(anterior tibial osteochondrosis)

Acquired disease of the knee resulting from repetitive strain injuries exerted on the growth cartilage of the anterior tibial tuberosity via the patellar ligament. It is a cause of knee pain in older children and athletic teenagers (especially boys). It affects nearly 20 % of young athletes, and 5 to 10 % of not sporting children, and is bilateral in a third of cases.

The pain sits on the anterior side of the knee, at the level of the anterior tibial tuberosity. On palpation, it is swollen, sensitive or even painful. The knee itself, as well as the patella, are painless.

An X-ray  may be useful to rule out another involvement if the pain is unilateral, atypical or rebellious to treatment. Initially there is an uplift of the anterior tibial tuberosity with enlargement of its growth cartilage; in the more advanced stages, the anterior tibial tuberosity appears fragmented and calcifications can sometimes be seen in the patellar ligament.

The disease is benign and usually progresses without sequelae in a few months after the cessation of sports activity in more than 90 % of cases. Complications are possible such as pseudarthrosis or migration of a fragment of tuberosity. Sequelae may persist until adulthood: pain due to intratendinous calcifications, or swelling of the anterior tibial tuberosity.

When sports rest is not sufficient, immobilization by orthosis or cruro-malleolar resin may be required in order to limit the efforts of the patellar tendon and quickly relieve pain. Tearing off and displacement of the tibial tuberosity can sometimes require surgical fixation.

Anesthetic implications:

chronic pain of the knee

References:

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Updated: December 2021