Bilateral osteochondral defects of the patellae in an 11-year-old girl

Abstract

Osteochondral defect or osteochondritis dissecans (OCD) of the knee usually affects young, active populations. It is a challenging diagnosis as patients typically present with poorly localised activity-related pain, which is non-specific and covers many differentials. We present an active 11-year-old girl with bilateral osteochondral defects of the patellae: a rare clinical disorder which was affecting her sporting activities. She had a 12-month history of bilateral anterior knee pain before the diagnosis was achieved with appropriate imaging. Her pain significantly improved with activity modification and physiotherapy. Follow-up will require outpatient clinic assessment and imaging to determine if non-operative management continues to be successful or surgery may be required. This case report emphasises the importance of appropriate high index of suspicion when managing patients with non-specific knee pain. It also demonstrates the importance of judicious use of imaging to avoid a missed or delayed diagnosis.

15% of Talar Osteochondral Lesions Are Present Bilaterally While Only 1 in 3 Bilateral Lesions Are Bilaterally Symptomatic

“…During skeletal growth, this can result in an osteochondral fragment embedded in the talus or an area of the talus that is more susceptible to injury. As the result of a traumatic event (e.g., an ankle sprain), repetitive overloading, or suboptimal loading in a patient with chronic ankle instability, the embedded fragment could become destabilized or the high-risk area could be injured, resulting in symptoms 9,10 . Through osteolytic changes, the morphology of these lesions may change over time as fragments can dissolve, potentially developing into a crater (see Appendix).…”

“…Although most patients with OLT have unilateral symptoms, OLT can also present bilaterally 8 . Early discovery of bilateral OLT is important as the symptomatology may change over time—from asymptomatic to symptomatic—because of factors such as trauma to the ankle joint, high body mass index (BMI), or ankle microinstability 9,10 . Furthermore, it can be hypothesized that early diagnosis may prevent further damage through lifestyle changes and may increase the chance of successful conservative or surgical treatment, thereby limiting the progression on the incremental cascade toward end-stage osteoarthritis 1,4,11 .…”

Patella and Trochlea Osteochondritis Dissecans: Demographics and Treatment Paradigms

“…4 Previous research on treatment outcomes has been limited by small sample sizes, with prior case reports and series reviewing small numbers of pediatric and adolescent knees-ranging from 1 to 34 patients. 1,3,[5][6][7][8][9][10][11][12] In an effort to address gaps in the literature, this study aims to describe the presentation of patients with OCD lesions of the patella and trochlear groove and characterize the common clinical and functional results of operative and nonoperative treatments to help guide management.…”

“…A recent multicenter prospective study from the “Research in Osteochondritis Dissecans of the Knee” group found that only 9.5% of OCD lesions of the knee were found in the trochlea and 6.0% were in the patella 4 . Previous research on treatment outcomes has been limited by small sample sizes, with prior case reports and series reviewing small numbers of pediatric and adolescent knees—ranging from 1 to 34 patients 1,3,5–12 …”