Osgood-Schlatter Disease: Osgood-Schlatter Disease By: Kevin Dang Dustin Dobbs Brittany Farnsworth 2/10/2012 Description: Description Osgood-Schlatter disease is osteochondrosis of the anterior tibial tubercle. 1 Osteochondrosis is disease that is characterized by a disruption of the blood supply to the bone. 1 Osteochondrosis affects many different bones in the body including femoral head, calcaneus, capitulum of elbow, navicular, 2 nd metatarsal of the foot, lunate, and anterior tibial tubercle. 1,2 4 Stages of Osteochondrosis: 4 Stages of Osteochondrosis Phase 1- Necrosis- no blood supply as well as osteocyte & bone marrow death. 2 Phase 2- Revascularization- return of blood supply and bone reformation. 2 Phase 3- Bone Healing- continuation of bone deposition. 2 Phase 4- R esidual Deformity- completion of bone reformation and possible residual bone deformity. 2 Incidence: Incidence Osgood-Schlatter disease primarily affects children and adolescents during growth spurts. 3 Affects boys (13 to 14 years) more than girls (11 to 12 years). 3 More common in children who play sports that involve running, jumping, and quick changes in direction. 3 It affects as many as 1 in 5 adolescent athletes. 3 Signs & Symptoms: Signs & Symptoms The signs & symptoms vary between the different phases of the disease. Phase 1- Necrosis- Described as the “Quiet Period” because radiographs are negative and the patients are asymptomatic. 2 Phase 2- Revascularization- A diagnosis can be made in this phase, radiograph shows fragmentation, symptoms are present and include knee pain that worsens with activity and lessens with rest, swelling and tenderness over tubercle. 2 Phase 3- Bone Healing- Symptoms are the same as phase 2. 2 Phase 4- Residual Deformity- The patient will be asymptomatic, but will present with a palpable deformity and have abnormal radiographs at the tibial tubercle. 2 Initial Observation: Initial Observation On initial observation, you may notice the patient has a raised tibial tubercle. You can observe the raised tibial tubercle on the right leg in this photo. 4 Positive Radiograph for Osgood-Schlatter: Positive Radiograph for Osgood-Schlatter Notice the tibial tubercle being pulled away from the tibia. 5 Diagnosis: Diagnosis Confirmed with a radiograph showing swelling, damage, and/or abnormal bony growth on the tibial tubercle. 9 Patient reports pain, swelling, and tenderness of the tibial tubercle with activity that lessens with rest. 8 For mild cases of Osgood-Schlatter disease without any abnormal bony changes, the symptoms may be limited to soft tissue swelling; particularly of the infrapatellar fat pads. 6 MRI Imaging: MRI Imaging T1 MRI T2 MRI 7 Prognosis: Prognosis Outcomes vary depending on age of onset and severity of symptoms. The prognosis is usually very good with most cases improving on their own within weeks to months. In most cases, once the child has finished growing, the residual deformity becomes asymptomatic. 3 Biomechanical and Physical Impairments: Biomechanical and Physical Impairments The increase in length of the tibial tuberosity causes a decrease in length of the patellar ligament creating a shorter lever arm for the muscle and ligament. This decrease in lever arm may cause a decrease in force production of the quadriceps muscle. Due to a possible decrease in force production as well as an increase in swelling and inflammation the patient may present with a decrease in strength and range of motion. Impact on Function: Impact on Function Usually the patient limits their activity due to pain. Patient complains of knee pain that worsens with activity and is relieved with rest. 8 Movement analysis may reveal an antalgic gait. 8 Decreased participation in athletic activities due to pain with kneeling, running, jumping, and quick direction changes is recommended. 9 Management: Management Osgood-Schlatter disease is managed conservatively, which includes rest, bracing, icing, physical therapy, and the use of anti-inflammatory drugs. 9,12 Physical therapy will include examination of functional limitations, muscle length, manual muscle testing, as well as stretching and strengthening of the surrounding musculature of the knee. 9 Differential diagnosis can be made by using the behavior of symptoms, history, imaging, and specific tests and measures. Management: Management When conservative management is not effective, then surgery might be necessary. As you can see in this radiograph, the surgeon used a ORIF to anchor the tibial tubercle to the tibia. 10 Ultrasound Imaging: Ultrasound Imaging Ultrasound is growing in popularity for diagnosis of Osgood-Schlatter. As depicted in this photo, the patellar tendon (with fibers in the transverse direction) are avulsing the tibial tubercle (the structure with greater density) from the tibia. Note the deviated alignment of the tibia. 11 Questions to classmates: Questions to classmates What specific exercises would be appropriate for a patient with Osgood-Schlatter and why? Of the three imaging modalities described in this powerpoint , which do you prefer and why? References: References Siffert, RS. Classification of the osteochondroses. Clin Orthop Relat Res. 1981 ;158:10–18. Chaconas , E. Orthopedics Notes. University of St Augustine for Health Sciences. Summer 2010. Mayo Clinic Staff. Osgood-Schlatter Disease. Available at: www.mayoclinic.com/health/osgood-schlatter-disease/DS00392 . Accessed February 10, 2012. Drug Information Online. Osgood Schlatters Disease. Available at: http://drugster.info/ail/pathography/3181/ . Accessed February 11, 2012. E-Medicine Case Study. Right Knee Pain. Available at: http://www.jasoncartermd.com/teaching/0015.htm. Accessed Februrary 11 , 2012. Scotti D, Sadhu V, Helmberg F, et al. Osgood-Schlatter’s Disease , an emphasis on soft tissue changes in roentgen diagnosis. Skeletal Radiology. 1979 (4) 21-25. My E-Radiology Cases. Case 153: 12 Year Old Boy with Anterior Knee Pain. Available at: http://mye-rad.blogspot.com/2011_01_01_archive.html . Accessed February 11, 2012. Antich T, Brewster C. Osgood-Schlatter Disease: Review of Literature and physical Therapy Management. The Journal of Orthopedic and Sports Physical Therapy . 1985;7(1):5-10. A.D.A.M. Medical Encyclopedia. Osgood-Schlatter Disease. Available at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002238/ . Accessed February 10, 2012. Gaibor J, Sánchez D, Martillo J, et al. Avulsion-Fracture Of The Tibial Tuberosity During Osgood- Schlatter Disease In Adolescent: Case Report And Review Of The Literature. Available at: http://www.ispub.com/journal/the-internet-journal-of-orthopedic-surgery/volume-3-number-1/avulsion-fracture-of-the-tibial-tuberosity-during-osgood-schlatter-disease-in-adolescent-case-report-and-review-of-the-literature.html . Accessed February 11, 2012. Ultrasound Cases. Osgood Schlatter disease with fragmentation of the apophysis and hypervascularity. Available at: http://www.ultrasoundcases.info/Slide-View.aspx?cat=401&case=3444 . Accessed February 11, 2012. Anonymous. Osgood - Schlatter Disease; New Osgood -Schlatter Disease Study Findings Reported from University of Kansas. Pediatrics Week. 2011; 121.