Diagnosis Of Osgood-Schlatter Disease Research Articles

Adult Knee Pain - The Diagnostic Dilemma

Knee pain is one of the frequent reasons adult patients seek care in primary care clinics. The cause of knee pain varies, from overuse syndrome to inflammatory diseases. The Osgood-Schlatter Disease (OSD) is one of the overuse syndromes, a condition of proximal tibial apophysitis commonly seen among physically active boys, particularly young athletes aged 10-14 years, during the highest growth spurt. The common presenting symptoms are intermittent or continuous knee pain while walking or playing the sport that involves jumping or running. This condition is self-limiting, resolves within 6-18 months after the growth plates close, and responds well with conservative treatment. However, few patients might have long term sequelae that persist into adulthood. The case report presents a case of recurring knee pain in a 35-year-old man upon his re-engagement with active sports. Clinical assessment and radiological investigation confirm his condition to be consistent with OSD. The diagnosis of OSD in this patient may be another rare case of the recurrence of the childhood condition in a skeletally mature adult.
 
 Keywords: Osgood-Schlatter Disease, adult, knee pain.

Osgood-Schlatter Disease in Adult: Would Early Diagnosis and Treatment Improve the Prognosis?

Osgood-Schlatter Disease (OSD) is a juvenile osteochondritis of tibial tuberosity affecting athletic adolescents. However, the classical feature of persistent para-patellar pain is uncommon in skeletally mature adults. This case presents a 23-year-old gentleman with an 8- year history of bilateral anterior knee pain and swelling. The symptoms began after a sports injury which occurred when he was 15. The diagnosis of OSD was missed at this point as the presentation and radiological features mimic cracked fracture of the tibial tuberosity. Subsequently, he did not obtain medical care which resulted in worsening knee pain and swelling. Recent X-ray showed fragmented apophysis in both knees, supporting the diagnosis of bilateral OSD. Further evaluation suggests that he probably developed OSD long before he presented with the sport injury. This case highlights the importance of early diagnosis and management of OSD in childhood to improve the prognosis and reduce the risk of complications in adulthood.

KNEE RADIOGRAPHS DEMONSTRATE SMALL BUT STATISTICALLY SIGNIFICANT INCREASE IN POSTERIOR TIBIAL SLOPE IN PATIENTS WITH OSGOOD-SCHLATTER DISEASE

Background:Previous research has demonstrated an association between Osgood-Schlatter disease (OSD) and increased posterior tibial slope (PTS) in a small subset of patients with MRI and clinical exam consistent with OSD.Hypothesis/Purpose:To determine if children diagnosed clinically with OSD have an increased PTS on routine radiographs compared to controls.Methods:Patients 10-18 years old with the clinical diagnosis of OSD and a true lateral knee X-ray between 2016 and 2019 were eligible for the OSD group. Subjects were excluded if they had other significant knee pathology (Figure 1). The same number of controls were selected from patients in the same age and date range with history of anterior knee pain and a true lateral knee X-ray but no evidence of OSD or other significant pathology on clinical exam or X-ray. Demographic data and HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores were collected for each subject. PTS measurements were performed on true lateral X-Rays by three blinded investigators. Independent samples t-test and chi-squared test were used to compare variable means and frequency between OSD and control knees. Logistic regression analysis was used to investigate the effects of OSD, age, sex, height, weight, and HSS Pedi-FABS score on PTS (≥12º versus <12º).Results:258 total knees (129 with OSD and 129 controls) were included. Mean age was 12.9 ± 1.8 years and 53% knees were male. There were no differences in age, sex, BMI, or laterality of knees between groups (Table 1). Mean PTS was significantly higher in the OSD group (11.6º ± 2.9º) compared to the control group (9.3º ± 2.7º, p<0.0001). In the OSD group, 46% of knees had a PTS ≥12º and in the control group, 19% knees had a PTS >12º (p<0.001). Logistic regression analysis showed that patients with OSD had 3.63 greater odds (95% CI 1.78-7.40) of having PTS ≥12º compared to patients without OSD, when controlling for age, sex, height, weight, and HSS Pedi-FABS score (Table 2).Conclusion:This study further supports an association between OSD and a mild increase in PTS. Patients with OSD had 3.6 greater odds of having PTS≥12º. The clinical implications of this finding have not yet been elucidated. We speculate that in patients with OSD, stresses (or force) exerted from the quadriceps muscle group through the patellar tendon loads the anterior portion of the tibia tubercle disproportionately to the posterior segment and causes asymmetric growth and an increased PTS.Tables/ FiguresFigure 1.Flowchart depicting OSD group patient exclusion.

IS OSGOOD-SCHLATTER DISEASE TRULY A BENIGN KNEE CONDITION? A PILOT STUDY DEMONSTRATING INCREASED POSTERIOR TIBIAL SLOPE

Background:Osgood-Schlatter disease (OSD) is a traction apophysitis caused by repetitive strain and chronic avulsion of the secondary ossification center of the tibal tuberosity from the patellar tendon.Purpose:The aim of this study was to determine if OSD is associated with increased posterior tibial slope (PTS).Methods:A total of 40 knees with OSD and 32 control knees examined by the senior author between 2008 and 2019 were included. Patients aged 10 to 15 years old with clinical diagnosis of OSD supported by radiographic findings on lateral X-ray and MRI were eligible. Age- and sex-matched subjects with history of anterior knee pain but no evidence of OSD on clinical exam and no fragmentation of the tibial tubercle on lateral X-Ray and MRI were included in the control group. PTS was defined as the angle between the reference line and a line drawn tangent to the uppermost anterior and posterior edges of the medial tibial plateau. Measurements were carried out in duplicate on true lateral X-Rays by two blinded investigators. Interrater reliability of posterior tibial slope measurements between the two examiners was evaluated using intraclass correlation coefficient (ICC). Independent-sample student t-test was used to compare PTS in the OSD and control knees.Results:Mean age at time of lateral radiograph was 12.6 ± 1.6 years and 51% (37/72) of knees were male. There were no differences in age, sex, and laterality of knees between the OSD and control groups. Mean PTS was significantly higher in the OSD group (12.23º ± 3.58º) compared to the control group (8.82 º ± 2.76 º, p<0.001) (Figure 1). ICC was 0.931 (95% confidence interval, 0.890 to 0.957) for measurement of PTS between the two examiners, indicating almost perfect interrater reliability.Conclusion:This study is the first to identify an association between OSD and increased PTS. The clinical implications of this novel finding have not yet been elucidated. However, several studies have demonstrated that increased PTS is a risk factor for ACL injury and re-tear. It may be speculated in patients with OSD, stress from the extensor mechanism through the patellar tendon loads the anterior portion of the tibia disproportionately to the posterior segment, thereby resulting in asymmetric growth and an increased PTS.Figure 1.Bar graph depicts mean and standard deviation of posterior tibial slope in the OSD and control groups. Data points represent individual measurements for each knee.

Increased Posterior Tibial Slope in Patients With Osgood-Schlatter Disease: A New Association

Background: Osgood-Schlatter disease (OSD) is a traction apophysitis of the tibial tubercle caused by repetitive strain and chronic avulsion from the patellar tendon. No widely accepted anatomic risk factors have been associated with OSD. Purpose: To determine if OSD is associated with increased posterior tibial slope (PTS). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Forty knees with OSD and 32 control knees examined by the senior author between 2008 and 2019 were included. Patients 10 to 15 years of age with a clinical diagnosis of OSD and available lateral radiograph and magnetic resonance imaging (MRI) were eligible. Age- and sex-matched patients with a history of knee pain but no evidence of OSD on clinical examination and without significant pathology on lateral radiograph and MRI were included in the control group. PTS was defined as the angle between a reference line perpendicular to the proximal anatomic axis and a line drawn tangent to the uppermost anterior and posterior edges of the medial tibial plateau. Measurements were carried out in duplicate on true lateral radiographs by 2 blinded investigators. Interrater reliability of PTS measurements was evaluated using intraclass correlation coefficient (ICC). The independent samples t test was used to compare PTS between the OSD and control knees. Results: The mean age was 12.6 ± 1.6 years and 51% (37/72) of the knees were from male youth. There were no differences in age, sex, and laterality of knees between the OSD and control groups. The mean PTS was significantly higher in the OSD group (12.23°± 3.58°) compared with the control group (8.82°± 2.76°; P < .001). The ICC was 0.931 (95% CI, 0.890-0.957), indicating almost perfect interrater reliability. Conclusion: This study identifies an association between OSD and increased PTS. The clinical implications of this finding have not yet been elucidated. It may be speculated that in patients with OSD, stress from the extensor mechanism through the patellar tendon loads the anterior portion of the tibia disproportionately to the posterior segment, thereby resulting in asymmetric growth and an increased PTS.

Long-term Prognosis and Impact of Osgood-Schlatter Disease 4 Years After Diagnosis: A Retrospective Study.

Background:Knee pain is common during adolescence, with Osgood-Schlatter disease (OSD) being the most frequent condition. Despite this, research regarding the long-term prognosis of OSD is limited.Purpose:To evaluate the prognosis 2 to 6 years after the diagnosis of OSD.Study Design:Cohort study; Level of evidence, 3.Methods:This retrospective cohort study included patients diagnosed with OSD at a single orthopaedic department between 2010 and 2016. Patients were contacted in 2018 and asked to complete a self-reported questionnaire regarding knee pain, knee function (Knee injury and Osteoarthritis Outcome Score [KOOS] Sports/Recreation subscale), Health-related quality of life (HRQoL) (youth version of EuroQol 5 dimensions 3 levels [EQ-5D-3L-Y]), and physical activity.Results:Out of 84 patients, 43 responded. Of these, 60.5% (n = 26) reported OSD-related knee pain at follow-up (median follow-up, 3.75 years). The median symptom duration was 90 months (interquartile range, 24-150 months) for those still experiencing knee pain, and 42.9% of these reported daily knee pain. Fifty-four percent with knee pain had reduced their sports participation compared with 35.3% of those without knee pain. KOOS Sports/Recreation subscale scores were significantly lower in those with knee pain compared with those without knee pain (53 [95% CI, 42-63] vs 85 [95% CI, 76-94], respectively). Participants with knee pain reported lower HRQoL (0.71 [95% CI, 0.57-0.84]) compared with those without knee pain (0.99 [95% CI, 0.97-1.00]).Conclusion:This study indicates that OSD may not always be self-limiting. The lower self-reported function and HRQoL in those with continued pain may be a consequence of impaired physical activity due to knee pain.

Is There a Relationship between Patellofemoral Alignment and Osgood-Schlatter Disease? A Case-Control Study.

This study was aimed to investigate the role of anatomic variations in patellofemoral alignment in patients with or without Osgood-Schlatter disease (OSD) and to determine the potential anatomic risk factors that may play role in the etiology. This prospective observational case-control study was conducted on two groups of adolescent patients. Group 1 comprised patients who were diagnosed as having OSD and group 2 consisted of an equal number of age-matched patients who presented to the outpatient clinic with traumatic knee injury and underwent knee radiographic examination but without a diagnosis of OSD. Age, height, weight, body mass index (BMI), dominant side, and level of sporting activity were recorded. Quadriceps (Q) angles were measured using a long-arm goniometer with patients lying in the supine position with their knees in full extension and contracting the Q muscles. On anteroposterior, lateral knee, and tangential patella (Merchant and Laurin views) radiographs, the following measurements were performed: Insall-Salvati (IS), Caton-Deschamps (CD), and Blackburne-Peel (BP) indexes, congruence angles, lateral patellofemoral angles, sulcus angles, and patella type according to Grelsamer's morphology classification. Both groups were similar in respect of age (p = 0.160), sex (p = 0.311), height (p = 0.326), weight (p = 0.596), BMI (p = 0.153), and dominancy (p = 0.500). The rate of patients engaged in sports activities was significantly greater in the OSD group (p = 0.003). No significant difference was determined between the groups in respect to IS index, CD index, BP index, sulcus angle, lateral patellofemoral angle, and congruence angle (p-values: 0.358, 0.995, 0.912, 0.802, 1.000, and 0.907, respectively). The mean Q angle was measured as 15.6 ± 2.2 degrees in the OSD group and 14.3 ± 2.5 degrees in the control group (p = 0.014). Despite the difference being statistically significant, it was clinically insignificant because the difference was only 1.3 degrees. The principle etiologic factor seems to be increased physical activity rather than subtle variations is patellofemoral anatomy and alignment of extensor mechanism.

Osgood-schlatter Disease Diagnosis by Algometry and Infrared Thermography

Background: The diagnosis of Osgood-Schlatter Disease (OSD) is based on clinical signs and symptoms. However, more objective parameters, like thermal images, have been researched to determine, along algometry, valid parameters. Objective: The aim of this study was to analyze the thermal differences and the painful sensibility between the knees (with SOS and contralateral) of young soccer players. Methods: 6 young men, aged between 12 and 15, members of football schools, composed the sample. Images were taken from an anterior view of both knees, with the volunteer in a seated position, the knees flexed at 90º degrees and both feet flat on the floor. After the thermal image capture, the patients were submitted to an evaluation with the pressure algometer. Results: According to the results, it was found that the knee affected by the OSD showed temperatures significantly higher than the contralateral (p = 0.027) and also greater sensitivity to the pressure algometry (p = 0.027). Conclusion: it can be concluded that the inflammatory process, during OS Syndrome, promotes a local thermal hyper-radiation, identified with the high sensitive thermographic infrared image, producing a significant difference in local temperature between the knees of a single individual. Moreover, this process also increases the pain sensibility, accessed by pressure algometry.

Assessment of Osgood-Schlatter Disease and the Skeletal Maturation of the Distal Attachment of the Patellar Tendon in Preadolescent Males.

Background:Osgood-Schlatter disease (OSD) is a traction apophysitis of the tibial tuberosity. Ultrasonography (US) is able to detect pathologic changes, such as cartilage swelling and fragmentation of the tibial tubercle ossification center.Purpose:To compare the US stages of tibial tuberosity development and the physical features and prevalence of OSD in this patient cohort.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Subjects included 238 males (n = 476 joints) with a mean age of 11.4 ± 1.6 years (range, 7-14 years). The tibial tuberosity development on US was divided into 3 stages: the cartilaginous stage (stage C), apophyseal stage (stage A), and epiphyseal stage (stage E). It was then investigated whether the subjects had pain in the tibial tuberosity on application of pressure. Age, height, body weight, body mass index (BMI), heel-buttock distance (HBD, cm), and straight-leg raise angle (SLRA) were evaluated. To confirm the diagnosis of OSD, the participant had to fulfill the following clinical criteria: pain with direct pressure on the tibial apophysis, fragmentation of the bone, and irregularity of the ossification center detected by US.Results:The tibial tuberosity was stage C in 195 knees, stage A in 105 knees, and stage E in 176 knees. The subjects’ heights, weights, and BMIs significantly increased with advancing development of the tibial tuberosity. The HBD increased in stage E (P < .01). The SLRA was not significantly different among groups. There was fragmentation of the bone and irregularity of the ossification center in 32 knees (6.8%): 0 in stage C, 21 (4.3%) in stage A, and 11 (2.3%) in stage E. Fragmentation of the bone and irregularity were observed significantly more often in stage A (P < .01). On the other hand, there were 10 joints with OSD (2.1%): 0 in stage C, 3 (0.6%) in stage A, and 7 (1.5%) in stage E. OSD was observed significantly more often in stage E than in the other stages (P < .05).Conclusion:The present study showed that the HBD increased from stage A to stage E. The prevalence of OSD was highest in stage E.

Evaluation and conservative treatment for Osgood-Schlatter disease: A critical review of the literature

Background Osgood-Schlatter disease (OSD) is a tibial tubercle traction apophysitis resulting from repetitive strain on the patellar tendon insertion. OSD can lead to significant functional limitations and disability that can persist into adulthood. Methods The authors of this review systematically searched PubMed, CINAHL, TWUniversal, and The Cochrane Library for articles dated from January 1980 to December 2013 that related to the evaluation and conservative treatment of Osgood-Schlatter disease. Search phrases included ‘Osgood-Schlatter disease AND diagnosis’ and ‘Osgood-Schlatter disease AND treatment’. Articles were assessed for evidence strength based upon modified criteria from the evidence-based medicine pyramid and the diagnosis and treatment sections of the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence Table. Findings There is a wealth of evidence to support a clinical diagnosis of Osgood-Schlatter disease. There is also fair evidence to employ functional outcome measures during evaluation. Evidence concerning conservative treatments for Osgood-Schlatter disease ranges from poor to strong based upon the intervention. Conclusion While strong evidence for clinical diagnosis is supported by the literature, further research is required to establish definitive functional outcome measures and effective interventions in the management of Osgood-Schlatter disease.

Is there a relationship between attention deficit/hyperactivity disorder and Osgood–Schlatter disease?

The purpose of this prospective study is to investigate the relationship between Osgood-Schlatter disease (OSD) and attention deficit/hyperactivity disorder (ADHD). Seventy-four children with a diagnosis of OSD were referred to child and adolescent psychiatry department for the evaluation of ADHD. Diagnostic and Statistical Manual of Mental Disorders was used for diagnostic criteria. Diagnosis of ADHD was made in 56 (75.6%) out of 74 children. Results of this study suggest that ADHD is a significant risk factor for OSD. During the evaluation of a patient with OSD, a thorough history should be obtained about the behavioral symptoms that indicate underlying ADHD. In case of suspicion, these patients should be referred for an additional evaluation by a child psychiatrist. II.

Simultaneous Bilateral Flexion-Type Salter-Harris II Fractures of the Proximal Tibia: A Case Report and Review of the Literature

A rare case is reported of bilateral physeal lesions of the proximal tibia classified as Salter-Harris type II, which occurred simultaneously after a “flexion type” injury in a 14-year-old boy. Treatment was conservative on the nondisplaced side and surgical, by closed reduction and internal fixation, on the displaced side. There was no previous diagnosis of Osgood-Schlatter disease. After reviewing all the cases described previously, which occurred either consecutively or simultaneously, we conclude that less resistance of the growth plate, typical of late adolescence, likely represents the cause of this type of lesion.

Histocompatibility antigens in Osgood-Schlatter disease.

Eighteen unrelated children (12 boys and six girls) with Osgood-Schlatter disease (OSD) were evaluated by history, physical examination, and histocompatibility antigen [human leukocyte antigen (HLA)] determination. Four boys and two girls had pain at sites other than the tibial tuberosity. By history, other related individuals with a diagnosis of OSD were found in six of the 18 families. The distributions of HLA antigens (A, B, and DR) were not demonstrably abnormal. The similarity of OSD and enthesitis accompanying HLA-B27-associated arthropathy may cause diagnostic difficulty. The lack of an association between OSD and HLA-B27 may be of assistance in differentiating the two disorders.