• 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
  • Sex: > (3:1)[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

  • Overuse (especially sports involving sprinting and jumping) during the ossification period (adolescence) → excessive strain of the patellar ligament on the tibial tuberosity → inflammation traction apophysitis
  • Chronic inflammation of the patella ligament can disrupt the secondary ossification of the tibial tuberosity → detachment of the apophysis possible → subsequent callous formation during the healing process results in a pronounced tibial tubercle

References:[1][2]

Clinical features

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

References:[1]

Diagnostics

  • X-ray
    • Anterior soft tissue swelling
    • Lifting of tubercle from the shaft
    • Irregularity or fragmentation of the tubercle
  • Ultrasound: soft tissue swelling[3]

References:[1]

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

References:[1][2]

  • 1. Gregory JR. Osgood-Schlatter Disease. In: Osgood-Schlatter Disease. New York, NY: WebMD. http://emedicine.medscape.com/article/1993268-overview. Updated February 13, 2017. Accessed April 11, 2017.
  • 2. 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.
  • 3. 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 05/28/2019
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