A 15-year-old male with knee pain
Patient will present as → a 14-year-old boy with left knee pain. He denies any trauma to the knee. The patient runs cross country 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
Classically present with tenderness over the tibial tubercle in a 9-14-year-old male who has undergone a rapid growth spurt and doing sports that involve running.
- 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.
- Pain and swelling over the tibial tubercle at the point of insertion of the patellar tendon.
- Pain on resisted knee extension with lump below the knee and prominent tibial tuberosity.
Osgood-Schlatter disease is a clinical diagnosis based on history; additional signs and symptoms include anterior knee pain that increases over time, an enlarged tibial tubercle, and localized edema
- Diagnostic imaging with a lateral radiograph of the knee
- For atypical presentation (pain not related to activity, fever, rash, etc.) to exclude other conditions (e.g. osteomyelitis)
- Irregularity and fragmentation of the tibial tubercle
Benign and self-limiting
- Conservative analgesics, ice, and physical therapy - first-line treatment for Osgood-Schlatter disease
- Operative - ossicle resection and/or excision of the tibial tuberosity - considered in patients who do not respond to conservative management and after skeletal maturity
Chondromalacia patellae can only be diagnosed under an arthroscopic examination, not on the basis of clinical features.
Legg–Calvé–Perthes disease is avascular necrosis of the proximal femur and usually presents between 4 and 8 years of age.
Subluxation of the patella or dislocation is more common in adolescent girls and the patient presents with acute knee pain. The knee is in flexion with a mass lateral to the knee and with absence of the bony prominence of the patella (flat).