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[The hyperostotic knee].

C Orzincolo1, P N Scutellari, N Aiello

  • 1Servizio di Radiologia, Arcispedale S. Anna, Ferrara.

La Radiologia Medica
|October 1, 1987
PubMed
Summary
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Diffuse idiopathic skeletal hyperostosis (DISH) commonly affects the patella, showing characteristic bone proliferation. These extraspinal findings, particularly at the patella, are crucial for diagnosing DISH.

Area of Science:

  • Rheumatology
  • Orthopedics
  • Radiology

Background:

  • Diffuse idiopathic skeletal hyperostosis (DISH) involves spinal and extraspinal bone proliferation.
  • Extraspinal manifestations can precede spinal involvement and are key diagnostic indicators.
  • The patella is a frequently affected extraspinal site in DISH.

Purpose of the Study:

  • To systematically evaluate the radiographic and xerographic patterns of knee involvement in patients with DISH.
  • To identify characteristic extraspinal manifestations of DISH in the knee.
  • To differentiate DISH knee findings from osteoarthritis.

Main Methods:

  • Radiographic and xerographic studies of 48 patients diagnosed with DISH using Resnick's criteria.
  • Systematic analysis of knee joint alterations, focusing on the patella and surrounding structures.

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  • Comparison of radiographic findings with osteoarthritis patterns.

    • Main Results:

    • Common radiographic patterns include patellar anterior margin thickening (81.1%) and supero-anterior ossifying enthesopathy (68.7%).
    • Periosteal new bone at cruciate ligament insertions (47.8%) and presence of fabella (41%) and megafabella (22.9%) were also noted.
    • DISH knee changes are typically symmetrical, with entheseal abnormalities on the antero-superior patella, unlike osteoarthritis's postero-superior osteophytes.

    Conclusions:

    • Extraspinal knee manifestations, especially patellar alterations, are highly characteristic of DISH.
    • Radiographic findings in DISH knees can be differentiated from osteoarthritis, particularly regarding enthesophyte location.
    • These extraspinal findings should be considered in the diagnostic criteria for DISH.