Osgood-Schlatter Research Articles

Cover Image

The cover image is based on the Review Article A systematic review of imaging findings in patients with Osgood-Schlatter disease by Line Bay Sørensen et al., https://doi.org/10.1002/tsm2.281.

Hyperosmolar dextrose injection for Osgood-Schlatter disease: a double-blind, randomized controlled trial.

Osgood-Schlatter disease (OSD) is one of the common causes of long-term knee pain, leading to functional limitations, long-term deformity of the tubercle interfering with kneeling, and impaired peer-important sport participation. Nonetheless, patient management continues to rely on the usual conservative methods. This study examined the use of hyperosmolar dextrose injection in patients with OSD. We conducted a randomized, double-blind clinical trial involving 70 patients with OSD. One group received a hyperosmolar dextrose injection (12.5%), while the other received a saline injection. The injections were conducted under ultrasound guidance. The Victorian Institute of Sport Assessment (VISA) score was used to assess each patient's pain and sport level. The dextrose group outperformed the saline group in improvement in the VISA-Patella (VISA-P) score from baseline to 3months (27.1 ± 6.5 vs. 1.4 ± 2.6; mean difference 25.4 (22.4 to 28.3); p < .0001), 6months (31.7 ± 7.9 vs. 25.2 ± 7.8; mean difference 6.2 (3.2 to 9.4); p < .0001), and 12months (34 ± 9.0 vs. 28.2 ± 7.5; mean difference 5.5 (1.9 to 9.1); p = .0026). The changes in both groups were clinically important, suggesting that both therapies were active treatments. The dextrose group improved too rapidly for spontaneous improvement to explain much of this change. After three injections, at the 6-month and 12-month follow-up visits, the VISA-P scores of the two groups were significantly improved; the dextrose group score was better than the saline group score, and there were significant differences between the two groups.

Medical assessment in the field of Social ActVII: pre-existing damage and causality of apophyseal injuries and detachments

The medical assessment of affections of the apophyses frequently presents the assessor with problems in causality testing and estimation of functional impairment. Apophyses are the insertion of tendons and are therefore at the center of an acting parallelogram of forces. They fuse via an apophyseal plate in the second decade of life. Depending on the age there is areduced mechanical load-bearing capacity of the apophyseal plates in the last 1-2years before complete mineralization of the joint. Two types of injury must be distinguished in an expert opinion: apophyseal detachment as aresult of repetitive microtrauma in the event of chronic overload and apophyseal avulsion fracture as an acute injury due to sudden maximum muscle tension. While chronic overload leads to exclusion from insurance cover by the statutory accident insurance, apophyseal avulsion fractures fulfil the necessary requirements for acceptance as an insurance case. The apophyseal avulsion fracture is subject to atime-limited force, which directly leads to damage to health and avulsion of the tibial tuberosity including its tension system. The sudden jerky maximum muscle pull leads to an overload of the tension system and avulsion of the apophysis in cases of an age-related vulnerable apophyseal plate. Once the mineralization is complete, this type of fracture no longer occurs. Osgood-Schlatter disease, an insertion tendinosis of the patellar tendon, occurs in around 20% of all sport-active adolescents but it is questionable whether it can be associated with the acute avulsion fracture. Knowledge of the pathogenesis of affections and injuries of the apophysis can provide the assessor with good foundations for the estimation of a causal association.

Muscle stiffness of the rectus femoris and vastus lateralis in children with Osgood–Schlatter disease

BackgroundThe relevance of the mechanical properties of muscles in relation to Osgood–Schlatter disease (OSD) remains unclear. The present study aimed to examine rectus femoris (RF) and vastus lateralis (VL) muscle stiffness in children with OSD. MethodsA total of 28 legs affected by OSD and 26 legs without OSD were assessed. The shear-wave velocity (SWV) of the RF and VL (in m/s) during passive knee flexion (0° (i.e., fully extended position), 45°, and 90° knee joint flexion) and isometric contraction (50% of maximal voluntary contraction) was measured using shear-wave elastography. ResultsThe SWV of the RF was higher in subjects with OSD than in those without OSD at 45° and 90° flexion (P = 0.033 and P = 0.035, respectively); however, the SWV of the RF did not significantly differ at 0° flexion (P = 0.469). Similarly, the SWV of the VL exhibited no significant difference between the tested groups (P > 0.05). No significant difference in the SWV of both muscles during isometric contraction was observed between the two groups (P > 0.05). ConclusionsThe results suggest that a stiffer RF under stretched conditions (45° and 90° flexion) is related to the presence of OSD. Furthermore, both muscles under unstretched and contracted conditions and the VL under stretched conditions have limited association with the presence of OSD. These results have important implications for understanding the association between the mechanical properties of muscles and OSD.

The Osgood-Schlatter disease: a large clinical series with evaluation of risk factors, natural course, and outcomes.

The aims of this prospective study were to define sport specific incidence rates in a large Osgood-Schlatter-disease group, to follow the natural course, and to determine late effects, i.e., changes in sport activities and resting pain. A total of 126 consecutive patients with functional pain in and after physical activity and local TT swelling were included in a longitudinal study. Physical examination, ultrasound, and a lateral X-ray were performed in a standardized clinically common manner. Sport participation, growth rate, BMI, and muscle status were recorded and assigned statistically. Follow-up took place after subsidence of functional pain. Exactly 101 boys and 25 girls showed a mean age at diagnosis of 12.8years (boys 13.2, girls 11.4years) complaining an average period of pain of 6.7months before diagnosis. A sport distribution displayed 64 football (soccer) players, 18 basketball players, seven athletes in track and field, six martial arts sportsmen, and five handball players, all participating in organized sport clubs, 16 patients in other and ten patients in no sports. The standing leg was affected in 69.6% of all football players, whereas the other disciplines did not show any significance. A total of 105 patients could be followed up after a median of 3.6years; six of them were still symptomatic. Final outcome could be recorded for 99 patients (79 boys, 20 girls). Osgood-Schlatter disease (OSD) symptoms in or after sport activity were reported to last an average of 19.1months (3-48months) without differences according to sex nor sport. Exactly 50% of the patients may expect to be free of functional symptoms after the 16th month, 75% after the 25th month. A total of 78.8% of the patients still complained of persistent but not impairing pain in kneeling or on direct TT contact. Exactly 28.3% of all patients responded having switched their sport activity to other disciplines due to OSD. OSD affects mainly adolescent boys active in football and basketball and represents a structural answer to repeated biomechanical stress. Only in football, the statically dominant side is more prone to develop OSD. Age at onset, growth rate, BMI, and muscle imbalance are not significantly predisposing. OSD runs a self-limiting course without specific treatment.

Is the Prognosis of Osgood-Schlatter Poorer Than Anticipated? A Prospective Cohort Study With 24-Month Follow-up.

Background:Osgood-Schlatter disease (OSD), an apophyseal injury of the tibial tuberosity, affects up to 1 in 10 adolescents. This condition has previously been assumed to be innocuous and to self-resolve with limited intervention.Purpose:To investigate the 24-month prognosis of OSD and examine if ultrasound (US) classification is associated with outcomes.Study Design:Case series; Level of evidence, 4.Methods:This study included a preregistered prospective cohort of 51 adolescents (aged 10-14 years) diagnosed with OSD who were evaluated for 24 months. The primary outcome at 24-month follow-up was whether participants continued to experience OSD-related knee pain. Baseline US scans were collected and characterized by OSD type (De Flaviis classification) as well as maturation of the tibial tuberosity. Secondary outcomes included sports participation, Knee injury and Osteoarthritis Outcome Score (KOOS) Sport/Recreation subscale, and health-related quality of life (European Quality of Life–5 Dimensions–Youth [EQ-5D-Y]). All participants were invited for re-examination by US at follow-up.Results:A total of 51 patients preregistered for the study, with 90% (n = 46) available at follow-up. Of these 46 participants, 37% (n = 17) still reported knee pain due to OSD. In this subgroup, the median duration since symptom onset was 42 months (interquartile range, 38-51 months). More than 1 in 5 participants reported stopping sport due to knee pain, and those who continued to experience knee pain reported significantly worse KOOS Sport/Recreation scores at follow-up compared with patients with no knee pain (mean 74 [95% CI, 63-84] vs 91 [95% CI, 85-97]). Participants with continued OSD-related pain also had lower health-related quality of life (mean difference in EQ-5D-Y, 0.11 [95% CI, 0.06-0.13]). Higher De Flaviis classification at baseline was significantly associated with an increased risk of knee pain at 2 years. Diagnostic US at follow-up demonstrated primarily tendon changes (thickening, positive Doppler signal), as well as an ununited ossicle in 32% of participants who underwent US scanning at follow-up.Conclusion:Over one-third of the study participants had knee pain at 2-year follow-up, which was associated with lower sports related function and health related quality of life. This questions the assumption that all patients with OSD experience quick recovery. Participants without any changes on imaging at baseline were less likely to report pain at follow-up.

Bifocal Patellar Tendon Avulsion Fracture in a Child

The avulsion fracture of the patellar tendon from its proximal and distal attachment is extremely rare. Only a few cases have been described in the English literature and many aspects are still poorly understood. During our practice we came across the case of a 13 year old boy with the above mentioned lesion that we present hereby. Other than describing our experience we tried to tackle the different questions surrounding this lesion, with a careful analysis of the previous reports. A “weaker bone” was considered the main risk factor without any connection with a particular disease or condition. We found out that it is a mainly a pediatric problem, due to the particular bone structure of this population, with many of the subjects being affected by Osgood–Schlatter disease. Different authors have reported their experiences and hypothesis concerning the mechanism behind this injury that has yet to be clearly defined. However most of them mentioned an eccentric load over a knee in forced flexion, leading us to believe that this could be the main source of this unique type of disruption of the extensor apparatus of the knee. Moreover the diagnosis can be quite challenging with many authors advocating for the use of advanced imaging. Treatment options are multiples and the choice relies for the most part on the practitioner preference. From what emerged from the available data it is almost exclusively surgical. Independently from the selected technique, the outcomes are generally favorable.

Running-related injuries in middle school cross-country runners: Prevalence and characteristics of common injuries.

Understanding the prevalence and factors associated with running-related injuries in middle school runners may guide injury prevention. To determine the prevalence of running-related injuries and describe factors related to a history of injury. Retrospective cross-sectional study. Survey distributed online to middle school runners. Participants completed a web-based survey regarding prior running-related injuries, training, sleep, diet, and sport participation. Prevalence and characteristics differentiating girls and boys with and without running-related injury history adjusted for age. Youth runners (total: 2113, average age, 13.2 years; boys: n = 1255, girls: n = 858). Running-related injuries were more prevalent in girls (56% vs. 50%, p = .01). Ankle sprain was the most common injury (girls: 22.5%, boys: 21.6%), followed by patellofemoral pain (20.4% vs. 7.8%) and shin splints (13.6% vs. 5.9%); both were more prevalent in girls (p < .001). Boys more frequently reported plantar fasciitis (5.6% vs. 3.3%, p = .01), iliotibial band syndrome (4.1% vs. 1.4%, p = .001) and Osgood-Schlatter disease (3.8% vs. 1.2%, p = .001). Runners with history of running-related injuries were older, ran greater average weekly mileage, ran faster, had fewer average hours of sleep on weekends, skipped more meals, missed breakfast, and consumed less milk (all p < .05). Girls with history of running-related injuries reported higher dietary restraint scores, later age of menarche, more menstrual cycle disturbances, and higher likelihood of following vegetarian diets and an eating disorder diagnosis (all p < .05). Runners with no history of running-related injuries were more likely to have participated in ≥2 years of soccer or basketball (p < .001). Most middle school runners reported a history of running-related injuries and certain injuries differing by gender. Modifiable factors with the greatest association with running-related injuries included training volume, dietary restraint, skipping meals, and less sleep. Sport sampling, including participation in ball sports, may reduce running-related injury risk in this population.

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.

SURGICAL TREATMENT OF OSGOOD-SCHLATTER DISEASE IN ADOLESCENT ATHLETES

Background:Osgood-Schlatter disease is an apophysitis of the tibial tubercle causing pain and difficulty kneeling. A majority of cases resolve spontaneously at skeletal maturity when the tibial tubercle apophysis fuses. Treatment is symptomatic when the physis is open. Adolescent athletes with closed physes and continued symptoms can benefit from surgery.Purpose:The purpose of this study is to report the outcomes of ossicle excision and tubercleplasty for unresolved Osgood-Schlatter disease that has failed conservative treatment.Methods:A retrospective review was performed on 6 athletes who underwent ossicle excision and tibial tubercleplasty for unresolved Osgood-Schlatter disease. Data collected include age at onset of symptoms, age at surgery, gender, laterality, radiographic findings, sports played, time to return to sport, length of follow up, and complications. Surgery involved an open ossicle excision, tubercleplasty, and repair of the patella tendon to bone using a suture anchor. A longitudinal incision was made over the antero-lateral aspect of the patella tendon. The patella tendon was reflected medially to gain access to the ossicle and bump. A direct anterior incision was avoided to minimize post-operative pain with kneeling. Post-operatively, patients were allowed to fully weight bear in an extension knee brace for 4 weeks, and then allowed to gradually resume activity.Results:4 males and 2 females were studied. The right knee was involved in 3 cases and the left knee in 3. The average age at onset of symptoms was 15.8 (range 12-18). The average age at surgery was 17.3 (range 17-18). Radiographic findings included a large bump in 3 cases, an ossicle in 2 cases, and free fragments at the tendon insertion in 3 cases. Sports played included basketball, football, running, and dancing. All patients returned to sports at an average of 23.9 weeks post-surgery (range 5-56). The average length of follow up was 14.2 weeks (range 5-27). No patients reported post-operative pain with kneeling, limp, need for a cane, locking sensations, giving way sensations, pain, swelling, difficulty climbing stairs or difficulty squatting. No patients needed additional surgery.Conclusion:Surgical treatment of unresolved Osgood-Schlatter disease was successful in 100% of adolescent athletes in this series. For symptomatic patients after closure of the growth plate, we recommend removal of the ossicle and adjacent bursae, smoothing down the bump with a burr, and repairing the reflected patella tendon to bone using suture anchors. The outcomes were excellent in all patients with no complications.

Nano-Arthroscopic Ultrasound-Guided Excision of Unresolved Osgood−Schlatter Disease

The nano-arthroscopic ultrasound-guided ossicle excision technique is used in the management of an unresolved Osgood−Schlatter disease. The NanoScope is inserted slightly lateral to the proximal patella tendon and moved on between the ossicle and anterior surface of the proximal tibia under ultrasonographic guidance. The 5-mm skin incision is made as a working portal on the medial side of the proximal patella tendon. The proximal border of the ossicle is clearly identified after bursectomy. Then, the ossicles are removed piece by piece using a 2-mm arthroscopic punch. During the resection, the remaining ossicle is continuously confirmed by ultrasound. Finally, the complete excision of the ossicle is shown by the nano-arthroscopic view and ultrasound. The patient is allowed to have a full weight-bearing and an unrestricted range of motion on the day of surgery. Patients are permitted to resume their sports activities without any restriction after 6 weeks. This technique is recommended to athletes who suffer from painful unresolved Osgood−Schlatter disease because of the benefits of it being a minimally invasive surgery with an early postoperative recovery.

Long‐term outcome of conservatively treated lower limb apophyseal injuries in children and adolescents: A systematic review

Apophyseal injuries are generally believed to run a self-limiting course, suggesting conservative treatment is indicated. We summarized the long-term consequences of lower limb apophyseal injuries after conservative treatment. We conducted a systematic review using the Cochrane methodology, and reported findings according to PRISMA. MEDLINE, EMBASE, Cochrane CENTRAL, PEDro, and SPORTDiscus were searched. Studies had to include participants aged 8-18 years old, with a clinical diagnosis of apophyseal injury in the lower limb, more specifically Sever's disease, Osgood-Schlatter disease, or Sinding-Larsen-Johansson disease, non-surgically treated, with a minimum follow-up time of 1 year, and with at least one of the following outcome measures: pain, secondary structural changes, functional outcome, participation in sports, and recurrent or subsequent injury. PROSPERO registration number: CRD42020146412. Twelve studies on Osgood-Schlatter disease, three studies on Sever's disease, and no studies on Sinding-Larsen-Johansson disease met inclusion criteria. Results of studies varied widely. Important limitations were heterogeneity between studies and lack of high-quality research studies. Apophyseal injuries do not always appear to be self-limiting, with some patients experiencing pain, secondary structural changes, a worse functional outcome, and difficulty resuming sports after more than 1 year of follow-up.

Describing Frequencies of Lower-Limb Apophyseal Injuries in Children and Adolescents: A Systematic Review.

To describe the frequency with which children are affected by lower-limb apophyseal injuries, and subgroups at greater risk. Systematic review. N/A. N/A. N/A. Systematic review of Medline OVID, PsycINFO, Cinahl, and PubMed from inception until February 21st, 2020. Articles reporting prevalence and/or incidence of an apophyseal injury (eg, calcaneal apophysitis) or its eponym (Severs or Sever disease). Per person data relating to the incidence or prevalence. Subgroup comparisons were made between sex groups and between activity participant groups. There was wide variation in measurement approaches and follow-up timeframes with the majority of studies reporting on traction apophysitis of the tibial tubercle (Osgood-Schlatter disease). This condition had a point prevalence of 10% in the general population of children between the ages of 12 and 15 years, whereas the lifetime incidence has been reported as 13%. Point prevalence was higher among those who participated in sport compared with those who did not {relative risk [95% confidence interval (CI): 1.98 (1.31-2.99)]}, whereas lifetime incidence was higher among those who participated in sport at the age of 13 years compared with those who did not [relative risk (95% CI): 4.63 (2.31-9.26)]. Other apophyseal injuries did not report enough data to permit comparisons. Sports participation is likely to substantially increase the frequency of traction apophysitis of the tibial tubercle. Further research is required with standardized approaches to compare frequencies between different apophyseal injuries and subgroups of interest.

Prevalence of lateral patellofemoral maltracking and associated complications in patients with Osgood Schlatter disease.

To evaluate adults with history of Osgood Schlatter disease (OSD) for imaging features of lateral patellofemoral maltracking. In a span of four years, 10,181 unique non-contrast knee MRIs were performed on patients aged 20-50. Patients with acute trauma, prior surgery, and synovial pathologies were excluded. 171 exams had imaging findings of OSD, and an age-matched control group of 342 patients without OSD was randomly selected. Two radiologists retrospectively reviewed MRIs for features of lateral patellofemoral maltracking. Maltracking was defined as edema in superolateral Hoffa's fat or a tibial tuberosity-trochlear groove (TT-TG) distance ≥20mm with either patellar tilt/translation. Binomial logistic regression identified predictors of maltracking in OSD. Optimal TT-TG distance to indicate maltracking was determined by receiver operating characteristic curve. 59% (101/171) of the knees with OSD showed findings of maltracking, with patella alta, trochlear dysplasia, and quadriceps tendinosis as significant predictors of maltracking (p < 0.001). Patellofemoral chondrosis was present in 63% (107/171), with maltracking contributing to higher grade chondrosis more so than increasing age (OR 8.4 versus 1.07). 13mm was the optimal cut-off TT-TG distance to indicate maltracking (sensitivity 83%, specificity 80%). The prevalence of maltracking in the control group was 15% (p < 0.001 compared with the OSD group). Adults with sequelae of OSD are at high risk of maltracking and are likely to develop patellofemoral chondrosis. A lower threshold for identifying maltracking patients, including a lower cut-off TT-TG distance can help identify those at risk. Radiologists should maintain a high index of suspicion for maltracking in adults with OSD to guide clinical intervention.

Болезнь Осгуда — Шлаттера — как улучшить результаты лечения?

The study is aimed at improving treatment of Osgood — Schlatter disease by reducing periods of pain relief and clinical and radiological recovery, minimizing the relapses of the disease and rehabilitation period. The study involved 70 people (aged from 8 to 18 y.o., the mean age 13 y.o.) with a diagnosis of Osgood — Schlatter disease, types 1-4, based on clinical and radiological data. The patients were divided into two groups: basic and control ones, both receiving comprehensive treatment, which included lifestyle correction, physiotherapy, and therapeutic exercises for the knee joints. In addition, each patient of the basic group received one injection of platelet-rich autoplasma, and as a result, in 3 days after the injection the pain syndrome completely stopped. In the control examination one week after the injection, the edema in the upper third of the leg significantly decreased, and the range of motion in the knee joint fully restored. Three months after the injection, all adolescents returned to active lifestyle, physical activity and sports. Complications and relapses of the disease were not observed during monitoring for 12 months. The use of platelet-rich autoplasma stimulating reparative osteogenesis for the treatment of Osgood — Schlatter disease (types 1-4) results in highly effective treatment due to minimally invasive intervention, shortening the time of pain syndrome, and shortening the period of rehabilitation and return to active lifestyle.

Basketball and Volleyball (Care of the Young Athlete)

Patient Education| 2021 Basketball and Volleyball (Care of the Young Athlete) Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Basketball and Volleyball (Care of the Young Athlete). Pediatric Patient Education 2021; 10.1542/peo_document298 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Subjects: Care of the Young Athlete Topics: ankle sprains, athlete, basketball, brain concussion, pain, sports, volleyball, knee joint, knee region, fractures Acute and overuse injuries are common in jumping sports like basketball and volleyball. Acute injuries include bruises (contusions); cuts and scrapes (lacerations); ankle, knee, or finger sprains or fractures; shoulder dislocations; eye injuries; and concussions. Overuse injuries include patellar tendonitis (also called jumper's knee) or Osgood-Schlatter disease, spondylolysis (stress fracture of the spine), rotator cuff tendinopathy, stress fractures, and shin splints. The following is information from the American Academy of Pediatrics (AAP) about how to prevent basketball and volleyball injuries. Also included is an overview of common basketball and volleyball injuries. Sports physical exam. Athletes should have a preparticipation physical evaluation (PPE) to make sure they are ready to safely begin the sport. The best time for a PPE is about 4 to 6 weeks before the beginning of the season. Athletes also should see their doctors for regular health well-child checkups.... Copyright © 20112011 American Academy of Pediatrics You do not currently have access to this content.

Osgood-Schlatter Disease (Care of the Young Athlete)

Osgood-Schlatter Disease (Care of the Young Athlete)

A case of gouty arthritis with a history of Osgood-Schlatter disease

A case of gouty arthritis with a history of Osgood-Schlatter disease

Overuse Knee Pain in the Pediatric and Adolescent Athlete.

Overuse knee pain is common in young athletes. There are many potential overuse injuries which present with insidious onset of pain that can challenge sports medicine providers, including Osgood-Schlatter's disease, patellofemoral syndrome, osteochondritis dissecans, and stress fractures. The differential diagnosis of insidious onset knee pain also includes malignancies, infections, and rheumatologic issues. A thorough history and physical examination can guide the treating provider in making a diagnosis and appropriate treatment plan. Although not always necessary, imaging is often helpful in overuse knee pain, and laboratory workup may be necessary. Conservative treatment is often the first recommendation in the management of overuse knee pain in young athletes, and this may include activity modification, ice, anti-inflammatory medications, bracing, and physical therapy. This review summarizes common overuse knee injuries seen in pediatric and adolescent athletes.

ADOLESCENCE TIBIAL TUBERCLE AVULSION FRACTURE: OPTION OF SURGICAL TREATMENT IN WORSENING CONDITION OF PRE-EXISTING OSGOOD-SCHLATTER DISEASE (OSD)

Background: Osgood-Schlatter disease (OSD) is the most frequent cause of chronic knee pain in adolescents. Tibial tubercle avulsion fractures are an infrequent injury, approximately between 0.4-2.7% of all epiphyseal injury. Even though the relation between OSD and tibial tubercle avulsion fracture is still controversial, there are cases previously reported with this presentation.Case Report: A 16-years-old boy complained of pain on his left knee, significantly below the patella with ambulation limitation. He had a two-months history of knee pain in the same location and prominence on the area below the patella that was getting more significant over time. The patient was actively involved in volleyball in his school. The radiographic findings show fragmented tubercle fractures on the left tibial, soft tissue swelling in the tubercle's anterior side, and increased density of the infrapatellar fat pad. The patient underwent ORIF with screws. After a one-month post-surgery, the patient felt minimal pain when bending his left knee.Discussion: Male adolescents (12-15 years) and repetitive sprinting and jumping sports are the risk factors for OSD. About 90% of cases show a complete resolution, but some conditions make the OSD worse, such as low compliance at exercise avoidance. Surgery is rarely indicated for OSD, but in the condition of, even though very uncommon, tibial tubercle avulsion fracture, surgery gives a better outcome and resolution.Conclusion: All Osgood-Schlatter disease' patients should temporarily restrict sports activities to prevent tibial tubercle avulsion fractures.