A 20-year-old man presented with complaints of right upper leg pain that extended over six months, with no relief after taking analgesics. He had a history of multiple asymptomatic swellings in both upper and lower limbs including the forearm, thighs, and the medial aspect of both upper legs since childhood. However, he did not report a rapid increase in any of the swellings. The patient’s father had a similar history of multiple bony swellings since childhood. Examination revealed an immobile, non-tender, 4cm x 2cm swelling fixed to the underlying bone, over the right medial proximal tibia. Also, there was diffuse tenderness along the course of pes anserinus tendons. Plain X-ray demonstrated a pedunculated bony swelling over medial proximal tibia with a tiny stalk without any associated matrix changes/periosteal reaction, pointing away from the knee joint, suggestive of a diagnosis of osteochondroma (Figure ).\nBased on the skeletal survey, a presumptive diagnosis of diaphyseal aclasis with pes anserinus syndrome was made, and excision of the painful right proximal tibial swelling was planned. The swelling was excised through a direct medial approach, which revealed swelling of the pes anserinus tendons that were stretched over the bony swelling. The bony swelling was excised extraperiostealy en masse, and the adjoining part of the tibial cortex was nibbled out (Figure ).\nThe histopathology report revealed a bony mass with marrow elements in the stalk along with an overlying hyaline cartilage cap without any cellular atypia, confirming the diagnosis of benign osteochondroma. By the end of the year at the last follow-up, the patient was pain-free i.e., measuring zero on the visual analog scale (VAS) with no evidence of recurrence. Consent was obtained from the patient for the publication of this manuscript.
Another 13-year-old male child presented to the outpatient department with similar complaints of knee pain on the left side for the last two months. The onset was insidious and there was no history of trauma. There was no history of swelling or pain in any other part of the body. On examination, it was found that tenderness was present at the medial aspect of left proximal tibia. No swelling was palpable. Rest of the local examination and systemic examination were unremarkable. Plain radiographs of the left knee revealed a sharp bony spur arising from proximal tibial metaphysis, similar to the first case (Figure ). But the radiograph of the contra-lateral knee was unremarkable. The patient was again advised rest and analgesic medications for three weeks. No other subsequent intervention was required, and at the last follow-up of two years, there was no recurrence of pain.