Primary bone and soft-tissue tumors may present by mimicking common sports injuries. Their diagnosis is contingent on maintaining a broad differential. We report a case of a 20-year-old male athlete who sustained a twisting injury to his planted right knee while playing college lacrosse. He was unable to bear weight or fully extend his knee. The team’s orthopaedic surgeon was concerned for a locked knee secondary to a possible flipped meniscal tear. Radiographs and magnetic resonance imaging were performed that led to the discovery of an expansile, sclerotic lesion arising from the posteromedial aspect of the distal femur. Biopsy of the lesion showed an intracortical osteosarcoma. The patient underwent curative kneesparing en bloc resection with an intercalary allograft and reconstruction of the medial collateral ligament. At 2 years postoperatively, the patient returned to play, but not at the previous level.

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