Bilateral Osteochondrosis of the Primary Patellar Ossification Centers in a Young Athlete

A Case Report

Aisha S. Dharamsi, MD; Rebecca L. Carl, MD

Disclosures

Clin J Sport Med. 2014;24(1):80-82. 

In This Article

Case Report

A 6-year 11-month-old male presented to the outpatient sports medicine clinic reporting an 8-week history of insidious onset anterior knee pain initially left sided but now predominantly on the right. Symptoms occurred during athletic activities, prolonged ambulation, and with extremes of knee flexion/extension. Severe pain occasionally resulted in a noticeable limp. There was no history of trauma, systemic symptoms, or relevant medical, surgical, or family history.

The patient and his parents presented seeking a second opinion; he had been evaluated by multiple providers and undergone an extensive workup including infectious disease and rheumatologic evaluations. Previous investigations included laboratory tests, bilateral knee x-rays, and a left knee magnetic resonance image (MRI).

Focused examination of the knees was negative for effusion or obvious deformity. Range of motion was full and symmetrical; however, he was tender to palpation at the inferior right patellar pole. Patellar mobility and tracking were normal; no ligamentous laxity was appreciated. Examination of his hips was unremarkable.

Data review revealed normal erythrocyte sedimentation rate, C-reactive protein, and complete blood count. X-rays (Figures 1A, B) showed a mottled appearance of both patellae with irregular margins and subtle fragmentation. A left knee MRI (Figure 1C) demonstrated fragmentation of the primary patellar ossification center with diffusely decreased T1-weighted signal and corresponding enhancement on T2-weighted sequences.

Figure 1.

Initial x-rays of the bilateral knees (A: right, B: left) showed a mottled appearance of both patellae with irregular margins and subtle fragmentation. An MRI of the left knee (C) demonstrated fragmentation of the primary patellar ossification center with enhancement seen on this T1-w sequence.

We diagnosed the patient with bilateral osteochondrosis of the primary patellar ossification centers (Köhler's disease of the patellae) and recommended activity modification, relative rest from irritating activities, and the use of ice and ibuprofen/acetaminophen as needed.

One month after his initial visit, the patient reported significant symptom improvement; 3 months later his pain had completely resolved. Eight months after his first evaluation, he remained symptom free and had resumed full activities. Repeat x-rays (Figures 2A, B) showed that the patellae had increased in size as expected with normal growth-related ossification. Irregular bilateral patellar margins were again seen along with reduced fragmentation and increased sclerosis compared with previous radiographs, findings consistent with the natural course of osteochondrosis of the primary patellar ossification centers.

Figure 2.

Repeat x-rays of the bilateral knees (A, right; B, left) showed reduced fragmentation and increased sclerosis of the patellae compared with the previous radiographs.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....