Managing Recurrence in Intraarticular Melorheostosis Involving the Knee Joint: A Case Report

Melorheostosis is a rare benign sclerosing dysplasia affecting bone, which causes significant morbidity in the form of pain and restriction of joint movement. Treatment options are varied, and recurrence is common after surgical treatment. Choosing the most appropriate treatment option in the management of a recurrent case is challenging, with very little supporting evidence in literature owing to the rarity of the disease. We hereby present a case of recurrent melorheostosis involving the knee; discuss treatment options and the rationale of our treatment.

We present the case of a 42-year-old female who was operated at our institution previously 7 years ago for melorheostosis of her left knee and had undergone excision of intrarticular hyperostotic masses. However, pain and limitation of motion recurred in the operated knee 4 years later, and radiographs and computed tomography revealed a mineralized mass situated behind the patella in the patellofemoral joint. She was treated with repeat open excision of the mass and put on a regimen of physiotherapy and bisphosphonates.

Open excision of symptomatic hyperostotic or mineralized soft tissue masses is perhaps the favored treatment option in such cases, the other options being arthroscopic excision and total knee arthroplasty. Limited knee motion and size of the mass often make arthroscopy an unfeasible option. Total knee arthroplasty should be reserved for cases with significant flexion contractures of the knee, or where multiple excisions have failed.