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| Osgood-Schlatter disease Classification and external resources | |
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|---|---|
| Lateral radiograph of the knee demonstrating fragmentation of the tibial tubercle (see inset) with overlying soft tissue swelling. | |
| ICD-10 | M92.5 |
| ICD-9 | 732.4 |
| DiseasesDB | 9299 |
| MedlinePlus | 001258 |
| eMedicine | emerg/347 orthoped/426radio/491 sports/89 |
Osgood-Schlatter disease or syndrome (also known as tibial tubercle apophyseal traction injury) is an inflammation of the growth plate at thetibial tuberosity, and is one of a group of conditions collectively called osteochondroses. The condition is named after the American surgeon Robert Bayley Osgood (1873–1956) and the Swiss surgeon Carl Schlatter (1864–1934), who independently described the disease in 1903.[1][2][3]
The condition occurs in active boys and girls aged 11-15[4], coinciding with periods of growth spurts. It occurs more frequently in boys than in girls, with reports of a male-to-female ratio ranging from 3:1 to as high as 7:1. It has been suggested the difference is related to a greater participation by boys in sports and risk activities than by girls.
The condition is usually self-limiting and is caused by stress on the patellar tendon that attaches the quadriceps muscle at the front of the thighto the tibial tuberosity. Following an adolescent growth spurt, repeated stress from contraction of the quadriceps is transmitted through the patellar tendon to the immature tibial tuberosity. This can cause multiple subacute avulsion fractures along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump.
The syndrome may develop without trauma or other apparent cause; however, some studies report up to 50% of patients relate a history of precipitating trauma.
In a retrospective study of adolescents, young athletes actively participating in sports showed a frequency of 21% reporting the syndrome compared with only 4.5% of age-matched nonathletic controls.[5]
Sinding–Larsen–Johansson syndrome is an analogous condition involving the patellar tendon and the lower margin of the patella bone, instead of the upper margin of the tibia.
[edit]Symptoms
Knee pain is usually the presenting symptom that occurs during activities such as running, jumping, squatting, and ascending or descending stairs. The pain can be reproduced by extending the knee against resistance, stressing the quadriceps, or squatting with the knee in full flexion. Pain is mild and intermittent initially. In the acute phase the pain is severe and continuous in nature. Impact of the affected area can very painful. Bilateral symptoms are observed in 20–30% of patients.
The symptoms usually resolve with treatment but may recur for 12–24 months before complete resolution at skeletal maturity, when the tibial epiphysis fuses. In approximately 10% of patients the symptoms continue unabated into adulthood, despite all conservative measures.[6]
[edit]Treatment
Diagnosis is made clinically,[7] and treatment is conservative with rest, ice packs application, and if required oral paracetamol (acetaminophen) or ibuprofen. The condition usually resolves in a few months, with a study of young athletes revealing a requirement of complete training cessation for 3 months (on average) and gradual resumption of full training by 7 months.[5]
Bracing or use of an orthopedic cast to enforce joint immobilization is rarely required and does not necessarily give quicker resolution. Sometimes, however, bracing may give comfort and help reduce pain as it reduces strain on the tibial tubercle. [8] Surgical excision may rarely be required in skeletally mature patients.[6]
After symptoms have resolved, a gradual progression to the desired activity level may begin. In addition, predisposing factors should be evaluated and addressed. Commonly quadricepsand/or hamstring tightness is present and should be addressed with stretching exercises. Training factors such as intensity and repetition should also be evaluated and addressed.
[edit]Additional images
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[edit]References
- ^ Osgood R.B. (1903). "Lesions of the tibia tubercle occurring during adolescence". Boston Medical and Surgical Journal 148: 114–7.
- ^ Schlatter C. (1903). "Verletzungen des schnabelförmigen Forsatzes der oberen Tibiaepiphyse". [Bruns] Beiträge zur klinischen Chirurgie 38: 874–87.
- ^ Nowinski RJ, Mehlman CT (1998). "Hyphenated history: Osgood-Schlatter disease". Am J. Orthop. 27 (8): 584–5. PMID 9732084.
- ^ Yashar A, Loder RT, Hensinger RN (1995). "Determination of skeletal age in children with Osgood-Schlatter disease by using radiographs of the knee". J Pediatr Orthop 15 (3): 298–301. PMID 7790482.
- ^ a b Kujala UM, Kvist M, Heinonen O (1985). "Osgood-Schlatter's disease in adolescent athletes. Retrospective study of incidence and duration". Am J Sports Med 13 (4): 236–41. doi:.PMID 4025675.
- ^ a b Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW (2007). "Osgood Schlatter syndrome". Curr. Opin. Pediatr. 19 (1): 44–50. doi:. PMID 17224661.
- ^ Cassas KJ, Cassettari-Wayhs A (2006). "Childhood and adolescent sports-related overuse injuries". Am Fam Physician 73 (6): 1014–22. PMID 16570735.
- ^ Engel A, Windhager R (1987). "[Importance of the ossicle and therapy of Osgood-Schlatter disease]" (in German). Sportverletz Sportschaden 1 (2): 100–8. doi:. PMID 3508010.
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