Working Diagnosis:
Osteoid Osteoma

Treatment:
Patient underwent physical therapy and radiation.

Outcome:
Patient had six rounds of radiation that resulted in resolution of pain. Patient continued physical therapy and returned to run protocol.

Author's Comments:
This case illustrates an atypical presentation of a benign tumor, Osteoid Osteoma. Although Osteoid Osteoma typically presents with less than 30 minutes of pain that resolves with NSAIDs use in children and adolescents, this case demonstrates that on a provider's differential this should be ruled out if chronic pain continues for prolonged time after appropriate and adequate treatment was given. Also, the radiograph and MRI did not show these findings and the over-read CT scan was able to make a diagnosis. More so, the treatment of choice was six rounds of radiation and not NSAIDS as recommended for Osteoid Osteoma. Recognizing this syndrome can reduce chronic knee pain in future patients.

Editor's Comments:
Usually these tumors are being diagnosed by x-rays and bone scan. Sometimes a MRI is added for clarification. It is important that the Sports Medicine expert reads his/ her images personally and does not rely on the radiologist's interpretation. The gold standard for treating osteoid osteoma is CT-guided radiofrequency ablation (RFA). This minimally-invasive, outpatient procedure is commonly performed in the Interventional Radiology department.

References:
1. Carneiro BC, Da Cruz IAN, Ormond Filho AG, et al. Osteoid osteoma: the great mimicker. Insights Imaging. 2021;12(1):32. Published 2021 Mar 8. doi:10.1186/s13244-021-00978-8
2. Dookie AL, Joseph RM. Osteoid Osteoma. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 2, 2022.
3. De Filippo M, Russo U, Papapietro VR, et al. Radiofrequency ablation of osteoid osteoma. Acta Biomed. 2018;89(1-S):175-185. Published 2018 Jan 19. doi:10.23750/abm.v89i1-S.7021

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