II Side affected Bilateral Neurological type Spastic diplegia Spastic tetraplegia Myelomeningocele and hypertonia 4 I I 3 Spastic tetraplegia

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Four children are described, each with spontaneous osteonecrosis affecting nearly one-third of the lateral femoral condyle. All the children had a motor and a sensory deficit in the affected limb: two had been previously treated for neuroblastoma of the spine, one for an infected lumbar dermoid cyst and one had spina bifida. We consider that these disorders, singly or in combination, may lead to repeated excessive loading of the lateral femoral condyle, which cannot be appreciated in a knee that is not protected by normal sensation.