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Distal Femoral Avulsive Irregularity
A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Distal femoral avulsive irregularity (DFAI)
            • Synonyms

              • Benign cortical irregularity of distal femur
              • Avulsive cortical irregularity or tug lesion
              • Cortical desmoid: Misnomer as biology & histology differ from true desmoid tumors (which are locally aggressive benign neoplasms)
            • Definitions

              • Irregularity of posterior, medial distal femoral metaphyseal cortex deep to attachments of gastrocnemius muscle medial head or adductor magnus aponeurosis
              • Benign self-limited lesion likely due to chronic avulsion

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Nuclear Medicine Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          Selected References

                                          1. Lerisson H et al: Radiographic/MR imaging correlation of the pediatric knee growth. Magn Reson Imaging Clin N Am. 27(4):737-51, 2019
                                          2. Kay M et al: Cortical desmoid of the humerus: radiographic and MRI correlation. Skeletal Radiol. 46(7):1011-5, 2017
                                          3. Tscholl PM et al: Cortical desmoids in adolescent top-level athletes. Acta Radiol Open. 4(5):2058460115580878, 2015
                                          4. Thapa MM et al: MRI of pediatric patients: part 2, normal variants and abnormalities of the knee. AJR Am J Roentgenol. 198(5):W456-65, 2012
                                          5. Hall FM: Cortical desmoid: a misnomer? AJR Am J Roentgenol. 197(4):1022; author reply 1023, 2011
                                          6. Vieira RL et al: MRI features of cortical desmoid in acute knee trauma. AJR Am J Roentgenol. 196(2):424-8, 2011
                                          7. Kontogeorgakos VA et al: Cortical desmoid and the four clinical scenarios. Arch Orthop Trauma Surg. 129(6):779-85, 2009
                                          8. Gould CF et al: Bone tumor mimics: avoiding misdiagnosis. Curr Probl Diagn Radiol. 36(3):124-41, 2007
                                          9. Connolly SA et al: Avulsive cortical irregularity and F-18 FDG PET. Clin Nucl Med. 31(2):87-9, 2006
                                          10. Jung C et al: Symptomatic cortical desmoids detected on knee SPECT. Clin Nucl Med. 27(6):437-8, 2002
                                          11. Donnelly LF et al: Chronic avulsive injury of the deltoid insertion in adolescents: imaging findings in three cases. Radiology. 211(1):233-6, 1999
                                          12. Yamazaki T et al: MR findings of avulsive cortical irregularity of the distal femur. Skeletal Radiol. 24(1):43-6, 1995
                                          13. Craigen MA et al: Symptomatic cortical irregularities of the distal femur simulating malignancy. J Bone Joint Surg Br. 76(5):814-7, 1994
                                          14. Resnick D et al: Distal femoral cortical defects, irregularities, and excavations. Radiology. 143(2):345-54, 1982
                                          15. Brower AC et al: Histological nature of the cortical irregularity of the medial posterior distal femoral metaphysis in children. Radiology. 99(2):389-92, 1971
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Distal femoral avulsive irregularity (DFAI)
                                                    • Synonyms

                                                      • Benign cortical irregularity of distal femur
                                                      • Avulsive cortical irregularity or tug lesion
                                                      • Cortical desmoid: Misnomer as biology & histology differ from true desmoid tumors (which are locally aggressive benign neoplasms)
                                                    • Definitions

                                                      • Irregularity of posterior, medial distal femoral metaphyseal cortex deep to attachments of gastrocnemius muscle medial head or adductor magnus aponeurosis
                                                      • Benign self-limited lesion likely due to chronic avulsion

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Ultrasonographic Findings

                                                              • Nuclear Medicine Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  Selected References

                                                                                  1. Lerisson H et al: Radiographic/MR imaging correlation of the pediatric knee growth. Magn Reson Imaging Clin N Am. 27(4):737-51, 2019
                                                                                  2. Kay M et al: Cortical desmoid of the humerus: radiographic and MRI correlation. Skeletal Radiol. 46(7):1011-5, 2017
                                                                                  3. Tscholl PM et al: Cortical desmoids in adolescent top-level athletes. Acta Radiol Open. 4(5):2058460115580878, 2015
                                                                                  4. Thapa MM et al: MRI of pediatric patients: part 2, normal variants and abnormalities of the knee. AJR Am J Roentgenol. 198(5):W456-65, 2012
                                                                                  5. Hall FM: Cortical desmoid: a misnomer? AJR Am J Roentgenol. 197(4):1022; author reply 1023, 2011
                                                                                  6. Vieira RL et al: MRI features of cortical desmoid in acute knee trauma. AJR Am J Roentgenol. 196(2):424-8, 2011
                                                                                  7. Kontogeorgakos VA et al: Cortical desmoid and the four clinical scenarios. Arch Orthop Trauma Surg. 129(6):779-85, 2009
                                                                                  8. Gould CF et al: Bone tumor mimics: avoiding misdiagnosis. Curr Probl Diagn Radiol. 36(3):124-41, 2007
                                                                                  9. Connolly SA et al: Avulsive cortical irregularity and F-18 FDG PET. Clin Nucl Med. 31(2):87-9, 2006
                                                                                  10. Jung C et al: Symptomatic cortical desmoids detected on knee SPECT. Clin Nucl Med. 27(6):437-8, 2002
                                                                                  11. Donnelly LF et al: Chronic avulsive injury of the deltoid insertion in adolescents: imaging findings in three cases. Radiology. 211(1):233-6, 1999
                                                                                  12. Yamazaki T et al: MR findings of avulsive cortical irregularity of the distal femur. Skeletal Radiol. 24(1):43-6, 1995
                                                                                  13. Craigen MA et al: Symptomatic cortical irregularities of the distal femur simulating malignancy. J Bone Joint Surg Br. 76(5):814-7, 1994
                                                                                  14. Resnick D et al: Distal femoral cortical defects, irregularities, and excavations. Radiology. 143(2):345-54, 1982
                                                                                  15. Brower AC et al: Histological nature of the cortical irregularity of the medial posterior distal femoral metaphysis in children. Radiology. 99(2):389-92, 1971