Osgood- Schlatter

Osgood–Schlatter disease or syndrome (also known as tibial tubercle apophyseal traction injury) is an irritation of the patellar ligament at the tibial tuberosity. Sinding–Larsen–Johansson syndrome is an analogous condition involving the patellar tendon and the lower margin of the patella bone, instead of the upper margin of the tibia. The condition occurs in active boys and girls aged 9–16 coinciding with periods of growth spurts. It occurs more frequently in boys than in girls, with reports of a male-to-female ratio ranging from 3:1 to as high as 7:1.

It has been suggested the difference is related to a greater participation by boys in sports and risk activities than by girls. The condition is usually self-limiting and is caused by stress on the patellar tendon that attaches the quadriceps muscle at the front of the thigh to the tibial tuberosity. Following an adolescent growth spurt, repeated stress from contraction of the quadriceps is transmitted through the patellar tendon to the immature tibial tuberosity.

This can cause multiple sub-acute avulsion fractures along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump which can be very painful when hit. In more detail, activities such as kneeling may irritate the tendon. The syndrome may develop without trauma or other apparent cause; however, some studies report up to 50% of patients relates a history of precipitating trauma. In a retrospective study of adolescents, young athletes actively participating in sports showed a frequency of 21% reporting the syndrome compared with only 4.

5% of age-matched nonathletic controls. Intense knee pain is usually the presenting symptom that occurs during activities such as running, jumping, squatting, and especially ascending or descending stairs and during kneeling. The pain is worse with acute knee impact. The pain can be reproduced by extending the knee against resistance, stressing the quadriceps, or striking the knee. Pain is mild and intermittent initially. In the acute phase the pain is severe and continuous in nature. Impact of the affected area can be very painful. Bilateral symptoms are observed in 20–30% of patients.

The symptoms usually resolve with treatment but may recur for 12–24 months before complete resolution at skeletal maturity, when the tibial epiphysis fuses. In some cases the symptoms do not resolve until the patient is fully grown. In approximately 10% of patients the symptoms continue unabated into adulthood, despite all conservative measures. The condition is named after Robert Diagnosis is made clinically, and treatment is conservative with RICE (Rest, Ice, Compression, and Elevation),Bracing or use of an orthopedic cast to enforce joint immobilization is rarely required and does not necessarily give quicker resolution.

Sometimes, however, bracing may give comfort and help reduce pain as it reduces strain on the tibial tubercle. Surgical excision may rarely be required in skeletally mature patients. In chronic cases that are refractory to conservative treatment, surgical intervention yields good results, particularly for patients with bony or cartilaginous ossicles. Excision of these ossicles produces resolution of symptoms and return to activity in several weeks.

Removal of all loose intratendinous ossicles associated with prominent tibial tubercles is the procedure of choice, both from the functional and the cosmetic point of view. According to one study, in the great majority of young adults, the functional outcome of surgical treatment of unresolved Osgood-Schlatter disease is excellent or good, the residual pain intensity is low, and postoperative complications or subsequent reoperations are rare. After symptoms have resolved, a gradual progression to the desired activity level may begin.

In addition, predisposing factors should be evaluated and addressed. Commonly quadriceps and/or hamstring tightness is present and should be addressed with stretching exercise. After being clinically diagnosed the patient should rest for at least 3 days and must try not to use the knee as hard for about 1–2 weeks without any physical activities. If the disease continues to a certain extent where the patient cannot move the joint then they should seek medical advice right away as although this is very rare it can be severely limiting for the patient’s sporting future if it does occur.

The Strickland Protocol has shown a positive response in patients with a mean return to sport in less than 3 weeks. Paul Scholes, Danny Welbeck, and Mark Winterburn are sportsmen who have recovered from this condition. The French tennis player, Gael Monfils, wears patella bands in an attempt to combat the condition. http://www. cnn. com/HEALTH/library/osgood-schlatter-disease/DS00392. html http://www. mayoclinic. com/health/osgood-schlatter-disease/DS00392/DSECTION=risk-factors.

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