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
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
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
Dr. Cláudio Espírito Santo
USF Rainha Santa Isabel, Coimbra
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