Osgood-Schlatter Disease (OSD)

Osgood-Schlatter Disease (OSD)

Key Points

  • Traction apophysitis of the tibial tubercle
  • Common in adolescents during growth spurts
  • More frequent in athletic teenagers
  • Boys typically affected age 13-14
  • Girls typically affected age 11-12

Overview

Osgood-Schlatter Disease is a common cause of anterior knee pain in growing adolescents, particularly those involved in sports requiring running, jumping, and quick directional changes. It represents inflammation of the patellar tendon insertion at the tibial tubercle apophysis during periods of rapid growth.

Pathophysiology

Anatomical Considerations:

  • Biomechanical factors:
    • Repetitive quadriceps contraction
    • Traction force on tibial tubercle
    • Microavulsion at tendon insertion
  • Growth-related factors:
    • Rapid skeletal growth
    • Apophyseal vulnerability
    • Muscle-tendon imbalance

Risk Factors:

  • Sports participation:
    • Basketball
    • Volleyball
    • Soccer
    • Gymnastics
    • Dance
  • Anatomic factors:
    • Tight quadriceps
    • Tight hamstrings
    • Patella alta
  • Growth-related:
    • Adolescent growth spurt
    • High activity level during growth

Clinical Presentation

History:

  • Symptoms:
    • Anterior knee pain
    • Pain worse with activity
    • Pain with direct pressure
    • Bilateral in 20-30% of cases
  • Aggravating activities:
    • Running
    • Jumping
    • Stairs
    • Kneeling
  • Timing:
    • Gradual onset
    • During growth spurts
    • Athletic seasons

Physical Examination:

  • Inspection:
    • Tibial tubercle prominence
    • Soft tissue swelling
    • Local tenderness
  • Palpation:
    • Point tenderness over tubercle
    • Soft tissue swelling
    • Warmth possible
  • Special tests:
    • Pain with resisted knee extension
    • Pain with jumping
    • Flexibility assessment

Diagnosis & Assessment

Imaging Studies:

  • Radiographs:
    • Lateral knee view primary
    • Findings:
      • Fragmentation of tibial tubercle
      • Soft tissue swelling
      • Irregular ossification
  • Ultrasound:
    • Cartilage swelling
    • Tendon thickening
    • Bursal inflammation
  • MRI:
    • Rarely necessary
    • Used to rule out other pathology
    • Shows edema and inflammation

Differential Diagnosis:

  • Sinding-Larsen-Johansson syndrome
  • Patellar tendonitis
  • Tibial tubercle fracture
  • Patellar subluxation
  • Soft tissue tumor
  • Infection

Management

Conservative Treatment:

  • Activity modification:
    • Relative rest
    • Sport modification
    • Avoid aggravating activities
  • Physical therapy:
    • Stretching exercises:
      • Quadriceps
      • Hamstrings
      • Hip flexors
    • Strengthening:
      • Core stability
      • Hip muscles
      • VMO exercises
  • Pain management:
    • Ice after activity
    • NSAIDs as needed
    • Patellar strap

Return to Activity Protocol:

  • Phase 1: Pain control
  • Phase 2: Flexibility
  • Phase 3: Strengthening
  • Phase 4: Sport-specific training
  • Phase 5: Return to full activity

Surgical Management:

  • Rarely indicated
  • Indications:
    • Persistent symptoms after skeletal maturity
    • Large painful ossicles
    • Failed conservative treatment
  • Procedures:
    • Ossicle excision
    • Tubercle recontouring

Prognosis & Complications

Expected Course:

  • Natural History:
    • Self-limiting condition
    • Resolves with skeletal maturity
    • Duration: 12-24 months
  • Recovery Phases:
    • Acute: 2-3 weeks
    • Rehabilitation: 6-8 weeks
    • Return to sport: 2-3 months

Potential Complications:

  • Short-term:
    • Persistent pain
    • Activity limitation
    • Tibial tubercle avulsion (rare)
  • Long-term:
    • Persistent tubercle prominence
    • Painful ossicles
    • Anterior knee pain

Prevention Strategies:

  • Pre-season conditioning
  • Proper warm-up
  • Flexibility maintenance
  • Load management
  • Proper equipment


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