the knee: a non-traumatic injury with prolonged recovery time. BMJ Case Rep. 2015;8:2015.

    Google Scholar 

  5. Seeman E, Delmas PD. Bone quality--the material and structural basis of bone strength and fragility. N Engl J Med. 2006;354(21):2250–61.

    Article  CAS  PubMed  Google Scholar 

  6. Pathria MN, Chung CB, Resnick DL. Acute and stress-related injuries of bone and cartilage: pertinent anatomy, basic biomechanics, and imaging perspective. Radiology. 2016;280(1):21–38.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lee S, Saifuddin A. Magnetic resonance imaging of subchondral insufficiency fractures of the lower limb. Skelet Radiol. 2019;48(7):1011–21.

    Article  Google Scholar 

  8. Daffner RH, Pavlov H. Stress fractures: current concepts. AJR Am J Roentgenol. 1992;159(2):245–52.

    Article  CAS  PubMed  Google Scholar 

  9. Ramnath RR, Kattapuram SusanV. MR appearance of SONK-like subchondral abnormalities in the adult knee: SONK redefined. Skelet Radiol. 2004 Oct [cited 2020 Feb 5];33(10). Available from: http://link.springer.com/10.1007/s00256-004-0777-7.

  10. Karim AR, Cherian JJ, Jauregui JJ, Pierce T, Mont MA. Osteonecrosis of the knee: review. Ann Transl Med. 2015;3(1):6.

    PubMed  PubMed Central  Google Scholar 

  11. Karantanas AH, Drakonaki E, Karachalios T, Korompilias AV, Malizos K. Acute non-traumatic marrow edema syndrome in the knee: MRI findings at presentation, correlation with spinal DEXA and outcome. Eur J Radiol. 2008;67(1):22–33.

    Article  PubMed  Google Scholar 

  12. Yamamoto T. Subchondral insufficiency fractures of the femoral head. Clin Orthop Surg. 2012;4(3):173–80.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Plett SK, Hackney LA, Heilmeier U, Nardo L, Yu A, Zhang CA, et al. Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome. Skelet Radiol. 2015;44(12):1785–94.

    Article  Google Scholar 

  14. Wilmot AS, Ruutiainen AT, Bakhru PT, Schweitzer ME, Shabshin N. Subchondral insufficiency fracture of the knee: a recognizable associated soft tissue edema pattern and a similar distribution among men and women. Eur J Radiol. 2016;85(11):2096–103.

    Article  PubMed  Google Scholar 

  15. Sayyid S, Younan Y, Sharma G, Singer A, Morrison W, Zoga A, et al. Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome. Skelet Radiol. 2019;48(12):1961–74.

    Article  Google Scholar 

  16. Muscolo DL, Costa-Paz M, Ayerza M, Makino A. Medial meniscal tears and spontaneous osteonecrosis of the knee. Arthroscopy. 2006;22(4):457–60.

    Article  PubMed  Google Scholar 

  17. Robertson DD, Armfield DR, Towers JD, Irrgang JJ, Maloney WJ, Harner CD. Meniscal root injury and spontaneous osteonecrosis of the knee: an observation. J Bone Joint Surg Br. 2009;91(2):190–5.

    Article  CAS  PubMed  Google Scholar 

  18. Yamamoto T, Bullough PG. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Joint Surg Am. 2000;82(6):858–66.

    Article  CAS  PubMed  Google Scholar 

  19. Marti CB, Rodriguez M, Zanetti M, Romero J. Spontaneous osteonecrosis of the medial compartment of the knee: a MRI follow-up after conservative and operative treatment, preliminary results. Knee Surg Sports Traumatol Arthrosc. 2000;8(2):83–8.

    Article  CAS  PubMed  Google Scholar 

  20. Carrino JA, Blum J, Parellada JA, Schweitzer ME, Morrison WB. MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts. Osteoarthr Cartil. 2006;14(10):1081–5.

    Article  CAS  Google Scholar 

  21. Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43-B:752–7.

    Article  CAS  PubMed  Google Scholar 

  22. Gomoll AH, Minas T, Farr J, Cole BJ. Treatment of chondral defects in the patellofemoral joint. J Knee Surg. 2006;19(4):285–95.

    Article  PubMed  Google Scholar 

  23. Pelletier J-P, Raynauld J-P, Abram F, Haraoui B, Choquette D, Martel-Pelletier J. A new non-invasive method to assess synovitis severity in relation to symptoms and cartilage volume loss in knee osteoarthritis patients using MRI. Osteoarthr Cartil. 2008;16(Suppl 3):S8–13.

    Article  Google Scholar 

  24. Nelson FR, Craig J, Francois H, Azuh O, Oyetakin-White P, King B. Subchondral insufficiency fractures and spontaneous osteonecrosis of the knee may not be related to osteoporosis. Arch Osteoporos. 2014;9:194.

    Article  PubMed  Google Scholar 

  25. Nakagawa S, Kadoya Y, Todo S, Kobayashi A, Sakamoto H, Freeman MA, et al. Tibiofemoral movement 3: full flexion in the living knee studied by MRI. J Bone Joint Surg Br. 2000;82(8):1199–200.

    Article  CAS  PubMed  Google Scholar 

  26. Depasquale R, Fotiadou A, Kumar DS, Lalam R, Tins B, Tyrrell PNM, et al. Subchondral impaction fractures of the non-weight-bearing portion of the lateral femoral condyle. Skelet Radiol. 2013;42(2):177–85.

    Article  Google Scholar 

  27. Radin EL, Paul IL. Does cartilage compliance reduce skeletal impact loads? The relative force-attenuating properties of articular cartilage, synovial fluid, periarticular soft tissues and bone. Arthritis Rheum. 1970;13(2):139–44.

    Article  CAS  PubMed  Google Scholar 

  28. Radin EL, Rose RM. Role of subchondral bone in the initiation and progression of cartilage damage. Clin Orthop Relat Res. 1986;213:34–40.

    Google Scholar 

  29. Madry H, van Dijk CN, Mueller-Gerbl M. The basic science of the subchondral bone. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):419–33.

    Article  PubMed  Google Scholar 

  30. Layton MW, Goldstein SA, Goulet RW, Feldkamp LA, Kubinski DJ, Bole GG. Examination of subchondral bone architecture in experimental osteoarthritis by microscopic computed axial tomography. Arthritis Rheum. 1988;31(11):1400–5.

    Article  CAS  PubMed  Google Scholar 

  31. Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014;29(11):2520–6.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Yamamoto T, Iwamoto Y, Schneider R, Bullough PG. Histopathological prevalence of subchondral insufficiency fracture of the femoral head. Ann Rheum Dis. 2008;67(2):150–3.

    Article  CAS  PubMed  Google Scholar 

  33. Zanetti M, Romero J, Dambacher MA, Hodler J. Osteonecrosis diagnosed on MR images of the knee. Relationship to reduced bone mineral density determined by high resolution peripheral quantitative CT. Acta Radiol. 2003;44(5):525–31.

    CAS  PubMed  Google Scholar 

  34. Lotke PA, Abend JA, Ecker ML. The treatment of osteonecrosis of the medial femoral condyle. Clin Orthop Relat Res. 1982;171:109–16.

    Google Scholar 

  35. Norman A, Baker ND. Spontaneous osteonecrosis of the knee and medial meniscal tears. Radiology. 1978;129(3):653–6.

    Article  CAS  PubMed  Google Scholar 

  36. Pan J, Pialat J-B, Joseph T, Kuo D, Joseph GB, Nevitt MC, et al. Knee cartilage T2 characteristics and evolution in relation to morphologic abnormalities detected at 3-T MR imaging: a longitudinal study of the Normal control cohort from the osteoarthritis initiative. Radiology. 2011;261(2):507–15.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Musculoskeletal Radiology, Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street 10 Main, Philadelphia, PA, 19106, USA

    Terence P. Farrell, Diane M. Deely, Adam C. Zoga & Kristen E. McClure

Authors
  1. Terence P. Farrell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Diane M. Deely
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Adam C. Zoga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kristen E. McClure
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Terence P. Farrell.

Ethics declarations

This Health Insurance Portability and Accountability Act–compliant retrospective single-center study was approved by the institutional review board. The requirement to obtain informed consent was waived because of the retrospective nature of the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Farrell, T.P., Deely, D.M., Zoga, A.C. et al. Lateral femoral condyle insufficiency fractures: imaging findings, demographics, and analysis of outcomes. Skeletal Radiol 50, 189–199 (2021). https://doi.org/10.1007/s00256-020-03548-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-020-03548-z

Keywords

Search

Navigation