General Information

DEFINITION--A temporary condition of the leg at the knee, characterized by swelling, tenderness and pain.

BODY PARTS INVOLVED--Tibial tubercle, a prominence just below the knee cap attached to a large thigh muscle connecting the bone of the upper leg (femur) to the large bone in the lower leg (tibia). This disorder often affects both knees.

SEX OR AGE MOST AFFECTED-- Adolescents of both sexes. It is uncommon after age 16.

SIGNS & SYMPTOMS

• A slightly swollen, warm and tender bump below the knee.
• Pain with activity, especially straightening the leg against force, as in stair-climbing, jumping or weight-lifting.

CAUSES--Probably results from stress or injury of the tibial tubercle (which is still developing during adolescence). Repeated stress or injury interferes with development, causing inflammation.

RISK INCREASES WITH

• Overzealous conditioning routines, such as running, jumping or jogging.
• Overweight.
• Male between 11 and 18.
• Rapid skeletal growth.

HOW TO PREVENT

• Help an overweight child lose weight.
• Encourage your child to exercise moderately, avoiding extremes.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• X-ray and bone scan of the knee (sometimes).

APPROPRIATE HEALTH CARE

• Home care after diagnosis.
• Doctor's treatment.
• Initial treatment involves ice, medications (if needed) and decreased exercise.
• The affected leg may be immobilized for 6-8 weeks (reinforced elastic knee support, plaster cast or splint).
• Surgery (rarely needed) if conservative measures fail.

POSSIBLE COMPLICATIONS

• Bone infection.
• Recurrence of the condition in adulthood.
• Persisting prominence below the kneecap.

PROBABLE OUTCOME--Usually resolves within 2 years after reaching full skeletal growth.

How To Treat

GENERAL MEASURES--

• Use heat to relieve pain. Warm compresses, heating pads, warm whirlpool baths, heat lamps, diathermy or ultrasound are effective.
• Ice applications may help.
• Use a cushioned knee pad.
• Provide the patient with emotional support and assurances that symptoms will diminish with time.

MEDICATION--

• For minor discomfort, you may use non-prescription drugs such as aspirin.
• Your doctor may prescribe cortisone injections, if other treatment fails. Cortisone injections may weaken tendons, so it is better to give the condition more time to heal than to use them.

ACTIVITY--

• Resting the affected leg is the most important treatment.
• May require crutches, leg cast or splint, or an elastic knee brace that prevents the knee from bending fully. The child should not participate in sports during treatment. This is temporary, and normal activity can be resumed when inflammation subsides, but treatment often requires 2 to 12 months.
• Avoid jumping activities and activities that cause pain to the leg.

DIET--No special diet, unless the child is overweight. Ask your doctor about a weight reduction diet.

Call Your Doctor If