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Aseptic necrosis of the tibial tuberosity occurs unilaterally or bilaterally, more often in boys aged 10–15 years. Children complain of pain in this area, which increases after longer walking, running or cycling. In treatment, it is important to spare the limb and limit its mobility in the knee joint.
What is aseptic tuberosity necrosis of the tibia?
This disease is also known as Osgood-Schlatter’s disease and is one of the conditions of the group of sterile bone necrosis. This condition may occur on one or both sides. It develops in the area of tibial tuberosity and mainly affects boys between 10 and 14 years of age who play football. This condition causes pain in the knee area and prevents normal activity. Lumpiness is a small thickening of the tibia that can be felt below the kneecap.
Aseptic necrosis of the tibial tuberosity – causes
The main cause of ailments is the sterile process of bone necrosis, during which the bone tissue and a piece of cartilage die. The sterile necrosis is probably caused by disturbed vascularization, e.g. due to vitamin A deficiency or hormonal disorders. An overload of the patellar ligament, which attaches to the tibial tuberosity, may also contribute to the development of aseptic necrosis of the tibial tuberosity. Most often, such situations occur when practicing intense sports (e.g. athletics, football). The knee straightening movement from its significant bend is especially negative.
The main factors that increase the risk of the disease are primarily age (10-14 years of age) and gender (boys get sick much more often than girls).
Symptoms of aseptic necrosis of tibial tuberosity
There is thickening, swelling and increased warmth in the area of the tuberosity. In addition, there is a pressing soreness of this place. Knee pain may worsen after prolonged walking, jogging, or climbing stairs. The knee area is also tender.
In children, a characteristic symptom of the disease is a condition in which severe pain is felt in the area of the tibial tuberosity when the leg is extended in the knee joint. Passive movement is usually not associated with pain.
Osgood-Schlatter disease has a long course and may last from several months to even two years. Symptoms are usually mild during the course of the disease, although there are occasional exacerbations.
How to diagnose aseptic tuberosity necrosis of the tibia?
Diagnostics is based primarily on the observation of clinical symptoms and assessment of the radiological image taken. During the palpation of a child complaining of pain during active movement, the doctor finds warmth in the area and pain when touched. Additionally, a bone fragment is felt. On the other hand, radiological examination shows the disappearance of the trabecular structure, and with the development of the disease – bone calcification. This examination also shows the breakdown of tibial tuberosities into bone fragments.
Aseptic necrosis of the tibial tuberosity – treatment
The treatment of the disease consists mainly in sparing the limb and limiting its mobility in the knee joint (special longitudinal adhesive tapes or round bands can be used for this purpose). Pain is self-limiting when bones stop growing. Before this happens, however, it is worth alleviating it with pharmacological preparations (non-steroidal anti-inflammatory drugs) or ice packs. In the period of exacerbations, avoid irritation in this area, strenuous efforts, and limit the full bending of the knee. In patients with severe pain, it is recommended to use a pneumatic tourniquet, which eliminates pain and ensures comfort for the patient. In rare cases, there are indications for surgical treatment. The disease process lasts from several months to 2 years, the course is usually mild with periodic exacerbations.
Prognosis are generally good. The changes found in the radiological examination and clinical symptoms disappear spontaneously in a mild form after about 2-3 years. In all other cases, treatment is necessary. Sometimes complications also occur, e.g. the tuberosity is partially detached from the tibia.
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