Osgood-Schlatter's Disease

Question 1

What is OSD?

Answer 1

Overuse syndrome
Inflammation of insertion point of patellar tendon at tibial tuberosity
Seen in young adults during adolescent growth spurt
Typically self-limiting and resolves after activity modification

Question 2

Another term for Osgood-Schlatter disease?

Answer 2

Tibial apophysitis

Question 3

How does OSD typically present?

Answer 3

Pain, tenderness to palpation, and swelling directly over tibial tubercle

Question 4

risk factors for OSD?

Answer 4

adolescent male
athletic
hx of OSD in CL knee
patella alta

Question 5

dx of OSD?

Answer 5

CLINICAL DIAGNOSIS

risk factors present
pain at tibial tubercle
localised tenderness

Question 6

ix of OSD?

Answer 6

NOT USUALLY DONE

plain xrays - ordered initially if sx unilateral, severe or persistent + trauma hx
if dx uncertain, consider ultrasonography or MRI

Question 7

what would plain x-rays show in OSD?

Answer 7

early: maybe normal, anterior soft tissue swelling
later:
- enlarged tibial tubercle
- irregular ossification of tubercle
- fragmentation of tubercle
- formation of separate ossicle

Question 8

differentials for OSD?

Answer 8

tibial tubercle fracture
fat pad hypertrophy (Hoffa’s disease)
inferior patellar pole traction apophysitis
patellar stress fracture
osteochondritis dissecans of knee

Question 9

how to differentiate OSD from tibial tubercle fracture?

Answer 9

signs: fracture - unable to extend knee + WB, sudden onset, trauma

x-ray: irregular fracture line usually without tubercular fragmentation

Question 10

how to differentiate OSD from fat pad hypertrophy/hoffa’s disease?

Answer 10

signs: max tenderness at ant. joint line lateral to patellar tendon

x-ray: normal in hoffa’s

Question 11

how to differentiate OSD from inferior patellar pole traction apophysitis?

Answer 11

signs: max tenderness at inferior patellar pole

x-ray: separated ossicle/elongated inferior pole of patella with normal tibial tubercle

Question 12

how to differentiate OSD from patellar stress fracture?

Answer 12

signs: very rare, crack/pop with activities, varying WB degree, pain/swelling/tenderness ant. patella

x-ray: transverse fracture line, callus formation possibly, no changes to tibial tubercle

Question 13

how to differentiate OSD from osteochondritis dissecans of knee?

Answer 13

signs: anterior knee pain, intermittent swelling, mechanical symptoms + trauma + tenderness in joint line possibly

x-ray: lat aspect of medial femoral condyle lesion

Question 14

mx of OSD?

Answer 14

early - >90% respond w rest, ice NSAIDs, physio, knee immobilisation/braces if severe

progressive/late - despite conservative mx. may need surgery (only if skeletally mature) or local injections of lidocaine or hyperosmolar dextrose.

Question 15

first-line surgical options for OSD?

Answer 15

partial tibial tubercle resection
drilling of tibial tubercle
excision of separated ossicle

Question 16

long-term comps of OSD?

Answer 16

bony overgrowth of tibial tubercle
persistence of bony ossicle into adulthood

may be cosmetic or may cause pain/f(x) limitation

Question 17

how does a bony prominence at the tibial tubercle form in OSD?

Answer 17

a small ossicle forms from the fragmentation of the apophysis

ths ossicle can then impinge on the patellar tendon -> pain, functional limitation

Question 18

how are OSD ossicles treated?

Answer 18

surgical excision and/or osteoplasty of tibial tubercle