Tibial tubercle osteochondritis

　　Children with osteochondritis dissecans of the patellar tubercle are in a period of rapid growth and development before the onset of the disease, with increased tension and swelling at the insertion site of the patellar ligament, causing osteochondritis of the patellar tubercle. The following editor will introduce the etiology of this disease.

　　The quadriceps muscle is the strongest muscle in the human body, but its insertion point - the patellar tubercle is very small. It is often subjected to strong tension at this point, leading to some special situations, such as:

　　1. Patellar tubercle avulsion fracture.

　　2. Quadriceps tendinitis, often accompanied by the formation of new bone.

　　Osteochondritis dissecans of the patellar tubercle is mainly characterized by tendinitis, bursitis, or subcutaneous bursitis at the insertion site of the patellar ligament on the tibial tubercle, and the local prominence caused by calcification and ossification of the adjacent lesions. This disease may have two late complications:

　　1. Due to the upward avulsion of the patellar tubercle epiphysis, the insertion point of the quadriceps muscle moves up, causing the irregular surface of the patella to contact the lower end of the femur easily, leading to osteoarthritis. It is possible to take a bilateral lateral X-ray film during the contraction of the quadriceps muscle to observe whether the position of the patella is consistent, and if there is displacement, surgical correction is recommended.

　　2. Abnormal ossification of the patellar tubercle, which can cause genu recurvatum when fused with the superior tibial ossification center in the early stage.

　　Osteochondritis dissecans of the patellar tubercle is more common in boys aged 11 to 15. The clinical manifestations include pain at the patellar tubercle, mild swelling, and tenderness, which worsens after exertion. Some people have a history of intense exercise or trauma before the onset of the disease. Pain is exacerbated when extending the knee, which is due to the tension of the quadriceps muscle pulling on the affected epiphysis; pain is also present during passive flexion of the knee, which is due to the quadriceps muscle pulling on the epiphysis.

　　Osteochondritis dissecans of the patellar tubercle often occurs in recruits, caused by improper training. To prevent the occurrence of such diseases, reasonable training methods should be adopted, progressing gradually, with the intensity of exercise increasing from low to high; improve the quality of leadership, avoid blindly working for results, and hard work; treatment should be thorough, and follow-up should be timely to avoid reinjury of the patellar epiphysis due to early exercise.

　　Tibial tuberosity osteochondritis, also known as tibial tuberosity epiphysitis, is a disease that commonly occurs in boys aged 11-15 who are fond of intense sports, with more males than females, which can occur unilaterally or bilaterally, and most have a history of trauma. The main examination method for this disease is X-ray examination.

　　X-ray manifestations:Lateral radiographs of the knee joint, especially those with slight internal rotation, are most helpful for diagnosis. Because the tibial tuberosity is slightly lateral to the middle of the tibia. In the early stage of the disease, local soft tissue swelling, thickening of the patellar tendon, and disappearance of the inferior fat pad under the patella can be seen. Later, one or more free新生 bone fragments can be seen in front of the tibial tuberosity. In the later stage, the image of the new bone fragments is more obvious, and there is bone hyperplasia near the tibial tuberosity.

　　Patients with tibial tuberosity osteochondritis should eat more high-calcium foods to ensure the normal needs of bone metabolism. Therefore, it is advisable to eat more milk, eggs, soy products, vegetables, and fruits, and foods rich in calcium. For example: dried potatoes, potato flour, bread; coriander, rapini, rapeseed, seafood such as kelp, jellyfish, sea cucumber, nori, shrimp, etc. Calcium supplements may be necessary if needed.

　　The treatment for tibial tuberosity osteochondritis varies depending on the severity of the condition:

　　1. Most patients can recover within 2-3 weeks by reducing their activity. Severe cases may require a splint in a straight position for 4-6 weeks, followed by physical therapy to restore knee extension and flexion. However, to recover from intense knee activities, it may take at least 4 months. Corticosteroid injections can also be used locally, but some people oppose this method because it can cause atrophy of surrounding soft tissues, even spontaneous rupture of the patellar tendon.

　　2. If pain and knee dysfunction occur repeatedly and the patient is older, surgical treatment should be adopted. The patellar tendon can be split, and a thin osteotome can be used to flip the cortex on both sides of the tibial tuberosity in the middle line. Use a sharp scraper to scrape off the debris. Then, suture the cortex back to its original place, which can relieve pain and reduce the excessively prominent tibial tuberosity to a normal shape.