Patellar Pain

• Osgood-Schlatter disease is a common cause of knee pain, particularly in adolescent male athletes
• During early adolescence (typically ages 13-14 for affected males, and ages 10-11 for affected females), there are periods of rapid growth in which the quadriceps tendon puts traction on the apophysis of the tibial tubercle where the patellar tendon inserts This traction apophysitis is worsened by sports that involve repetitive running. jumping, or kneeling, and it improves with rest
• Approximately one fourth of affected individuals have bilateral disease
• Radiographic findings are nonspecific and include anterior soft tissue swelling, lifting of tubercle from the shaft, and irregularity or fragmentation of the tubercle.
• Treatment consists of activity restriction, stretching exercises, and non-steroidal anti-inflammatory medications.

   
   

   
   

Prepatellar bursitis		Occurs with chronic irritation of the anterior knee.	Symptoms include pain with direct pressure and superficial swelling over the patella.
Patellar tendonitis		Overuse syndrome resulting from repetitive jumping or kicking Patients present with anterior knee pain after exercise.	point tenderness at the inferior pole of the patella
Tibial osteomyelitis		Bone infection, usually bacterial in origin Symptoms include pain. swelling, tenderness, and erythema,	Patients classically present with refusal to bear weight on the affected extrernity Systemic symptoms may also be present The pain from osteomyelitis does not remit with rest.
Patellofemoral stress syndrom		Overuse injury commonly seen in runners Patients present with anterior knee pain that worsens upon descending steps or hills	Pain is localized to the patella and radiographs do not demonstrate separation at the tibial tubercle.
Osgood-Schlatter disease		Traction apophysis of the tibial tubercle Radiographic findings include anterior soft tissue swelling, lifting of tubercle from the shaft, and irregularity or fragmentation of the tubercle.	On physical examination, there is edema and tenderness over the tibial tubercle A firm mass can sometimes be felt due to heterotopic bone formation. Pain can be reproduced by extending the knee against resistance.