Osgood-Schlatter disease

Question 1

A 13-year-old male basketball player presents with several months of insidious onset of unilateral anterior knee pain, worse during practice and games and alleviated by rest, ice, and anti-inflammatory medicines. Physical examination demonstrates prominence of the tibial tubercle, with mild swelling and tenderness to palpation over the tubercle

Answer 1

Impression
Given location and natural history of the pain, most likely Osgood-schlatter disease: which is osteochondritis of the tibial tubercle, occurs in over-use injuries, get traction agpophysitis at the insertion of the patellar tendon

• usually occurs in paeds aged 9-14 who have undergone a rapid growth spurt

DDx

• malignancy: oesteosarcoma, ewings sarcoma, estochondroma
• oestomyelitis
• fractures
• quadriceps tendon avulsion
• tendonitis

Question 2

OS disease - History

Answer 2

History

• sx pain (SCORATES), site, sports history, impact on function, what activities exacerbate pain? what relieves? swelling? any ROM limitation? instability? clicking, locking, etc
• fam hx
• symmetric vs asymmetric

Question 3

OS disease - examination

Answer 3

Examination
- general appearance + vitals
- knee exam
o palpate: point tenderness
o normal ROM, ligaments, etc
o pain elicited with stressing the quadriceps whilst in full flexion
- assess joint above and below for ?referred pain

Question 4

OS disease - Investigations

Answer 4

Investigations
- knee x-ray: AP and Lateral
o elevation of tubercle away from shaft
o irregularity, fragmentation
o calcification within or thickening of the patellar tendon

Question 5

OS disease - Management

Answer 5

Management
is a benign and self-limiting condition. symptoms generally resolve once the growth plate has ossified

supportive

• parent and patient education
• analgesia
• continue activity provided pain is tolerated and resolves in <24 hours
• physical therapy to stretch out quadriceps

definitive
- arthroscopic removal of ossicle if formed and present