Patella avascular necrosis (Kohler disease)

Case contributed by Dr Domenico Nicoletti

Presentation

Spontaneous right knee anterior pain

Patient Data

Age: 8 years
Gender: Male
Modality: X-ray

The ossification centre of the right patella is small and irregularly thickened. The left knee is normal

Modality: Annotated image

The ossification centre of the right patella is small and irregularly thickened (blue circle).

Case Discussion

Most authors recognise the distinction between osteochondritis of the centre or the primary nucleus (Kohler disease) and osteochondritis of the secondary ossification centre 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, 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.

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Case Information

rID: 50792
Case created: 21st Jan 2017
Last edited: 30th Jan 2017
Inclusion in quiz mode: Included

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