Tibial tubercle apophyseal pain and maturation, a cross-sectional study in male´s youth elite football

OBJECTIVES: Pain provocation tests are commonly used among youth athletes to diagnose tibial tubercle apophyseal-related pain. However, their diagnostic value remains unclear, particularly in relation to tibial tubercle apophyseal-maturation. This study investigated the association between pain provocation tests and 1) reported pain during football, and 2) tibial tubercle apophyseal-maturation in symptomatic and asymptomatic youth male elite football players.

DESIGN: Cross-sectional observational cohort study.

METHODS: We collected data during the annual health evaluation of male football players of U13-U19 teams of an elite Dutch football academy. Outcome measures included reported pain at the tibial tubercle apophysis during football, four pain provocation tests (palpation, stretch, isometric knee extension at 0 and 90°), and ultrasound assessed tibial tubercle apophyseal-maturation categorised in four stages according to the Ehrenborg classification.

RESULTS: 548 assessments were completed in 257 individual players over four seasons. All pain provocation tests showed a strong association with reported pain during football (p < 0.001). Of the 341 player seasons with no reported pain during football, 106 (23.7 %) had a positive palpation test. This sensitivity to palpation was observed more frequently in maturation stages B (29.9 %) and C (30.2 %) than in A (17.6 %) and D (15.3 %).

CONCLUSIONS: Pain provocation tests for tibial tubercle apophyseal-related pain are strongly associated with reported pain during football. Young asymptomatic football players exhibit increased sensitivity to the palpation test, especially during maturation stages B and C. Therefore, a positive palpation test alone may be insufficient for diagnosing tibial tubercle apophyseal-related pain.