Definition
Tibial tuberosity apophysitis
Inflammation of the patella tendon insertion onto the tibial tuberosity
Epidemiology
Early teens / adolescents
- male more than females
- associated with growth spurt
Increased incidence with sporting activity
Bezuglov et al Int Orthop 2020
- 280 teenage soccer players
- 10% Osgood-Schlatter
- bilateral 43%
- mean duration one month
Clinical
Activity related pain at insertion patella tendon
Tender lump over tibial tuberosity
X-ray
Bony fragmentation over tibial tubersity +/- loose ossicle
Ossicle over tibial tuberosity
Fusion of ossicle
CT scan
Loose ossicles over tibial tuberosity
Loose ossicles over tibial tuberosity
MRI
Inflammation around patella tendon insertion
Loose ossicle at patella tendon insertion
Non operative management
Natural history
Symptoms resolve with physeal closure
Gaulrapp et al Int Orthop 2022
- 99 adolescents with Osgood-Schlatter
- mean age 13
- mean duration of symptoms 6 months
- 3 years later 6% still symptomatic
Options
Prolotherapy / hyperosmolar dextrose
- systematic review of hyperosmolar dextrose v placebo
- no effect at 3 months
PRP
Guszczyn et al Med Sci Monit 2023
- 153 chronic Osgood-Schlatter treated with leucocyte rich PRP
- skeletally immature
- 72% return to full activity
- better results with shorter duration of symptoms
Operative management
Indication
Skeletally mature
Loose ossicle at insertion patella tendon
Options
Removal of loose ossicle +/- removal bony prominence
Open / arthroscopic
Open
Technique
Arthroscopic techniques open ossicle resection PDF
Midline incision
- longitudinal split in patella tendon
- remove loose pieces
- +/- repair patella tendon
Results
Pihlajamaki et al JBJS Am 2009
- open resection in 117 knees in the military
- 87% no restrictions in activity
Arthroscopic
Arthroscopic technique arthroscopic resection Osgood Schlatter ossicle PDF