Osgood-Schlatter disease
Encyclopedia
Osgood–Schlatter disease and or syndrome (also known as tibial tubercle apophyseal traction injury) is an irritation of the patellar tendon at the tibial tuberosity.
Sinding–Larsen–Johansson syndrome is an analogous condition involving the patellar tendon and the lower margin of the patella bone, instead of the upper margin of the tibia.
The condition occurs in active boys and girls aged 9–16 coinciding with periods of growth spurts. It occurs more frequently in boys than in girls, with reports of a male-to-female ratio ranging from 3:1 to as high as 7:1. It has been suggested the difference is related to a greater participation by boys in sports and risk activities than by girls.
The condition is usually self-limiting and is caused by stress on the patellar tendon
that attaches the quadriceps muscle at the front of the thigh
to the tibial tuberosity
. Following an adolescent growth spurt, repeated stress from contraction of the quadriceps is transmitted through the patellar tendon to the immature tibial tuberosity. This can cause multiple subacute avulsion fracture
s along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump which can be very painful when hit.
The syndrome may develop without trauma or other apparent cause; however, some studies report up to 50% of patients relate a history of precipitating trauma.
In a retrospective study of adolescents, young athletes actively participating in sports showed a frequency of 21% reporting the syndrome compared with only 4.5% of age-matched nonathletic controls.
Intense knee pain is usually the presenting symptom that occurs during activities such as running, jumping, squatting, and especially ascending or descending stairs and during kneeling. The pain is worse with acute knee impact. The pain can be reproduced by extending the knee against resistance, stressing the quadriceps, or striking the knee. Pain is mild and intermittent initially. In the acute phase the pain is severe and continuous in nature. Impact of the affected area can be very painful. Bilateral symptoms are observed in 20–30% of patients.
The symptoms usually resolve with treatment but may recur for 12–24 months before complete resolution at skeletal maturity, when the tibial epiphysis fuses. In some cases the symptoms do not resolve until the patient is fully grown. In approximately 10% of patients the symptoms continue unabated into adulthood, despite all conservative measures.
The condition is named after Robert Bayley Osgood and Carl B. Schlatter who described the condition independently in 1903.
(Rest, Ice, Compression, and Elevation), and if required acetaminophen (paracetamol) or ibuprofen
. The condition usually resolves in a few months, with a study of young athletes revealing a requirement of complete training cessation for 1 week (on average) and gradual resumption of full training by 1 months.
Bracing or use of an orthopedic cast
to enforce joint immobilization is rarely required and does not necessarily give quicker resolution. Sometimes, however, bracing may give comfort and help reduce pain as it reduces strain on the tibial tubercle. Surgical excision may rarely be required in skeletally mature patients.
After symptoms have resolved, a gradual progression to the desired activity level may begin. In addition, predisposing factors should be evaluated and addressed. Commonly quadriceps and/or hamstring
tightness is present and should be addressed with stretching exercise.
After being clinically diagnosed the patient should rest for at least 3 days and must try not to use the knee as hard for about 1–2 weeks without any physical activities. If the disease continues to a certain extent where the patient cannot move the joint then they should seek medical advice straight away as although this is very rare it can be severely limiting for the patient's sporting future if it does occur.
The Strickland Protocol has shown a positive response in patients with a mean return to sport in less than 3 weeks. Further research into the anatomical and biomechanical responses of this protocol are currently being undertaken by the authors. The study was presented at the European College of Sports Science - 13th Congress Proceedings Estoril,Portugal, July 9–12, 2008.
Paul Scholes
is a sportsman who has recovered from this condition. The French tennis player, Gaël Monfils
, wears patella bands in an attempt to combat the condition. Liverpool Captain Steven Gerrard also suffered from the condition in his youth.
Sinding–Larsen–Johansson syndrome is an analogous condition involving the patellar tendon and the lower margin of the patella bone, instead of the upper margin of the tibia.
The condition occurs in active boys and girls aged 9–16 coinciding with periods of growth spurts. It occurs more frequently in boys than in girls, with reports of a male-to-female ratio ranging from 3:1 to as high as 7:1. It has been suggested the difference is related to a greater participation by boys in sports and risk activities than by girls.
The condition is usually self-limiting and is caused by stress on the patellar tendon
Patellar ligament
The patellar ligament is the central portion of the common tendon of the Quadriceps femoris, which is continued from the patella to the tuberosity of the tibia.-Anatomy:It is a strong, flat, ligament, about 10 cm...
that attaches the quadriceps muscle at the front of the thigh
Thigh
In humans the thigh is the area between the pelvis and the knee. Anatomically, it is part of the lower limb.The single bone in the thigh is called the femur...
to the tibial tuberosity
Tibia
The tibia , shinbone, or shankbone is the larger and stronger of the two bones in the leg below the knee in vertebrates , and connects the knee with the ankle bones....
. Following an adolescent growth spurt, repeated stress from contraction of the quadriceps is transmitted through the patellar tendon to the immature tibial tuberosity. This can cause multiple subacute avulsion fracture
Avulsion fracture
An avulsion fracture is a bone fracture which occurs when a fragment of bone tears away from the main mass of bone as a result of physical trauma. This can occur at the ligament due to the application forces external to the body or at the tendon due to a muscular contraction that is stronger than...
s along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump which can be very painful when hit.
The syndrome may develop without trauma or other apparent cause; however, some studies report up to 50% of patients relate a history of precipitating trauma.
In a retrospective study of adolescents, young athletes actively participating in sports showed a frequency of 21% reporting the syndrome compared with only 4.5% of age-matched nonathletic controls.
Intense knee pain is usually the presenting symptom that occurs during activities such as running, jumping, squatting, and especially ascending or descending stairs and during kneeling. The pain is worse with acute knee impact. The pain can be reproduced by extending the knee against resistance, stressing the quadriceps, or striking the knee. Pain is mild and intermittent initially. In the acute phase the pain is severe and continuous in nature. Impact of the affected area can be very painful. Bilateral symptoms are observed in 20–30% of patients.
The symptoms usually resolve with treatment but may recur for 12–24 months before complete resolution at skeletal maturity, when the tibial epiphysis fuses. In some cases the symptoms do not resolve until the patient is fully grown. In approximately 10% of patients the symptoms continue unabated into adulthood, despite all conservative measures.
The condition is named after Robert Bayley Osgood and Carl B. Schlatter who described the condition independently in 1903.
Treatment
Diagnosis is made clinically, and treatment is conservative with rest, RICERice
Rice is the seed of the monocot plants Oryza sativa or Oryza glaberrima . As a cereal grain, it is the most important staple food for a large part of the world's human population, especially in East Asia, Southeast Asia, South Asia, the Middle East, and the West Indies...
(Rest, Ice, Compression, and Elevation), and if required acetaminophen (paracetamol) or ibuprofen
Ibuprofen
Ibuprofen is a nonsteroidal anti-inflammatory drug used for relief of symptoms of arthritis, fever, as an analgesic , especially where there is an inflammatory component, and dysmenorrhea....
. The condition usually resolves in a few months, with a study of young athletes revealing a requirement of complete training cessation for 1 week (on average) and gradual resumption of full training by 1 months.
Bracing or use of an orthopedic cast
Orthopedic cast
An orthopedic cast, body cast or surgical cast, is a shell, frequently made from plaster, encasing a limb to hold a broken bone in place until healing is confirmed...
to enforce joint immobilization is rarely required and does not necessarily give quicker resolution. Sometimes, however, bracing may give comfort and help reduce pain as it reduces strain on the tibial tubercle. Surgical excision may rarely be required in skeletally mature patients.
After symptoms have resolved, a gradual progression to the desired activity level may begin. In addition, predisposing factors should be evaluated and addressed. Commonly quadriceps and/or hamstring
Hamstring
In human anatomy, the hamstring refers to any one of the three posterior thigh muscles, or to the tendons that make up the borders of the space behind the knee. In modern anatomical contexts, however, they usually refer to the posterior thigh muscles, or the tendons of the semitendinosus, the...
tightness is present and should be addressed with stretching exercise.
After being clinically diagnosed the patient should rest for at least 3 days and must try not to use the knee as hard for about 1–2 weeks without any physical activities. If the disease continues to a certain extent where the patient cannot move the joint then they should seek medical advice straight away as although this is very rare it can be severely limiting for the patient's sporting future if it does occur.
The Strickland Protocol has shown a positive response in patients with a mean return to sport in less than 3 weeks. Further research into the anatomical and biomechanical responses of this protocol are currently being undertaken by the authors. The study was presented at the European College of Sports Science - 13th Congress Proceedings Estoril,Portugal, July 9–12, 2008.
Paul Scholes
Paul Scholes
Paul Scholes is a retired English footballer, a one-club man who played his entire professional career for Manchester United.Born in Salford, but later moving to Langley, Scholes excelled in both cricket and football in school. He first trained with Manchester United at the age of 14 after being...
is a sportsman who has recovered from this condition. The French tennis player, Gaël Monfils
Gaël Monfils
Gaël Sébastien Monfils is a French professional tennis player. he was the highest-ranked French tennis player, ranked no. 7 in the world ATP rankings. He was the runner-up at the Paris Masters in 2009 and 2010 and a semifinalist at the 2008 French Open.-2002:In 2002, Monfils finished 24th at the...
, wears patella bands in an attempt to combat the condition. Liverpool Captain Steven Gerrard also suffered from the condition in his youth.