Osgood-Schlatter disease (OSD) is a chronic fatigue injury due to repeated microtrauma to involving the patellar ligament insertion onto the tibial tuberosity.
Osgood-Schlatter disease is seen in active adolescents, especially those who jump and kick, and because of this, is seen more frequently in boys. It is bilateral in up to 25-50% of patients 1-3. Typical age of onset in females may be slightly earlier ( (boys, 12-15 years; girls, 8-12 years) 8.
Clinically, patients present with pain and swelling over the tibial tuberosity, exacerbated with exercise.
- unresolved OSD - clinical and radiological findings of OSD that persist into adulthood
- Sinding-Larsen-Johansson syndrome - equivalent condition involving the inferior pole of the patella
- jumper's knee - involves the patellar tendon rather than the bone, and is essentially a tendinopathy for focal tenderness although it may eventually be associated with bony changes; more frequently involves the proximal attachment to the patella
It is important not to equate 'fragmentation' of the apophysis with OSD, as there may well be a secondary centers of ossification. Soft tissue swelling and a compatible history are essential in making the diagnosis.
Ultrasound examination of the patellar tendon can depict the same anatomic abnormalities as can plain radiographs, CT scans, and magnetic resonance images. The sonographic appearances in Osgood-Schlatter disease include 3:
- swelling of the unossified cartilage and overlying soft tissues
- fragmentation,and irregularity of the ossification center with reduced internal echogenicity
- thickening of the distal patellar tendon
- infrapatellar bursitis
MRI, as expected, is more sensitive and specific, and will demonstrate:
- soft-tissue swelling anterior to the tibial tuberosity
- loss of the sharp inferior angle of the infrapatellar fat pad (Hoffa's fat pad)
- thickening and oedema of the inferior patellar tendon
infrapatellar bursitis (clergyman's knee)
- a distended deep infrapatellar bursa can be frequent finding 6.
Treatment and prognosis
Treatment is usually conservative, and involves rest, icing, activity modification - decreasing activities that stress the insertion (especially jumping or lunging sports), quadriceps and hamstring strengthening exercises. Analgesia and padding to prevent pressure on the tibial tubercle are also useful. Only rarely are therapeutic casts required 4-5.
The condition spontaneously resolves once the physis closes.
In rare cases surgical excision of the ossicle and/or free cartilaginous material may give good results in skeletally mature patients, who remain symptomatic despite conservative measures.
History and etymology
It is named after
- Robert B. Osgood - Boston orthopaedic surgeon (1873-1956)
- Carl Schlatter - Swiss professor of surgery (1864-1934)
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- 3. Carr JC, Hanly S, Griffin J et-al. Sonography of the patellar tendon and adjacent structures in pediatric and adult patients. AJR Am J Roentgenol. 2001;176 (6): 1535-9. AJR Am J Roentgenol (full text) - Pubmed citation
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- 6. Rosenberg ZS, Kawelblum M, Cheung YY et-al. Osgood-Schlatter lesion: fracture or tendinitis? Scintigraphic, CT, and MR imaging features. Radiology. 1992;185 (3): 853-8. doi:10.1148/radiology.185.3.1438775 - Pubmed citation
- 7. Hirano A, Fukubayashi T, Ishii T et-al. Magnetic resonance imaging of Osgood-Schlatter disease: the course of the disease. Skeletal Radiol. 2002;31 (6): 334-42. doi:10.1007/s00256-002-0486-z - Pubmed citation
- 8. Gholve PA, Scher DM, Khakharia S et-al. Osgood Schlatter syndrome. Curr. Opin. Pediatr. 2007;19 (1): 44-50. doi:10.1097/MOP.0b013e328013dbea - Pubmed citation
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Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Osgood Schlatter lesion||✗|
|Osgood-Schlatter disease (OSD)||✗|
|Osgood and Schlatter disease||✗|
|Osgood Schlatter syndrome||✗|