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.
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.