Multiple osteochondroses of bilateral knee joints: a case report

Abstract

Knee injuries in young athletes include not only the typical adult bone injuries, ligament and cartilage, but also the growth plate lesions. Osteochondroses are idiopathic, self-limited disturbance of enchondral ossification in which a rapid growth spurt is present. The patella could be affected by two different kinds of osteochondroses: Kohler syndrome and Sinding-Larsen-Johansson. Here we are reporting the first case of simultaneous location of osteochondroses of the two ossification centers of both patella. A 9-year-old boy, competitive skater, presented a history of anterior knee pain involving both knees. Standard X-rays, axial patellar view, MRI and arthro-MR were performed. In order to follow the natural history of the pathology and the evolution of the healing, examinations at 2 years were repeated. We proposed the young skater a medical and a physiotherapeutic treatment based on unloading, isometric exercises, NSAID. As the symptoms improve a gradual return to competitive sports activity was allowed. The case mentioned above can be considered an atypical case because the patient suffered for a bilateral knee osteochondroses, involving simultaneously the primary ossification centre (Kohler syndrome) and the secondary ossification centre (Larsen syndrome) of the patella.

Osteochondritis dissecans and Osgood Schlatter disease in a family with Stickler syndrome

“…Much of the early literature collected osteochondritis dissecans, osteochondral fracture, and accessory ossification in one basket! Franceschi et al [ 32 ] reported the first case of simultaneous location of ostechondroses of the two ossification centers of both patellae in a 9-year-old boy. The boy was considered as an atypical case of osteochondrosis because he presented with bilateral knee osteochondroses, involving simultaneously the primary ossification centre (Kohler syndrome) and the secondary ossification centre (Larsen syndrome) of the patella.…”

Osteochondrosis of Primary Center of Patella: A Case Report

“…On the other hand, Keats [ 16 ] believes that irregular ossification of the patella is a normal developmental variation, as demonstrated with several cases in his textbook. Franceschi et al reported the first case of simultaneous location of osteochondroses of the two ossification centers of both patellae in 9-year-old boy [ 2 ]. Sakai et al found osteonecrosis of the patella in nine patients (ten knees) while evaluating non-traumatic osteonecrosis of the femoral head in 60 patients [ 4 ].…”

“…Kohler’s disease of patella a group of self-limited conditions due to unknown etiology in which endochondral ossification is disturbed. Very few cases have been reported in literature [ 2 , 3 , 4 ]. Pain in the patellar region of a growing child is a common occurrence.…”

The osteochondrosis of superior pole of Patella: a case report

“…In condition of patellar osteochondrosis, rarely the primary ossification centre is affected and seen more often between the ages of 5 and 9 known as Köhler's disease (1-4). More frequently, the secondary ossification centre, usually at the distal pole, is involved between the ages of 9 and 11 known as SLJ (1,2). Superior pole osteochondrosis of patella has been reported in the literature on only a handful of occasions was no name (6)(7)(8).…”

“…The aetiology of osteochondroses remains uncertain and rather speculative. Catch-up growth or strenuous sports activities have been thought to be the cause of this benign disease in children between 5 and 9 years of age (1)(2)(3)(4)(5). Because of traction exerted through the ligament, the osteochondritic changes may occur at either the upper or the lower attacments of the ligamentum patellae as known Sinding LarsenJohanson(SLJ) and OsgoodSchlatter's(OS) disease (6).…”