Module 51, Pediatric 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

Placing the boy in a knee cylinder cast would have removed his symptoms faster and more completely.

Question 51B

The blood supply only enters the apophysis of the tibia from the medial side and this condition is probably an avascular necrosis of the apophysis.

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

Tendonitis is an important aspect in the symptoms of this condition.

Question 51E

Fragmentation of tibial tubercle may be seen as a normal variation in ossification and is not by it self diagnostic of Osgood Schlatter.