Osgood Schlatter Disease—An ultrasound grading system with practical application

Abstract

Athletes who sustain a knee joint injury, namely to the anterior cruciate ligament and/or meniscus, are at an increased risk of subsequent osteoarthritis (OA) – the so-called ‘young people with old knees’. Surgical intervention does not appear to reduce this increased risk. There is no good evidence that moderate sporting activity in thepresenceofnormal jointspredisposes toOA.Whether high-level participation in sport, particularly impact type sports, is associatedwithOA is unclear as it is difficult to disentangle the confounding effect of joint injury. Attention to strategies that prevent joint injury in athletes, such as neuromuscular exercise, is therefore paramount to reduce the burden of OA. Optimal management is needed to minimize the onset and extent of joint symptoms in athletes following joint injury. Clinicians should counsel the athlete about their increased likelihood of future OA as this allows athletes to make informed decisions about return to sport as well as plan future management. Prevention and management of OA in athletes includes use of load-reducing strategies such as variable stiffness shoes, bracing, activity modification, muscle strengthening and weight control although these have not been tested in clinical trials in athletes. There are currently no pharmacologic agents with convincing structural disease-modifying efficacy for people with existing joint damage and most have been tested in midto late-term OA rather than early OA. There are no high quality clinical trials investigating the effects of platelet-rich plasma therapy in treatment of knee OA. Evidence for a possible structuremodifying effect of glucosamine, the most commonly used dietary supplement for OA, is still controversial.