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Condition/Disorder Synonym

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  • Apophysitis of the tibia tubercle

  • Lannelongue disease

  • Osgood-Schlatter syndrome (OSS)

  • Osteochondritis of the tibia tubercle

  • Juvenile osteochondrosis of the tibia tubercle

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ICD-9-CM Code

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  • 732.4 Juvenile osteochondrosis of the lower extremity, excluding the foot

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ICD-10-CM Codes

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  • M92.4 Juvenile osteochondritis of the patella

  • M92.5 Juvenile osteochondrosis of the tibia and fibula

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Preferred Practice Pattern

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  • 4E: Impaired joint mobility, motor function, muscle performance, and range of motion (ROM) associated with localized inflammation1

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Key Features

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Description

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  • Disease described by Robert Bayley Osgood and Carl Schlatter in 1903.

  • Repetitive traction at the growth plate at the quadriceps insertion can cause inflammation and microfracturing.

  • Short-term disorder associated with overuse and growth spurt with increased femur length and inability of quadriceps to lengthen as fast2

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Essentials of Diagnosis

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  • Insidious gradual onset aggravated by quadriceps tightness and tibial tuberosity immaturity3,4

  • Intermittent pain and swelling increased with activity or compression on the tibial tuberosity (kneeling)

  • Osteochondrosis of the proximal tibia, the diagnosis is Blount disease.

  • Possibility of migration of the ossicle and fragmentation5

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General Considerations

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  • Three types of tibial tuberosity avulsion fractures

    • - Type 1: Small fragment displaced proximally, no surgery required

    • - Type 11: Articular surface remains intact, fracture at the secondary center of ossification and proximal tibia epiphysis

    • - Type III: Total break through articular surface

  • Bilateral symptoms in 20% to 30%6

  • Quadriceps tightness increases along with a decrease in hamstring tightness

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Demographics

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  • Adolescent

  • More common in boys than girls7

  • Symptoms usually disappear when the adolescent growth spurt completes, usually around ages 9 to 16, about 14 in girls and 16 in boys8

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Clinical Findings

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Signs and Symptoms

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  • Pain increasing with severity

  • Swelling at the tibia tubercle

  • Enlargement of the tibia tubercle

  • Anterior knee pain

  • Tenderness at the tibia tubercle

  • Tight quadriceps muscles

  • Anterior knee pain with deep squatting, descending stairs, prolonged sitting9

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Functional Implications

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  • Decreased sitting tolerance

  • Difficulty descending stairs

  • Decreased ability to squat

  • Decreased participation in running or jumping

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Possible Contributing Causes

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  • Intrinsic risk factors are maturity of the tibial tuberosity, rapid growth of the femur, quadriceps flexibility.

  • Complaints of anterior knee pain following sports involve jumping and running (ie, football, soccer, basketball, running) and kneeling.

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Differential Diagnosis

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  • Sinding-Larsen-Johansson syndrome (traction pull on the distal patella)10

  • Patella tendonitis

  • Meniscal injury

  • Patellofemoral syndrome, arthritis, subluxation, or instability11

  • Plica syndrome11

  • Anterior knee pain11

    • - Patellar subluxation or dislocation

    • - Jumper knee (patellar tendonitis)

    • - Posterior cruciate ligament (PCL) injury

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