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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

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.
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Osgood-Schlatter Disease

Osgood-Schlatter Disease. Red arrow points to fragmentation of the tibial tubercle (tuberosity) with overlying soft tissue swelling (white arrow).

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.