Osgood-Schlatter Disease

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Osgood-Schlatter disease (OSD) is a condition that commonly affects growing adolescents involved in activities that place repetitive stress on the knee joint. The disease primarily involves traction apophysitis of the tibial tubercle, where the patellar tendon attaches to the tibia. This condition typically presents in boys aged 12-15 years and in girls aged 8-12 years, with a higher prevalence in boys due to greater participation in high-impact sports such as basketball, soccer, and track and field.
Pathophysiology
The tibial tubercle is a secondary ossification center that undergoes significant stress during growth spurts. OSD arises when repetitive tension from the quadriceps muscle, transmitted via the patellar tendon, causes inflammation and microtrauma at the insertion point on the tibial tubercle. This process leads to pain, swelling, and tenderness localized to the anterior aspect of the knee.
As skeletal development progresses, the tibial tubercle goes through different stages:
Less than 11 years: The tibial tubercle is cartilaginous.
11-14 years: The apophysis forms.
14-18 years: The apophysis fuses with the tibial epiphysis.
More than 18 years: The epiphysis and apophysis are completely fused to the tibia.
The combination of rapid growth and high physical activity in adolescence makes this population particularly susceptible to OSD.
Clinical Presentation
Symptoms: Patients typically present with pain localized over the tibial tubercle, which is exacerbated by physical activities such as running, jumping, or squatting. The pain may increase with kneeling or direct pressure on the tubercle.
Physical Exam: The tibial tubercle may appear enlarged and is often tender to palpation. In severe cases, a palpable prominence is observed.
Imaging: Although diagnosis is usually clinical, lateral X-rays can be useful to confirm fragmentation of the tibial tubercle and rule out other causes of knee pain.
Diagnosis
The diagnosis of OSD is primarily clinical and based on characteristic symptoms and physical findings. Imaging, such as lateral knee X-rays, may show irregularity or fragmentation of the tibial tubercle, particularly in more advanced or persistent cases. However, imaging is not always necessary unless the clinical picture is unclear or if there is concern for other conditions such as fractures or tumors.
Treatment
Nonoperative Management: The cornerstone of treatment is activity modification. Patients are advised to reduce or avoid activities that exacerbate the symptoms until the inflammation resolves. Other nonoperative treatments include:
NSAIDs: To manage pain and inflammation.
Quadriceps and Hamstring Stretching: Reducing the tension on the tibial tubercle by improving flexibility in the muscles surrounding the knee.
Ice Therapy: Applied post-activity to alleviate inflammation.
Knee Bracing: Patellar straps or braces can be helpful in reducing stress on the tubercle.
Surgical Intervention: Surgery is rarely necessary and is reserved for cases where conservative management fails, particularly in skeletally mature patients. Procedures may include the removal of ossicles or bony prominences causing persistent pain.
Prognosis
Osgood-Schlatter disease is generally a self-limiting condition that resolves once the individual reaches skeletal maturity and the tibial tubercle fuses with the tibia. Most patients experience complete resolution of symptoms with appropriate activity modification and physical therapy. However, a small percentage may experience persistent discomfort or residual swelling into adulthood, especially if the condition was untreated or severe during adolescence.