Osgood-Schlatter disease
Updates to Article Attributes
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. Typical age of onset in females may be slightly earlier ( (boys, 12-15 years; girls, 8-12 years) 8.
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:
- 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
edemaoedema 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 decreasing 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.
EtymologyHistory and etymology
It is named after
- Robert B. Osgood - Boston orthopaedic surgeon (1873-1956)
- Carl Schlatter - Swiss professor of surgery (1864-1934)
Related topics
-<p><strong>Osgood-Schlatter disease</strong> <strong>(OSD)</strong> is a chronic fatigue injury due to repeated microtrauma to involving the patellar ligament insertion onto the tibial tuberosity. </p><h4>Epidemiology</h4><p>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 <sup>1-3</sup>.</p><h4>Clinical presentation</h4><p>Clinically, patients present with pain and swelling over the tibial tuberosity, exacerbated with exercise.</p><h5>Associated conditions</h5><ul>- +<p><strong>Osgood-Schlatter disease</strong> <strong>(OSD)</strong> is a chronic fatigue injury due to repeated microtrauma to involving the patellar ligament insertion onto the tibial tuberosity. </p><h4>Epidemiology</h4><p>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 <sup>1-3</sup>. Typical age of onset in females may be slightly earlier ( (boys, 12-15 years; girls, 8-12 years) <sup>8</sup>.</p><h4>Clinical presentation</h4><p>Clinically, patients present with pain and swelling over the tibial tuberosity, exacerbated with exercise.</p><h5>Associated conditions</h5><ul>
-<li>thickening and edema of the inferior patellar tendon</li>- +<li>thickening and oedema of the inferior patellar tendon</li>
-<a href="/articles/infrapatellar-bursitis">infrapatellar bursitis</a> (<a href="/articles/clergyman-s-knee">clergyman's knee</a>)</li>-</ul><h4>Treatment and prognosis</h4><p>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 <sup>4-5</sup>. </p><p>The condition spontaneously resolves once the physis closes.</p><h4>Etymology</h4><p>It is named after</p><ul>- +<a href="/articles/infrapatellar-bursitis">infrapatellar bursitis</a> (<a href="/articles/clergyman-s-knee">clergyman's knee</a>)<ul><li>a distended deep infrapatellar bursa can be frequent finding <sup>6</sup>.</li></ul>
- +</li>
- +</ul><h4>Treatment and prognosis</h4><p>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 <sup>4-5</sup>. </p><p>The condition spontaneously resolves once the physis closes.</p><p>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.</p><h4>History and etymology</h4><p>It is named after</p><ul>
-<li><a href="/articles/extensor_mechanism_of_the_knee_injuries">extensor mechanism of the knee injuries</a></li>- +<li><a href="/articles/extensor-mechanism-of-the-knee-injuries">extensor mechanism of the knee injuries</a></li>
References changed:
- 8. Gholve P, Scher D, Khakharia S, Widmann R, Green D. Osgood Schlatter Syndrome. Curr Opin Pediatr. 2007;19(1):44-50. <a href="https://doi.org/10.1097/MOP.0b013e328013dbea">doi:10.1097/MOP.0b013e328013dbea</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/17224661">Pubmed</a>
- 9. Dunn J. Osgood-Schlatter Disease. Am Fam Physician. 1990;41(1):173-6. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/2403722">Pubmed</a>
- 6. Rosenberg Z, Kawelblum M, Cheung Y, Beltran J, Lehman W, Grant A. Osgood-Schlatter Lesion: Fracture or Tendinitis? Scintigraphic, CT, and MR Imaging Features. Radiology. 1992;185(3):853-8. <a href="https://doi.org/10.1148/radiology.185.3.1438775">doi:10.1148/radiology.185.3.1438775</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/1438775">Pubmed</a>
- 7. Hirano A, Fukubayashi T, Ishii T, Ochiai N. Magnetic Resonance Imaging of Osgood-Schlatter Disease: The Course of the Disease. Skeletal Radiol. 2002;31(6):334-42. <a href="https://doi.org/10.1007/s00256-002-0486-z">doi:10.1007/s00256-002-0486-z</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/12073117">Pubmed</a>
Image 18 X-ray (Lateral) ( create )
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