osgood-schlatter disease

Osgood-Schlatter DiseaseOsgood-Schlatter Disease

Raymond G Buick FRCS

Osgood-Schlatter disease

1903

Robert Bayley Osgood

Carl B Schlatter

Osgood-Schlatter disease

most frequent cause of knee pain in children aged 10-15 years

gradual onset of pain – tibial tuberosity– after repetitive activity

Osgood-Schlatter disease

M>F 3:1 7:1

Age 8 to 16 yearsPeak age• boys about 12 to 15 years • girls about 10 to 12 years.

• bilateral symptoms 30%

pathogenesis

definitely linked with the growth spurt

pathogenesis

caused by forceful contractions of the quadriceps muscles transmitted through the patellar tendon to the tibial tuberosityleading to pathological changes at the at the proximal tibial apophysis insertion

pathogenesis

caused by forceful contractions of the quadriceps muscles transmitted through the patellar tendon to the tibial tuberosityleading to pathological changes at the at the proximal tibial apophysis insertion

apophysisan outgrowth, projection or

protuberance, especially of bone

pathogenesis

patellar tendon

tibial tuberosity

pathogenesis

The tibial tubercle apophysis appears in children aged 7-9 years.

mismatch between the force of the quadriceps contraction and the maturity of the patellar tendon - tibial junction

pathogenesis

leading to

•multiple small avulsion fractures•distal patellar tendinitis•osteochondritis

aetiology

• activity (during or after football, ballet, gymnastics,

• running or jumping sports, or kneeling,

diagnosis - clinical presentation

• age and activity• pain inferior to the patella at the insertion of

the patellar tendon– aggravated by exercise and relieved by rest

• tenderness• swelling• limp

examination

• prominence and soft-tissue swelling over the tibial tubercle

• tenderness over tibial tuberosity and patellar tendon • pain on knee extension• pain on resisted knee extension• pain on flexion• remainder of the knee examination usually is normal.• Tight hamstrings and/or quadriceps may also be

noted when compared with the uninvolved side.

differential diagnosis

• trauma • referred from hip• systemic symptoms (including fever, weight• loss, or general malaise)• bone or joint pain elsewhere

• Sinding–Larsen–Johansson syndrome - an analogous condition involving the patellar tendon and the lower margin of the patella

diagnosis

• history

• clinical examination

• x-ray

diagnosis

• history

• clinical examination

• x-ray

Author James Heilman MD

treatment• explanation• reassurance• reduction in activity

treatment• explanation• reassurance• reduction in activity

• pain management– Paracetamol– non-steroidal anti-inflammatory– application of ice (10–15 minutes, up to three times a

day)

treatment• explanation• reassurance• reduction in activity

• pain management– Paracetamol– non-steroidal anti-inflammatory– application of ice (10–15 minutes, up to three times a day)

• Physiotherapy – stretching & strengthening (reducing muscle imbalance of the quadriceps, hamstrings, calf muscles, and iliotibial band)

treatment

NOT recommended

• Corticosteroid injections

• Surgery

• In adults– a large ossicle and an overlying bursa– may cause pain with kneeling– treatment consists of excision of the bursa, ossicle, and

any prominence

prognosis

NOT recommended

• Corticosteroid injections

• Surgery

• In adults– a large ossicle and an overlying bursa– may cause pain with kneeling– treatment consists of excision of the bursa, ossicle, and

any prominence

prognosis

it is usually self limiting

90% of patients treated with conservative care were relieved of all of their symptoms approximately 1 year after onset of symptom

After skeletal maturity, patients may continue to have problems kneeling or may have tenderness over an unfused tibial tubercle ossicle or a bursa that may require resection

rarely a cause of permanent impairment or disability.

The EndThe End

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