Pathology/History

  • Osteochondrosis

  • Occurs at the growth plate of Tibial tubersoity

  • Girls 10-12yo

  • Boys 13-15yo

  • 30% present with bilateral symptoms

  • Excessive traction on the soft apophysis of tibial tuberosity by powerful patellar tendon

  • may cause softening and partial avulsion of the developing secondary ossification centre

  • high levels of activity during period of rapid growth

  • associated with changes in the tendon

Examination

  • tenderness over tibial tuberosity

  • Tightness of surrounding muscles - esp. quadriceps

Investigations

  • Clinical diagnosis

  • radiographs not necessary

  • may be indicated to exclude tumour

  • osteogenic sarcoma

  • 10-30yo

Treatment

  • Reassurance

  • Self limiting but may persist up to two years

  • Return to play - depends on symptoms

  • modification of program

  • cease

  • amount of sport doesn't seem to affect time condition takes to heal

  • Symptomatic

  • Ice

  • Local electrotherapy trialled but should be ceased if no noticable improvement within 2-3 treatments

  • Stretching of quadriceps

  • soft tissue therapy to quadricps

  • Correct any predisposing biomechanical abnormality

  • excessive subtalar pronation

  • Refer to ortho if symptoms persist in a mature skeleton:

  • may be an ossicle/avulsion

References

  • Brukner and Khan, Climical sports medicine 3E, McGraw-Hill Professional

  • BMJ 2011; 343:d4534

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