Approach

The main goals are to eliminate or decrease repetitive tensile loading of the patellar tendon insertion in the tibial tubercle apophysis to prevent further damage, and alleviate existing injury with non-steroidal anti-inflammatory drugs (NSAIDs) and therapeutic modalities.

Furthermore, a long-term goal is to improve strength and flexibility of the lower extremity, so as to allow participation in sport and recreational activities.

Early stage

Typically, >90% of patients with OSD treated with rest, ice, NSAIDs, and physiotherapy respond with excellent outcome and full return to activities.[14][15]

For patients with prolonged or severe pain, knee immobilisation and bracing may be necessary. Evidence from randomised controlled trials is lacking.[16]

Progressive or late stage

Review of literature indicates that up to 10% to 12% of patients with OSD may have prolonged symptoms despite conservative management, and some may go on to require surgical treatment. Surgery should not be performed until after the patient reaches skeletal maturity.[1]

Non-surgical modalities for symptom reduction in recalcitrant cases of OSD include local injections with lidocaine or hyperosmolar dextrose. These injections are temporising measures that are not routinely performed.[17]

Surgical, equal first-line options include:

  • Partial resection of the tibial tubercle[18][19][20]

  • Excision of the separated ossicle[21][22]

  • Drilling of the tibial tubercle.[23]

Long-term complications

Bony overgrowth of the tibial tubercle or persistence of a bony ossicle into adulthood may be a purely cosmetic problem or may cause pain and functional limitations. The bony prominence at the tibial tubercle results from the small ossicle that forms from the fragmentation of the apophysis. This ossicle may impinge on the patellar tendon, causing pain and limiting activity.[4] This can be addressed surgically with excision of the ossicle and/or osteoplasty of the tibial tubercle, with excellent long-term outcomes.[24]

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