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Osgood-Schlatter disease

Classifies as, but not truly an osteochondrosis Etiology: 1) microtearing of the quadriceps tendon at its attachment to the anterior tibial tubercle 2) partial separation of the physis may also occur 3) most frequent in males age 11-13 active in sports requiring running, kicking, &/or jumping Pathology: - osteochondrosis of the tibial tubercle Clinical manifestations: 1) activity related pain localized over the tibial tubercle 2) pain aggravated by running, jumping, kicking, stair- climbing, kneeling 3) the dominant leg is typically more symptomatic 4) limping gait 5) tibial tubercle may be swollen, warm, & exquisitely tender 6) pain is reproducible by repeated flexion & extension of the knee or by direct pressure on the tibial tubercle 7) no synovial thickening or joint effusion 8) no focal patellar pain or knee joint pain Laboratory: none indicated Radiology: 1) lateral radiograph of knee may help exclude other diagnoses 2) may show sclerosis, fragmentation or separation of tibial tubercle or overlying soft tissue swelling 3) radiographic findings may not correlate with clinical presentation 4) other diagnostic imaging procedures offer no advantage over plain radiographs a) ultrasound b) magnetic resonance imaging (MRI) c) computed tomography (CT) * radiographs [5] Differential diagnosis: 1) tumor 2) infection 3) bone cyst 4) stress fracture 5) arthritis 6) chondromalacia patellae 7) osteochondritis dissecans 8) Sinding-Larsen-Johansson syndrome 9) meniscus injuries 10) hemophilia Management: 1) limitation of activities that cause the pain 2) ice packs to swollen tubercle 3) NSAIDs may be of some value 4) local corticosteroid injections may increase injury & are contraindicated 5) immobilization by cast or splint should be avoided 6) protective padding to the knee during activities where trauma is possible 7) generally self-limited disorder that resolves with closure of the proximal tibial growth plate 8) rarely, bony ossicles may fail to fuse with the tibia & require surgical excision from the infrapatellar segment of the quadriceps tendon

General

repetitive strain disorder; repetitive motion disorder; cumulative trauma disorder; overuse syndrome osteochondrosis

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 801-802
  2. NEJM Knowledge+ Question of the Week. June 6, 2017 https://knowledgeplus.nejm.org/question-of-week/3005/
  3. Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter syndrome. Curr Opin Pediatr 2007 Feb; 19:44 PMID: 17224661
  4. Cunill-De Sautu B, Gereige RS. Knee conditions. Pediatr Rev. 2014 Sep;35(9):359-70. PMID: 25183771
  5. Indiran V, Jagannathan D. Osgood-Schlatter Disease N Engl J Med 2018; 378:e15. March 15, 2018 PMID: 29539285 http://www.nejm.org/doi/full/10.1056/NEJMicm1711831