A 55-year-old female paatient was suffering from low back pain and bilateral knee and feet pain for four years.
Our patient presented with suspected lumbar disc hernia. She was suffering from low back pain and bilateral knee and feet pain for four years. She said that she had bilateral knee pain, tenderness and swelling for one year when she was 10 years old, which limited itself. Lateral plain radiographs revealed an ossicle in bilateral distal patellar tendons (Fig. 1). Computed tomography showed bilateral fragments separated from tibial tuberosities, and the fragmented segments’ margins were sclerotic on both sides (Fig. 2).
Osgood-Schlatter`s Disease (OSD) refers to partial avulsion of the tibia tuberosity, with no involvement of the tibial physis. OSD typically develops in girls between the ages of 8 and 13 and in boys between 10 and 15 years of age at the beginning of their growth spurt. This disease is more frequent in boys, and it may represent an overuse disease. It causes knee pain in children and teens which can be mild to severe. The condition usually goes away on its own over time but it may take months or years. The repetitive stress on tuberosity may cause partial avulsion. Radiographs will not be helpful if injury occurs during the preossification phase. Once an ossification center develops, radiographs will reveal radiodense fragments separated from tibial tuberosity. During periods of rapid growth, stress from contraction of the quadriceps is transmitted through the patellar tendon onto a small portion of the partially developed tibial tuberosity. This may result in a partial avulsion fracture through the ossification center. Approximately 25% of patients have bilateral lesions and their frequency of occurance is not known. Their etiology is unclear, but their condition is clearly exacerbated by exercise. Risk factors: Age between 11–18 years, male sex, rapid skeletal growth, repetitive jumping sports. Reported complications of Osgood-Schlatter's disease include fracture nonunion of the bone fragment, patellar subluxation, chondromalacia patellae and avulsion of the patellar tendon.
Bilateral Osgood-Schlatter disease sequel.
Based on the provided X-ray (including anteroposterior and lateral views of both knees) and CT images, the main findings are as follows:
Taking the patient’s age, medical history (4 years of bilateral knee and foot pain), and radiological findings into consideration, the following diagnoses can be considered:
Combining the patient’s age, duration of symptoms, and possible tibial tuberosity changes or evidence of old injury on imaging, the most likely diagnosis is:
“Chronic tibial tuberosity pathology (possibly residual adult Osgood-Schlatter disease with mild degenerative changes in the knee joint).”
The patient’s presentation could be due to incomplete resolution of Osgood-Schlatter disease during the growth period, leaving behind ossification or chronic inflammation at the tibial tuberosity. Additionally, mild to moderate degenerative changes associated with this age group may exacerbate symptoms. If further clarification is needed, an MRI of the knee joint can help rule out other soft tissue or meniscal pathology.
Considering the patient’s age and prolonged symptoms, the exercise prescription should be gradual and individualized to reduce stress on the tibial tuberosity and knee joint:
Additional recommended exercises include:
Disclaimer:
This report is a reference medical analysis based on the currently available imaging and medical history. It does not replace face-to-face consultations or professional medical advice. Should further concerns arise or symptoms worsen, please seek prompt evaluation at a qualified medical facility.
Bilateral Osgood-Schlatter disease sequel.
