ADOLESCENCE TIBIAL TUBERCLE AVULSION FRACTURE: OPTION OF SURGICAL TREATMENT IN WORSENING CONDITION OF PRE-EXISTING OSGOOD-SCHLATTER DISEASE (OSD)
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Background: Osgood-Schlatter disease (OSD) is the most frequent cause of chronic knee pain in adolescents. Tibial tubercle avulsion fractures are an infrequent injury, approximately between 0.4-2.7% of all epiphyseal injury. Even though the relation between OSD and tibial tubercle avulsion fracture is still controversial, there are cases previously reported with this presentation.
Case Report: A 16-years-old boy complained of pain on his left knee, significantly below the patella with ambulation limitation. He had a two-months history of knee pain in the same location and prominence on the area below the patella that was getting more significant over time. The patient was actively involved in volleyball in his school. The radiographic findings show fragmented tubercle fractures on the left tibial, soft tissue swelling in the tubercle's anterior side, and increased density of the infrapatellar fat pad. The patient underwent ORIF with screws. After a one-month post-surgery, the patient felt minimal pain when bending his left knee.
Discussion: Male adolescents (12-15 years) and repetitive sprinting and jumping sports are the risk factors for OSD. About 90% of cases show a complete resolution, but some conditions make the OSD worse, such as low compliance at exercise avoidance. Surgery is rarely indicated for OSD, but in the condition of, even though very uncommon, tibial tubercle avulsion fracture, surgery gives a better outcome and resolution.
Conclusion: All Osgood-Schlatter disease' patients should temporarily restrict sports activities to prevent tibial tubercle avulsion fractures.
Nakase J, Goshima K, Numata H, Oshima T, Takata Y, Tsuchiya H. Precise risk factors for Osgood–Schlatter disease. Arch Orthop Trauma Surg. 2015; 135(9): 1277-81.
El-Husseini, Timour F., Amr Atef Abdelgawad. Results of surgical treatment of unresolved Osgood-Schlatter disease in adults. J Knee Surg. 2010; 103-8.
Schlatter C. Verletzungen des Schnabel-formigen Fortsatzes der aberen Tibiaepiphyse. Bruns Beitr Klin Chir. 1903; 38: 874.
Uwaezuoke SN, Iloanus NI, Okafor HU. Osgood-Schlatter's disease in a Nigerian male adolescent: A case report and literature review. Curr Pediatr Res. 2014; 18(1): 18-20.
Yanagisawa S, Osawa T, Saito K, Kobayashi T, Tajika T, Yamamoto A, Takagishi K. Assessment of Osgood-Schlatter Disease and the Skeletal Maturation of the Distal Attachment of the Patellar Tendon in Preadolescent Males. Orthop J Sports Med. 2014; 2(7) 2325967114542084.
Circi E, Atalay Y, Beyzadeoglu T. Treatment of Osgood–Schlatter disease: review of the literature. Musculoskelet Surg. 2017; 101(3): 195-200.
Samim M, Smitaman E, Lawrence D, Moukaddam H. MRI of anterior knee pain. Skelet radiol. 2014; 43(7): 875-93.
Seyfettinoğlu F, Köse í–, Oğur HU, Tuhanioğlu íœ, í‡içek H, Acar B. Is There a Relationship between Patellofemoral Alignment and Osgood–Schlatter Disease ? A Case-Control Study. J Knee Surg. 2018; 1(212): 1–6.
Dalla Rosa Nogales J, Nogales Zafra JJ. Bilateral Simultaneous Tibial Tubercle Avulsion in an Adolescent Football Player with Previous Bilateral Osgood–Schlatter Disease. Case Rep Orthop. 2019; 2019.
Tulic G, Sopta J, Bumbasirevic M, Todorovic A, Vucetic C. Simultaneous bilateral avulsion fracture of the tibial tubercle in adolescent: a case report. J Pediatr Orthop B. 2010; 19(1): 118-21.
Mosier SM, Stanitski CL. Acute tibial tubercle avulsion fractures. J Pediatr Orthop. 2004 Mar 1; 24(2): 181-4.
Nicolini AP, Carvalho RT, Ferretti M, Cohen M. Simultaneous bilateral tibial tubercle avulsion fracture in a male teenager: case report and literature review. J Pediatr Orthop B. 2018 Jan 1; 27(1): 40-6.
Newman C, Musiienko D, Law S. Surgical fixation of bilateral simultaneous avulsion fractures of the proximal tibia in a 12-year-old with history of conservatively managed unilateral tibial avulsion fracture. Case Rep Orthop. 2017 Apr 3; 2017.
Roy SP, Nag K. Simultaneous bilateral tibial tuberosity avulsion fractures in adolescence: case report and review of 60 years of literature. Injury. 2013; 44(12): 1953-5.
Pandya NK, Edmonds EW, Roocroft JH, Mubarak SJ. Tibial tubercle fractures: complications, classification, and the need for intra-articular assessment. J Pediatr Orthop. 2012 Dec 1; 32(8): 749-59.
Davidson D, Letts M. Partial sleeve fractures of the tibia in children: an unusual fracture pattern. J Pediatr Orthop. 2002 Jan 1; 22(1): 36-40.
Woolfrey BF, Chandler EF. Manifestations of OsgoodSchlatter's disease in the late teenage and early adulthood. J Bone Joint Surg. 1960; 42: 327-32.
Vaishya R, Azizi AT, Agarwal AK, Vijay V. Apophysitis of the Tibial Tuberosity (Osgood-Schlatter Disease): A Review. Cureus. 2016; 8(9):e780.
Kaya DO, Toprak U, Baltaci G, Yosmaoglu B, Ozer H. Long-term functional and sonographic outcomes in Osgood–Schlatter disease. Knee Surgery, Sports Traumatology, Arthroscopy. 2013 May 1; 21(5): 1131-9.
Suhaila IN, Suhaila MS, Aireene WW. An active boy with bilateral knee pain. Malays Fam Physician: the official Journal of the Academy of Family Physicians of Malaysia. 2019; 14(1): 26-8
Bezuglov EN, Tikhonova ÐÐ, Chubarovskiy PV et al. Conservative treatment of Osgood-Schlatter disease among young professional soccer players. International Orthopaedics (SICOT). 2020.
Topol GA, Podesta LA, Reeves KD, Raya MF, Fullerton BD, Yeh HW. Hyperosmolar dextrose injection for recalcitrant Osgood–Schlatter disease. Pediatrics. 2011; 128(5): e1121–e28.
Gowda BN, Kumar JM. Simultaneous bilateral tibial tubercle avulsion fracture in a case of pre-existing Osgood-Schlatter disease (OSD). J Orthop Case Rep. 2012; 2(1): 24.
Jalgaonkar AA, Dachepalli S, Al-Wattar Z, Rao S, Kochhar T. Atypical tibial tuberosity fracture in an adolescent. Orthopedics. 2011; 34(6): e215-8.
Chow SP, Lam JJ, Leong JC. Fracture of the tibial tubercle in the adolescent. J Bone Joint Surg. British volume. 1990; 72(2): 231-4.
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