Patella avascular necrosis (Köhler disease)


Most authors recognize the distinction between osteochondritis of the center or the primary nucleus (Kohler disease) and osteochondritis of the secondary ossification center at the lower pole (Sinding-Larsen - Johansson disease). Kohler disease can also refer to navicular avascular necrosis.

The diagnosis of osteochondritis of the patella can only be placed when the x-ray is definitely accompanied by clinical symptoms. 

The early form is less common than the later-onset Sinding-Larsen disease. There is a slight male predominance. The early form occurs between 5 and 7 years, late between 9 and 14 years, in puberty. They are quite frequently bilateral.

It has been associated with apophysitis tibialis anterior and to a lesser extent with avascular necrosis at other locations. 

Case courtesy: Prof. Fabio Denicolò.