Tibial tuberosity avulsion

At a Tibial tuberosity avulsionwhich mainly affects children and adolescents, it is a partial or complete tear off of the tibia. If the joint surface is also affected, the joint surface is also involved. Then there is talk of an avulsion fracture.

What is a tibial tuberosity avulsion?

With regard to children and adolescents, this diagnosis is a total or partial tear off of the tibia, Latin tuberositas tibiae, in connection with a current sporting or joint stressful experience. If the joint surface is involved, it is called an avulsion fracture.

The term "Avulsion" stands for a violent demolition. In young domestic dogs, the term is used synonymously with "apophyseal necrosis of the tibial tiberositas" in relation to an aseptic disease of the affected bone. The formation of a necrosis and subsequent detachment of the tibial bulge can be observed Tibial tuberosity avulsion referred to as.

It is similar to Osgood-Schlatter disease in humans. Even if the name is identical, it should be avoided because of some differences in relation to the dog.

causes

In humans, spontaneous or sustained physical activity is the most common cause. The joint is no longer able to cope with the load, overloading occurs and, ultimately, joint damage. An existing joint osteoarthritis can also be responsible as a triggering symptom.

The same applies to existing metabolic diseases such as gout and osteoarthritis. Diabetes mellitus and chronic inflammation such as polyarthritis are also known to be triggers. Certain sports such as volleyball and basketball, but also tennis and badminton, stress the entire joint and muscle mechanism.

This also applies to weight lifting, soccer, road cycling, weight lifting and bodybuilding. As an extrinsic (from the outside) occurring factor, a high jump frequency is primarily responsible. Heavy and unfamiliar loads follow. A training floor that is too hard increases the risk of injury.

Age is one of the intrinsic (from within) injury factors. Statistically speaking, symptoms increase from the age of 15. If there is a difference in leg length, the shorter leg is less affected than the longer one.

Symptoms, ailments & signs

The pain is load-dependent but does not only occur when running (running training). Actually, any movement that exerts strong to very strong tension on the thigh muscles can be responsible for further pain from mild to very strong.

In the initial stage, pain occurs at the beginning and at the end of a load. If the injury continues, the pain is constant. And not only during sporting activities, but also during everyday processes such as climbing stairs, driving a car or getting up after sitting for a long time.

The angle at which the joint is located is also decisive for the intensity of the pain. Chronic development is not uncommon. Stress peaks with severe to severe pain then often alternate with symptom-free periods. Active extension against resistance is also painful. A bilateral injury of this type occurs in only 20 to 30 percent.

Diagnosis & course of disease

A sonography (ultrasound), an MRI (magnetic resonance tomography) or a projection radiography provide information about the current condition of the affected joint. It is quite typical that there is no complete detachment of the shin pouch.

In contrast to Osgood-Schlatter's disease, bony fragments do not appear in the attachment of the patella ligament. Three types can be classified according to Pfeil et al:

• Type I shows a displacement of the tibia of less than 2 mm. There is also a minimalized apophyseal area.
• In type II, the apophyseal fracture shows a displacement of more than 2 mm.
• If type III is present, the apophysis is already widely displaced and the kneecap is elevated. There is also a step formation in the knee joint.

The classifications for the three types according to Watson-Jones are: Type I represents an avulsion of the apophysis, but without damage to the tibial epiphysis. In type II, the cephalad epiphysis is raised and incomplete. Type III shows that the proximal base of the epiphysis with the fracture line is displaced into the joint.

Complications

The tibial tuberosity avulsion primarily leads to very severe pain in the affected person. These pains mainly occur when running or walking, but can also appear in the form of pain at rest. This also leads to sleep problems and possibly irritability in the person concerned.

Often the pain spreads through the tibial tuberosity avulsion to the neighboring regions. Physical activities or sporting activities are therefore no longer easily possible for the patient. The patient's joints are also permanently damaged by the complaint, which can lead to restrictions in movement. If the tibial tuberosity avulsion already occurs in a child, the disease leads to a significantly delayed development and thus also to disorders and complaints in adulthood of the patient.

Treatment of the tibial tuberosity avulsion is not associated with complications and can usually take place with the help of medication. The symptoms are alleviated as a result, but those affected are dependent on long-term use of these drugs. Various exercises can also have a positive effect on the course of the disease. The tibial tuberosity avulsion does not usually have a negative effect on the life expectancy of the patient and does not reduce it.

When should you go to the doctor?

Since tibial tuberosity avulsion cannot heal itself, the person affected must consult a doctor so that there is no further deterioration or further complications. The earlier a doctor is consulted, the better the further course of the disease usually is. A doctor should be consulted in the case of tibial tuberosity avulsion if the person affected suffers from slight pain in the thighs.

This pain occurs for a recognizable reason and usually does not go away on its own. They can also appear in the form of pain at rest and therefore also have a negative effect on the patient's sleep. The pain can also get worse with a higher load. The disease can be detected by a general practitioner. Further treatment is usually carried out by a specialist. As a rule, this does not lead to a reduction in life expectancy, although the further course of the disease itself depends heavily on the exact severity of the tibial-tibial avulsion.

Treatment & Therapy

Type I initially enables conservative treatment in the form of immobilization and cooling with ice, ice spray, as well as anti-inflammatory ointments and medication. Stabilizing knee supports and injection treatments without cortisone (this would cause the tendon to tear) can also follow. A kinesio tape often leads to an effective relief. If the tendon is completely torn off, an operation is inevitable.

If the disease is more advanced and has reached type II or even type III, osteosynthetic care is required. Physiotherapy exercises are important to optimize the flexibility of the hip flexing muscles and to strengthen the hip extending muscles.

Movement in the form of brisk walking or a moderate running pace is advisable for long-term improvement. Long distances, steep climbs and sloping stretches should only be mastered with extreme caution, because they put too much strain on the affected joint. Movement in water, on the other hand, is particularly suitable.

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prevention

Avoid overpronation and negative hip extension. Shoes with pronation protection are recommended. Beginners should slowly learn "correct running" under sports therapy guidance and optimize it step by step.

Like all muscles, joints should not be trained without a warm-up phase. When exercising outdoors on cold days, warming ointments and protective clothing can protect against injuries because they protect against hypothermia.

Aftercare

After the successful treatment of a tibial tuberosity avulsion, a good and comprehensive follow-up treatment is important to avoid long-term consequences. The aim should be, on the one hand, to prevent the recurrence of a tibial tuberosity avulsion and, on the other hand, to permanently restore full mobility of the knee joint and leg. In order to achieve the latter, the therapy of the tibial tuberosity avulsion must be followed by intensive physiotherapy, in which the knee joint and leg are slowly strengthened again and returned to normal resilience and mobility.

Until this physiotherapy treatment has been completed, exercise should largely be avoided in order not to put excessive strain on the affected leg or legs. Regular check-ups with an orthopedic surgeon should also be carried out to prevent the recurrence of tibial tibial avulsion. In addition to an external examination, imaging methods (X-rays) are also used. If necessary, the orthopedic surgeon can also prescribe knee supports for sport, especially for the leg that is not (yet) affected, which stabilize and relieve the knee joint and thus prevent the recurrence of symptoms of a tibial tibial avulsion.

You can do that yourself

Type I tibial tuberosity avulsion can be treated with conservative therapy with cooling and immobilization. Patients must also take anti-inflammatory drugs. Suitable self-help measures are cooling, protection and, if necessary, the use of natural painkillers and anti-inflammatory drugs.

A walking aid is required due to the restricted mobility. In severe cases, a wheelchair must be used. The patient should also be supported in everyday life. Physical activities, especially those that involve the lower limbs, must be avoided. The doctor will also recommend extensive physiotherapy. The healing process can be supported by gentle massages, warm baths and, under certain circumstances, alternative practices from Chinese medicine. Here, too, the doctor must give his consent, as complications may arise under certain circumstances.

An osteosynthetic supply is required for severe clinical pictures. Patients should contact a specialist early on, especially if they experience severe pain or restricted mobility. The physical activity can be restarted after the treatment is over. The exact steps need to be discussed with the specialist and a physiotherapist. Further self-help measures are usually not to be used with tibial tuberosity avulsion.