Post-traumatic Para-articular Ossification of the Knee Joint (“Köhler-Pellegrini-Stieda Shadow”)

THE knee joint, because of its anatomical position, is often exposed to varying forms of trauma. In the event of injury the first thought is of a bone lesion, and, because of possible fracture, the patient is sent to the radiographic department. If the report is in the negative, the condition is regarded as a simple contusion, its cure to be effected in a short time with proper treatment or even spontaneously. When the healing is prolonged and the patient continues to complain, other hypotheses may attribute these pains to alterations in the nervous system and even give rise to the suspicion that the patient is malingering. However, repeated radiographic examinations can, in many of these cases, settle the question. In this paper we wish to consider the structures located at the internal condyle of the femur, described under the names of “Stieda shadow-fracture,” “Stieda-Pellegrini fracture disease,” “Köhler-Pellegrini-Stieda disease,” etc. However, all these terms are inexact and do not correspond with the nature of the changes or the priority of the discovery, and we agree with Petrignani that it is superfluous to designate by a proper name any of the bone lesions of the type under discussion. But even if we wished to follow the custom, it would be more correct to call these “Köhler-Pellegrini-Stieda concomitant shadows” or, as Petrignani prefers, “Köhler-Pellegrini-Stieda syndrome.” In 1905, Köhler, while studying a film, noted for the first time an unusual shadow of the coxofemoral articulation and of the femur, which he regarded as due to an ossification of the connective tissue about the joint. At the same time Pellegrini described the clinical picture, radiology, and histology of a case of post-traumatic ossification in the region of the internal condyle of the femur. These papers did not arouse any special interest and it was not until two years later, in 1907, that Stieda, at the Third Radiological Congress, called the attention of physicians to this structure. Papers on the important work of Petrignani, Bistolfi, and Fredet, dealing with the question of the concomitant shadow of the knee joint, have appeared during the last three or four years in France and Italy. This question has lost none of its importance even to-day, and a series of publications, with histories of cases, is sufficient proof of that. After an interval of seven years there will be found the works of Michelson, Andreesen, Temler, and Berner in the German literature. Only the editorial (18) which appeared in the “American Journal of Roentgenology and Radium Therapy,” in 1932, and the work of Kulowski (7), in 1933, have been found in the American literature. It would seem that this subject has been sufficiently studied and that it is useless to discuss it further.