A 10-year-old male child presented to us with pain over the medial aspect of both knees since the last two months. There was no history of trauma, fever, or pain in other joints. On clinical examination, it was found that there was localized tenderness over the medial aspect of the proximal tibia at the attachment of pes anserinus. Tenderness was marginally more with the knee joint in extension. Overlying skin was normal. No underlying bony swelling was palpable. The knee joint was stable. There were no bony swellings in other limbs. Systemic examination of the child was normal. Radiographic examination of both the knee joints revealed bilateral, symmetrical, sharp, bony spurs arising from the proximal tibial metaphysis corresponding to the attachment of the hamstring tendons (Figure ). A computed tomography (CT) scan of both knees was done to further characterize the lesions. CT scans of both the knees showed sharp “rose-thorn” like bony spurs arising from the medial proximal tibial metaphysis hanging down like an icicle (Figure ). The spurs had no cap. A clinico-radiological diagnosis of bilateral symmetrical tibial osteochondroma with pes anserinus bursitis was made.\nThe child was initially managed by giving rest and routine analgesics for a period of three weeks. All sporting activities were restricted for the said period. There was an initial reduction in his symptomatology but pain reappeared following return to routine activities. Injections of hydrocortisone and 2% xylocaine were given bilaterally at the most tender point of the pes anserinus area followed by a period of rest for two weeks. The patient showed complete resolution of pain and was symptom free two years after injections.
A 12-year-old boy presented with pain and a mass on the medial aspect of the right proximal leg. He first noticed symptoms at around 10 years of age. The pain appeared on knee flexion, and was absent when he walked or ran. His height and body weight were 162 cm and 59 kg, respectively. He had no past medical history related to the lesion. There was no history of trauma or injury at the knee. On examination, a non-mobile hard mass was palpable with tenderness at the medical side of the proximal tibia. Swelling was not obvious. Plain radiographs showed a lesion protruding from the bone with continuity to the underlying bone. The size of the lesion was 0.8 cm on a plain radiograph (Fig. ). CT depicted a protuberant bone lesion with continuity to normal bone (Fig. ), but an overlying cartilaginous cap was not obvious. The MRI showed the lesion had continuity to the host bone marrow. There was no obvious inflammation characterized by high signal intensity on a T2 weighted fat-suppression image around the tip of the osteochondroma (Fig. ). For surgical resection, the lesions were approached posterior to the conjoint tendon (Fig. ). While retracting the attachment of the pes anserinus, the lesion was resected using a curved chisel. Histologically, the specimen showed partially sclerotic lamellar bone trabeculae covered by an attenuated hyaline cartilaginous cap undergoing endochondral ossification with fatty marrow, compatible with osteochondroma. There was no evidence of malignancy. Six months after surgery, the symptoms disappeared.