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Osgood-Schlatter Syndrome

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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

Created by:
Jesse Fodero on 9 July 2019 04:08:22
Last edited:
7 April 2020 14:53:08