Right Knee Pain - What's Your Dx? Save

A 36 year-old white male butcher has right knee pain for 3 weeks. He noted a similar episode 5 years earlier and admits to a traumatic fall on that knee years ago. He denies fever, redness, warmth, other joints or other past medical problems. He only takes OTC ibuprofen prn. 

What's your diagnosis?

Radiologist Diagnosis:  Old Osgood-Schlatter with ossified fragments,accompanied by anterior soft tissue swelling. If chronic or persistent, MRI would be advised.

Osgood-Schlatter (tibial apophysitis) is a traction apophysitis of the distal patellar tendon insertion at the tibial tuberosity. When this occurs at the insertion of the patellar tendon on to patella it is called Larsen-Johansson disease. It is a common sporting injury that occurs in 4% of adolescents, more commonly in athletic adolescent boys more so than girls.

Pain, with or without swelling, may be intense over the tibial tuberosity and may be worse with squatting, jumping, or using stairs. Bony hypertrophy may persist after pain subsides. Rarely tibial tubercle avulsion fractures occur.

Symptomatic management and physical therapy is advised in children and adolescents. In adults surgery may be necessary

Case and Radiograph submitted by Daniel Ricciardi, MD (Brooklyn, NY)