Transient Ischemia of the Distal Femur and Proximal Tibia in a 19-Year-Old Man

A 19-year-old man with neither trauma nor predisposing factors to nontraumatic osteonecrosis developed increasing pain in both knees. Radiographs of both knees and arthroscopy of the left knee were normal. Bone scintigraphy initially showed reduced activity distal to the epiphyseal line in both femora. Core biopsies from the distal part of the left femur six months after the onset of pain showed partial osteonecrosis with signs of revascularization. The patient was treated with partial weight-bearing and physiotherapy. Recovery followed after 26 months. We suggest that the symptoms were linked with the epiphyseal closure in the distal femur and proximal tibia.