• A 15-year-old boy presents to his pediatrician with left knee pain. He denies any trauma to the knee. He plays football for his high school team and attends practice regularly. On physical exam, the tibial tubercle is pronounced and there is tenderness to palpation over the affected area. The patient reports pain upon resisted knee extension.
  • Clinical definition
    • describes an apophysitis of the tibial tuberosity
  • Epidemiology
    • demographics
      • male:female ratio
        • more common in males
      • age bracket
        • 12-15 years of age in boys
        • 8-12 years of age in girls
    • risk factors
      • participating in sports
  • Pathogenesis
    • repetitive traction of the apophysis of the tibial tuberosity results in microtrauma and micro-avulsion
      • the proximal patellar tendon insertion separates from the tibial tubercle
        • during healing there is callous deposition that leads to a pronounced tubercle
  • Prognosis
    • self-limiting
    • responds well to conservative management
  • Symptoms
    • anterior knee pain
  • Physical exam
    • inspection
      • enlarged tibial tubercle
      • tenderness over tibial tubercle
    • provocative test
      • pain on resisted knee extension
  • Radiographs
    • recommended views
      • lateral radiograph of the knee
    • findings
      • irregularity and fragmentation of the tibial tubercle  
  • Diagnostic criteria
    • a clinical diagnosis
  • Sinding-Larsen-Johansson syndrome
    • chronic apophysitis or minor avulsion injury of the inferior patellar pole
  • Osteochondroma of the proximal tibia
  • Tibial tubercle fracture 
  • Patellar tendonitis
  • Conservative
    • analgesics, ice, and physical therapy
      • indication
        • first-line treatment for Osgood-Schlatter disease
  • Operative
    • ossicle resection and/or excision of the tibial tuberosity
      • indication
        • considered in patients who do not respond to conservative managament and after skeletal maturity
  • Tubial tubericle prominence persists
  • Genu recurvatum

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