Bilateral osteochondritis dissecans of the lateral trochlea of the femur: a case report

Abstract

Osteochondritis dissecans of the bilateral trochlea of femur is unusual case for orthopedic surgeon. The patient was a healthy 15-year-old male with symptomatic osteochondritis dissecans of the bilateral distal lateral femoral condyle of the trochlea. A surgery on the bilateral knee joints was performed simultaneously. The osteochondral free fragment of the right knee was resected by a minimum open surgery after arthroscopic evaluation. In the left knee the fragment was stabilized with multiple cortical bone pegs harvested from the proximal tibia. The surgery was successful, and the patient was able to play basketball 3 months postoperatively. The course of the right knee is currently under careful observation because of the possibility of recurrence. The left knee has remained in an excellent condition for 18 months following surgery with bone pegs.

Multifocal Juvenile Osteochondritis Dissecans of the Knee

“…Others have found that nonmedial femoral condylar lesions are associated with a better prognosis and that coronal plane location has no influence on healing. 27, 28 We found a statistically significant higher rate of healing for MFC lesions (89%) versus LFC lesions (37%) (P < 0.001). However, LFC lesions were more likely to be unstable than MFC lesions (32% vs. 14% respectively).…”

“…29 Others, however, demonstrated successful healing rates of only 50% after a period of 6 to 18 months of nonoperative treatment. 9,10,28 While all lesions in our study considered stable on initial MRI underwent a trial of nonoperative management, only 12 of the 47 lesions (25.5%) healed with conservative management. Although there was an obvious trend for stable lesions treated surgically to heal more reliably compared with unstable lesions treated surgically (25/32 vs. 5/12, respectively), this difference was not significant (P = 0.1374).…”

“…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.…”

A case of osteochondritis dissecans of the lateral femoral condyle and patellofemoral joint surface occurring in the same knee

“…In addition, this patient jumped frequently during soccer heading practice. We concluded that repeated abrupt and strong knee extensions from a deep position had caused external deviation of the patella, adding strong pressure to the lateral femoral condyle, resulting in OCD of the patellofemoral joint surface [10–12]. Repetitive microtraumas are unlikely to be the sole cause of two lesions occurring in the same joint, and an underlying predisposition cannot be ruled out.…”

Surgical Management of Osteochondritis Dissecans Lesions of the Patella and Trochlea in the Pediatric and Adolescent Population

“…Little is known about how OCD lesions in the patellofemoral joint may differ. 22,29,31,[39][40][41] The American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines for OCD treatment do not address treatment of lesions in the trochlea. 8 There is a paucity of published data regarding the management of OCD lesions of the patellofemoral joint, with most restricted to small series and case reports, and there is no consensus for optimal treatment.…”