Introduction Osteochondrosis or traction apophysitis of tibial tubercle Epidemiology demographics male:female ratio more common in boys age bracket boys 12-15y girls 8-12y location bilateral in 20-30% risk factors jumpers (basketball, volleyball) or sprinters Pathophysiology stress from extensor mechanism Prognosis self-limiting but does not resolve until growth has halted Anatomy Tibial tubercle is a secondary ossification center age <11y, tubercle is cartilaginous age 11-14y, apophysis forms age 14-18y, apophysis fuses with tibial epiphysis age >18y, epiphysis (and apophysis) is fused to rest of tibia Presentation Symptoms pain on anterior aspect of knee exacerbated by kneeling Physical exam inspection enlarged tibial tubercle tenderness over tibial tubercle provocative test pain on resisted knee extension Imaging Radiographs recommended views lateral radiograph of the knee findings irregularity and fragmentation of the tibial tubercle MRI indications not essential for diagnosis diagnosis can be made based on history, presence of tender swelling and radiographs alone findings soft tissue swelling thickening and edema of inferior patellar tendon fragmentation and irregularity of ossification center Differential Sinding-Larsen-Johansson syndrome chronic apophysitis or minor avulsion injury of inferior patella pole occurs in 10-14yr old children, especially children with cerebral palsy Osteochondroma of the proximal tibia Tibial tubercle fracture Jumpers knee Treatment Nonoperative NSAIDS, rest, ice, activity modification, strapping/sleeves to decrease tension on the apophysitis and quadriceps stretching indications first line of treatment outcomes 90% of patients have complete resolution cast immobilization x 6 weeks indications severe symptoms not responding to simple conservative management above Operative ossicle excision indications refractory cases (10% of patients) in skeletally mature patients with persistent symptoms Complications Complications of cast immobilization quadriceps wasting
QUESTIONS 1 of 2 1 2 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.21) A 13-year-old male patient presents with complaints of bilateral knee pain. He notes that the pain is increased with jumping, squatting or running up a flight of stairs. No other joints are affected. On physical exam, he has tenderness to palpation directly over his tibial tubercles. No effusion is noted. Radiographs are shown in Figures A and B. What is the most likely diagnosis? Review Topic QID: 4656 FIGURES: A B 1 Lyme disease 0% (8/5247) 2 Stress fractures of the tibial plateau 0% (13/5247) 3 Osgood-Schlatter disease 98% (5124/5247) 4 Patellar tendinopathy 1% (38/5247) 5 Sinding-Larsen-Johansson syndrome 1% (43/5247) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 3
Tibial tubercle pain in a 33M (C2720) Knee & Sports - Osgood Schlatter's Disease (Tibial Tubercle Apophysitis) HPI - A 33 year old male patient presents with a 4 year history of pain over the tibial tubercle of his right knee. The patient works in construction as a general laborer and states that his pain has become much worse over the past few weeks. What further imaging, if any, would you order on this patient? 10/31/2016 606 7 4