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Tibial tubercle apophysitis
64%
7/11
Patellar tendonitis
0%
0/11
Patellofemoral arthritis
Patellar stress fracture
9%
1/11
Tibial stress fracture
18%
2/11
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A young patient with a recent increase in activity involving jumping with anterior knee pain most likely has tibial tubercle apophysitis (AKA Osgood-Schlatter's disease or OSD). OSD is an overuse injury which typically presents in the setting of increased activity in young children. It presents with anterior knee pain that can be increased with palpation along the area of the insertion of the patellar tendon on the tibial tubercle. Due to overuse traction, the insertion site can become a secondary ossification center and lead to pain. Cassas et al. discuss overuse injuries in children and adolescents. During physical exam, it is common in OSD to palpate a growth on the tibial tubercle, which represents the secondary ossification center. Pain with knee extension is common. Patients in this setting are most commonly treated conservatively with rest, ice, and immobilization for 2 to 3 weeks. To relieve symptoms, an infrapatellar strap may also be useful. Hanada et al. discuss the relationship between the clinical findings and radiographic severity in Osgood-Schlatter disease. They stated that boys (12 years and 6 months) were significantly older than girls (12 years and 1 month) at onset. In addition, they state that longer duration of symptoms, older bone age on radiographs, older age, and higher bodyweight were associated with more severe OSD. Figure A shows fragmentation over the tibial tubercle, the attachment of the patellar tendon. This is indicative of Osgood-Schlatter's disease. Incorrect Answers: Answers 2, 4, and 5: Patellar tendonitis, patellar stress fractures, and tibial stress fractures can present in a similar fashion as the patient above with anterior knee pain in the setting of increased activity. The radiograph clearly shows tibial tubercle apophysitis, inflammation of the insertion site of the patellar tendon, making Osgood-Schlatter's disease a better answer. Radiographs in patellar tendonitis are often normal, with patellar and tibial stress fractures revealing lines of lucency and overlying healing response. Answer 3: Patellofemoral arthritis would be uncommon in a young child and typically presents in elderly patients or patients with a history of patellar malalignment. It would typically present on radiographs as reduced joint space, osteophytes, subchondral cysts, and sclerosis.
4.8
(5)
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