Osgood-Schlatter disease

Introduction

Classifies as, but not truly an osteochondrosis

Etiology

• microtearing of the quadriceps tendon at its attachment to the anterior tibial tubercle
• partial separation of the physis may also occur
• most frequent in males age 11-13 active in sports requiring running, kicking, &/or jumping

Pathology

• osteochondrosis of the tibial tubercle

Clinical manifestations

• activity related pain localized over the tibial tubercle
• pain aggravated by running, jumping, kicking, stair- climbing, kneeling
• the dominant leg is typically more symptomatic
• limping gait
• tibial tubercle may be swollen, warm, & exquisitely tender
• pain is reproducible by repeated flexion & extension of the knee or by direct pressure on the tibial tubercle
• no synovial thickening or joint effusion
• no focal patellar pain or knee joint pain

Laboratory

none indicated

Radiology

• lateral radiograph of knee may help exclude other diagnoses
• may show sclerosis, fragmentation or separation of tibial tubercle or overlying soft tissue swelling
• radiographic findings may not correlate with clinical presentation
• other diagnostic imaging procedures offer no advantage over plain radiographs
  • ultrasound
  • magnetic resonance imaging (MRI)
  • computed tomography (CT)

* radiographs

Differential diagnosis

• tumor
• infection
• bone cyst
• stress fracture
• arthritis
• chondromalacia patellae
• osteochondritis dissecans
• Sinding-Larsen-Johansson syndrome
• meniscus injuries
• hemophilia

Management

• limitation of activities that cause the pain
• ice packs to swollen tubercle
• NSAIDs may be of some value
• local corticosteroid injections may increase injury & are contraindicated
• immobilization by cast or splint should be avoided
• protective padding to the knee during activities where trauma is possible
• generally self-limited disorder that resolves with closure of the proximal tibial growth plate
• rarely, bony ossicles may fail to fuse with the tibia & require surgical excision from the infrapatellar segment of the quadriceps tendon

More general terms

• repetitive strain disorder
• osteochondrosis