Osgood-Schlatter Disease

Snapshot

• A 12-year-old boy presents to his pediatrician with right knee pain. He began playing basketball for his school a few months ago. On physical exam, there is a pronounced, tender tibial tubercle and tenderness to palpation over the affected area. The patient reports pain upon resisted knee extension.

Introduction

• Clinical definition
  • describes traction apophysitis of the tibial tuberosity 
• Epidemiology
  • demographics
    • male:female ratio
      • more common in males
    • age bracket
      • 12-15 years of age in boys
      • 8-12 years of age in girls
  • risk factors
    • participating in sports
• Pathogenesis
  • repetitive traction of the apophysis of the tibial tuberosity results in microtrauma and micro-avulsion 
    • the patellar tendon insertion separates from the tibial tubercle
      • during healing there is callous deposition that leads to a pronounced tubercle
• Prognosis
  • self-limiting
• responds well to conservative management

Presentation

• Symptoms
  • anterior knee pain
• Physical exam
  • inspection
    • enlarged tibial tubercle
    • tenderness over tibial tubercle
  • provocative test
• pain on resisted knee extension

Imaging

• Radiographs
  • recommended views
    • lateral radiograph of the knee
  • findings
• irregularity and fragmentation of the tibial tubercle 

Studies

• Diagnostic criteria
• a clinical diagnosis

Differential

• Sinding-Larsen-Johansson syndrome
  • chronic apophysitis or minor avulsion injury of the inferior patellar pole 
• Osteochondroma of the proximal tibia
• Tibial tubercle fracture 
• Patellar tendonitis

Treatment

• Conservative
  • analgesics, ice, and physical therapy
    • indication
• first-line treatment for Osgood-Schlatter disease

Complications

• Tubial tubericle prominence persists
• Genu recurvatum