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Osgood-Schlatter Syndrome
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Contents
Other Names
- Tibial Tuberosity Apophysitis
- Osteochondrosis
- Traction apophysitis of the tibial tubercle
Background
- Overuse injury in adolescent athletes (skeletally immature)
- Atraumatic, insidious onset of anterior knee pain, at the tibial tuberosity where patellar tendon inserts
- Self-limited condition
- Caused by repetitive strain and microtrauma from extensor forces applied by the patellar tendon onto the apophysis of the tibial tubercle
- Results in irritation and severe cases cause partial avulsion of the tibial tubercle apophysis
- Prevalence of Osgood Schlatter disease is 9.8% in adolescents ages 12 to 15
- Bilateral symptoms in 20% to 30% of patients
Pathophysiology
- Tibial tubercle develops as a secondary ossification center that provides attachment for the patellar tendon
- Bone growth exceeds the ability of the muscle-tendon unit to stretch sufficiently to maintain previous flexibility
- Leads to increased tension across the apophysis
- Physis is the weakest point in the muscle-tendon-bone-attachment and is at risk of injury from repetitive stress
- Repeated contraction of the extensor mechanism softening and partial avulsion of the apophyseal ossification center occurs resulting in osteochondritis
Risk Factors
- Poor flexibility of quadriceps and hamstrings
- Extensor mechanism misalignment
Clinical Features
- Pain on anterior aspect of knee, exacerbated by kneeling
- Enlarged tibial tubercle
- Tenderness over tibial tubercle
- Pain on resisted knee extension
Differential Diagnosis
- Sinding-Larsen-Johansson syndrome
- Osteochondroma of the proximal tibia
- Tibial tubercle fracture
- Jumpers knee
- Hoffa's syndrome
- Synovial plica injury
Evaluation
- X-rays
- lateral radiograph of the knee will show irregularity and fragmentation of the tibial tubercle
- MRI
- not essential for diagnosis as diagnosis is made on history, physical exam and radiographs
- will show soft tissue swelling, thickening and edema of inferior patellar tendon, fragmentation and irregularity of ossification center
Classification
Management
- Condition is self-limited (may persist for years until apophysis fuses)
- Modify activity to prevent continuous contraction of extensor mechanism as guided by level of pain
- No evidence that rest speeds up recovery though activity restriction reduces pain
- May continue with sports as long as pain resolves with rest and does not limit activity
- Ice
- NSAIDs
- Knee pad may be worn to protect from direct trauma
- Stretching of hamstrings and quadriceps
- Physical therapy if conservative measures not effective
- No evidence to recommend injection therapy or surgical intervention
- Ossicle excision may be performed in skeletally mature patients with persistent symptoms
Return to Play
- May continue with sports as long as pain resolves with rest and does not limit activity
Complications
See Also
References
- Dold A. Osgood Schlatter's Disease (Tibial Tubercle Apophysitis). Orthobullets. https://www.orthobullets.com/knee-and-sports/3029/osgood-schlatters-disease-tibial-tubercle-apophysitis?expandLeftMenu=true. Accessed March 23, 2020.
- Smith JM. Osgood Schlatter's Disease (Tibial Tubercle Apophysitis). StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK441995/. Published May 5, 2019. Accessed March 23, 2020.
- Surgery aDof PO. Osgood Schlatter syndrome : Current Opinion in Pediatrics. LWW. https://journals.lww.com/co-pediatrics/Fulltext/2007/02000/Osgood_Schlatter_syndrome.8.aspx. Accessed March 23, 2020.
Created by:
Jesse Fodero on 9 July 2019 04:08:22
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Last edited:
7 April 2020 14:53:08
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