Osgood-Schlatter Disease

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Osgood-Schlatter Disease

Osgood-Schlatter Disease

General Considerations A clinical diagnosis, Osgood-Schlatter disease is a common cause of knee pain in adolescents between 10-15 Ossification center(s) of tibial tubercle (aka tuberosity) usually fuse to each other and tibia at age 12 (girls) to 13 (boys) Etiology is not certain, but it involves a traction apophysitis (osteochondritis) secondary to repetitive stress injury at site of tubercle Contractions of quadriceps transmitted to patellar tendon produce partial avulsion of anterior surface of tibial tubercle May lead to heterotopic ossification at site of tibial tubercle and visible lump Bilateral in 25-50%; more frequent in males Females affected are usually slightly younger (10-11) than males (13-14) Occurs more often with jumping sports Soccer, volleyball, basketball and gymnastics Clinical Findings Intermittent pain at the tibial tubercle, worsened with exercise and relieved by rest Edema and redness at the tubercle Tenderness over the tubercle Imaging Findings Normal x-ray findings do not exclude the disease, which is diagnosed clinically Radiographs are usually obtained to exclude other causes of pain Conventional radiography Not helpful if tubercle has not calcified (usually around 9 [girls]-11 [boys] years of age) Best seen on lateral knee Irregular ossification or fragmentation of tibial tubercle Separated from remainder of tibial tubercle Soft tissue swelling Calcification in or thickening of the patellar tendon MRI Increased size and increased signal intensity on both T 1 and T2 of patellar tendon consistent with tendinitis Distension of the deep infrapatellar bursa Differential Diagnosis Normal separate ossification centers Avulsion fractures of the tibial tubercle Involve entire tubercle rather than just anterior surface Sinding-Larsen-Johansson syndrome Affects inferior pole of patella Seen in preteens Jumper’s knee Patellar (tendinitis) Seen in older adolescents Treatment Analgesics Ice compresses Avoidance of jumping Complications Painful non-union Union is not required, though, for relief of symptoms Prognosis Months or, less commonly, years to resolve Self-limited
Osgood-Schlatter Disease. White arrow points to fragmentation of the tibial tubercle (tuberosity) with overlying soft tissue swelling. There is also edema in the region of the infrapatellar bursa. For more information, click on the link if you see this icon  For this same photo without the annotations, click here and here
Osgood-Schlatter lesion: fracture or tendinitis? Scintigraphic, CT, and MR imaging features. Rosenberg ZS, Kawelblum M, Cheung YY, Beltran J, Lehman WB, Grant AD. Radiology. 1992 Dec;185(3):853-8. eMedicine. Osgood-Schlatter Disease. Chang, A.