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OSGOOD SCHLATTER DISEASE

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Definition
OsgoodSchlatter disease or syndrome (OSD) is an irritation of the patellar ligament at the tibial tuberosity.

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[1]. Kujala et al. "Osgood-Schlatter's disease in adolescent athletes. Retrospective

study of incidence and duration. 1985. Am J Sports Med 13

(4): 23641.

It was named after two physicians in 1903, Dr. Robert Osgood and Dr. Carl Schlatter. Osgood Schlatters disease is a very common cause of knee pain in children and young athletes. It occurs during the period of rapid growth, due to a combined high level of sporting activity.

It occurs more frequently in boys than in girls, with reports of a male-to-female ratio ranging from 3:1 to as high as 7:1. [1]

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Other names for Osgood-Schlatter Disease

Osteochondrosis Tibial Aponphysitis. Tibial tubercle apophyseal traction injury Morbus Osgood-Schlatter Rugby knee

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Causes
OSD is thought to be caused by small injuries due to repeated overuse before the area has finished growing.

Some studies report that up to 50% of patients relates a history of precipitating trauma. It is common in adolescents who play soccer, basketball, and volleyball, and who participate in gymnastics. Osgood-Schlatter disease affects more boys than girls.

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Pathomechanics

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Key Structures Involved in OSD

Key areas involving OSD

Quadriceps Femoris

Muscle- Tendon Unit

Patella Tibial Tuberosity

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Following an adolescent growth spurt, repeated stress from contraction of the quadriceps is transmitted through the patellar tendon to the immature tibial tuberosity. This can cause multiple sub-acute avulsion fractures along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump which can be very painful when hit.
Activities such as kneeling may irritate the tendon further.

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Who Gets OSD?

Most often seen in teenage boys and young men.
Age range: Boys ~ 12 to 15 ; Girls ~ 8 or 12 years. Most times it is seen after the boy or girl has had a growth spurt and the symptoms gradually come on.

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Who Gets OSD?

New research shows that athletes with limited dorsiflexion could be at great risk for OSD. It is thought that a decrease in dorsiflexion in the ankle leads to compensation in the leg with increased knee flexion, tibial inversion and foot pronation during the stance phase of running. These three compensations may lead to greater stress placed on the patellar tendon which could lead to OSD.
Zoran arevi. Limited ankle dorsiflexion: a predisposing factor to Morbus Osgood Schlatter? Knee Surgery, Sports Traumatology,

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Who Gets OSD?

If the patellar tendon attaches more proximally and in a broader area to the tibia, this might probably cause OSD.

Burak Demirag.The pathophysiology of Osgood-Schlatter disease: a magnetic resonance investigation. J Pediatr Orthop B. 2004 Nov ;13 (6):379-82.

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What Makes OSD Worse?

o o o o o o o o squatting running walking up or down stairs cycling forceful contractions of the quadriceps muscle jumping (basketball, volleyball) kneeling repetitive hard landings

Anything that puts excessive stress on the insertion of the patellar tendon

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Symptoms
o Main symptom - painful swelling over a bump on the tibia o Symptoms occur on one or both legs. o Pain:
o Pain is mild and intermittent initially. o Later stages- the pain is severe and continuous in nature.

o Palpation: The area is tender to pressure, and swelling ranges from mild to very severe. o Function: The pain is worse with acute knee impact.

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Painful swelling

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Calcification at the tibial tuberosity

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o The pain can be reproduced by extending the knee against resistance, stressing the quadriceps, or striking the knee. o Bilateral symptoms are observed in 2030% of patients. o The symptoms usually resolve with treatment but may recur for 1224 months before complete resolution at skeletal maturity, when the tibial epiphysis fuses.

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CLASSIFICATION
o Presentation of Osgood-Schlatter Disease was classified into two groups according to X-ray examination, those with and without fragmentation of the tibial tuberosity. o Later Woolfrey and Chandler (1960) classified the radiological changes associated with Osgood-Schlatter disease into 3 types.

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Woolfrey and Chandler, 1960

o Type I, where the tibial tubercle is prominent and irregular o Type II, where there is additional small fragments of bone adjacent to the anterior and superior aspects o Type III, where the tubercle is normal, but there is free bone particles in similar distribution.

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Diagnosis

Radiographic imaging (x-ray) Ultrasonography Magnetic Resonance Imaging (MRI)

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Radiographs

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Differential Diagnosis
SindingLarsenJohansson syndrome

Patellar subluxation or dislocation

Patellofemoral pain syndrome Jumpers knee Housemaids knee Tibial tubercle fracture

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Prevention

The small injuries that may cause this disorder are usually unnoticed, so prevention may not be possible.

Regular stretching, both before and after exercise and athletics, can help prevent injury.

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Conservative Management
o Ibuprofen or other nonsteroidal anti inflammatory drugs (NSAIDs),

or acetaminophen (Tylenol).
o Rest (3 days) and decreasing activity (1-2 weeks) o Ice - over the painful area, 2 to 3 times a day, 20 to 30 minutes at a time, o Bracing, Orthopedic casting

o Infra patellar strap 6 to 8 weeks

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Surgical Management

Excision of intra-tendon ossicles

Tibial sequestrectomy

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Physiotherapy Management:
Stretching Hamstrings Quadriceps Calf muscles Strengthening SLR Prone Hip extension Knee stabilisation Quadriceps strength training, with terminal range movement

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Kaiser Permanente, Exercises for OSD:

SLR to the front SLR to the front Short Arc Quadriceps

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Half-squat with knees and feet turned out to the side

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Step- up and Step down

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Terminal Knee extension

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Interesting Facts About OSD:

15% of teenage suicides occur due to depression caused by OSD during the game seasons OSD has been proved to occur in dogs!
(though a new system of classification of the disease is required)

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