Management consists first and foremost of avoiding activities that place stress on the tibial tubercle This is perhaps the most difficult instruction to enforce in young athletes A brief period of immobilization or nonweight bearing is recommended by some as a means of ensuring compliance Application of ice for 20 minutes at least twice daily will reduce pain and swelling Nonsteroidal antiinflammatory medications are commonly recommended Activity may be resumed when the patient is free of pain Flexibility exercises concentrate on stretching the quadriceps and hamstrings to alleviate stress on the tubercle and avoid recurrences A neoprene sleeve on the knee or patellar tendon strap will reduce forces on the tubercle Over 90% of cases resolve within 12 to 24 months with conservative treatment Sinding-Larsen–Johansson Disease The tension in the infrapatellar tendon that causes Osgood–Schlatter disease is also transmitted proximally to the inferior pole of the patella A traction apophysitis at this site results in pain and localized tenderness, and is known as Sinding-Larsen–Johansson disease The predisposing factors for this injury are the same as those for Osgood–Schlatter disease, and include running and jumping activities Sinding-Larsen–Johansson disease and Osgood–Schlatter disease can occur simultaneously Provocative maneuvers that produce discomfort in Osgood–Schlatter disease produce pain at the distal patella Radiographs are nonspecific but may show fragmentation or a small avulsion at the distal pole of the patella ( Fig 121.9 ), which must be differentiated from an acute sleeve fracture of the patella or a bipartite patella Treatment emphasizes rest, application of ice, stretching exercises, and oral anti-inflammatory agents Resolution occurs over a period of 12 to 18 months