title: Painful lateral knee condyle bone marrow edema after treatment with lateral wedged insole.
abstract: A 50-yr-old man arrived at our department for a rehabilitation prescription after a right knee medial collateral ligament sprain. Magnetic resonance imaging showed medial collateral ligament partial rupture and medial femoral condyle increased signal intensity indicating bone edema. After treatment, the patient still complained of weight-bearing knee medial compartment pain. A lateral wedged insole was prescribed to decrease medial compartment compression forces. Initial response to insole use was good, but soon after, the patient complained of severe worsening knee pain. On examination, the lateral joint line and condyle palpation were tender. Insole use discontinuation was recommended, and another magnetic resonance imaging scan was performed. It showed an high T2-weighted signal intensity, representing bone marrow edema comprising a volume of 5 x 5 x 4.5 cm of lateral femoral condyle. Discontinuation of orthosis use relieved the pain, and the edema disappeared. To our knowledge, lateral femoral condyle painful bone marrow edema after lateral wedged insole use has not been previously described. The findings of this case report indicate that lateral wedged insole prescription should be carefully evaluated.
authors.affiliation: Department of PM&R, Egarsat-SUMA, Terrassa, Barcelona, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Chaler
authors.forename: Mercè
authors.initials: M
authors.lastname: Torra
authors.forename: Josep Lluís
authors.initials: JL
authors.lastname: Dolz
authors.forename: Bertram
authors.initials: B
authors.lastname: Müller
authors.forename: Roser
authors.initials: R
authors.lastname: Garreta
mesh_terms: D018771:Arthralgia / Q000209:etiology* / Q000628:therapy*; D001853:Bone Marrow / Q000473:pathology; D004487:Edema / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint; D008279:Magnetic Resonance Imaging; D008297:Male; D017888:Medial Collateral Ligament, Knee / Q000293:injuries; D008875:Middle Aged; D009989:Orthotic Devices / Q000009:adverse effects*; D016059:Range of Motion, Articular; D013180:Sprains and Strains / Q000150:complications