Characteristics of Benign Bone Tumors Incidentally Detected on Magnetic Resonance Imaging in Patients Presenting with Knee Pain

Abstract

Aim: Benign bone tumors are usually asymptomatic lesions that may be found incidentally or present with different clinical presentations. Due to their asymptomatic course, their exact rates are unknown. The purpose of this study was to determine the incidence of benign bone tumors incidentally detected on magnetic resonance imaging in patients with knee pain and to explore the links between benign bone masses and pain in the knee. Method: The retrospective study was conducted at Adana City Training and Research Hospital. The files of cases admitted to the Orthopedics and Traumatology Clinic between January 1, 2021, and November 30, 2023, were analyzed. Radiological evaluation of the patients showed that 46.2% (n=25) of the masses were enchondroma, 24.1% (n=13) were intraosseous ganglion cysts, 13% (n=7) were non-ossifying fibroma, 5.6% (n=3) were fibrous dysplasia, 3.7% (n=2) were fibrous cortical defects, 3.7% (n=2) were subchondral cysts, 1.8% (n=1) were enostosis, and 1.8% (n=1) were chondromyxoid fibroma. Results: Among 21,016 patients who applied to the orthopedics and traumatology clinic between January 2021 and November 2023, the data of 54 adult files in which images indicated the presence of benign bone tumors detected in the femur distal, tibia proximal, or fibula proximal bone regions within the 5 cm from the knee joint were analyzed. The mean VAS score was 3.78±1.75, minimum 1, maximum 8. The comparison of VAS scores showed that the mass being closer than 20 mm to the joint compared to being further away and the presence of additional pathology inside the knee compared to no additional pathology were significantly different (p=0.007). Conclusion: The increased average mass size and the rate of presence in the tibia, compared to studies conducted on tumors of cartilage origin are noteworthy findings. The presence of additional pathology inside the knee was shown as a factor that developed a significant difference in the VAS scores in this particular group of patients.

Keywords

• Knee
• Intra-Osseous Ganglions
• Chondroma
• Neoplasm
• Bone

References

1. 1.Crossley KM, van Middelkoop M, Callaghan MJ, etal. 2016 Patellofemoral pain consensus statementfrom the 4th International Patellofemoral PainResearch Retreat, Manchester. Part 2:recommended physical interventions (exercise,taping, bracing, foot orthoses and combinedinterventions). Br J Sports Med. 2016; 50(14) :844-52.
2. 2.Farha N, Spencer A, McGervey M. OutpatientEvaluation of Knee Pain. Med Clin North Am. 2021;105(1): 117-36.
3. 3.Wolf M. Knee Pain in Children, Part III: StressInjuries, Benign Bone Tumors, Growing Pains.Pediatr Rev. 2016; 37(3): 114-8.
4. 4.Walden MJ, Murphey MD, Vidal JA. Incidentalenchondromas of the knee. AJR Am J Roentgenol.2008; 190(6): 1611-5.
5. 5.Stomp W, Reijnierse M, Kloppenburg M, et al.Prevalence of cartilaginous tumours as an incidental finding on MRI of the knee. Eur Radiol. 2015; 25(12):3480-7.
6. 6.Eyesan SU, Idowu OK, Obalum DC, et al. Surgicalconsideration for benign bone tumors. Niger J ClinPract. 2011; 14(2): 146-50.
7. 7.De Salvo S, Pavone V, Coco S, et al. Benign BoneTumors: An Overview of What We Know Today. JClin Med. 2022; 11(3): 699.
8. 8.Murphey MD, Choi JJ, Kransdorf MJ, et al. Imagingof osteochondroma: variants and complicationswith radiologic-pathologic correlation.Radiographics. 2000; 20(5): 1407-34.

9. 9.Hong ED, Carrino JA, Weber KL, et al. Prevalenceof shoulder enchondromas on routine MR imaging.Clin Imaging. 2011; 35(5): 378-84.
10. 10.Woertler K. Benign bone tumors and tumor-likelesions: value of cross-sectional imaging. Eur Radiol.2003; 13(8): 1820-35.
11. 11.Junaid S, Gnanananthan V, Malhotra K, et al.Tumours and tumour-like lesions of joints:Differential diagnoses in a paediatric populationcompared to adults. Br J Radiol. 2021; 94(1120):20201389.
12. 12.Grainger R, Stuckey S, O’Sullivan R, et al. What isthe clinical and ethical importance of incidentalabnormalities found by knee MRI? Arthritis ResTher. 2008; 10(1): R18.
13. 13.Patel A, Davies AM, Botchu R, et al. A pragmaticapproach to the imaging and follow-up of solitarycentral cartilage tumours of the proximal humerusand knee. Clin Radiol. 2019; 74(7): 517-26.
14. 14.Woltsche JN, Smolle MA, Szolar D, et al.Prevalence and characteristics of benigncartilaginous tumours of the knee joint as identifiedon MRI scans. Cancer Imaging. 2023; 23(1): 50.
15. 15.Karaca MO, Balaban K . Incidental Benign BoneTumors on Knee Radiographs. J Ankara Univ FacMed. 2022; 75(2): 268-73.
16. 16.Steffner R. Benign bone tumors. Cancer TreatRes. 2014; 162: 31-63.
17. 17.Pattamapaspong N, Peh WC. Benign incidentaldo-not-touch bone lesions. Br J Radiol. 2023;96(1142): 20211334.