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Imaging recommendation · Musculoskeletal

Adolescent athlete with anterior knee pain at tibial tubercle

Recommended: Clinical diagnosis; X-ray Knee + Ultrasound for atypical / refractory is the preferred imaging study for adolescent athlete with anterior knee pain at tibial tubercle. Apophysitis of tibial tubercle in growing athletes.

Recommended study

Clinical diagnosis; X-ray Knee + Ultrasound for atypical / refractory

XR No contrast Preferred Musculoskeletal Outpatient Reviewed

Apophysitis of tibial tubercle in growing athletes. Self-limited.

If the default doesn't apply

Refractory or atypical (suspect avulsion)
MRI MRI Knee No contrast

Watch-outs

Avulsion fracture concern

If acute severe pain after jumping injury — image for avulsion of tibial tubercle (surgical).

Pearls

  • X-ray: fragmentation and swelling at tibial tuberosity; soft tissue swelling on lateral view.
  • Ultrasound: tendon thickening, hypoechoic infrapatellar bursa, fragmentation.
  • Treatment: activity modification, ice, stretching; resolves with skeletal maturity.
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