Osgood-Schlatter disease

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Osgood-Schlatter disease, also known as ~~(OSD)~~apophysitis of the tibial tubercle, is a chronic fatigue injury due to repeated microtrauma at the patellar ~~ligament~~tendon insertion onto the tibial tuberosity, usually affecting boys between ages 10-15 years.

Terminology

Unresolved Osgood-Schlatter disease is the term given to clinical and radiological findings that persist into adulthood ¹⁰.

Epidemiology

Osgood-Schlatter disease is seen in active adolescents, especially those who jump and kick. It is bilateral in 25-50% of patients ^1-3. The typical age of onset in females may be slightly earlier (boys 10-15 years; girls 8-12 years) ⁸.

Clinical presentation

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

Radiographic features

Plain radiograph

Soft tissue swelling with loss of the sharp margins of the patellar tendon is the earliest ~~signs~~sign in the acute phase; thus, a compatible history is also essential in making the diagnosis. Bone fragmentation at the tibial tuberosity may be evident 3 to 4 weeks after the onset.

It is important not to equate isolated 'fragmentation' of the apophysis with OSD, as there may well be secondary ossification centres.

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 of Osgood-Schlatter disease include ³:

swelling of the unossified cartilage and overlying soft tissues
fragmentation and irregularity of the ossification centre 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 fat pad)
thickening and oedema of the distal patellar tendon
infrapatellar bursitis (clergyman's knee)
- a distended deep infrapatellar bursa can be a frequent finding ⁶
bone marrow oedema may be seen at the tibial tuberosity

Treatment and prognosis

Treatment is usually conservative and involves rest, ice, activity modification (decreasing activities that stress the insertion, especially jumping and lunging sports), and quadriceps and hamstring strengthening exercises. Analgesia and padding to prevent pressure on the tibial tuberosity are also useful. Only rarely are therapeutic casts required ^4,5.

The condition usually spontaneously resolves once the physis closes.

In rare cases, surgical excision of the bone fragment(s) and/or free cartilaginous material may give good results in skeletally mature patients who remain symptomatic despite conservative measures¹⁰.

~~Unresolved OSD is the term given to clinical and radiological~~Adults with findings of ~~OSD that persist into adulthood~~prior Osgood-Schlatter disease are more likely to have patella alta and are at a higher risk of patellofemoral maltracking with subsequent chondrosis, and transient patellar dislocation¹¹.

History and etymology

It is named after American orthopaedic surgeon Robert B Osgood (1873-1956)and Swiss professor of surgery Carl Schlatter (1864-1934).

Differential diagnosis

Imaging differential considerations include:

Sinding-Larsen-Johansson disease (SLJ): similar condition involving the inferior pole of the patella
jumper's knee: involves the patellar tendon rather than the bone, and is essentially tendinopathy with focal tenderness, although it may eventually be associated with bony changes (some authors do not distinguish between SLJ and jumper's knee)
infrapatellar bursitis

-<p><strong>Osgood-Schlatter disease</strong> <strong>(OSD)</strong> is a chronic fatigue injury due to repeated microtrauma at the patellar ligament insertion onto the tibial tuberosity, usually affecting boys between ages 10-15 years.</p><h4>Epidemiology</h4><p>Osgood-Schlatter disease is seen in active adolescents, especially those who jump and kick. It is bilateral in 25-50% of patients <sup>1-3</sup>. The typical age of onset in females may be slightly earlier (boys 10-15 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><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Soft tissue swelling with loss of the sharp margins of the patellar tendon is the earliest signs in the acute phase; thus, a compatible history is also essential in making the diagnosis. Bone fragmentation at the tibial tuberosity may be evident 3 to 4 weeks after the onset.</p><p>It is important not to equate isolated 'fragmentation' of the apophysis with OSD, as there may well be secondary ossification centres.</p><h5>Ultrasound</h5><p>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 of Osgood-Schlatter disease include <sup>3</sup>:</p><ul>
+<p><strong>Osgood-Schlatter disease</strong>, also known as <strong>apophysitis of the tibial tubercle</strong>, is a chronic fatigue injury due to repeated microtrauma at the <a title="Patellar tendon" href="/articles/patellar-tendon">patellar tendon</a> insertion onto the <a title="Tibia" href="/articles/tibia">tibial tuberosity</a>, usually affecting boys between ages 10-15 years.</p><h4>Terminology</h4><p><strong>Unresolved Osgood-Schlatter disease</strong> is the term given to clinical and radiological findings that persist into adulthood <sup>10</sup>.</p><h4>Epidemiology</h4><p>Osgood-Schlatter disease is seen in active adolescents, especially those who jump and kick. It is bilateral in 25-50% of patients <sup>1-3</sup>. The typical age of onset in females may be slightly earlier (boys 10-15 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><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Soft tissue swelling with loss of the sharp margins of the patellar tendon is the earliest sign in the acute phase; thus, a compatible history is also essential in making the diagnosis. Bone fragmentation at the tibial tuberosity may be evident 3 to 4 weeks after the onset.</p><p>It is important not to equate isolated 'fragmentation' of the apophysis with OSD, as there may well be secondary ossification centres.</p><h5>Ultrasound</h5><p>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 of Osgood-Schlatter disease include <sup>3</sup>:</p><ul>
-</ul><h4>Treatment and prognosis</h4><p>Treatment is usually conservative and involves rest, ice, activity modification (decreasing activities that stress the insertion, especially jumping and lunging sports), and quadriceps and hamstring strengthening exercises. Analgesia and padding to prevent pressure on the tibial tuberosity are also useful. Only rarely are therapeutic casts required <sup>4,5</sup>.</p><p>The condition spontaneously resolves once the <a href="/articles/physis">physis</a> closes.</p><p>In rare cases, surgical excision of the bone fragment(s) and/or free cartilaginous material may give good results in skeletally mature patients who remain symptomatic despite conservative measures. </p><p>Unresolved OSD is the term given to clinical and radiological findings of OSD that persist into adulthood.</p><h4>History and etymology</h4><p>It is named after American orthopaedic surgeon <strong>Robert B Osgood </strong>(1873-1956)<strong> </strong>and Swiss professor of surgery <strong>Carl Schlatter </strong>(1864-1934). </p><h4>Differential diagnosis</h4><p>Imaging differential considerations include:</p><ul>
+</ul><h4>Treatment and prognosis</h4><p>Treatment is usually conservative and involves rest, ice, activity modification (decreasing activities that stress the insertion, especially jumping and lunging sports), and quadriceps and hamstring strengthening exercises. Analgesia and padding to prevent pressure on the tibial tuberosity are also useful. Only rarely are therapeutic casts required <sup>4,5</sup>. The condition usually spontaneously resolves once the <a href="/articles/physis">physis</a> closes.</p><p>In rare cases, surgical excision of the bone fragment(s) and/or free cartilaginous material may give good results in skeletally mature patients who remain symptomatic despite conservative measures <sup>10</sup>. </p><p>Adults with findings of prior Osgood-Schlatter disease are more likely to have <a title="Patella alta" href="/articles/patella-alta">patella alta</a> and are at a higher risk of <a title="patellofemoral maltracking" href="/articles/patellofemoral-maltracking">patellofemoral maltracking</a> with subsequent chondrosis, and <a title="Transient lateral patellar dislocation" href="/articles/lateral-patellar-dislocation">transient patellar dislocation</a> <sup>11</sup>.</p><h4>History and etymology</h4><p>It is named after American orthopaedic surgeon <strong>Robert B Osgood </strong>(1873-1956)<strong> </strong>and Swiss professor of surgery <strong>Carl Schlatter </strong>(1864-1934). </p><h4>Differential diagnosis</h4><p>Imaging differential considerations include:</p><ul>

References changed:

1. Stevens M, El-Khoury G, Kathol M, Brandser E, Chow S. Imaging Features of Avulsion Injuries. Radiographics. 1999;19(3):655-72. <a href="https://doi.org/10.1148/radiographics.19.3.g99ma05655">doi:10.1148/radiographics.19.3.g99ma05655</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10336196">Pubmed</a>
2. Hunter T, Peltier L, Lund P. Radiologic History Exhibit. Musculoskeletal Eponyms: Who Are Those Guys? Radiographics. 2000;20(3):819-36. <a href="https://doi.org/10.1148/radiographics.20.3.g00ma20819">doi:10.1148/radiographics.20.3.g00ma20819</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10835130">Pubmed</a>
3. Carr J, Hanly S, Griffin J, Gibney R. Sonography of the Patellar Tendon and Adjacent Structures in Pediatric and Adult Patients. AJR Am J Roentgenol. 2001;176(6):1535-9. <a href="https://doi.org/10.2214/ajr.176.6.1761535">doi:10.2214/ajr.176.6.1761535</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/11373229">Pubmed</a>
4. Harry B. Skinner. Current Diagnosis & Treatment in Orthopedics. (2003) ISBN: 9780071387583 - <a href="http://books.google.com/books?vid=ISBN9780071387583">Google Books</a>
5. William E. Prentice, Michael L. Voight. Techniques in Musculoskeletal Rehabilitation. (2001) ISBN: 0071354980 - <a href="http://books.google.com/books?vid=ISBN0071354980">Google Books</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>
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>
10, Circi E, Atalay Y, Beyzadeoglu T. Treatment of Osgood–Schlatter Disease: Review of the Literature. Musculoskelet Surg. 2017;101(3):195-200. <a href="https://doi.org/10.1007/s12306-017-0479-7">doi:10.1007/s12306-017-0479-7</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28593576">Pubmed</a>
11. Kamel S, Kanesa-Thasan R, Dave J et al. Prevalence of Lateral Patellofemoral Maltracking and Associated Complications in Patients with Osgood Schlatter Disease. Skeletal Radiol. 2021;50(7):1399-409. <a href="https://doi.org/10.1007/s00256-020-03684-6">doi:10.1007/s00256-020-03684-6</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/33404668">Pubmed</a>
1. Stevens MA, El-khoury GY, Kathol MH et-al. Imaging features of avulsion injuries. Radiographics. 19 (3): 655-72. <a href="http://radiographics.rsna.org/content/19/3/655.full">Radiographics (full text)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/10336196">Pubmed citation</a><div class="ref_v2"></div>
2. Hunter TB, Peltier LF, Lund PJ. Radiologic history exhibit. Musculoskeletal eponyms: who are those guys? Radiographics. 20 (3): 819-36. <a href="http://radiographics.rsna.org/content/20/3/819.full">Radiographics (full text)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/10835130">Pubmed citation</a><div class="ref_v2"></div>
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. <a href="http://www.ajronline.org/cgi/content/full/176/6/1535">AJR Am J Roentgenol (full text)</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/11373229">Pubmed citation</a><div class="ref_v2"></div>
4. Skinner HB. Current diagnosis & treatment in orthopedics. McGraw-Hill Medical. (2003) ISBN:0071387587. <a href="http://books.google.com/books?vid=ISBN0071387587">Read it at Google Books</a> - <a href="http://www.amazon.com/gp/product/0071387587?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0071387587">Find it at Amazon</a><div class="ref_v2"></div>
5. Prentice WE, Voight ML. Techniques in musculoskeletal rehabilitation. McGraw-Hill Medical. (2001) ISBN:0071354980. <a href="http://books.google.com/books?vid=ISBN0071354980">Read it at Google Books</a> - <a href="http://www.amazon.com/gp/product/0071354980?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0071354980">Find it at Amazon</a><div class="ref_v2"></div>
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. <a href="http://dx.doi.org/10.1148/radiology.185.3.1438775">doi:10.1148/radiology.185.3.1438775</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/1438775">Pubmed citation</a><span class="auto"></span>
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. <a href="http://dx.doi.org/10.1007/s00256-002-0486-z">doi:10.1007/s00256-002-0486-z</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/12073117">Pubmed citation</a><span class="auto"></span>
8. Gholve PA, Scher DM, Khakharia S et-al. Osgood Schlatter syndrome. Curr. Opin. Pediatr. 2007;19 (1): 44-50. <a href="http://dx.doi.org/10.1097/MOP.0b013e328013dbea">doi:10.1097/MOP.0b013e328013dbea</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/17224661">Pubmed citation</a><span class="auto"></span>
9. Dunn JF. Osgood-Schlatter disease. Am Fam Physician. 1990;41 (1): 173-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2403722">Pubmed citation</a><span class="auto"></span>

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