A 13-year-old girl had noticed pain for six months when she ran, but no pain while she walked. She also noticed snapping at the medial site of the proximal leg on knee flexion. Her height and body weight were 150cm and 42kg, respectively. She had no past medical history related to the lesion. On physical examination, a small hard lesion was palpable. Tenderness at the medial side of the proximal tibia was observed. The snapping phenomenon was reproduced on knee flexion. Plain radiographs showed a small 0.5 cm osseous lesion on the antero-posterior radiographic view (Fig. ). CT depicted a small protuberant bone lesion with continuity to normal bone (Fig. ). Surgically, the lesions were approached posterior to the conjoint tendon, and resected with a curved chisel while retracting the attachment of the pes anserinus. The lesion was composed of a hyaline cartilaginous cap and underlying lamellar bone trabeculae and fatty marrow (Fig. ). There was no evidence of malignancy. Six months after the surgery, the symptoms had disappeared.
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.