Osgood-Schlatter Disease

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Osgood-Schlatter Disease (OSD) is an overuse injury that occurs in the knee, typically affecting adolescents during periods of rapid growth. It is characterised by inflammation of the patellar tendon at its attachment to the tibial tuberosity.

Aetiology

Osgood-Schlatter Disease is caused by repetitive stress and overuse of the quadriceps muscle, which exerts tension on the patellar tendon. Key aetiological factors include:

• Frequent participation in sports involving running, jumping, and swift changes in direction
• Rapid growth spurts
• Excessive physical activity without adequate rest

Pathophysiology

The pathophysiology of Osgood-Schlatter Disease involves:

• Repetitive traction on the tibial tuberosity by the patellar tendon
• Inflammation and microfractures at the site of tendon insertion
• Potential for avulsion fractures in severe cases
• Formation of a bony prominence at the tibial tuberosity

Risk Factors

• Adolescence (particularly during growth spurts)
• Male gender
• Participation in sports such as football, basketball, volleyball, and gymnastics
• High levels of physical activity
• Previous history of knee injuries

Signs and Symptoms

The signs and symptoms of Osgood-Schlatter Disease include:

• Pain and tenderness at the tibial tuberosity
• Swelling and inflammation at the site of pain
• Worsening pain with physical activity, especially running, jumping, and kneeling
• Relief of pain with rest
• Prominent bony lump at the tibial tuberosity

Investigations

Specific investigations to diagnose Osgood-Schlatter Disease include:

• Clinical examination: Physical assessment of pain, swelling, and tenderness over the tibial tuberosity.
• Imaging studies:
  • X-rays: To rule out other conditions and show fragmentation or elevation of the tibial tuberosity.
  • Ultrasound: To assess soft tissue involvement and inflammation.

Management

Primary Care Management

• Rest and activity modification: Reducing physical activity and avoiding activities that exacerbate symptoms.
• Pain management: Analgesics such as paracetamol or NSAIDs to relieve pain and inflammation.
• Ice application: Applying ice packs to the affected area to reduce swelling and pain.
• Stretching and strengthening exercises: Gentle quadriceps and hamstring stretches and strengthening exercises to support knee function.
• Patellar tendon straps or knee braces: To reduce strain on the tibial tuberosity during physical activity.

Specialist Management

• Physiotherapy: Referral to a physiotherapist for tailored exercise programmes and management strategies.
• Severe or persistent cases: Orthopaedic referral may be necessary for further evaluation and management, including consideration of surgical intervention in rare cases.

References

1. NHS (2024) Osgood-Schlatter Disease. Available at: https://www.nhs.uk/conditions/osgood-schlatter-disease/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Osgood-Schlatter Disease. Available at: https://cks.nice.org.uk/topics/osgood-schlatter-disease/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Osgood-Schlatter Disease: clinical features, diagnosis, and management. Available at: https://www.bmj.com/content/350/bmj.h2921 (Accessed: 24 June 2024).
4. American Academy of Orthopaedic Surgeons (2024) Osgood-Schlatter Disease. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/osgood-schlatter-disease-knee-pain/ (Accessed: 24 June 2024).

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