Neuropathic osteonecrosis of the knee in childhood: Two cases of myelomeningocele

Two girls, aged 11 and 7 years, with myelomeningocele had osteonecrosis in the lateral tibial epiphysis and in the medial femoral condyle, respectively. Both girls suffered from sensory impairment of the affected area and presented with warmth and swelling of the knee. No signs of infection were found. The necroses seen in radiographs were confirmed by biopsy and 99mTc-MDP scintigraphy. The lesions showed only little tendency to heal, and rather severe growth disturbances developed despite treatment in long leg calipers. One of the girls was unable to walk because of the loss of muscular power during the long period of bracing.