Abstract
We report the case of a young boy who presented a dorsal defect of the patella (DDP) with fracture after a small sport trauma. The patient’s parents (professional of health care) had been warned on a possible tumoral disease in a previous consultation and claimed for an accurate diagnosis. Although fracture is rarely reported in DDP, the radiographic image strongly suggested this condition; nevertheless, the diagnosis accuracy requested by the parents lead to indicate a biopsy that showed irregular fragments of laminar bone and hyaline cartilage islands similar to articular cartilage compatible with a non-specific developmental ossification defect. The lytic defect was filled with morselized cancellous bone graft, the fracture having a normal consolidation. With a follow-up of 4 years, the patient is asymptomatic, and the radiological morphology of the patella is normal. Although DDP is accepted to be a radiologically well-defined condition, images may perhaps not get accuracy enough for diagnosis and biopsy may be indicated by clinical and radiological features different than the typical ones. Although fracture is rarely reported in case of DDP, it has not to be considered as indicative of tumor or malignancy.
Similar content being viewed by others
References
Mercuri M, Casadei R (2001) Patellar tumors. Clin Orthop Rel Res 389:35–46
Johnson JF, Brogdon BG (1982) Dorsal defect of the patella incidence and distribution. Am J Roentgenol 139:339–340
van Holsbeeck M, Vandamme B, Marchal G, Martens M, Victor J, Baert AL (1987) Dorsal defect of the patella: concept of its origin and relationship with bipartite and multipartite patella. Skeletal Radiol 16:304–311
Safran MR, McDonough P, Seeger L, Gold R, Oppenheim WL (1994) Dorsal defect of the patella. J Pediatr Orthoped 14:603–607
Goergen TG, Resnick D, Greenway G, Saltzstein SL (1979) Dorsal defect of the patella (DDP): a characteristic radiographic lesion. Radiology 130:333–336
Haswell DM, Berne AS, Graham CB (1976) The dorsal defect of the patella. Pediatr Radiol 4:238–242
Keats TE (1992) An atlas of normal roentgen variants that may simulate disease. Mosby year book, Chicago
Huang YL, Yeh LR, Chen CK, Pan HB, Yang CF (2004) Bilateral dorsal defect of patellae with patellar hypoplasia and patellofemoral malalignment. J Chin Med Assoc 67:369–372
Denham RH Jr (1984) Dorsal defect of the patella. J Bone Joint Surg Am 66:116–120
Mellado JM, Salvadó E, Ramos A, Camins A, Saurí A (2001) Dorsal defect on a multi-partite patella: imaging findings. Eur Radiol 11:1136–1139
Sueyoshi Y, Shimozaki E, Matsumoto T, Tomita K (1993) Two cases of dorsal defect of the patella with arthroscopically visible cartilage surface perforations. Arthroscopy 9:164–169
Locher S, Anderson S, Ballmer FT (2002) Noninvasive management of a dorsal patellar defect. Arch Orthop Trauma Surg 122:466–468
Neitzschman HR, Gopal H (2005) Radiology case of the month. What is the cause of this patient’s knee pain? Dorsal defect of the patella. J La State Med Soc 157:13–14
Vaninbroukx J, Martens M, Verhelst M, Mulier JC (1976) Hematogenous osteomyelytis of the patella. Acta Orthop Scand 47:566–569
Ehara S, Khurana JS, Kattapuram SV, Rosenberg AE, El-Khoury GY, Rosenthal DI (1989) Osteolytic lesions of the patella. Am J Roent 153:103–106
Herring JA (2002) Lower extremity injuries. In: Herring JA (ed) Tachdjian’s pediatric orthopedics. WB Saunders Company, Philadelphia, pp 2251–2438
Tam W, Resnick D, Parviz H, Vaugan L (1966) Intraosseous ganglion of the patella. Skeletal Radiol 25:588–591
Dhillon MS, Rao SS, Sandhu MS, Vasisht RK, Nagi ON (1998) Tuberculosis of the patella. Skeletal Radiol 27:40–42
Miller WB, Murphy WA, Gilula LA, Kantor OS (1977) Brodie’s abcess of the patella. JAMA 238:1179–1180
Bahri I, Yahia NB, Boudawara T, Makni S, Fakhfakh B, Kechaou S, Keskes H, Jlidi R (2003) Tumeur à cellules gántes de la retule avec metastases pulmanaires. A propos dún cas. Rev de Chirur Orthop 89:361–366
Ferguson PC, Griffn AM, Bell RS (1997) Prymary patellar tumors. Clin Orthop Rel Res 336:199–204
Georgoulis AD, Papageorgiou CD, Moebius UF, Rossis J, Papadonikolakis A, Soucacos PN (2002) The diagnostic dilemma created by osteoid osteoma that presents as knee pain. Arthroscopy 18:32–37
Lammot TR (1968) Enchondroma of the patella A case report. J Bone Joint Surg Am 50:1230–1232
Bansal VP, Singh R, Grewal DS, Bannerjee AK (1974) Haemangioma of the patella. J Bone Joint Surg Br 56:139–141
Linscheid RL, Dahlin DC (1966) Unusual lesions of the patella. J Bone Joint Surg Am 48:1359–1366
Soonmee C, Schultz E, McHeffey-Atkinson B, Sherr D (1966) Malignant lymphoma involving the patella. Skeletal Radiol 25:783–785
Goodwin MA (1961) Primary osteosarcoma of the patella. J Bone Joint Surg Br 43:338–341
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Villas, C., Pons-Villanueva, J. Dorsal defect of the patella with fracture in a teenager. Musculoskelet Surg 94, 93–97 (2010). https://doi.org/10.1007/s12306-010-0074-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12306-010-0074-7