Melorheostosis is a rare benign sclerosing bone dysplasia characterized by eccentric cortical hyperostosis, classically described as a “dripping candle wax” appearance on radiographs. Although some patients are symptomatic, many lesions remain clinically silent and are discovered incidentally during imaging performed for unrelated complaints. Accurate recognition is important because its striking appearance may mimic aggressive osseous pathology and prompt unnecessary investigation. We report a 70-year-old man presenting with medial knee pain. Radiographs and magnetic resonance imaging (MRI) demonstrated classic melorheostosis involving the lateral distal femur. However, MRI also revealed a posterior root tear of the medial meniscus with meniscal extrusion and reactive inflammatory change involving the medial supporting structures of the knee, concordant with the patient’s symptoms. The distal femoral lesion showed benign chronic imaging features without marrow edema, cortical destruction, or soft-tissue mass. This case highlights the importance of distinguishing incidental imaging abnormalities from the true pain generator and recognizing characteristic features of melorheostosis to avoid unnecessary biopsy, oncologic referral, and patient anxiety.