Page 86 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

Chapter 5
Abstract
Introduction
Clinical features and risk factors of Slipped Capital Femoral Epiphysis (SCFE) are commonly discussed in literature, however histopathology of this disorder remains obscure. We conducted an observational study to compare histology of the physes in SCFE with normal physes to see if there was a relationship between SCFE and hormonal imbalance during puberty.
Methods
18 patients with SCFE (20 physes) and 9 controls (11 physes) were biopsied and studied histomorphologically and with immunohistochemistry, using S100 expression to highlight physes in the biopsies.
Results
The main histomorphological feature was an architectural disorder of chondrocytes in the physes of patients with SCFE. Within SCFE physes, hypertrophic chondrocytes maintained their S100 staining pattern, to comparison to these chondrocytes in control physes. Vascular proliferation was seen in only a small number of cases, suggesting that either pre- or post slippage an inflammatory response occurred. Caspase- and expression of eight hormonal receptors in chondrocytes of SCFE physes was similar to chondrocytes controls, making a role for either altered apoptosis or hormonal signalling, less likely.
Conclusion
SCFE generally shows perturbed architecture of regular aligned chondrocytes in the physis, but the phenotype of hypertrophic chondrocytes remains normal. These findings support a biomechanical cause for slippage in the hypertrophic zone. Transient hormonal imbalance, pre-slippage due to puberty, without effects on expression of receptors could not be detected but could still play a role.
Level of evidence
Observational study.
Keywords SCFE, biopsy, histomorphology, immunohistochemistry, physis, chondrocyte, cartilage
84