Summary
Definition
History and exam
Key diagnostic factors
- pain at the tibial tubercle
- localized tenderness
Other diagnostic factors
- activity limitation
- localized swelling
- localized warmth
- prominence of the tibial tubercle
- pain at the tubercle with resisted knee extension
Risk factors
- adolescent males
- athletic participation
- history OSD in the contralateral knee
- high position of the patella (patella alta)
- more proximal/broader tibial attachment of the patella tendon
- increased external tibial torsion
Diagnostic tests
1st tests to order
- plain radiographs
Tests to consider
- ultrasonography
- MRI
Treatment algorithm
early stage
progressive or late stage
persistence of pain into late adolescence or adulthood
Contributors
Authors
Alexander Golant, MD
Attending Physician
Department of Orthopaedics and Rehabilitation
New York-Presbyterian-Queens
Flushing
Assistant Professor of Clinical Orthopaedic Surgery
Weill Medical College of Cornell University
New York
NY
Disclosures
AG declares that he has no competing interests.
Jeffrey Rosen, MD
Chairman
Department of Orthopaedics and Rehabilitation
New York-Presbyterian-Queens
Flushing
Associate Professor of Clinical Orthopaedic Surgery
Weill Medical College of Cornell University
New York
NY
Disclosures
JR is an author of a reference cited in this topic.
Acknowledgements
Dr Jeffrey Rosen and Dr Alexander Golant would like to gratefully acknowledge the assistance of Jonathan Naysan. JN declares that he has no competing interests.
Peer reviewers
Paul M. Sethi, MD
Orthopedic Surgeon
Orthopedic and Neurosurgery Specialists PC
Greenwich
CT
Disclosures
PMS declares that he has no competing interests.
Andreas Roposch, MD, MSc, FRCS
Consultant Orthopaedic Surgeon
Reader in Clinical Epidemiology and Surgery
UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust
London
UK
Disclosures
AR declares that he has no competing interests.
Differentials
- Fracture of the tibial tubercle
- Fat pad hypertrophy/impingement (Hoffa disease)
- Inferior patellar pole traction apophysitis (Sinding-Larsen and Johansson syndrome)
More Differentials- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer