Arthroscopic Resection of Symptomatic Tibial Tubercle Ossicles for Recalcitrant Osgood-Schlatter Disease Using a 2-Portal Technique

An MRI-Based Method for the Morphologic Assessment of the Anterior Tibial Tuberosity

Background: A prominent anterior tibial tuberosity (or tibial tubercle) can be seen in ongoing Osgood-Schlatter disease (OSD) in teenagers or as a sequela of OSD in adults. Current radiological methods do not provide a true anatomical assessment of the tibial tuberosity; therefore, we proposed and developed a Magnetic Resonance Imaging (MRI)-based method for measuring the anterior tibial tuberosity index, aiming to deal with the current lack of effective techniques for accurately assessing these particular morphologic features. Methods: A retrospective study included 47 knees with tibial tuberosity measurements on both true sagittal MPR images of 3D proton density (PD)-weighted MRI sequences and lateral knee radiographs. The same landmarks were followed and the anterior tibial tuberosity index (ATTI) was measured. Results: The comparison of the results obtained by the two methods demonstrates that our method is reliable and reproducible with substantial inter- and intra-observer agreement. The intraclass correlation coefficient was 0.9250 (95% CI: 0.8654 to 0.9582), indicating excellent reliability between the two methods. A strong positive correlation was also identified, with a correlation coefficient of r = 0.8746 (95% CI: 0.7845 to 0.9286, p < 0.0001) between the two methods. No significant deviation from linearity was observed by analyzing the linear model validity using the cusum test (p = 0.62). Conclusions: Based on these results, we encourage the use of 3D PD-weighted MRI sequences for the measurement of the anterior tibial tuberosity on MRI in order to avoid unnecessary exposure to ionizing radiation and potentially obtain a more accurate measurement. Future larger studies should also explore the benefit of utilizing 3D sequences over 2D lateral projections to minimize measuring bias.

Osgood-Schlatter Disease: Ossicle Resection and Patellar Tendon Repair in a Symptomatic Adult

Chronic Osgood-Schlatter disease can cause significant knee pain and can result in severe functional deficits. For large, painful Osgood-Schlatter disease ossicles refractory to conservative management, surgical ossicle excision can provide resolution of symptoms. After diagnostic arthroscopy and intra-articular debridement, our preferred excision technique uses an open incision for direct visualization and removal of intratendinous ossicles, followed by distal patellar tendon repair and subsequent fixation with FiberTape sutures and knotless anchors to the tibial tubercle.

Tibial tubercle avulsion fracture following preexisting Osgood-Schlatter disease in an adolescent: a case report

Tibial tubercle avulsion fractures (TTAFs) are rare but typical in children and adolescents and Osgood-Schlatter disease (OSD) may be involved in their pathogenesis. However, few publications have reported the relationship between OSD and TTAF. A 16-year-old healthy male adolescent presented with pain, swelling and limited range of motion of the right knee following sudden acceleration while running. Based on the radiographic evidence, the patient was diagnosed with an avulsion fracture of the right tibial tubercle and OSD. Open reduction and internal fixation were performed using two cannulated screws and two Kirschner wires. The patient returned to preinjury activity levels at the 12-month follow-up postoperatively. This case report aimed to highlight this unique injury pattern. For patients with TTAFs, not only should the fracture be treated, but the cause of the fracture, such as OSD, should also be given appropriate treatment.

Bone Infarcts and Tumorigenesis—Is There a Connection? A Mini-Mapping Review

(1) Background: Avascular necrosis (AVN) may affect every part of the bone. Epiphyseal infarcts are likely to be treated early because most are symptomatic. However, meta- and diaphyseal infarcts are silent and are diagnosed incidentally. Sarcomas developing in the necrotic bone are extremely rare, but they have been reported in the literature. (2) Methods: We conducted a mapping review of recent evidence regarding these malignancies. Methods: A mapping review using a systematic search strategy was conducted to answer research questions. We limited our research to the last ten years (2012–2022). (3) Results: A total of 11 papers were identified, including 9 case reports and 3 case series. The pathomechanism of carcinogenesis in AVN was not investigated to date. Histologically, most tumors were malignant fibrous histiocytoma. The prognosis is relatively poor, especially for patients with metastases, but adjuvant chemotherapy may increase short- and long-term survival. (4) Conclusions: Since AVN-related malignancies are sporadic, no prospective studies have been conducted. The majority of evidence comes from small case series. More research is needed to identify the risk factors that would justify follow-up of patients after bone infarcts at higher risk of developing a malignancy.