Osgood-Schlatter Disease (Osteochondrosis, Apophysitis of the Tibial Tubercle)

Osgood-Schlatter Disease (Osteochondrosis, Apophysitis of the Tibial Tubercle)



Description


Osgood–Schlatter disease is characterized by inflammation of the growth plate of the leg just below the knee at the tibial tubercle, a prominence just below the kneecap. The tibial tubercle is the bony attachment of the big, powerful thigh muscle (quadriceps) on the large bone of the lower leg (tibia). The growth plate is an area of relative weakness, and injury to it occurs as a result of repeated stress or vigorous exercise. It is a temporary condition of the tibial tubercle that is uncommon after age 16.



Common signs and symptoms



• A slightly swollen, warm, and tender bump is evident below the knee.

• Pain occurs with activity, especially straightening the leg against force (stair climbing, jumping, deep knee bends, or weight lifting) or following an extended period of vigorous exercise in an adolescent. In more severe cases, pain occurs during less vigorous activity.


Causes


Osgood–Schlatter disease results from stress or injury to the tibial tubercle growth plate, which is still developing during adolescence. Repeated stress or injury interferes with development, causing inflammation.



Factors that increase risk



• Overzealous conditioning routines, such as running, jumping, or jogging

• Being overweight

• Prevalent in boys between 11 and 18

• Rapid skeletal growth

• Poor physical conditioning (strength, flexibility)


Preventive measures



• Lose weight or maintain an ideal body weight.

• Appropriately warm up and stretch before practice and competition.

• Maintain appropriate conditioning that includes muscle strength, flexibility, and endurance training and cardiovascular fitness.

• Exercise moderately, avoiding extremes.

• Use proper technique.


Expected outcome


Mild cases of osteochondrosis can be resolved with a slight reduction of activity level, whereas moderate to severe cases may require significantly reduced activity and, occasionally, immobilization for 3 to 4 months.



Possible complications



• Bone infection

• Recurrence of the condition in adulthood, with symptomatic bone fragments (ossicles) below the affected knee

• Persisting bump below the kneecap


General treatment considerations


Initial treatment consists of medications and ice to relieve pain; stretching and strengthening exercises, particularly of the quadriceps and hamstrings; and modification of activities. Kneeling, jumping, squatting, stair climbing, and running on the affected knee should be avoided. The exercises can all be carried out at home for acute cases. Chronic cases often require a referral to a physical therapist or athletic trainer for further evaluation or treatment. Uncommonly, the affected leg may be immobilized for 6 to 8 weeks with a reinforced elastic knee support, cast, or a splint. A patellar band, a brace between the kneecap and tibial tubercle on top of the patellar tendon, may help relieve symptoms. Surgery is recommended in the growing patient in the rare situation of failed conservative treatment, and it is occasionally necessary after skeletal maturity if the bone fragments become painful.



Medication



• Nonsteroidal antiinflammatory medications, such as aspirin and ibuprofen (do not take for 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician, and contact your doctor immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Cortisone injections are rarely, if ever, indicated. Because cortisone injections may weaken tendons, it is better to give the condition more time to heal than to use cortisone.

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Figure 1


From Miller MD, Cooper DE, Warner JJP: Review of sports medicine and arthroscopy, Philadelphia, 1995, W.B. Saunders, p 61.

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Jul 18, 2016 | Posted by in SPORT MEDICINE | Comments Off on Osgood-Schlatter Disease (Osteochondrosis, Apophysitis of the Tibial Tubercle)

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