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.
The third child was a 12-year-old male presenting to the outpatient department with complaints of swelling located in the medial aspect of right knee for the last three months. The swelling was insidious in onset without any history of trauma or fever. It was of the size of a lemon, as described by the patient’s guardian. There was associated vague pain in the same area, without any aggravating factor. There was no history of rapid increase in the size of swelling or the intensity of pain. Similar to the other two cases, there was no other swelling or pain elsewhere in the body. On examination, it was found that there was a bony hard, spherical, nodular, tender swelling on the medial aspect of right proximal tibia measuring 3 x 3 cm in size. The overlying skin was normal. Range of motion of knee joint was comparable to the other side. Plain radiograph of the right knee showed the presence of a bony outgrowth from the medial aspect of right proximal tibial metaphysis suggestive of an osteochondroma (Figure ). There was no evidence of malignant transformation on the plain radiograph. The patient was advised rest from exertional activities along with analgesic medications for three weeks causing reduction in pain. However, soon the pain started again gradually over a few days, for which the patient was injected with injection hydrocortisone and 2% xylocaine at the most tender point in the pes anserinus area. After this intervention, the patient became pain-free. The patient was regularly followed-up to check malignant transformation of the swelling. At the last follow-up of one-and-a-half years, there was no increase in the size of swelling or recurrence of pain.