ALPER KAYA, BERK GÜÇLÜ, DOĞAÇ KARAGÜVEN, İsmet Teoman BENLİ, Önür ATAOĞLU

Aynı dizde patella ve medial femoral kondilde görülen osteokondritis dissekans

Osteokondritis dissekans (OKD) eklem kıkırdağının, altındaki subkondral kemikle birlikte kemikten ayrıldığı bir durumdur. Klasik yerleşimi medial femoral kondildir. Bu yazıda, aynı dizde hem medial femoral kondilde hem de patellada OKD tanısı konan 14 yaşında bir erkek hasta sunuldu. Hasta, spor yaptıktan sonra sol dizinde ortaya çıkan ağrı, şişlik ve takılma şikayetleriyle başvurdu. Manyetik rezonans görüntülemede patelladaki lezyonun parçalı olduğu ve tam ayrıldığı, instabiliteye neden olduğu görülerek artroskopik cerrahi tedavi planlandı. Kondiler lezyona in situ tespit, patelladaki lezyona ise debridman uygulandı. Altıncı ay kontrolünde hastanın eklem hareket açıklığı tam idi, patellar öğütme testi ile bir miktar ağrı olduğu görüldü.

Anahtar Kelimeler:

Ergen, Artroskopi, Debridman, Diz eklemi, Erkek, Patella, Osteokondritis dissekans

Osteochondritis dissecans occurring in the patella and medial femoral condyle in the same knee

Osteochondritis dissecans (OCD) is a condition in which a portion of articular cartilage separates from the bone together with the underlying subchondral bone. Its classical localization is the medial femoral condyle. We presented a 14-year-old boy who had OCD lesions in both the medial femoral condyle and patella in the same knee joint. He presented with complaints of pain, swelling, and locking following sports activities. Magnetic resonance imaging showed completely detached loose bodies causing instability. Arthroscopic treatment was performed including in situ fixation of the condylar lesion and debridement of patellar lesions. At six-month follow-up, he had full range of motion of the knee joint, with some pain in the patellar grind test.

Keywords:

Adolescent, Arthroscopy, Debridement, Knee Joint, Male, Patella, Osteochondritis Dissecans,

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1. Tandoğan NR, Ozgür F, Akkaya T. Osteokondritis dissekans. Acta Orthop Traumatol Turc 2007;41 Suppl 2:113-22.
2. Gomoll AH, Flik KR, Hayden JK, Cole BJ, Bush-Joseph CA, Bach BR Jr. Internal fixation of unstable Cahill Type- 2C osteochondritis dissecans lesions of the knee in adolescent patients. Orthopedics 2007;30:487-90.
3. Lindén B. The incidence of osteochondritis dissecans in the condyles of the femur. Acta Orthop Scand 1976;47:664-7.
4. Bradley J, Dandy DJ. Osteochondritis dissecans and other lesions of the femoral condyles. J Bone Joint Surg [Br] 1989;71:518-22.
5. Mubarak SJ, Carroll NC. Familial osteochondritis dissecans of the knee. Clin Orthop Relat Res 1979;(140):131-6.
6. Reddy AS, Frederick RW. Evaluation of the intraosseous and extraosseous blood supply to the distal femoral condyles. Am J Sports Med 1998;26:415-9.
7. Hefti F, Beguiristain J, Krauspe R, Möller-Madsen B, Riccio V, Tschauner C, et al. Osteochondritis dissecans: a multicenter study of the European Pediatric Orthopedic Society. J Pediatr Orthop B 1999;8:231-45.
8. Crawford DC, Safran MR. Osteochondritis dissecans of the knee. J Am Acad Orthop Surg 2006;14:90-100.
9. Bohndorf K. Osteochondritis (osteochondrosis) dissecans: a review and new MRI classification. Eur Radiol 1998; 8:103-12.
10. Guhl JF. Arthroscopic treatment of osteochondritis dissecans. Clin Orthop Relat Res 1982;(167):65-74.
11. Hanna SA, Aston WJ, Gikas PD, Briggs TW. Bicondylar osteochondritis dissecans in the knee: a report of two cases. J Bone Joint Surg [Br] 2008;90:232-5.
12. Makino A, Muscolo DL, Puigdevall M, Costa-Paz M, Ayerza M. Arthroscopic fixation of osteochondritis dissecans of the knee: clinical, magnetic resonance imaging, and arthroscopic follow-up. Am J Sports Med 2005;33:1499-504.
13. Akgün I. Osteokondritis dissekans. In: Tandoğan NR, Alpaslan AM, editörler. Diz cerrahisi. Ankara: Haberal Eğitim Vakfı Yayınları; 1999. s. 247-59.
14. Schwarz C, Blazina ME, Sisto DJ, Hirsh LC. The results of operative treatment of osteochondritis dissecans of the patella. Am J Sports Med 1988;16:522-9.