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Cortical desmoid

Cortical desmoids, also known as cortical avulsive injuries, are a benign self-limiting entity. This is a classic 'don't touch' lesion, and should not be confused with an aggressive cortical/periosteal process (e.g. osteosarcoma). 


It typically presents in adolescents (10-15 years of age). There may be a male predilection. 

Clinical presentation

Patients are usually asymptomatic, and it is discovered incidentally. Occasionally pain may be present.


It is related to repetitive stress at the attachment of the adductor magnus aponeurosis at the posterior medial aspect of the distal femoral metaphysis.


It is seen at the posterior aspect of the distal femur. Can be bilateral in approximately one-third of cases.

Radiographic features


Typically shows a saucer-shaped radiolucent cortical irregularity involving the posteromedial aspect of the distal femoral metaphysis at the attachment of the adductor magnus tendon. The lesion lacks an outer margin.


Defines anatomy much better and is seen as a cortically based lesion in the expected location (i.e. posteromedial distal femoral metaphysis) 3,4:

  • T1: low signal
  • T2: high signal and surrounding low signal rim may be present
  • T1 C+ (Gd): most show enhancement
Nuclear medicine

On bone scan, there is an abnormal increase in activity because of the chronic stress/traumatic origin of this lesion.

Differential diagnosis

Imaging differential considerations include

Practical points

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