Why does it occur
During adolescence, in the area of the tibial tuberosity there is a growth zone - a section of cartilage that has not yet turned into bone and is therefore mechanically weaker. The patellar ligament is attached to it. With every jump, jerk and squat, the quadriceps femoris muscle pulls this area, and with frequent repetitions, microdamage occurs with inflammation and proliferation of bone tissue. Adolescents are especially vulnerable during the growth spurt, when muscles and tendons cannot keep up with the lengthening of bones and become relatively short and tight. Boys are more often affected, but as girls' participation in sports increases, the difference is narrowing.
- Open growth zone in the tuberosity area
- Patellar ligament traction during loading
- Period of rapid bone growth
- Shortening and tightening of the thigh muscles
- Jumping and running sports
- Age 10–15 years
Symptoms
The main complaint is pain below the kneecap, exactly at the site of the bony protrusion. It intensifies when running, jumping, squatting, climbing stairs and kneeling, and decreases at rest. Gradually, a dense, painful swelling, visible to the eye, forms in this area. The process is often bilateral, although one leg is usually more painful. The general condition does not suffer: there is no fever, redness of the skin and effusion in the joint. If these signs are present, the diagnosis needs to be reconsidered.
- Pain below the kneecap with exertion
- Dense painful lump on the shin
- Increased pain when running, jumping, climbing stairs
- Pain when kneeling
- Reducing pain at rest
- Both knees are often affected
- No fever or redness
Diagnostics
The diagnosis is usually made by examination: typical age, relationship with exercise and pain exactly in the area of the tuberosity are quite characteristic. Additional research is needed when the picture is atypical. Ultrasound shows thickening of the patellar ligament and soft tissue swelling. An x-ray is performed if a fragment is suspected, if there is pain at rest and at night, if there is an injury, or to exclude other causes. MRI is rarely used in complex cases. Alarming symptoms - night pain, fever, weight loss - require the exclusion of infection and tumor processes, so they cannot be ignored.
- Inspection and palpation of the tuberosity
- Assessing hip muscle flexibility
- Ultrasound of the knee joint
- X-ray of the knee joint with an atypical picture
- MRI in difficult cases
- Exclusion of infection and tumor with alarming signs
Treatment
There is no specific treatment to speed up recovery, and it is not necessary: the goal is to reduce pain and maintain activity. The load is adjusted, and not canceled completely: the volume of jumping and running is temporarily reduced, replacing them with swimming, cycling and exercises without impact load. Daily stretching of the quadriceps and hamstring muscles, as well as gradual strengthening of the thigh and buttock muscles, are key. After training, cold for 15 minutes helps. Painkillers are used briefly and as needed. Surgery is required extremely rarely, in adults, when a painful bone fragment remains.
- Reduces impact without completely stopping movement
- Swimming, cycling, exercises without jumping
- Daily thigh stretching
- Strengthening the muscles of the thighs and buttocks
- Cold after exercise for 15 minutes
- Knee brace or taping as recommended by a doctor
- Short course pain medication if necessary
- Surgery only in rare cases in adults
Sports and forecast
It is usually not necessary to completely quit sports, and it is important to explain this to both the teenager and parents: prolonged inactivity weakens muscles and delays recovery. The guideline is pain: mild discomfort is acceptable, which goes away after training, but if the pain intensifies, persists the next day, or lameness appears, the load should be reduced. The disease goes away on its own as the growth plates close, usually within a few months or one to two years. A protruding lump under the knee often remains for life, but it is painless and does not affect function. Some adults may still experience discomfort when kneeling.
- A complete abstinence from sports is not required.
- Focus on pain and its dynamics
- Warm-up and cool-down are required
- Gradual return to previous loads
- Passes with completion of growth
- The bony protrusion may remain permanently
- Discomfort when kneeling in some adults