Bilateral double-layered patella in a patient with advanced knee osteoarthritis

Abstract

Double layered patella (DLP) is a rare anomaly of the patella that may go undiagnosed, especially in patients with progressive knee dysfunction and early degenerative changes. Clinical symptoms such as motion-dependent pain and anterior knee pain most typically occur in adolescents or young adults; however, gradually increasing pain and early generalised degenerative changes have also been seen in patients over 40 years old. Diagnosis of DLP could be difficult, especially in cases with coexisting arthrosis. DLP is considered to be pathognomonic for the diagnosis of multiple epiphyseal dysplasia and usually coexists with other anomalies seen in this syndrome, such as hip dysplasia. In extremely rare cases, DLP can occur as a solitary disorder. The prevalence of such cases, however, is unknown, and they could be easily misdiagnosed. Computed tomography and magnetic resonance imaging are the most sensitive radiological methods used in DLP diagnosis. This case report presents a case of a bilateral DLP incidentally found in a 47-year-old patient with advanced arthritis referred for arthroplasty because of increasing symptoms of knee joint failure with no other abnormalities recorded. An important goal of our case study is to raise the awareness of this abnormality with radiologists and orthopaedic surgeons.