Osgood-Schlatter disease

Osgood-Schlatter disease

OVERVIEW:

The syndrome associated with traction apophysitis in adolescent boys and girls consisting of pain of the tibial tubercle with swelling

System(s) affected: Musculoskeletal
Genetics: Unknown
Incidence/Prevalence in USA: Not known, but common (13% of athletes in one Finnish study)
Predominant age:
• Females 10-16
• Males 11-18
Predominant sex: Male > Female

SIGNS AND SYMPTOMS:

• Unilateral or bilateral (30%) tibial tuberosity pain
• Pain exacerbated by exercise, especially jumping and landing after jumping
• Tibial tuberosity swelling
• Pain increased with knee extension against resistance or kneeling
• Knee pain with squatting or crouching
• Absence of effusion or condyle tenderness
• Erythema of tibial tuberosity

CAUSES:

Basic etiology unknown, but clearly exacerbated by exercise - jumping and pivoting sports are the worst

RISK FACTORS:

• Age between 11 and 18
• Male sex
• Rapid skeletal growth
• Involvement in repetitive jumping sports

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS:

• Stress fracture of the proximal tibia
• Pes anserinus bursitis
• Quadriceps tendon avulsion
• Patellofemoral stress syndrome
• Chondromalacia patellae
• Proximal tibial neoplasm
• Osteomyelitis of the proximal tibia
• Tibial plateau fracture
• Patellar tendonitis
• Sinding-Larson-Johansson syndrome

LABORATORY:

No blood tests indicated unless other diagnostic considerations are entertained

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS:

• Osteochondritis of the tibial tubercle
• Heterotopic bone formation at insertion of the patellar tendon
• Bony fusion of the tibial metaphysis
• Inflammatory infiltrate of the epiphysis in severe cases
• Complete avulsion of the tibial tubercle with nonunion of the tubercle with the tibia - possible complication (extremely rare)

SPECIAL TESTS:

N/A

IMAGING:

• X-ray imaging of the proximal tibia and knee may show heterotopic calcification in the patellar tendon. X-rays are rarely diagnostic.
• Calcified thickening of the tibial tuberosity with irregular ossification at insertion of tendon to tibial tubercle
• Bone scan may show increased uptake in the area of the tibial tuberosity; will have increased uptake in apophysis in any child, but may be more than opposite side

DIAGNOSTIC PROCEDURES:

N/A

TREATMENT

APPROPRIATE HEALTH CARE:

Outpatient

GENERAL MEASURES:

• Frequent ice applications post exercise with pain
• Rest
• Knee immobilization in extension
• In more severe cases, avoidance of activities that increase pain or swelling
• Quadriceps isometric strengthening, hip extensions, adductor strengthening, hamstring and quadriceps stretching exercises

SURGICAL MEASURES:

Debridement of a thickened cosmetically unsatisfactory tibial tubercle (rare)

ACTIVITY:

Activity to be restricted to those activities not causing pain

DIET:

N/A

PATIENT EDUCATION:

• Consider avoidance of jumping sports. Assure family that symptoms and findings will diminish with time and rest.
• OK to play sport with mild pain

MEDICATIONS

DRUG(S) OF CHOICE:

None in particular, but all analgesics may be considered. NSAIDs are of minimal benefit; however narcotics are not recommended

Contraindications: N/A
Precautions: N/A
Significant possible interactions: N/A

ALTERNATIVE DRUGS:

More potent analgesics such as narcotics may be considered for short term use or in extreme situations

FOLLOW UP

PATIENT MONITORING:

Follow up on a prn basis for management of pain and disability

PREVENTION/AVOIDANCE:

• Avoidance of those sports involving heavy quadriceps loading
• Patients may compete if the pain is minimal
• Increase hamstring and quadriceps flexibility

POSSIBLE COMPLICATIONS:

• Nonunion of the tubercle to the tibia
• Upriding of the patella
• Patellar tendon avulsion
• Genu recurvatum
• Patellofemoral degenerative arthritis
• Patella alta
• Chondromalacia

EXPECTED COURSE AND PROGNOSIS:

Except in rare complicated cases, this is a self-limiting illness resolved within two years after full skeletal maturation. However, up to 50% of adults with prior Osgood-Schlatter disease will still report occasional symptoms.

MISCELLANEOUS

ASSOCIATED CONDITIONS:

N/A

AGE-RELATED FACTORS:

Pediatric: In skeletally mature boys and girls, with boys more frequent than girls
Geriatric: N/A
Others: Participants in sports involving heavy quadriceps activity

PREGNANCY:

N/A

SYNONYMS:

Osteochondritis of the tibial tubercle

ICD-9-CM:

732.4 Juvenile osteochondrosis of lower extremity, excluding foot

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Medical Diagnosis » O » Osgood-Schlatter disease