Osgood-Schlatter’s Disease Posted on Thursday, September 11, 2003 - 00:00 Synonyms: Traumatic upper tibial apophysitis Anatomy: - The apophysis develops from a few ossification centres. Calcification of the apophysis begins at ±9 years in girls, and ± 11 years in boys. Fusion occurs at 12 years in girls and 13 years in boys. Micro-avulsions occur especially when there are separate ossification centres, and abnormal fragmentation may occur. Mechanism of Injury: An overload injury caused by excessive repetitive traction on the anterior portion of the developing ossification centre of the tibial tuberosity. In adolescents this apophysis is weaker than the bone and tendons so it can be easily injured by repetitive overloading. Incidence: - Age 13 - 14 years - Boys more common than girls Sports: All sports where overloading of the patella tendon at its insertion into the tibial tubercle causes micro avulsions in the apophysis Symptoms: - Pain this is aggravated by playing sport is aggravated by knee extension against resistance Local prominence occurs in the region of the tibial tubercle. There is usually some associated swelling. A direct blow to the swollen area is usually painful. Signs: Tenderness over the tibial tuberosity - (A on photograph) Local prominence over the tibial tuberosity Increased local heat over the tibial tuberosity Differential - Patella paratendinitis Diagnosis:- Patellar tendinitis (jumper’s knee, Sindling-Larson disease) The diagnosis is made clinically Investigations: X-ray - Soft tissue swelling anterior to the tibial tuberosity. Loss of the sharp inferior angle of the infrapatellar fat pad Thickening of the patellar tendon Abnormal fragmentation of the ossification centres (difficult to differentiate from normal ossification centres) Of value only in cases where symptoms occur early, persist for long or are very severe Help rule out fractures or tumours Prevention: This condition could possibly be prevented by progressive loading of the quadriceps, and therefore the tibial tuberosity. A progressive resistance exercise programme before the season may be helpful. Complications: Sometimes an ossicle does not incorporate into the tibial tuberosity. This give rise to pain. Treatment; Conservative Rest from all physical activity causing pain, especially at the beginning of the disease, appears to speed up the healing process. This rest should be for about ±2-4 months. Non-steroidal anti-inflammatory drugs Icing This treatment will settle most cases Steroid injections are unlikely to have any real value. Surgery Indications: Condition fails to settle despite apophyseal fusion Procedure Excision of loose fragments of the tibial tuberosity or separate ossicles, which become symptomatic, is helpful. Article by: Dr Clive Noble (SARFU Medical Committee Member)