Patella avascular necrosis (Köhler disease)

Case contributed by Dr Domenico Nicoletti


Spontaneous right knee anterior pain.

Patient Data

Age: 8 years
Gender: Male

Knee joint

The ossification center of the right patella is small and irregularly thickened.

The left knee is normal.

Annotated image

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

Case Discussion

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.

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Case information

rID: 50792
Published: 30th Jan 2017
Last edited: 14th Mar 2021
Inclusion in quiz mode: Included

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