Surgical treatment of residual XXXX in young adults: role of the mobile osseous fragment.

@entity1 @entity6995 @entity158
@entity6995 is a well-known condition in late childhood characterized by @entity158 over the tibial tubercle. This condition usually resolves spontaneously at skeletal maturity. Few @entity1 develop @entity158 over the tibial tubercle. Radiological examination demonstrates a round regular ossification over the tubercle. Treatment is usually symptomatic, but occasionally surgical treatment is necessary, usually due to the development of a painful ossicle. This article reports our experience with refractory @entity6995 in 22 @entity1 . Most @entity1 were operated under local anesthesia. A midline longitudinal skin incision was used, followed by subperiosteal dissection of the osseous fragment. The knee was put in soft dressing. @entity1 were encouraged to resume daily activity immediately postoperatively. No wound complications were noted. All @entity1 returned to their previous level of physical activity within 12 weeks postoperatively. All but 1 were free of @entity158 on kneeling or direct pressure over the knee joint. Based on our experience, we devised a treatment algorithm. We believe that the key factors for successful surgical treatment are clear visualization of separation on lateral knee radiographic view and a clinical mobility positive test (firm grasping of the prominent part of the tubercle and its sliding movement). Our results are uniformly good; the only failure related to mistaken inclusion criteria where the lateral radiograph did not show a distinctly separated fragment.
