Deroussen François, Hustin Charles, Moukoko Didier, Collet Louis-Michel, Gouron Richard
Orthopedics. 2014 Feb;37(2):e218-20. doi: 10.3928/01477447-20140124-30.
Osteochondritis dissecans is a rare cause of painful knees in children. Only 10 cases of lateral tibial condyle involvement have been reported in the literature. Congenital agenesis of both cruciate ligaments has been described even less, and its prevalence is unknown. The authors report an atypical association of osteochondritis dissecans of the tibia with congenital absence of both cruciate ligaments. A 12-year-old male soccer player presented with a painful right knee. Magnetic resonance imaging revealed the diagnosis. The child was treated conservatively. At 18-month follow-up, radiographs showed osseointegration of the osteochondritis dissecans, and the patient had resumed normal athletic activity without pain. To the authors' knowledge, this is the only report describing such an association. The authors discuss the possible etiology of osteochondritis dissecans associated with agenesis of the cruciate ligaments and highlight the possibility of this association when osteochondritis dissecans of the tibia is diagnosed in a child with a painful knee. In this patient, the strain due to anteroposterior instability may have been the cause of osteochondritis. Conservative treatment should be considered in this setting.
剥脱性骨软骨炎是儿童膝关节疼痛的罕见病因。文献中仅报道了10例累及外侧胫骨髁的病例。双侧交叉韧带先天性发育不全的描述更少，其患病率尚不清楚。作者报告了一例胫骨剥脱性骨软骨炎与双侧交叉韧带先天性缺失的非典型关联。一名12岁的男性足球运动员因右膝疼痛就诊。磁共振成像确诊了病情。该患儿接受了保守治疗。在18个月的随访中，X线片显示剥脱性骨软骨炎骨整合，患者已恢复正常体育活动且无疼痛。据作者所知，这是描述这种关联的唯一报告。作者讨论了与交叉韧带发育不全相关的剥脱性骨软骨炎的可能病因，并强调在诊断患有膝关节疼痛的儿童胫骨剥脱性骨软骨炎时这种关联的可能性。在该患者中，前后不稳定导致的应力可能是剥脱性骨软骨炎的病因。在这种情况下应考虑保守治疗。
