Pediatric emergency medicine trisk 3952 3952
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Management consists first and foremost of avoiding activities that place stress
on the tibial tubercle. This is perhaps the most difficult instruction to enforce in
young athletes. A brief period of immobilization or nonweight bearing is
recommended by some as a means of ensuring compliance. Application of ice for
20 minutes at least twice daily will reduce pain and swelling. Nonsteroidal antiinflammatory medications are commonly recommended. Activity may be
resumed when the patient is free of pain. Flexibility exercises concentrate on
stretching the quadriceps and hamstrings to alleviate stress on the tubercle and
avoid recurrences. A neoprene sleeve on the knee or patellar tendon strap will
reduce forces on the tubercle. Over 90% of cases resolve within 12 to 24 months
with conservative treatment.
Sinding-Larsen–Johansson Disease
The tension in the infrapatellar tendon that causes Osgood–Schlatter disease is
also transmitted proximally to the inferior pole of the patella. A traction
apophysitis at this site results in pain and localized tenderness, and is known as
Sinding-Larsen–Johansson disease. The predisposing factors for this injury are
the same as those for Osgood–Schlatter disease, and include running and jumping
activities. Sinding-Larsen–Johansson disease and Osgood–Schlatter disease can
occur simultaneously. Provocative maneuvers that produce discomfort in
Osgood–Schlatter disease produce pain at the distal patella. Radiographs are
nonspecific but may show fragmentation or a small avulsion at the distal pole of
the patella ( Fig. 121.9 ), which must be differentiated from an acute sleeve
fracture of the patella or a bipartite patella. Treatment emphasizes rest,
application of ice, stretching exercises, and oral anti-inflammatory agents.
Resolution occurs over a period of 12 to 18 months.
