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Knee Pain: The Fine Line Between Malignant and Benign.

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Summary

Focal periphyseal edema (FOPE) is a common finding in adolescent knee MRIs, often mistaken for injury. Recognizing FOPE as a normal variant prevents misdiagnosis and unnecessary treatments in young patients.

Keywords:
benignchronic painedemafocal periphyseal edemafopekneeknee painsalter-harris fracture

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Area of Science:

  • Orthopedics
  • Radiology
  • Pediatric Imaging

Background:

  • Focal periphyseal edema (FOPE) is a common, incidental finding on knee MRI in adolescents.
  • It is associated with normal physeal (growth plate) closure during adolescence.

Observation:

  • FOPE zones are areas of edema near the growth plate, frequently seen in females aged 11-14.
  • This phenomenon can be asymptomatic or cause knee pain, mimicking fractures or bone marrow edema.

Findings:

  • A 14-year-old female presented with chronic knee pain and MRI revealed distal femur FOPE zones without other abnormalities.
  • Conservative management including observation and physical therapy led to symptom resolution.

Implications:

  • FOPE should be recognized as a normal physiological variant in adolescent knee imaging.
  • Correct identification of FOPE can prevent misdiagnosis of pathological conditions and avoid unnecessary interventions.
  • Understanding FOPE aids radiologists and clinicians in accurate pediatric orthopedic assessments.