A 13-year-old boy complains of a bump in the anterior aspect of his proximal tibia. What is your interpretation of the lateral projection of his knee?

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ANSWER

By all indications, this is a normal knee. The apparent fragmentation of the tibial tubercle represents ossification of the tibial apophysis from multiple centers, rather than from a single focus. This finding alone should not be misinterpreted as evidence of Osgood-Schlatter's disease. That diagnosis would require additional findings of localized tenderness over the tubercle and edema of the patellar tendon and the infrapatellar (Hoffa's) fat pad.

This series of diagnostic quizzes that challenge your ability to read a variety of x-ray films is edited by Dr. Keats, professor of radiology and professor of orthopedics at the University of Virginia School of Medicine in Charlottesville.

Emerg Med 35(10):55, 2003