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Knee Pain: The Fine Line Between Malignant and Benign
Andrew Lew1, Suleman Janjua2, Tariq M Awan2
1Family Medicine, University of Nevada, Reno, Reno, USA.
Cureus
|August 12, 2025
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.
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.
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