Bilateral osteochondritis dissecans of the medial trochlea femoris: an unusual case of patellofemoral pain

Abstract

We report a case of bilateral osteochondritis dissecans of the medial trochlea femoris. Arthroscopic removement of loose bodies in the symptomatic left knee led to an excellent result; the untreated right knee showed effusion and locking one year later. This condition should be considered in the diagnosis of patellofemoral pain.

Multifocal Juvenile Osteochondritis Dissecans of the Knee

“…Bilateral knee involvement has been reported to exist in 13% to 30% of juvenile patients with OCD lesions, but outcome data and even lesion characteristics are lacking in these studies. [2][3][4]8,11,[21][22][23][24][25][26][27][28] The large, multicenter review of the Micro fx = 2/5 healed *Healing rates between osteochondritis dissecans lesions located on the medial femoral condyle were significantly better than lesions on the lateral femoral condyle (P < 0.0001). European Pediatric Orthopedic Society by Hefti et al 8 reported bilateral involvement in 13% of patients, but failed to mention specific lesion location in this subset of patients.…”

What Do We Currently Know About Patellofemoral Osteochondritis Dissecans?

“…6 , 44 - 46 Pooling the results of the studies analyzed, 283 patients (244 patellar OCD, 39 trochlear OCD) have been reported to date, but figures are likely to be higher as a significant percentage of published studies have not been included due to exclusion criteria. 12 - 39 Mean age at time of diagnosis of PF-OCD is higher than that of general knee OCD, being it around 16 years with the oldest patient reported being 30 years old. 12 , 16 , 19 , 20 , 23 , 26 - 36 , 38 , 39 Normally, only 1 knee is involved, but 11 studies reported bilateral involvement.…”

“… 13 , 16 , 20 , 21 , 23 , 27 , 28 , 34 , 37 , 40 , 41 Men are more commonly affected than women with ratios ranging from 2:1 to 9:1 (mean 4:1), 16 , 18 , 23 , 24 , 26 , 30 , 31 , 33 - 36 , 39 and 2 studies reported only on male patients. 18 , 24 Mechanical pathomechanism such as repetitive shearing stress and overuse is reported by 12 studies, 13 , 15 - 17 , 20 - 22 , 24 , 25 , 29 , 36 , 41 while only 3 studies report a possible biological etiology. 20 , 27 , 29 One study found a significant association between PF-OCD and sports like soccer and basketball 36 and 4 studies reported a history of previous trauma.…”

“…12,16,19,20,23 , 26-36 , 38,39 Generally only 1 knee is affected but 11 studies reported bilateral involvement. 13,16,20,21,23,27,28,34,37,40,41 Men are more commonly affected than women with ratios ranging from 2:1 to 9:1 (mean 4:1), 16,18,23,24,26,30,31 , 33-36 , 39 and 2 studies reported only on male patients. 18,24 Mechanical pathomechanism such as repetitive shearing stress and overuse is reported by 12 studies, 13 , 15-17 , 20-22 , 24,25,29,36,41 while only 3 studies report a possible biological etiology.…”

Osteochondritis dissecans of the medial femoral trochlear ridge in two bulldog siblings

“…Most of the lesions in the trochlea occur in the lateral trochlear ridge (23,26,32). Medial trochlear ridge has recently been identified as an affected site, although there exist only three cases reported, one of them with bilateral involvement (15,26).…”