• A 12-year-old boy presents to his pediatrician with right knee pain. He began playing basketball for his school a few months ago. On physical exam, there is a pronounced, tender tibial tubercle and tenderness to palpation over the affected area. The patient reports pain upon resisted knee extension.
  • Clinical definition
    • describes traction 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
  • Tubial tubericle prominence persists
  • Genu recurvatum

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