Question
A 14 year old boy feels a pop while jumping for a basketball rebound. He cannot straight leg raise.
- Describe the radiograph and classify the injury.
- What complication must you watch for?
- Outline management.
Answer
Radiograph
- Avulsion of the tibial tubercle (arrow)
- Occurs near physeal closure, which proceeds from proximal to distal and posterior to anterior
- Often in boys with Osgood-Schlatter disease
Ogden classification (modified)
| Type | Description |
|---|---|
| I | Distal to the physis, within the ossification centre |
| II | Through the junction of tubercle and epiphysis |
| III | Extends into the knee joint |
| IV | Whole proximal tibial physis |
| V | Y shaped, combining III and IV |
Complication
- Compartment syndrome from the anterior tibial recurrent artery
- Monitor closely and consider prophylactic fasciotomy
- Genu recurvatum is rare as patients are near maturity
Management
- Undisplaced type I, cylinder cast in extension
- Displaced, open reduction and screw fixation
- Arthrotomy or arthroscopy for type III to assess the joint and meniscus
- Repair periosteum and retinaculum
- Return to sport at 3 to 6 months
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.