Endoscopic Management of Osgood-Schlatter Disease Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S.  Arthroscopy Techniques  Volume 5, Issue 1, Pages e121-e125 (February 2016) DOI: 10.1016/j.eats.2015.10.023 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A) Lateral radiograph of the left knee of the illustrated case shows a prominent tibial tuberosity and ossicle proximal to the tubercle. (B) Magnetic resonance imaging (sagittal, T2-weighted image) shows that the tubercle and ossicle are at the anterior aspect of the patellar tendon. Arthroscopy Techniques 2016 5, e121-e125DOI: (10.1016/j.eats.2015.10.023) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Arthroscopic excision of the ossicle and debridement of the tibial tuberosity in the left knee. The patient is positioned supine. The proximal-lateral portal (PLP) and distal-medial portal (DMP) are located at the proximal-lateral and distal-medial aspects of the tibial tuberosity (TT), respectively. These can avoid formation of painful surgical scars over the patellar tendon. Moreover, a sufficient working space can be obtained and instrument crowding can be avoided. Arthroscopy Techniques 2016 5, e121-e125DOI: (10.1016/j.eats.2015.10.023) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Arthroscopic excision of the ossicle and debridement of the tibial tuberosity in the left knee. The patient is positioned supine. (A) A plane is developed anterior to the bony prominence. This is the working area for the endoscopy. The proximal-lateral portal is the viewing portal. (B) An inflamed pretibial bursa (PB), if present, can be resected with an arthroscopic shaver through the distal-medial portal. Arthroscopy Techniques 2016 5, e121-e125DOI: (10.1016/j.eats.2015.10.023) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Arthroscopic excision of the ossicle and debridement of the tibial tuberosity in the left knee. The patient is positioned supine. The distal-medial portal is the viewing portal. (A) The avulsed ossicle can be identified at the distal part of the patellar tendon. (B) The thin layer of tendinous tissue over the ossicle (OS) is resected with an arthroscopic shaver through the proximal-lateral portal. (C) The dimensions of the ossicle, especially its deep margin, can be defined with an arthroscopic probe and a small dissector. (D) The ossicle is resected with an arthroscopic acromionizer. (PT, patellar tendon.) Arthroscopy Techniques 2016 5, e121-e125DOI: (10.1016/j.eats.2015.10.023) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Arthroscopic excision of the ossicle and debridement of the tibial tuberosity in the left knee. The patient is positioned supine. The distal-medial portal is the viewing portal. (A) After resection of the ossicle, the patellar tendon is traced distally to the tibial tuberosity (TT). The prominent tuberosity is resected with preservation of the patellar tendon (PT) insertion. This is performed by starting the bone shaving from the proximal end of the prominence with the acromionizer facing distally. (B) A postoperative radiograph shows that the ossicle and prominent tibial tuberosity have been resected. Arthroscopy Techniques 2016 5, e121-e125DOI: (10.1016/j.eats.2015.10.023) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions