Rosh Pediatrics Practice Exam

What is the pathogenesis of knee pain in a 13-year-old boy involved in soccer preseason training?

1. Bursal inflammation from repetitive direct pressure

2. Chronic traction apophysitis of the tibial tubercle apophysis

3. Referred pain from slipped capital femoral epiphysis

4. Repetitive strain on the patellar tendon

The correct answer is: Chronic traction apophysitis of the tibial tubercle apophysis

The pathogenesis of knee pain in a 13-year-old boy involved in soccer preseason training is often linked to chronic traction apophysitis of the tibial tubercle, more commonly known as Osgood-Schlatter disease. This condition usually occurs during periods of rapid growth, when the bones are growing faster than the surrounding muscles and tendons. In physically active adolescents, especially those participating in sports that involve running and jumping, the repetitive strain can lead to inflammation at the site where the patellar tendon attaches to the tibial tubercle. This repetitive traction can cause pain and swelling beneath the knee and is often exacerbated by activities that involve knee extension or jumping, common in soccer. The condition reflects an overuse injury as the body adapts to increased training intensity without sufficient time for the growth plate at the tibial tubercle to recover, leading to localized tenderness and pain. Understanding the physical demands placed on the knee joint in young athletes helps clarify why chronic traction apophysitis results from the specific activities associated with soccer. Other options, while relevant to knee pain in adolescents, do not specifically align with the pattern seen in this scenario.