PANCE Blueprint Musculoskeletal (8%)

Osgood–Schlatter disease is caused by microfractures of the patellar ligament where it inserts into the tibial tubercle. This condition usually occurs in the preteen and adolescent years, and is more common in males than females. The history of injury can be vague and the patient may not remember a specific injury that precipitated the pain. Often, the pain progresses to the point of interference of even routine physical activities. X-rays may or may not show any abnormalities. Upon x-ray, type I disease appears normal, but type II will reveal fragmentation of the tibial tubercle. Often, after healing there will be enlargement of the tibial tubercle. Generally, treatment consists of rest, limitation of activities, and isometric exercises. Chondromalacia patellae can only be diagnosed under an arthroscopic examination, not on the basis of clinical features. Patellofemoral overuse syndrome presents with medial knee pain and subpatellar pain. Additional signs are swelling and crepitus in the knee and it is more common in females than males. It is diagnosed by increased Q-angles (anterosuperior iliac spine through center of patella to tibial tubercle). 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). X-ray confirms the dislocation. Legg–Calvé–Perthes disease is avascular necrosis of the proximal femur and usually presents between 4 and 8 years of age.