II. Pathophysiology
- Apophysitis secondary to traction injury at the inferior pole of the Patella
- Contrast with Osgood Schlatter which is aphophysitis at the tibial tubercle
III. Epidemiology
- Ages 10 to 13 years old
IV. Symptoms
- Anterior Knee Pain
- Worse with jumping or direct pressure on the inferior Patellar pole
V. Signs
VI. Imaging
-
Knee XRay
- Rule-out Fracture, tumor, Patellar sleeve avulsion or ostemyelitis
- May demonstrate partial Patellar avulsion with overlying swelling
- Abnormal calcification at Ossification Center (at inferior Patellar pole)
-
Bedside Ultrasound
- Fragmentation of the inferior Patella (compared with opposite side)
VII. Differential Diagnosis
- Osgood-Schlatter (affects tibial tubercle)
VIII. Management
- Relative rest with activity modification
- Analgesics (NSAIDs, Acetaminophen)
- Ice Therapy
- Physical therapy
- Flexibility Exercises with hamstring, quadriceps, and heel cord stretches
- Patellar counterforce strap
- Refractory Cases
- Immobilization is rarely needed and only recommended in severe cases
- Orthopedic referral if persistent symptoms despite a mature skeleton
IX. Course
- Self-limited with resolution within 12-24 months and by skeletal maturity (when apophysis fuses)
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Related Studies
Concepts | Disease or Syndrome (T047) |
ICD10 | M92.4 |
SnomedCT | 34976002, 203386001, 203389008 |
English | Kohler's disease, Osteochondritis of the patella, Juvenile osteochondrosis of patella, Larsen-Johansson syndrome, larsen-johansson syndrome, kohler's disease, juvenile osteochondrosis of patella (diagnosis), Juvenile osteopathia patellae, Juvenile osteopathia patellae (disorder), Köhler; patella (osteochondrosis), Larsen-Johansson, juvenile; osteochondritis, patellar, osteochondritis; juvenile, patellar, osteochondrosis; Köhler, patella, osteochondrosis; Sinding-Larsen, osteochondrosis; patella (Köhler), patella; Köhler, patella; osteochondrosis (Köhler) |
German | Juvenile Osteochondrose der Patella |
Korean | 무릎뼈의 청소년성 골연골증 |
Spanish | osteopatía rotuliana juvenil, osteopatía rotuliana juvenil (trastorno), síndrome de Larsen - Johansson, osteopatía patelar juvenil |
Dutch | Köhler; patella (osteochondrose), juveniel; osteochondritis, patellair, osteochondritis; juveniel, patellair, osteochondrose; Köhler, patella, osteochondrose; Sinding-Larsen, osteochondrose; patella (Köhler), patella; Köhler, patella; osteochondrose (Köhler), Juveniele osteochondrose van patella |