Dear Dr,
I am searching for medical help for my 35 year old duaghter, Karena. She has had knee pain for about 2 years and it has now reached a level that is unbearable. We have not been able to find a local Dr who can help her. The X-rays and MRI report is as follows:
FINDINGS: Abnormal signal is preserved within both femoral Condyles extending down to the cortical margin which is nonspecific. Findings may represent avascular necrosis. There is similar abnormal signal present within the superior aspect of the patella. Other considerations would be osteochondritis desiccans. The medial and lateral collateral ligaments appear intact. The menisci appear normal. The anterior and positive cruciate ligaments appear normal. The extensor mechanism is intact. The medial and lateral collateral ligaments appear intact.
IMPRESSION:
1. Multifocal areas of abnormal mixed signal within the medial and lateral femoral condyles as well as the patella. Within the femoral Condyles, both areas demonstrate extension to the articular surfaces particularly laterally. Findings may be due to Osteonecrosis or Avascular necrosis. Other considerations would include underlying osteochondritis desiccans.
2. No joint effusion observed.
Karena was prescribed prednisone 15 years ago. Her platelet count was extremely low and she took high doses of this steroid, which did not work. She ultimately had to have her spleen removed, which solved that problem.
The two orthopedic surgeons that she has seen believe that the steroid use is the reason for the AVN. Both have said that they can not help her, due to the cause being “secondary”.
What should I do now?