Knee Pain - Basketball

HISTORY: 13 y/o year-round basketball and flag-football male athlete without any significant past medical history presents for a 4-month history of progressively worsening anterior right knee pain. No trauma, initial injury, or inciting factor. He has been able to continue playing despite ongoing symptoms. He does note occasional anterior swelling. He has been using ice for pain. No prior PT or prior surgeries. Denies erythema, warmth, or any additional skin changes. PHYSICAL EXAMINATION: Left Knee Exam: Normal Right Knee Exam:Inspection: No EffusionPalpation: Pain on palpation of tibial tubercle, with soft tissue edema No pain on palpation of medial joint lineNo pain on palpation of lateral joint lineNegative Patellar apprehension testNo pain on medial patellar facetNo pain on lateral patellar facetNegative Patella compression test ROM: FROMStrength: 5/5 Quadriceps, Hamstring, Hip Flexor StrengthSpecialty Tests: Negative LackmanNegative Lever SignNegative McMurray TestNo pain/instability on Valgus/Varus TestNegative Ant/Post Drawer DIFFERENTIAL DIAGNOSIS: Osgood-Schlatter Disease Sinding-Larsen-Johansson Disease Patellar Tendinopathy TEST AND RESULTS: MSK Ultrasound: Large Fluid Collection in the area of Hoffa’s Fat pad.Knee X-Ray: Fragmentation of the Tibial Tubercle with distal patellar tendon thickening.Knee MRI: Ogden Type IB Tibial Tubercle apophyseal fracture with large amount of fluid between the apophysis and epophysis that extends into Hoffa’s Fat pad. Distal patellar tendinosis. Patellar origin edema. Small Osteochondral defect of the mid to posterior aspect of the lateral femoral condyle FINAL WORKING DIAGNOSIS: Osgood Schlatter Ogden Type IB TREATMENT AND OUTCOMES: Return to Play with reassurance Ice/Heat Cycles to Anterior Knee Physical Therapy