OSGOOD-SCHLATTER DISEASE

Overview

In 1903, Robert Bayley Osgood and Carl B Schlatter first described this entity as traction apophysitis of insertion of tibial tubercle leading initially to tendinitis (inflammation) and later on avulsion. 

It’s usually at the ligament-bone junction of the patellar tendon and the tibial tuberosity. 

The tibial tuberosity is a slight elevation of bone around the proximal and front portion of the tibia (lower bone of the leg). 

The patellar tendon is an extension of the quadriceps (thigh) muscles to the tibia via the patella (knee cap)

This disease typically occurs in boys ages 12 to 14 and girls ages 10 to 13. The difference is because girls enter puberty earlier than do boys. The condition usually resolves on its own, once the child’s bones stop growing. 

It’s usually one-sided but bilateral symptoms are seen in around 30% of cases. 

ETIOPATHOGENESIS

It has definitely linked with the growth spurt. Probably caused by forceful contractions of the quadriceps muscles transmitted through the patellar tendon to the tibial tuberosity leading to pathological changes at the proximal tibial apophysis insertion. Also proposed is a mismatch between the force of the quadriceps contraction and the maturity of the patellar tendon – tibial junction leading to multiple small avulsion fractures, distal patellar tendinitis or osteochondritis.

Causes

Sporting Activities like:

• Soccer
• Basketball
• Volleyball
• Ballet
• Gymnastics

Repeated Activities like:

• Squatting
• Jumping
• Ascending or Descending Stairs
• Running

RISK FACTORS

Age

• Mainly occurs during puberty’s growth spurts
• Age ranges: Boys-12 to 14; Girls- 10 to 13

Gender 

• More common in boys

Sports

• Involving running, jumping and swift changes in direction

Flexibility

• Tightness in the quadriceps muscles can increase the pull of the kneecap’s tendon on the growth plate at the top of the shinbone.

DIAGNOSIS

Clinical presentation: 

Age group:

• Boys: 12-15 years
• Girls: 10- 12 years

History of activity:

• Pain present over the patellar tendon which is increased by exercise and relieved by rest 
• Difficulty in walking with associated limp.

Examination:

• Visible lump/ Prominence and soft-tissue swelling over the tibial tubercle
• Tenderness over tibial tuberosity and patellar tendon
• Pain on extension of the knee 
• Pain on resisted knee extension 
• High rising patella
• Tight hamstrings and/or quadriceps with weakness of quadriceps may also be noted when compared with the uninvolved side.
• In adults, a large ossicle and an overlying bursa may cause pain with kneeling and its treatment consists of excision of the bursa, ossicle and any prominence.

Radiological Examination: 

• X-ray usually clinches the diagnosis but may occasionally be normal.
• Ultrasound can be used to detect any swelling in cartilage or tissue around tibial tuberosity or early new bone formation.

Treatment

Physiotherapy

• Stretching & Strengthening (Quadriceps, Hamstrings & Calf Muscles)
• Bracing

Surgery

• In very rare cases, if pain is debilitating and doesn’t subside after the growth spurt, surgery to remove the bony overgrowth might be recommended.