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.