Bilateral Lateral Condyle Lesion with Valgus Deformities of Lower Extremities Hank Chambers MD Professor of Clinical Orthopedic Surgery University of California San Diego Rady Childrens Hospital San Diego ID: 770814
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Bilateral Lateral Condyle Lesion with Valgus Deformities of Lower Extremities Hank Chambers, MD Professor of Clinical Orthopedic SurgeryUniversity of California, San DiegoRady Children’s Hospital, San Diego
History 11 y.o. female who presented to clinic with b/l knee pain and difficulty ambulating. 2+ effusion, locking and catching PE: unable to ambulate L side with 15° loss of extension, TTP over b/l LFC
Imaging
Imaging
Standing EOS Imaging
MRI Right Knee
MRI Right Knee
Treatment Bilateral lower extremities: Diagnostic arthroscopy with findings of complete delamination of the cartilage or lateral compartment almost like a rolled up rugFindings of a cartilage covered ridge in mid portion of the tibial weight bearing surface bilaterallylateral femoral condyle vascular stimulationtemporary hemiepiphysiodesis with application of plates to medial distal femur and proximal tibia
1. Arthroscopy – L Knee
1. Arthroscopy – R Knee
1. Post-op Imaging 1 week
1. Post-op Imaging 1 week
1. Post-op Imaging 8 months
1. Post-op Imaging 8 months
1. Post-op Imaging 8 months
1. Post-op Imaging 8 months 8 months post-op Pre-op
1 year later 12 yr old female with severe b/l lateral femoral condyle OCD and genu valgum who is 1 year s/p open b/l OCD vascular stimulation, b/l fem/tib medial 8 plates.Recovered well from surgery w/ weekly PT. Swims and rides bike, but does not participate in sports.Her RLE has responded well to guided growth but left continued to have a valgus alignment.
2. Pre-op Imaging
2. Treatment Bilateral lower extremities: removal of temporary guided growth tension band plates from the medial distal femur /proximal tibia. LLE: lateral distal femoral opening wedge osteotomy
2. Post-op Imaging 1 month
2. Post-op Imaging 4 months 4 months post-op Pre-op before 1st surgery
2. Post-op Imaging 4 months
2. Post-op Imaging 4 months
2. Post-op Imaging 4 months
2 years later MS is a 13 yo female who is 1 year s/p left distal femoral osteotomy with retained implant.Implant removal
3. Post-op Imaging 1 month
Current Condition No painFull range of motionNo effusionNo clicking, popping or lockingAble to ride a bicycle and swimAvocations are art and music
The American Journal of Sports Medicine, July 2010 Background: Prevalence 0.01 – 0.06%, 2:1 males, 75% involve knee, thereof 70-80% medial femoral condyle. Etiology unknown – mechanical, vascular, genetic, inflammatory, ossification problems?Purpose: Relationship b/n localization of OCD & mechanical axis of leg?Study Design: Retrospective study of case series between January 1993 and December 2007 in single ortho dept.
Methods: Used b/l full-leg standing radiographs in 93 adolescent and adult patients (103 knees) with OCD of medial or lateral femoral condyle. Mechanical axis was calculated by the method of Fujisawa et al*: 0% represents knee center100% represents medial and lateral border of the joint *Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee: an arthroscopic study of 54 knee joints. Orthop Clin North Am. 1979;10(3):585-608.
Results : Location of OCD and position of mechanical axis in same knee compartment was significantly correlated for both medial (P< 0.001) as well as lateral (P< 0.012) compartment OCD. Significant lateral shift compared to unaffected side. Statistically insignificant medial shift with respect to unaffected side.
Results: No significant difference between adolescents with open growth plates compared with adults with closed growth plates (P > .05).
Conclusion: Association between medial condyle OCD and varus axis and between lateral condyle OCD and valgus axis. Higher loading of the affected than of the unaffected knee compartment. Axial alignment may be a cofactor in OCD of the femoral condyles.Limitations:9 b/l cases in medial OCD -- affecting shift calculations?Single institutionRelatively small subgroups in sample – bias? The full-leg standing radiographs are not done uniformly at the onset of symptoms – many patients were referred later to their institution