Osteochondritides: Osgood-Schlatter Disease Flashcards
Define Osgood-Schlatter Disease.
Extra-articular disease consisting of a tibial tubercle appophyseal traction injury causing pain and inflammation.
Explain the aetiology of Osgood-Schlatter Disease.
General: Traumatic mechanism. Coincides with the year following a rapid growth spurt. Bilateral in 25%.
Mechanism: Stress from quadriceps contraction is transmitted through the patellar tendon onto a small portion of the partially developed tibial tubercle apophysis, possibly resulting in a partial avulsion fracture through the ossification centre. Secondary heterotopic bone formation occurs in the tendon near its insertion point, forming the visible lump.
What are risk factors for Osgood Schlatter Disease?
Sports, especially those with high knee impact (e.g. repetitive jumping).
What are differential diagnoses for Osgood-Schlatter Disease?
Tibial fracture
Underlying tumour
Quadriceps tendon avulsion
Chondromalacia patellae
Osteomyelitis of the proximal tibia
Patellar tendonitis
Summarise the epidemiology of Osgood-Schlatter Disease.
Most common knee disorder in adolescence; post-rapid growth spurt; girls 10-11 years, boys 13-14 years. M>F (increased sporting activities in boys).
What are presenting symptoms of Osgood-Schlatter Disease?
Pain just below the knee where the patellar tendon inserts, usually present for several months before presentation.
Memorable history of trauma.
Pain is exacerbated by running, jumping, ascending and descending stairs, relieved by rest.
What are the signs of Osgood-Schlatter Disease?
Look: Soft tissue swelling over the proximal tibial tuberosity.
Feel: Tenderness over the proximal tibial tuberosity at the site of patellar insertion.
Move: Pain is reproducible on extending the knee against resistance, stressing the quadriceps or squatting with the knee in full flexion. Hamstrings and quadriceps are usually tight and frequently weak. Knee joint examination is normal as this is an extra-articular condition.
What are appropriate investigations for Osgood-Schlatter Disease?
X-ray knee: Shows fractures of the tibial tubercle, possibly a separate ossicle.
What is the management for Osgood-Schlatter Disease?
Rest: Avoidance of offending activity and other sports with strain on quadriceps. Aim is the achievement of pain-free state.
Medical: NSAIDs (pain relief/inflammation).
Orthopaedic devices: Infrapatellar strap and in severe cases a knee immobiliser splint may be used.
Surgical: Excision of the mobile ossicle is rarely required (skeletally mature adults).
Rehabilitation: Quadriceps-stretching and hip extension exercises should be advised after the acute symptoms have resolved so as to reduce tension on the tibial tubercle.
What are complications associated with Osgood-Schlatter Disease?
Non-uniform of the tibial tubercle
Patellar tendon avulsion
Continuing pain
Bony prominence
What is the prognosis of Osgood-Schlatter Disease?
Benign self-limiting disease
