Definition
Epiphysial aseptic necrosis of the tibial tubercle. An
osteochondritis of the tuberosity of the tibia that occurs
especially among adolescent males.
Robert Bayley Osgood (1873-1956) American orthopaedic
surgeon, born July 6, 1873, Salem, Massachusets; died 1956.
Carl B. Schlatter Swiss physician,
born March 18, 1864, Wallisellen-Zürich; died 1934.
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Radiographic Appearance
Osgood Schlatter disease is most often diagnosed by the
symptoms. An x ray may be normal, or show an avulsion injury, or,
more typically, show that the apophysis is in fragments.Knee
radiography (AP and lateral)
The Osgood Schlatter lesion is best seen on the lateral view
with the knee in slight internal rotation.
Not all patients with OS disease need radiographs since the
diagnosis is primarily clinical. Plain films are helpful to rule out
other etiologies, such as neoplasm and infection.
Superficial ossicle in the patellar tendon
Irregular ossification of the proximal tibial tuberosity
Calcification within the patellar tendon
Thickening of the patellar tendon
Soft tissue edema proximal to the tibial tuberosity
Bone scan may demonstrate increased uptake in the area of the tibial
tuberosity.
MRI and CT can provide more detail but rarely affect the treatment.
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Pathology
Osteochondrosis of the tuberosity of the tibia. One of the most
common causes of knee pain in the adolescent, Osgood-Schlatter
condition is an orthopaedic problem involving the leg just below the
knee cap where the tendon inserts into a bony prominence, the tibial
tubercle. Clinical signs and symptoms include pain in the medial
area of the knee, heat, tenderness and local swelling with
prominence at the tibial tuberosity. The pain is aggravated by
active extension. In about 25 percent of the cases it presents
bilaterally. Some 50 percent of the patients have a history of
precipitating trauma. The condition may result from a single injury
or, more frequently, repeated flexing of the knee against a tight
quadriceps muscle, causing microtrauma to the tibial tuberosity. The
injury occurs most commonly in rapidly growing and active
adolescents between the age of 11 and 15, boys being three times
more often affected than girls. Girls are typically 10-11 years old,
boys are typically 13-14 years old. The condition is generally
benign and the problem usually disappears later in adolescence
without treatment.Osgood-Schlatter (OS) disease is one of the most common causes of
knee pain in the adolescent. Consisting of pain and edema of the
tibial tubercle (and hence this is an extra-articular disease), OS
disease is generally a benign, self-limited knee condition
associated with traction apophysitis in adolescent boys and girls.
Paget first described the clinical syndrome in 1891. In 1903, Osgood
and Schlatter published separate papers on the subject. Because of a
lack of a precise definition, it is difficult to differentiate OS
disease from avulsion fractures of the tibial tubercle.
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Treatment
Osgood-Schlatter disease usually goes away with time.
It typically lasts 12-24 months. When the child stops growing, the
pain and swelling subside - perhaps because of hormonal changes once
puberty is over. Only rarely does Osgood-Schlatter disease persist
beyond puberty.
Apply a plaster cast for three weeks if pain is severe, otherwise
rest is the treatment of choice.
Surgical treatment rarely is indicated and generally is
reserved for those patients with recurrent disabling pain
unresponsive to conservative therapy.
Once the other physes have closed, surgery may be necessary for
non-united ossicles.
Simple excision of the mobile ossicle may be necessary.
A tuberosity thinning procedure followed by ossicle excision may be
performed.
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Useful Link
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