• Clinical science

Osgood-Schlatter disease

Summary

Osgood-Schlatter disease is an avascular necrosis thought to arise from overuse of the quadriceps muscle during periods of growth. This causes a traction apophysitis at the tibial insertion of the quadriceps tendon. The most common symptom is anterior knee pain that worsens with exercise. A tibial bump may be felt and can often be seen on x-ray. Treatment is usually conservative. Surgical excision is only necessary in severe and treatment-resistant cases.

Epidemiology

  • Age
    • Adolescents; on average 9–14 years old
    • Commonly develops shortly after growth spurts
  • Sex: > (3:1)

Epidemiological data refers to the US, unless otherwise specified.

Etiology

Clinical features

  • Progressive anterior knee pain that is worse with activity and is reproducible with extension against resistance
  • Proximal tibial swelling

Diagnostics

  • X-ray
    • Anterior soft tissue swelling
    • Lifting of tubercle from the shaft
    • Irregularity or fragmentation of the tubercle
  • Ultrasound: soft tissue swelling [2]

Treatment

  • Mostly conservative (rest, ice, NSAIDs )
  • Strengthening and stretching of the quadriceps muscle
  • Generally resolves once full bone maturity is reached
  • Surgical excision of intratendinous ossicles in severe cases [1]

Other avascular necroses

Localization

Age group Features
Panner disease
  • 5–10 years
  • Good prognosis with conservative treatment
  • Often seen in throwers (e.g., baseball players)
Kienbock disease
  • 20–30 years
  • Typically associated with repetitive impact trauma (e.g., volleyball)
  • Manifests with dorsal wrist pain
Legg-Calvé-Perthes disease
  • Femoral head
  • 4–10 years
  • >
Ahlback disease
  • 55–70 years
  • Typically affects female patients
Blount disease
  • 1–3 years (infantile)
  • 4–10 years (juvenile)
  • > 10 years (adolescent)
Sinding-Larsen-Johansson disease
  • 10–14 years
  • More common in active children
Sever disease
  • 8–12 years
  • >
Kohler disease
  • 5–10 years
  • >
Freiberg disease
  • 10–18 years
  • >

  • 1. Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter syndrome. Curr Opin Pediatr. 2007; 19(1): pp. 44–50. doi: 10.1097/MOP.0b013e328013dbea.
  • 2. Blankstein A, Cohen I, Heim M, et al. Ultrasonography as a diagnostic modality in Osgood-Schlatter disease. Arch Orth Traum Surg. 2001; 536–539(121): p. 9. doi: 10.1007/s004020100285.
last updated 09/22/2020
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