Lijesen Emilie, Adhiyaman Akshitha, Tracey Olivia C, Bram Joshua T, Oji Nnaoma M, Chipman Danielle E, Simpson Shae K, Mintz Douglas N, Fabricant Peter D, Green Daniel W
Department of Pediatric Orthopedics, Hospital for Special Surgery, New York, New York, USA.
University of Florida College of Medicine, Gainesville, Florida, USA.
Am J Sports Med. 2025 Apr;53(5):1112-1118. doi: 10.1177/03635465251320117. Epub 2025 Feb 24.
Osteochondritis dissecans (OCD) lesions in the knee are most commonly found in the medial femoral condyle (MFC). However, a paucity of literature has explored the characteristics or morphology of patellar OCD lesions.
PURPOSE/HYPOTHESIS: The purpose of this study was to analyze patellar tracking and patellofemoral measurements of pediatric patients with patellar OCD compared with patients with MFC OCD. It was hypothesized that the patients with patellar OCD would demonstrate an increased bony sulcus angle, cartilaginous sulcus angle, and tibial tubercle-trochlear groove (TT-TG) distance compared with patients with MFC OCD.
Case series; Level of evidence, 3.
Patients aged ≤18 years diagnosed with either a patellar or MFC OCD lesion at a single tertiary care hospital between January 2016 and May 2023 were analyzed. Patients with a history of patellar instability were excluded. The Caton-Deschamps index, cartilaginous bony height, trochlear depth, patellar tilt, lateral patellar displacement, cartilaginous sulcus angle, bony sulcus angle, and TT-TG distance were assessed on magnetic resonance imaging (MRI). Patients were matched 1:2 based on sex and chronological age within 2 years between the patellar and MFC OCD groups.
A total of 40 extremities in 34 patients with patellar OCD were matched to 80 extremities in 73 patients with MFC OCD. The mean age at the time of MRI was 14.1 ± 2.3 years, and 23% were female. Compared with patients with MFC OCD, patients with patellar OCD had a significantly greater TT-TG distance (11.55 ± 4.15 vs 13.35 ± 4.07 mm, respectively; = .03). The cartilaginous sulcus angle (150.63°± 7.20° vs 128.09°± 14.07°, respectively; < .001) and bony sulcus angle (144.70°± 7.78° vs 137.37°± 9.62°, respectively; < .001) were higher in the patellar OCD group compared with the MFC OCD group. Of patients with patellar OCD, 40% had a TT-TG distance >15 mm, and of patients with MFC OCD, 20% had a TT-TG distance >15 mm. The patellar OCD group had 3.7 times the risk of having a patellar dislocation compared with the MFC OCD group.
An increased TT-TG distance and sulcus angle were associated with patellar OCD in pediatric patients. Patients with abnormal patellofemoral morphology who undergo treatment for a patellar OCD lesion may subsequently develop a patellar dislocation; in this study, patients with patellar OCD without a history of patellar dislocations demonstrated a nearly 4-fold higher dislocation rate compared with an age- and sex-matched group of patients with MFC OCD.
膝关节剥脱性骨软骨炎（OCD）病变最常见于股骨内侧髁（MFC）。然而，关于髌骨OCD病变的特征或形态的文献较少。
目的/假设：本研究的目的是分析髌骨OCD患儿与MFC OCD患儿的髌骨轨迹和髌股测量数据。假设与MFC OCD患儿相比，髌骨OCD患儿的骨沟角、软骨沟角和胫骨结节-滑车沟（TT-TG）距离会增加。
病例系列；证据等级，3级。
分析2016年1月至2023年5月期间在一家三级医疗中心诊断为髌骨或MFC OCD病变的18岁及以下患者。排除有髌骨不稳定病史的患者。在磁共振成像（MRI）上评估Caton-Deschamps指数、软骨骨高度、滑车深度、髌骨倾斜度、髌骨外侧移位、软骨沟角、骨沟角和TT-TG距离。根据性别和实际年龄在2年内将髌骨和MFC OCD组患者按1:2进行匹配。
34例髌骨OCD患者的40个肢体与73例MFC OCD患者的80个肢体相匹配。MRI检查时的平均年龄为14.1±2.3岁，23%为女性。与MFC OCD患者相比，髌骨OCD患者的TT-TG距离显著更大（分别为11.55±4.15 vs 13.35±4.07 mm；P = 0.03）。髌骨OCD组的软骨沟角（分别为150.63°±7.20° vs 128.09°±14.07°；P < 0.001）和骨沟角（分别为144.70°±7.78° vs 137.37°±9.62°；P < 0.001）高于MFC OCD组。髌骨OCD患者中，40%的TT-TG距离>15 mm，MFC OCD患者中，20%的TT-TG距离>15 mm。与MFC OCD组相比，髌骨OCD组发生髌骨脱位的风险是其3.7倍。
增加的TT-TG距离和沟角与小儿髌骨OCD有关。接受髌骨OCD病变治疗的髌股形态异常患者可能随后发生髌骨脱位；在本研究中，无髌骨脱位病史的髌骨OCD患者与年龄和性别匹配的MFC OCD患者组相比，脱位率高出近4倍。
