Name
OSGOOD-SCHLATTER DISEASE
DESCRIPTION
DETAIL
CAUSES Basic etiology unknown, but clearly exacerbated by exercise - jumping and pivoting sports are the worst; repetitive trauma the most likely source. Possible association with tight hip flexors, quadriceps and hamstring muscle groups. -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Stress fracture of the proximal tibia β’ Pes anserinus bursitis β’ Quadriceps tendon avulsion β’ Patellofemoral stress syndrome β’ Chondromalacia patellae β’ Proximal tibial neoplasm β’ Osteomyelitis of the proximal tibia β’ Tibial plateau fracture β’ Sinding-Larson Johansson disease (patellar apophysitis) β’ Patellar tendinitisLABORATORY No blood tests indicated unless other diagnostic considerations are entertained IMAGING β’ X-ray imaging of the proximal tibia and knee may show heterotopic calcifi cation in the patellar tendon. X-rays are rarely diagnostic. β’ Calcified thickening of the tibial tuberosity with irregular ossification at insertion of tendon to tibial tubercle β’ Bone scan may show increased uptake in the area of the tibial tuberosity; will have increased uptake in apophysis in any child, but may be more than opposite side β’ Ultrasound is becoming an excellent alternative with characteristic findings and classifications
TYPENOTES
RISK FACTORS: Age between 11 and 18, Male sex, Rapid skeletal growth, Involvement in repetitive jumping sportsGENERAL MEASURES β’ Frequent ice applications post exercise with pain β’ Rest β’ Knee immobilization in extension (severe cases) β’ In more severe cases, avoidance of activities that increase pain or swelling β’ Quadriceps isometric strengthening, hip extensions, adductor strengthening, hamstring and quadriceps stretching exercises β’ Patients with marked pronation may benefi t from orthotics SURGICAL MEASURES DΓ©bridement of a thickened cosmetically unsatisfactory tibial tubercle (rare) or removal of heterotopic bone ACTIVITY Activity to be restricted to those activities not causing pain PATIENT EDUCATION β’ Consider avoidance of jumping sports. Assure family that symptoms and findings will diminish with time and rest. β’ OK to play sport with mild pain DRUG(S) OF CHOICE None in particular, but all analgesics may be considered. NSAIDs are of minimal benefit; however narcotics are not recommended ALTERNATIVE DRUGS β’ More potent analgesics such as narcotics may be considered for short term use or in extreme situations β’ No objective evidence to support the use of selenium in OSD PATIENT MONITORING Follow up on a prn basis for management of pain and disability PREVENTION/AVOIDANCE β’ Avoidance of those sports involving heavy quadriceps loading β’ Patients may compete if the pain is minimal β’ Increase hamstring and quadriceps flexibility POSSIBLE COMPLICATIONS β’ Nonunion of the tubercle to the tibia β’ Upriding of the patella β’ Patellar tendon avulsion β’ Genu recurvatum β’ Patellofemoral degenerative arthritis β’ Patella alta β’ Chondromalacia EXPECTED COURSE/PROGNOSIS Except in rare complicated cases, this is a self-limiting illness resolved within two years after full skeletal maturation. However, up to 60% of adults with prior Osgood-Schlatter disease will still report occasional symptoms and have pain with kneeling.
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
X-RAY KNEE JOINT A.P. & LAT. VIEW, BONE SCAN, COMPLETE BLOOD COUNT, X-RAY, ULTRA SOUND EXAM