Module 51, General Orthopaedist Level
This patient is a 12 year old male who initially presented with a history
of left knee pain for 4 months. He denied any obvious history of trauma.
He claimed to play a lot of basketball and felt that the pain was worse
after playing. The 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 warm, 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. X-ray 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.
Question 51A
The
next stage in the work up should be to order an MRI scan to rule out intra-articular
pathology.
Question 51B
The ossicle seen on the x-ray should now be scheduled for excision.
Question 51C
The
diagnosis may not be Osgood-Sclatter disease because there are no symptoms
in the other knee and this condition is usually bilateral.
Question 51D
This
is a condition seen exclusively in boys.
Question 51E
The
apophysis of tibial tuberosity develops from one proximal ossification
center which gradually expands distally until it fuses at the end of growth.
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