JEFFREY GUTTMAN, M.D., Resident, Orthopaedic Surgery

WILLIAM MACKENZIE,M.D., Attending, Pediatric Orthopaedic Surgery

April 23, 1996






Patient is a 12 year old black male who initially presented with a history of left knee pain for 4 months. He denied any obvious history of trauma, but he claimed to play a lot of basketball and felt that the pain was worse after playing. Patient also claimed to have a "knot" over the anterior aspect of his proximal tibia. On physical examination the patient had a prominent tibial tubercle which was swollen and tender. The knee did not have an effusion, and there was no joint line tenderness. There was also no tenderness over the patellar tendon. There was full range of motion in the knee, but the patient had hamstring tightness. He also had pain with resisted knee extension. There was no instability to varus or valgus stress. McMurray test was negative. Lachman test was negative. Patellar tracking was normal, and there was no pain with loading of the patellofemoral joint. Xray of the left knee revealed an ossicle anterior to the tibial tuberosity. Patient was diagnosed with Osgood-Schlatter disease and told to refrain from playing ball for 4 weeks. He was also given a prescription for Motrin. The patient continued to play and returned complaining of increased pain and tenderness at the tibial tuberosity. The patient was then placed in a knee immobilizer for 4 weeks to be removed for stretching exercises. At his most recent follow-up, the patient's pain is resolved , although he continues to have pain with kneeling on the knee or contact on the tuberosity.




-excellent blood supply

-don't see stages of sclerosis, collapse, remodeling like Perthes

Signs and Symptoms


Fragmentation of tibial tubercle may be normal variation in ossification

Distended infrapatellar bursa.

Hypoechoic area of soft tissue swelling anterior to tubercle

Single or multiple fragments

Differential Diagnosis

Treatment: Overview

-most with no limitation of activity

-many unable to kneel without pain

-if fragmentation on XRay, much more likely to have chronic symptoms

Conservative Treatment

-excellent relief of symptoms

-atrophy of muscles prolongs return to sports

-does not alter course of disease

Surgical Treatment



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