II. Pathophysiology
- Apophysitis secondary to traction injury at the inferior pole of the Patella
- Contrast with Osgood Schlatter which is aphophysitis at the tibial tubercle
III. Epidemiology
- Ages 10 to 13 years old
IV. Symptoms
- Anterior Knee Pain
- Worse with jumping or direct pressure on the inferior Patellar pole
V. Signs
VI. Imaging
-
Knee XRay
- Rule-out Fracture, tumor, Patellar sleeve avulsion or ostemyelitis
- May demonstrate partial Patellar avulsion with overlying swelling
- Abnormal calcification at Ossification Center (at inferior Patellar pole)
-
Bedside Ultrasound
- Fragmentation of the inferior Patella (compared with opposite side)
VII. Differential Diagnosis
- Osgood-Schlatter (affects tibial tubercle)
VIII. Management
- Relative rest with activity modification
- Analgesics (NSAIDs, Acetaminophen)
- Ice Therapy
- Physical therapy
- Flexibility Exercises with hamstring, quadriceps, and heel cord stretches
- Patellar counterforce strap
- Refractory Cases
- Immobilization is rarely needed and only recommended in severe cases
- Orthopedic referral if persistent symptoms despite a mature skeleton
IX. Course
- Self-limited with resolution within 12-24 months and by skeletal maturity (when apophysis fuses)