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Osgood-Schlatter disease

Osgood-Schlatter disease (OSD) is a chronic fatigue injury due to repeated microtrauma to involving the patellar ligament insertion onto the tibial tuberosity. 

Epidemiology

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.

Clinical presentation

Clinically, patients present with pain and swelling over the tibial tuberosity, exacerbated with exercise.

Associated conditions
  • 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

Radiographic features

Plain film

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

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

MRI, as expected, is more sensitive and specific, and will demonstrate:

Treatment and prognosis

Treatment is usually conservative, and involves 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.

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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