Revista de Medicina Desportiva (English) November 2018 | Page 27
in about 5 to 10% of the situations
the symptoms persist, and surgery
might be needed. 16-20
There are several surgical tech-
niques for the treatment of this
pathology, with diverse results, and
there is no particular procedure
more effective than the others (Fig-
ure 5). 5,16,20,23-25 Mital et al presented
the results of surgical procedures
on 15 knees with OSS. In all there
was a free separated ossicle, pain e
tenderness, with symptoms for an
average period of 3,8 years without
improvement with the conservative
treatment. According to the authors,
all patients felt better after surgi-
cal excision of the ossicle and the
underneath synovial bursa. 20
Flowers and Bhadreswar performed
a technical modification of the
classical Ferciot and Thomson’s
technique of excision of the tibial
tuberosity prominence, adding
the removal of any osseocartilagi-
nous material. There was a relieve
of the pain in about 95% of the
patients and an improvement of
the prominence in about 86% of the
patients. 16,23,24
Complications
It is described that in about 10%
of the cases of OSS there might be
some complications. The pseudoar-
throsis and the persistence and
migration of the free ossicle inside
the patellar tendon can promote a
premature closure of the anterior
area of the superior tibial epiphysis,
leading to a recurvatum knee. Also
as a complication, it might result
on a patella alta and changes on the
biomechanical on the patelofemoral
joint, which could result on patellar
instability and gonarthrosis. There
Figure 5 – Exeresis of the ossicle at the
anterior tibial tuberosity.
are some reports about the fragility
on the insertion of the patellar ten-
don on the anterior tibial tuberosity
that can result on avulsions of the
tendon. 8,26
Conclusion
The OSS is in most cases a self-
limited disease, which diagnosis
must be known because it affects
the physical and the sports perfor-
mance. Its physiopathology explains
why most of the cases occurs during
adolescence and its typical presen-
tation allows a diagnosis supported
by the symptoms. The X-ray can
confirm the diagnosis and help with
the differential diagnosis. The initial
the treatment with nom-steroids
anti-inflammatory drugs and partial
limitation of physical activity are
o paramount importance for the
fast return to sports practice of the
young athlete. These measures are
effective in the majority of the cases
but in about 5 to 10% of the patients
the symptomatology will persist
until adulthood, and the surgical
treatment might be needed.
The authors declare the absence of any
conflict of interests
Correspondence:
Dr. Cláudio Espírito Santo
[email protected]
USF Rainha Santa Isabel, Coimbra
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