Cozen's Phenomenon After Repair of a Medial Collateral Ligament Periosteal Avulsion in a Pediatric Athlete

Abstract

Case: A 13-year-old boy sustained an acute, grade III medial collateral ligament (MCL) distal periosteal avulsion injury while playing noncontact football. Treatment consisted of diagnostic knee arthroscopy with open physeal-sparing MCL repair. At approximately 1-year follow-up, new development of genu valgum in the operative extremity was noted. After 8 months of nonoperative treatment with deformity progression, the patient underwent correction with proximal medial tibial hemiepiphysiodesis. Conclusion: Although Cozen's phenomenon commonly occurs after a proximal metaphyseal tibial fracture in children aged 2 to 7 years, it can occur as a rare complication of MCL injury/repair and remains a possible outcome in skeletally immature patients.

Late Onset Deformity in a Healed Fracture: A Case of Paediatric Post Traumatic Tibia Valga

“…In addition to falls and motor vehicle accidents, PTTV has been reported to occur during sports activities, such as trampoline injuries and medial collateral ligament avulsion injuries in paediatric athletes [2,3]. In the original article, Cozen described this condition as specifically occurring in lowenergy trauma and undisplaced and non-angulated fractures [4].…”

Pediatric and Adolescent Medial Collateral Ligament Injuries

“…present one case study of a skeletally immature athlete who had attempted nonoperative treatment that failed and went on to operative treatment with reconstruction and developed a significant genu valgum growth deformity requiring hemi-epiphysiodesis. 45 This resultant deformity may have been due to overgrowth from the medial physis after surgical intervention or from undergrowth from the lateral physis after persistent valgus instability, causing increased lateral-sided loading and subsequent damage to the lateral aspect of the proximal tibial physis. Either way, this is an excellent example of the importance of continued alignment radiographs in the postoperative period to document normal growth.…”