Osgood-Schlatter disease
A 13-year-old boy presents to the clinic for a complaint of right knee pain that he first noticed about a year ago. It started out as mild discomfort in the area just below the kneecap, but has been getting progressively worse. Now, it hurts anytime he uses his leg, even when walking. He does not remember any injury to his knee. On examination of his knee there is swelling and exquisite tenderness over the tibial tubercle. Radiographs are normal. What is the most likely diagnosis? A. Chondromalacia patellae B. Legg-Calvé-Perthes disease C. Osgood-Schlatter disease D. Patellar dislocation
C. Osgood-Schlatter disease Osgood-Schlatter disease is caused by microfractures of the patellar ligament where it inserts into the tibial tubercle. This condition usually occurs in the preteen and adolescent years, and is more common in males than females. The history of injury can be vague and the patient may not remember a specific injury that precipitated the pain. Often, the pain progresses to the point of interference of even routine physical activities. X-rays may or may not show any abnormalities. Upon x-ray, type I disease appears normal, but type II will reveal fragmentation of the tibial tubercle. Often, after healing there will be enlargement of the tibial tubercle. Generally, treatment consists of rest, limitation of activities, and isometric exercises. Chondromalacia patellae can only be diagnosed under an arthroscopic examination, not on the basis of clinical features. Patellofemoral overuse syndrome presents with medial knee pain and subpatellar pain. Additional signs are swelling and crepitus in the knee and it is more common in females than males. It is diagnosed by increased Q-angles (anterosuperior iliac spine through center of patella to tibial tubercle). Subluxation of the patella or dislocation is more common in adolescent girls and the patient presents with acute knee pain. The knee is in flexion with a mass lateral to the knee and with absence of the bony prominence of the patella (flat). X-ray confirms the dislocation. Legg-Calvé-Perthes disease is avascular necrosis of the proximal femur and usually presents between 4 and 8 years of age.
What is the epidemiology of Osgood-Schlatter disease?
It usually occurs after a growth spurt and is more common in boys. The age at onset is typically 11 years for girls and 13-14 years for boys.
How is Osgood-Schlatter disease diagnosed?
Osgood-Schlatter disease is a clinical diagnosis based on history; additional signs and symptoms include anterior knee pain that increases over time, an enlarged tibial tubercle, and localized edema. Diagnostic imaging with a lateral radiograph of the knee: -For atypical presentation (pain not related to activity, fever, rash, etc.) to exclude other conditions (e.g. osteomyelitis) -Irregularity and fragmentation of the tibial tubercle
What is Osgood-Schlatter disease?
Osgood-Schlatter disease is a common cause of knee pain at the insertion of the patellar tendon on the tibial tubercle. The stress from a contracting quadriceps muscle is transmitted through the developing tibial tubercle, which can cause microfractures and apophysitis.
When is surgical intervention warranted for Osgood-Schlatter disease?
Ossicle resection and/or excision of the tibial tuberosity - considered in patients who do not respond to conservative management and after skeletal maturity.
Osgood-Schlatter Disease is characterized as what type of syndrome?
Overuse syndrome
What is a "classic" presentation for Osgood-Schlatter disease?
Patient will present as → a 14-year-old boy with left knee pain. He denies any trauma to the knee. The patient runs cross country for his high school team and attends practice regularly. On physical exam, the tibial tubercle is pronounced and there is tenderness to palpation over the affected area. The patient reports pain upon resisted knee extension.
How does Osgood-Schlatter disease present clinically?
Patients will present with pain during and after activity as well as have tenderness and local swelling over the tibial tubercle at the point of insertion of the patellar tendon. Pain on resisted knee extension with lump below the knee and prominent tibial tuberosity. Radiographs may be necessary to rule out infection, tumor or avulsion fracture.
How is Osgood-Schlatter disease treated?
Rest and activity modification are paramount for treatment. Pain control medications and icing may be helpful. Lower extremity flexibility and strengthening exercise programs are important.
What is the prognosis of Osgood-Schlatter disease?
The course is usually benign, but symptoms frequently last 1-2 years. Complications can include bony enlargement of the tibial tubercle and avulsion fracture of the tibial tubercle.