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 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.