Osgood-Schlatter disease
Objectives- Define Osgood-Schlatter disease
- Describe clinical symptoms and signs of Osgood-Schlatter disease
- Describe the natural history of Osgood-Schlatter disease
- Discuss imaging of Osgood-Schlatter disease
- Discuss treatment of Osgood-Schlatter disease
- Describe the ossification process of the tibial tubercle
Discussion
Osgood-Schlatter (OS) disease obviously retains the eponymic label from the first two men to describe the condition almost 100 tears ago, even though it is not a disease. It is common, and usually presents between the ages of 10-15. Clinically, it is characterized by well localized pain to the patellar tubercle. The growth plate of the tibial tuberosity is unique, in that it is composed primarily of fibrocartilage and fibrous tissue. As the apophysis matures, ossification changes from membranous to enchondral. During the enchondral phase, the physis is less resistant to tensile stress, and failure may be manifested by fragmentation of bone at this site. Osgood-Schlatter disease is characterized by pain with kneeling and/ or pain with activity involving quadriceps contraction. The relation of the patellar tendon to the patella has been studied rather extensively. Using the Insall-Salvati method, patella infera was noted with OS disease; using the Caton-Deschamps method, patella alta was noted. Those using the Caton-Deschamps method feel it is more suitable for skeletally immature patients. Dejour and Caton felt patella alta was part of a regional patellofemoral dysplasia. Radiographically, OS disease is characterized by fragmentation and/ or prominence of the tibial tuberosity. Radiographic findings do not necessarily correlate with clinical symptoms and add little to management unless the diagnosis of OS disease is erroneus. The clinical picture of OS disease is so characteristic that a diagnosis can be made without radiography. Soft tissue changes, especially retropatellar bursitis have been noted on MRI, and it has been suggested that the soft tissue component is primarily responsible for symptoms rather than the bony fragmentation. Ultrasound can also reveal inflammatory changes.
The natural history of OS disease is benign, with almost all cases asymptomatic by skeletal maturity. Treatment is thus symptomatic, avoidance of kneeling or knee pads, maintenance of quadriceps strength by straight leg raising exercises, and rarely immobilization. Surgical treatment has been described for excision of a residual loose ossicle remaining at skeletal maturity with good results. Surgical treatment has also been described for the skeletally immature with refractory symptoms. The procedure, originally described by Fericot, consists of mobilizing the patellar tendon and excising the tibial tuberosity prominence. Series reporting favorable and unfavorable results are listed in the references. Most authors do not consider surgery until skeletally maturity, and then only in a small minority.
References
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- Binazzi R, Felli L, Vaccari V, Borelli P. Surgical treatment of unresolved Osgood-Schlatter lesion. Clinical Orthopaedics & Related Research 1993( 289): 202-4.
- Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. [Patella infera. Apropos of 128 cases]. Revue de Chirurgie Orthopedique et Reparatrice de l Appareil Moteur 1982; 68( 5): 317-25.
- Caton J, Mironneau A, Walch G, Levigne C, Michel CR. [Idiopathic high patella in adolescents. Apropos of 61 surgical cases]. Revue de Chirurgie Orthopedique et Reparatrice de l Appareil Moteur 1990; 76( 4): 253-60.
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- Lancourt JE, Cristini JA. Patella alta and patella infera. Their etiological role in patellar dislocation, chondromalacia, and apophysitis of the tibial tubercle. Journal of Bone & Joint Surgery -American Volume 1975; 57( 8): 1112-5.
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- Ogden JA, Southwick WO. Osgood-Schlatter's disease and tibial tuberosity development. Clinical Orthopaedics & Related Research 1976( 116): 180-9.
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- Rosenberg ZS, Kawelblum M, Cheung YY, Beltran J, Lehman WB, Grant AD. Osgood-Schlatter lesion: fracture or tendinitis? Scintigraphic, CT, and MR imaging features. Radiology 1992; 185( 3): 853-8.
- Sen RK, Sharma LR, Thakur SR, Lakhanpal VP. Patellar angle in Osgood-Schlatter disease. Acta Orthopaedica Scandinavica 1989; 60( 1): 26-7.
- Trail IA. Tibial sequestrectomy in the management of Osgood-Schlatter disease. Journal of Pediatric Orthopedics 1988; 8( 5): 554-7.
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