Vitamin D in Treatment of Cutaneous Tuberculosis
Authors: G. B. Dowling, S. Gauvain, D. E. Macrae
Journal: BMJ (1948)

CHONDROMALACIA PATELLAE BITIUSHAt operation an extensive lesion of the articular cartilage of the patella was disclosed.The whole of the articular surface, except a narrow strip along the lower border, was oedematous and covered with fine superficial fissures.The oedema was most pronounced over the medial facet.On the ridge between the middle and lateral facets a deep fissure had undercut a flap of cartilage about 1 cm.square.This flap was pedunculated, being attached by its outer margin.Underneath it the bone was exposed.The synovial membrane around the patella was congested.There was a " mirror" lesion in the intercondylar surface of the femur, with softening of the cartilage and fine vertical fissuring.The patella was excised.The patient made a complete recovery.Case 6.-A woman aged 20 had pain in her right knee-joint for six months.The pain was "under the knee-cap."The joint swelled at times.There was retropatellar crepitus, and rubbing the patella against the femur caused pain.X-ray films showed no abnormality.Prolonged physiotherapy had given no relief.The patella was removed.There was extensive shallow ulceration of the articular cartilage on the external facet, with fine vertical striations caused by superficial fissures.On the ridge between the facets there was a deep cleft in the cartilage, from which some rod-like pieces of degenerate car- tilage projected above the level of the articular surface (Fig. 6).After operation the quadriceps muscle recovered only slowly.It was six months before she had regained the full power of extension.One year later the knee-joint was painless and entirely satisfactory.Case 7.-A woman aged 22 had for 15 months had pain under the left knee-cap.especially on going up or down stairs and on getting up after sitting for some hours-e.g., in the cinema.The knee swelled occasionally.Passive movements of the patella across the femur caused pain and elicited a fine crepitus.X-ray films were negative.At operation fairly ad- vanced changes were found in the articular cartilage of the patella.There was oedema of both facets, with many super- ficial fissures in the articular cartilage.On the lower part of the internal facet a small ulcer extended through the whole thickness of the cartilage, exposing the subchondral bone.On the central ridge there were several small rounded excrescences caused by localized proliferation of the cartilage (Fig. 3).The patella was removed.After operation she had great difficulty in regaining control over her quadriceps.For several weeks the muscle appeared to be completely inhibited.It gradually recovered, but the knee became very stiff and was eventually mobilized by repeated manipulations.One year after operation she had a full range of movement, normal power of extension, and no pain.Case 8.-A woman aged 31 complained of persistent pain on the inner side of the knee and under the knee-cap after an operation for removal of the internal semilunar cartilage, which was said to have been badly torn.There was retropatellar crepitus and pain on passive movements of the patella.An exploratory operation was performed.The internal semilunar cartilage was absent-no regeneration had occurred.The patella showed an early stage of degeneration of the articular cartilage.Over most of the articular surface there was a slight oedema associated with a change in the colour from the normal bluish sheen to a lacklustre yellowish white.Superficial fissures produced fine vertical striations.In places very superficial erosion had occurred, and here the texture of the surface was like that of velvet.The patella was removed.This is a recent case.The patient is making a satisfactory recovery.Case 9.-A boy aged 11 injured his right knee.The patellar ligament was avulsed from the patella, pulling off a small flake of bone from the lower pole.At operation for repair of this injury an early chondromalacia of the articular cartilage of the patella was observed, with oedema, change of colour, and vertical striations.The patella was left in situ as there was no evidence that it had previously caused any disability.He will be kept under observation. SummaryDegenerative changes in the articular cartilage of the patella often occur and are a common cause of derangement of the knee-joint in young persons.The patellar lesion is a degeneration of articular cartilage in a circumscribed area, where oedema, fibrillation, and ulceration occur.The condition may be latent or may cause pain, effusion, de- rangement of motion, and crepitus.The differential diagnosis from lesions of the semilunar cartilages may be difficult.X-ray changes are absent or very slight.Excision of the patella may be necessary.A small number of cases are described.I am greatly indebted to Dr.