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Medial epicondyle of femur

The medial epicondyle of the femur is a prominent bony projection located on the medial aspect of the distal femur, just superior to the medial condyle. It serves as a major site of attachment for ligaments and muscles around the knee joint, contributing to the stability of the medial knee. Because of its superficial position, it is an important landmark in physical examination, surgery, and imaging.

Synonyms

  • Epicondylus medialis femoris

  • Medial femoral epicondyle

  • Medial supracondylar projection of femur

Muscular Attachments

  • Adductor magnus (hamstring part): Inserts at the adductor tubercle, located at the uppermost part of the medial epicondyle

  • Gastrocnemius (medial head): Originates from the posterior aspect just inferior to the epicondyle

Ligamentous Attachments

  • Medial collateral ligament (MCL): Attaches to the medial epicondyle, providing medial stability to the knee joint

  • Adductor magnus tendon expansions: Contribute to the adductor hiatus in relation to the epicondyle

Relations

  • Anteriorly: Continuous with the shaft of the femur and supracondylar ridge

  • Posteriorly: Related to the adductor tubercle and gastrocnemius origin

  • Medially: Subcutaneous tissue and skin; palpable landmark on the medial knee

  • Laterally: Medial condyle of femur and articular surface of knee joint

  • Inferiorly: Knee joint capsule and medial collateral ligament complex

Function

  • Provides attachment site for key ligaments and muscles stabilizing the medial knee

  • Acts as a landmark for surgical procedures and physical examination of the knee joint

  • Contributes indirectly to knee flexion and adduction via attached muscles

Clinical Significance

  • Palpable landmark: Easily identified on knee examination

  • Medial collateral ligament injuries: Avulsion fractures may involve the medial epicondyle

  • Overuse injuries: Can be associated with medial knee pain in athletes

  • Surgical relevance: Used as a landmark in knee arthroplasty and ligament reconstruction

  • Imaging importance: Evaluated for fractures, tendon/ligament injuries, and tumor extension

MRI Appearance

T1-weighted images:

  • Cortical bone appears very low signal (dark)

  • Marrow within the epicondyle appears intermediate signal

  • Fatty marrow (in adults) shows bright signal

T2-weighted images:

  • Cortical bone remains dark (low signal)

  • Marrow signal is intermediate to bright depending on fat content

  • Pathological lesions (edema, fracture, tumor) appear bright

STIR (Short Tau Inversion Recovery):

  • Normal bone cortex appears dark

  • Marrow is suppressed to low signal if fatty

  • Edema, fracture, or inflammation appears bright hyperintense

Proton Density Fat-Saturated (PD FS):

  • Normal cortex: dark

  • Marrow: intermediate to low after fat suppression

  • Pathology (bone bruise, edema): bright hyperintense

T1 Fat-Sat Post-Contrast:

  • Normal bone marrow shows mild homogeneous enhancement

  • Pathological changes (tumor, infection, inflammation) show strong or heterogeneous enhancement

  • Abscesses or necrotic lesions may show rim enhancement

CT Appearance

Non-Contrast CT:

  • Cortical bone appears as dense, hyperattenuating structure

  • Marrow appears as lower attenuation compared to cortex

  • Fractures, avulsions, and osteophytes are well demonstrated

Post-Contrast CT:

  • Bone cortex does not enhance

  • Marrow shows mild homogeneous enhancement

  • Pathology (tumor, infection, inflammation) may show irregular or heterogeneous enhancement

MRI image

Medial epicondyle of femur coronal cross sectional anatomy 3T MRI AI enhanced radiology anatomy image-img-00000-00000

MRI image

Medial epicondyle of femur axial cross sectional anatomy 3T MRI AI enhanced radiology anatomy image-img-00000-00000

MRI image

Medial epicondyle of femur sagittal cross sectional anatomy 3T MRI AI enhanced radiology anatomy image-img-00000-00000

CT image

Medial epicondyle of femur ct axial