Osgood–Schlatter Disease

Osgood–Schlatter Disease Definition

Osgood–Schlatter Disease (OSD) is a condition that is characterized by irritation of patellar ligament at tibial tuberosity. The disease is most often observed in young adults and its most common signs are painful lumps that are experienced just below the knee.

The disease was named after the physicians Robert Osgood and Carl Schlatter in the year 1903. Osgood–Schlatter Disease is also known as:

  • Osgood–Schlatter Syndrome
  • Knobby knees
  • Epiphysitis of the tibular tubercle

Osgood–Schlatter Disease Causes

The long bones in the arms and legs of an individual have growth plates that are made out of cartilage. Each of the cartilage plates is located at the end of the bones. The cartilage is not as strong as the bone, and stress experienced on growth plate can cause swelling and pain.

The patella tendon is inserted at tibial tuberosity and by repeated overuse can cause erosion of the bone which leads to inflammations. The tibia is still at its growing stage and is not quite sturdy enough to tolerate strain on it. During activities which require a lot of jumping, running and bending, like soccer, volleyball, basketball and ballet, an individual’s quadriceps or thigh muscles exert a pull on tendon which connects the shinbone to the kneecap. Repeated stress can make the tendon pull away slightly from the shinbone, which leads to pain and swelling that is associated with OSD. Sometimes, the gap might get filled by the growth of a new bone (callus) that results in the formation of a bony lump in that particular area.

Osgood–Schlatter Disease Risk Factors

The risk factors for the disorder might include excess weight gain and overzealous conditioning (jumping and running). However, adolescent bone growth is the prime factor behind this condition.

Osgood–Schlatter Disease Epidemiology

Osgood-Schlatter disease affects boys and girls aged between 9 and 16 years. It is mostly seen in boys than in girls, as boys tend to participate more in sports and other risky activities than girls. The male to female ratio ranges from being 3:1 to 7:1.

Osgood–Schlatter Disease Symptoms

The overall symptoms of this syndrome depend on its severity, but the general signs include:

  • Pain in either or both the knees
  • Pain that minimizes with rest
  • Calcification of the tendons
  • Quadriceps muscles low in strength and bulk
  • Pain experienced while running or moving up and down the stairs
  • Pain during a full squatting or while straightening one’s knee joint
  • Pain worsened by activities such as running or jumping
  • Tightness of the thigh muscles or quadriceps
  • Swelling of the tibial tuberosity that can range from being mild to severe
  • The skin over one’s tibial tuberosity becoming reddish with inflammations

The knee bump that is formed is usually permanent, although it becomes painless with time. The knee movements remain normal as the original knee joint is not affected. The pain can either be constant or come and go in a recurring manner.

Osgood–Schlatter Disease Diagnosis

While trying to diagnose OSD, a doctor first conducts a thorough physical examination of the knee of a child and checks whether there are any signs of tenderness, pain, redness and swelling. The doctor may also want to evaluate the range of motion of the hip and knee of a child. The tests that are generally conducted to affirm the diagnosis of this syndrome include X-rays and ultrasound scans. The X-rays are usually performed to study the status of calcification around the insertion of the kneecap (patellar) tendon. Signs of damage or swelling in the tibial tubercle may be seen on the X-rays.

Osgood–Schlatter Disease Differential Diagnosis

A number of bone and joint conditions show signs and symptoms similar to that of OSD. Hence, while determining the diagnosis of this syndrome, a doctor or a diagnostician needs to differentiate its symptoms from those of similar health conditions in order to arrive at an appropriate treatment plan. The differential diagnoses of OSD include conditions such as:

  • Tumors
  • Bone tumors
  • Septic arthritis
  • Sever’s disease
  • Perthes disease
  • Meniscal injuries
  • Hoffa’s syndrome
  • Patellar tendonitis
  • Transient synovitis
  • Synovial plica injury
  • Pes Anserine Bursitis
  • Infectious apophysitis
  • Tibial tubercle fracture
  • Soft-tissue malignancy
  • Tibial tuberosity fracture
  • Chondromalacia patellae
  • Osteochondritis dissecans
  • Juvenile idiopathic arthritis
  • Quadriceps tendon avulsion
  • Femur Fractures and Injuries
  • Patellofemoral pain syndrome
  • Osteomyelitis of proximal tibia
  • Accessory ossification centers
  • Fracture of the Tibia and Fibula
  • Patellofemoral Joint Syndromes
  • Knee Osteochondritis Dissecans
  • Slipped proximal femoral epiphysis
  • Infrapatellar and prepatellar bursitis
  • Stress fractures affecting the patella
  • Sinding-Larson-Johansson syndrome
  • Collateral and cruciate injuries of the ligament

Osgood–Schlatter Disease Treatment

OSD might resolve naturally within a year or two after the bones of a child have stopped growing. However, up until that time it might cause severe discomfort. Treatment for OSD is usually conservative with Rest, Ice, Compression, and Elevation (RICE). Other procedures include:

Medications

Medications include painkillers and anti-inflammatory drugs. Ibuprofen, acetaminophen (paracetamol) or Co-Codamol or any other stronger drug might be used if the patient is experiencing continuous acute pain. The condition generally resolves within a few months. An observation of athletes reveals that training sessions should be stopped for at least a week. Full training should not be started before a month’s time.

Supportive equipments

Bracing or using an orthopedic cast for enforcing joint immobilization is very rarely required and it does not necessarily provide with a quicker resolution. However, bracing might provide comfort on certain occasions and help to reduce the pain as it minimizes the strain on tibial tubercle. Crutches might be used while walking as this can help to keep the weight off from the painful leg.

Surgery

Surgical intervention might be rarely needed in patients who are skeletally mature. In chronic cases which do not respond well to conservative treatment methods, surgical treatment provides positive results. This is especially so for patients having cartilaginous or bony ossicles. Surgery is generally a good prospect for already mature patients who have stopped growing but is still having OSD. An excision of the ossicles can cause resolution of the symptoms, after which the patient can return to normal activities within several weeks. After a surgical procedure, it is quite common to have hindered blood flow to the area below the knees as well as to the feet. It leads to loss of circulation in the area, which might get back to normal shortly. An intense pain might come and go in a recurrent manner due to lack of proper blood flow. In such cases, the patient is advised to sit down as this will help to ease the pain. Removing all of the loose intratendinous ossicles that are associated with the prominent tibial tubercles is the ideal surgical procedure both from a functional as well as a cosmetic perspective. A study reveals that functional outcome of the surgical treatment of an unresolved OSD is very good or excellent. The intensity of residual pain is low in such cases and prevalence of postoperative complications or possibilities of subsequent reoperations are very rare.

After the symptoms have resolved, gradual progression to complete recovery may begin. The predisposing factors should also be noted and addressed. Tightness of the quadriceps or hamstring might be present, which should be managed with stretching exercises that are recommended by the physiotherapist.

Once the patient is clinically diagnosed with this syndrome, he or she should take rest for a minimum of 3 days, and should avoid all strenuous physical activities that might cause pressure to the knee for at least the next 1 or 2 weeks. If the disorder continues to the extent where a patient is having difficulty in moving the joint, he or she should seek medical advice immediately. Although this is quite rare, it might prove to be severely damaging for a patient’s sporting future. The Strickland Protocol has yielded positive results in patients, after which they have been found to return to full activity within 3 weeks.

Osgood–Schlatter Disease Complications

Complications relating to the OSD are quite uncommon. Sometimes chronic pains or localized swelling might be experienced, which can be treated with ice packs and anti-inflammatory medications. After the symptoms have resolved, there might be a bony lump on the shinbone around the locality of the swelling. The lump might be present throughout the child’s life, although it doesn’t normally interfere with the general functions of the knee.

Osgood–Schlatter Disease Prognosis

Most cases of OSD are cured spontaneously in a few months or once the child stops growing. In cases where the child is experiencing persistent pains, appropriate medical intervention can help to erase the symptoms. Sometimes, there might be a recurrence of symptoms which should be managed in a manner similar to that of the earlier treatments.

Osgood–Schlatter Disease Pictures

The following images will show you the areas of the body that are affected by this condition.

 

Picture 1 – Osgood–Schlatter Disease

Osgood Schlatter Disease

Picture 2 – Osgood–Schlatter Disease Image

The symptoms of Osgood–Schlatter disease often go away on its own or are cured by appropriate treatment measures.

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