OrthoDx: Knee Pain Below Patella in Child

Slideshow

  • Figure 1. Anteroposterior view of left knee.

  • Figure 2. Lateral view of left knee.

An 11-year-old girl presents to the office with her parents for evaluation of left knee pain for 2 months. The pain is located at the front of the knee just past the patella on the lower leg. The child notes that the pain is made worse with running and jumping. She has tried ice and anti-inflammatory medications, which offered mild relief. On physical examination, the patient has knee effusion. She has tenderness to palpation over the tibial tubercle on the left knee. Anteroposterior and lateral radiographs are shown in Figures 1 and 2.

Osgood-Schlatter disease (OSD) is a common knee condition seen in active adolescents and results from traction apophysitis at the tibial tubercle. Symptoms start during a period of rapid skeletal growth while patients participate in athletic activities. The diagnosis is straightforward...

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Osgood-Schlatter disease (OSD) is a common knee condition seen in active adolescents and results from traction apophysitis at the tibial tubercle. Symptoms start during a period of rapid skeletal growth while patients participate in athletic activities. The diagnosis is straightforward with pain to palpation over the tibial tubercle and pain that is made worse with running and jumping activities. Radiographs are usually normal but may show irregularity and fragmentation of the tibial tubercle. Advanced imaging with magnetic resonance imaging (MRI) and/or computed tomography (CT) is not indicated to confirm the diagnosis.1,2

Treatment involves nonsteroidal anti-inflammatory drugs (NSAIDs), ice, activity modification, and quadriceps stretching. Patients may have to pause athletic activities for a short period if pain is significant; however, most patients can play through mild discomfort. Osgood-Schlatter disease can be a nagging type of condition that lasts up to 12 to 18 months but generally resolves when patients reach skeletal maturity. Maintaining quadriceps flexibility through sports activities is critical to managing symptoms.1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopaedics for Physician Assistants.

References

1. Bloom OJ, Mackler L, Barbee J. Clinical inquiries. What is the best treatment for Osgood-Schlatter disease? J Fam Pract. 2004;53(2):153-156.

2. Circi E, Atalay Y, Beyzadeoglu T. Treatment of Osgood-Schlatter disease: review of the literature. Musculoskelet Surg. 2017;101(3):195-200. doi:10.1007/s12306-017-0479-7

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