Osgood-Schlatter disease is an aseptic destruction of the tuberosity and the nucleus of the tibia, which occurs against the background of their chronic injury during the period of intensive growth of the skeleton. It is manifested by pain in the lower part of the knee joint that occurs when it is bent (squats, walking, running), and swelling in the area of tuberosity of the tibia. It is diagnosed based on the assessment of anamnesis data, examination, X-ray examination and CT of the knee joint, local densitometry and laboratory studies. It is treated in most cases by conservative methods: gentle motor regimen, anti-inflammatory drugs, analgesics, physiotherapy, exercise therapy, massage.
ICD 10
M92.5 Juvenile osteochondrosis of the tibia and fibula
Meaning
Osgood-Schlatter disease was described in 1906 by Osgood-Schlatter, whose name it bears. Another name of the disease, which is also used in clinical orthopedics and traumatology, reflects the essence of the processes occurring in Osgood-Schlatter disease and sounds like “osteochondropathy of tibial tuberosity”. From this name it can be seen that Osgood-Schlatter disease, like Calve’s disease, Timann’s disease and Koehler’s disease, belongs to the group of osteochondropathies — diseases of non-inflammatory genesis, accompanied by necrosis of bone tissue.
Osgood-Schlatter disease is observed during the period of the most intensive bone growth in children from 10 to 18 years, much more often in boys. The disease can occur with the defeat of only one limb, but quite often there is a Schlatter disease with a pathological process in both legs.
Causes
Trigger factors in the development of Osgood-Schlatter disease can be direct injuries (damage to the ligaments of the knee joint, fractures of the shin and patella, dislocations) and constant microtraumatization of the knee during sports. Medical statistics indicate that Osgood-Schlatter disease appears in almost 20% of teenagers who are actively involved in sports, and only 5% of children who are not engaged in sports.
Sports with an increased risk of developing Osgood-Schlatter disease include basketball, hockey, volleyball, football, gymnastics, ballet, figure skating. It is sports that explain the more frequent occurrence of Osgood-Schlatter disease in boys. The recent more active participation of girls in sports sections has led to a reduction in the gap between the sexes regarding the development of Osgood-Schlatter disease in them.
Pathogenesis
As a result of overloads, frequent microtraumas of the knee and excessive tension of the patellar ligament, which occurs during contractions of the powerful quadriceps femoral muscle, there is a disorder of blood supply in the area of tuberosity of the tibia. There may be minor hemorrhages, rupture of the fibers of the patellar ligament, aseptic inflammation in the area of the bags, necrotic changes in the tuberosity of the tibia.
Osgood-Schlatter disease symptoms
Pathology is characterized by a gradual, low-symptom onset. Patients, as a rule, do not associate the occurrence of the disease with a knee injury. Osgood-Schlatter disease usually begins with the appearance of non-intense pain in the knee when bending, squatting, climbing or descending stairs. After increased physical exertion on the knee joint (intensive training, participation in competitions, jumping and squatting in physical education classes), symptoms of the disease manifest.
There are significant pains in the lower part of the knee, which increase when it is bent while running and walking and subside with complete rest. Acute attacks of cutting pain may appear, localized in the anterior region of the knee joint — in the area of attachment of the patellar tendon to the tuberosity of the tibia. In the same area, swelling of the knee joint is noted. Osgood-Schlatter disease is not accompanied by changes in the general condition of the patient or local inflammatory symptoms in the form of fever and redness of the skin at the site of swelling.
When examining the knee, its swelling is noted, smoothing the contours of the tuberosity of the tibia. Palpation in the area of tuberosity reveals local soreness and swelling, which has a dense-elastic consistency. A solid protrusion is palpated through the swelling. Active movements in the knee joint cause pain of varying intensity. Osgood-Schlatter disease has a chronic course, sometimes there is a wave-like course with the presence of pronounced periods of exacerbation. The disease lasts from 1 to 2 years and often leads to the recovery of the patient after the end of bone growth (approximately at the age of 17-19 years).
Diagnostics
The combination of clinical signs and the typical localization of pathological changes allows to establish Osgood-Schlatter disease. The age and gender of the patient are also taken into account. However, X-ray examination is crucial in making a diagnosis, which should be carried out in dynamics for greater informativeness. Radiography of the knee joint is performed in a straight and lateral projection.
In some cases, ultrasound of the knee joint, MRI and CT of the joint are additionally performed. Densitometry is also used to obtain data on the structure of bone tissue. Laboratory diagnostics is prescribed to exclude the infectious nature of the knee joint lesion (specific and nonspecific arthritis). It includes a blood test, a blood test for C-reactive protein and rheumatoid factor, and PCR studies.
In the initial period, Osgood-Schlatter disease is characterized by an X-ray picture of the flattening of the soft cover of the tuberosity of the tibia and the raising of the lower border of the enlightenment corresponding to the adipose tissue located in the anterior part of the knee joint. The latter is due to an increase in the volume of the subcollenary bag as a result of its aseptic inflammation. There are no changes in the nuclei (or nucleus) of ossification of the tuberosity of the tibia at the beginning of Osgood-Schlatter disease.
Over time, the displacement of the ossification nuclei forward and upward by an amount from 2 to 5 mm is radiologically noted. There may be an indistinctness of the trabecular structure of the nuclei and an unevenness of their contours. Gradual resorption of displaced nuclei is possible. But more often they merge with the main part of the ossification nucleus to form a bone conglomerate, the base of which is the tuberosity of the tibia, and the tip is a spike—shaped protrusion, well visualized on a lateral radiograph and palpable on palpation in the area of tuberosity.
The differential diagnosis of Osgood-Schlatter disease should be carried out with a tibial fracture, syphilis, tuberculosis, osteomyelitis, and tumor processes.
Osgood-Schlatter disease treatment
Patients usually undergo outpatient conservative treatment by a surgeon or orthopedic traumatologist. First of all, it is necessary to exclude physical exertion and ensure the maximum possible rest of the affected knee joint. In severe cases, it is possible to apply a fixing bandage to the joint. The drug treatment of Osgood-Schlatter disease is based on anti-inflammatory and painkillers. Physiotherapy methods are also widely used: mud therapy, magnetotherapy, UHF, shock wave therapy, paraffin treatment, massage of the lower limb. To restore the destroyed areas of the tibia, electrophoresis with calcium is performed.
Physical therapy classes include a set of exercises aimed at stretching the hamstrings and quadriceps of the thigh. Their result is a decrease in the tension of the patellar ligament attached to the tibia. To stabilize the knee joint, the therapeutic complex also includes exercises that strengthen the thigh muscles. After a course of treatment for Osgood-Schlatter disease, it is necessary to limit the loads on the knee joint. The patient should avoid jumping, running, kneeling, squats. It is better to change traumatic sports to more gentle ones, for example, swimming in the pool.
With pronounced destruction of bone tissue in the area of the tibial head, surgical treatment of Osgood-Schlatter disease is possible. The operation consists in removing necrotic foci and suturing a bone graft that fixes the tuberosity of the tibia.
Prognosis and prevention
Most of those who have suffered from Osgood-Schlatter disease retain a pineal protrusion of the tuberosity of the tibia, which does not cause pain and does not violate the function of the joint. However, complications can also be observed: mixing of the patella upwards, deformities and osteoarthritis of the knee joint, leading to a pain syndrome that constantly occurs when resting on a bent knee. Sometimes, after Osgood-Schlatter disease, patients complain of aching or aching pains in the knee joint area that occur when the weather changes. Prevention includes ensuring an adequate regime of loads on the joint.
Literature
- Basic Differences and Most Common Findings in Ultrasound Examinations of Musculoskeletal System in Children: A Narrative Literature Review. Poboży T, Konarski W, Piotrowska-Lis K, Domańska J, Poboży K, Kielar M. Healthcare (Basel). 2022 Oct 12;10(10):2010. link
- Osteochondroma of the Tibial Tubercle Masquerading as Osgood-Shlatter Disease: A Case Report. Agaronnik ND, Landrum M, Wait T, Hogue GD. Clin Med Insights Case Rep. 2022 Aug 13;15:11795476221111771. link
- Chronic insertional Achilles tendinopathy secondary to congenital os Achilles: A case report. Washburn FJ, Chiang E, Pyle C. Int J Surg Case Rep. 2022 Jun 27;96:107355 link
- Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review. Corbi F, Matas S, Álvarez-Herms J, Sitko S, Baiget E, Reverter-Masia J, López-Laval I. Healthcare (Basel). 2022 May 30;10(6):1011 link
