HSS What's the Diagnosis Case 187

What’s the Diagnosis – Case 187

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What’s the Diagnosis – Case 187

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What’s the Diagnosis – Case 187

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What’s the Diagnosis – Case 187

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What’s the Diagnosis – Case 187

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What’s the Diagnosis – Case 187

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Findings: The radiographs demonstrate irregularity at the ends of multiple bones and somewhat early onset advanced osteoarthritis of multiple articulations. The coned down lateral view of the knees gives a sense of almost “too many bones” about the patellae. On the subsequent CT knee images for preoperative planning, double layered patellae are seen.

What’s the Diagnosis – Case 187

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What’s the Diagnosis – Case 187

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What’s the Diagnosis – Case 187

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What’s the Diagnosis – Case 187

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Diagnosis: Multiple epiphyseal dysplasia is a vast array of genetic abnormalities and with somewhat varied presentations. Patients present with irregularity at the end of the bones, premature osteoarthritis, and typically some degree of short stature. In the pediatric population, radiographs can show irregular and delayed ossification at the epiphyses. Although not always found, when it is present, the double layered patella as shown in this case is pathognomonic for multiple epiphyseal dysplasia.

In the typical bipartite patella seen superolateral (most common), inferior, or laterally there is not a layering of the bone but simply a residual synchondorosis. The double layered patella is seen best on axial images or an axial view of the knee (Merchant, sunrise, etc.). Interestingly, the anterior segment has the quadriceps tendon attachment and the posterior segment the cartilage interface with the trochlea. As these patients develop severe degenerative changes, the double layered patella may need to be addressed at the time of knee arthroplasty.

What’s the Diagnosis – Case 187

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References Milants A, De Maeseneer M, De Mey J. Double-Layered Patella (DLP) in Multiple Epiphyseal Dysplasia (MED). J Belg Soc Radiol. 2017 Feb 2;101(1):8. doi: 10.5334/jbr-btr.1219. PMID: 30039000; PMCID: PMC5854308.

Sheila Unger, Luisa Bonafé and Andrea Superti-Furga. Multiple epiphyseal dysplasia: clinical and radiographic features, differential diagnosis and molecular basis. Best Practice & Research: Clinical Rheumatology, 2008-0301, Volume 22, Issue 1, Pages 19-32, Copyright © 2007 David Eichler, Pascal-André Vendittoli. Double-layered patella management in total knee arthroplasty for secondary osteoarthritis: A case report, Journal of ISAKOS,Volume 7, Issue 2, 2022,Pages 99-105, ISSN 2059 7754,https://doi.org/10.1016/j.jisako.2022.01.004. (https://www.sciencedirect.com/science/article/pii/S205977542200013X)

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