Also known as tibial tubercle epiphysitis or Osgood-Schlatter disease, it is a juvenile disorder characterized by enlargement and pain in the tibial tubercle of affected children.

bubble_chart Etiology

The quadriceps is the most powerful muscle in the human body, but its attachment point—the tibial tuberosity—is very small. This area is frequently subjected to strong tension, leading to: ① avulsion fracture of the tibial tuberosity; ② quadriceps tendinitis, often accompanied by new bone formation. This may be the cause of the condition.

bubble_chart Clinical Manifestations

It commonly occurs in boys aged 11 to 15. Pain is present at the tibial tuberosity, with grade I swelling and tenderness that worsens after exertion. Some children have a history of intense exercise or trauma before onset. The pain intensifies during knee extension due to the affected epiphysis being tightened by the contracted quadriceps muscle; it also hurts during passive knee flexion because the quadriceps muscle pulls on the epiphysis.

bubble_chart Auxiliary Examination

X-ray findings: A lateral view of the knee joint, especially with slight internal rotation, is most helpful for diagnosis because the tibial tubercle is located slightly lateral to the middle of the tibia. In the initial stage, local soft tissue swelling, thickening of the patellar tendon, and disappearance of the inferior angle of the infrapatellar fat pad can be observed. Later, one or several small free bone fragments may be seen anterior to the tibial tubercle. In the late stage, the newly formed bone fragments become more prominent, and bone hyperplasia is evident in the adjacent tibial tubercle.

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Most patients only need to reduce activity for 2 to 3 weeks. For those with severe symptoms, a straight-leg gypsum splint should be used for immobilization for 4 to 6 weeks, followed by physical therapy to restore knee joint flexion and extension. However, a return to strenuous knee joint activity should be delayed for at least 4 months. Alternatively, local injections of hydrocortisone acetate can be administered, though some oppose this method due to the risk of causing atrophy of surrounding soft tissues or even spontaneous rupture of the patellar tendon.

If pain and knee dysfunction recur frequently, especially in older patients, surgical treatment should be considered. The patellar tendon can be split, and a thin osteotome can be used to flip open the cortical bone on both sides of the tibial tuberosity along the midline. A sharp curette is then used to thoroughly scrape away debris. The cortical bone is then sutured back in place, which can alleviate pain and reduce the overly prominent tibial tuberosity to its normal shape.

bubble_chart Complications

This disease may have two advanced-stage complications: ① Due to the upward avulsion of the tibial tubercle epiphysis and the upward displacement of the quadriceps insertion, the irregular surface of the patella contacts the distal femur, making osteoarthritis prone to occur. Bilateral lateral X-rays can be taken during quadriceps contraction to observe whether the patellar positions are consistent. If displacement is present, surgical correction is advisable. ② The abnormal epiphysis of the tibial tubercle may fuse early with the upper tibial epiphysis, leading to genu recurvatum.