Diagnostic Considerations in the Pediatric Knee & Pelligrini-Stieda Disease
HIDEInteractive Transcript
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Now in children, different things may be seen.
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If we look at the attachment sites here in the immature
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skeleton, we can see that the tibial collateral ligament
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attaches to the epiphysis of the femur,
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but to the metaphysis of the tibia.
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There are reported histologic differences between those two
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uh, attachments.
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But in any case, as you know, in the immature skeleton,
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physio injuries may be seen.
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And because of that, if you have a salt
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or injury involving the FSIS
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and the proximal tibia, you may get entrapment of portions
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of the tibial collateral ligament.
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And indeed, if you have a similar abnormality involving the
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fasis of the distal femur,
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it may be the periosteum rather than the ligament itself
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that may be become entrapped in the area of injury.
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And in fact, adjacent physio injury has been emphasized in
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the pediatric population in this particular population.
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Typically it's the central portion of the femoral fasis
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that first closes.
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If you have a valgus force applied, you may end up
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with a physio fracture on the medial aspect of the fsis.
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That may in some cases also involve the epiphysis.
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If it's just in this region we're dealing
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with assault or one injury.
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If it also extends down, it would be a salt or three injury.
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And you may see this, okay, rather than an injury
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to the medial collateral ligament.
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Here's an example showing you here,
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a Salter three injury with elevation
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and tearing of the femoral periosteal, uh, membrane.
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Okay? And a lot of soft tissue edema.
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One other lesion that can occur about the SSIS in the
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immature skeleton is known as FO focal peral edema.
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It's seen in other sites in the skeleton,
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but dominates about the knee
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and especially in the distal femoral ssis.
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And what it looks like is a column
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of cartilage growing away from the FSIS with adjacent edema
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and sometimes widening
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and even fluid present within the fsis.
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One of the things that may indicate is impending physio
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closure typically is treated conservatively,
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although there may be pain at the time you see this
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abnormality, but it is generally self limited.
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We're gonna finish up in the last five minutes,
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which a couple of other points with regard
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to pellegrin ADA disease.
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You recognize the name, I'm sure we're told to look
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for ification following an injury
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to the medial supporting structure in the chronic stage.
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And we're told in fact that when you see it,
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It's typically seen involving
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the femoral region at the attachment
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of the tibial collateral ligaments.
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So this would be pellegrini sated disease.
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But one of the things we found years ago when we looked at
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cases of radiographically evident so-called
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pellegrini theta disease, that the ossification sometimes
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was not in the medial collateral ligament,
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but above it in the adductor magnus tendon
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as shown in this particular example, I.
Donald Resnick, MD
Professor Emeritus, Department of Radiology
University of California, San Diego
Mini N. Pathria, MD, FRCP(C)
Division Chief, Musculoskeletal Imaging
University of California San Diego
Eric Y. Chang, MD
Adjunct Professor, Radiology
University of California, San Diego
Brady K. Huang, MD
Clinical Professor of Radiology
UC San Diego Medical Center
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