- Discussion:
- type of juvenile traction osteochondritis;
- refers to partial avulsion of the tibial tuberosity (anterior surface of
apophysis) which has no involvement
of tibial physis;
- usually occurs in late childhood or early adolescence;
- more common in boys;
- may represent an over use disease;
- condition occurs at a time when increasing demands are made on a still
immature skeleton;
- repetitive stress on tuberosity may cause partial avulsion;
- a painful non union will develop, if intervening gap fills with fibrous
tissue rather than bone;
-
anatomy:
- in fetus, tibial tuberosity develops from anterior aspect of
proximal epiphysis;
- it subsequently develops its own growth plate and during childhood,
it develops its own center
of
ossification;
- this ossification center expands proximally and by age 17, it
blends with ossification center of the
tibial
epiphysis;
-
diff dx:
-
avulsion of tibial tubercle:
- Osgood-Schlatter disease may be a risk factor for complete
avulsion of the tibial tubercle;
-
jumper's knee;
-
Sindig-Larsen-Johanssen disease;
- Clinical Manifestions:
- local swelling and tenderness;
- pain is aggravated by direct prssure of tibial prominence & jumping;
- Radiographic Findings;
- radiographs will not be helpful if injury occurs during preossification
phase;
- once the ossification center develops, radiographs will reveal radiodense
fragments separated from
tibial tuberosity;
- fragmented appearance on radiography is due to partial separation of
chondro-osseous fragments
- in older teenagers, x-rays may show an ossicle in the substance of the
tendon adjacent to the tubercle;
- Non Operative Treatment:
- avoidance of strenuous exercise and jumping sports;
- some pts may require bracing or a sleeve cast;
- expect complete resolution w/ in 1-2 yrs in most patients;
- Surgical Treatment: rarely necessary;