eMedicine Specialties > Orthopedic Surgery > Knee

Osgood-Schlatter Disease: Treatment

Author: J Andy Sullivan, MD, Clinical Professor of Pediatric Orthopedics, Department of Orthopedic Surgery, University of Oklahoma College of Medicine
Contributor Information and Disclosures

Updated: Mar 24, 2009

Treatment

Medical Therapy

Most patients respond to conservative care that consists of rest and avoidance of the offending activity. Stretching of the quadriceps and hamstrings before engaging in athletics may be helpful. Applying ice after physical activity may decrease swelling and pain. Immobilization by casting or bracing usually is unnecessary except in severe cases. Nonsteroidal anti-inflammatory drugs may be used but have not been shown to shorten the course of the disease. Steroid injections should not be used. Other than the presence of an ossicle that causes pain with kneeling, there are no long-term disabilities or problems associated with this condition.

Surgical Therapy

Binazzi et al reviewed a series of patients who had been treated operatively.14 They stated that treatment generally is conservative and only rarely does surgical treatment become necessary. Their indications for surgery were persistence of pain and swelling. The most widely used procedure was excision of all intratendinous ossicles, with or without removal of a portion of the prominent tibial tubercle. A comparison of 2 groups of individuals, 1 with 15 individuals treated with excision of ossicles and 1 with 11 individuals treated with various methods before 1975, clearly showed that results of simple excision of the ossicles were better.

In another study, patients treated operatively were no more likely than conservatively treated patients to be relieved of pain or have improvement of cosmetic appearance.

The authors' preferred method of management of this condition is as follows:

  • Advise the patient and family that the disease will run its course over the next year.
  • Do not prohibit individuals from participating in sports, but warn them (in the presence of their parents) that it will take longer for the disease to become asymptomatic if they do not rest.
  • Some researchers have noted that tibial tubercle fractures can occur in patients with Osgood-Schlatter disease. No scientific study has shown that patients with OS condition are more likely than those without the condition to develop such fractures.
  • Advise patients that the only treatment is rest and avoidance of activities that cause the pain.
  • The authors have not used immobilization for many years, nor have they operated on any adolescents with OS condition. Patients are advised that they can be immobilized in a brace or cast if pain persists. The authors have not had any patients return requesting either of these 2 treatments.

Complications

Surgery is rarely indicated.15,16 Following resection of an ossicle, complications include continued pain and poor cosmetic appearance. In a study by Trail, 55% of patients had an obvious bony prominence postoperatively. One third of these prominences were quite marked and troublesome, and 3 required a subsequent shaving.12 One patient lost 10° of flexion, and another patient had 10° of recurvatum. Other complications that may occur include dehiscence, unsightly scar, anesthesia lateral to the scar, and continued presence of sequestra.

More on Osgood-Schlatter Disease

Overview: Osgood-Schlatter Disease
Workup: Osgood-Schlatter Disease
Treatment: Osgood-Schlatter Disease
Follow-up: Osgood-Schlatter Disease
Multimedia: Osgood-Schlatter Disease
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Gholve PA, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter syndrome. Curr Opin Pediatr. Feb 2007;19(1):44-50. [Medline].

  2. Pommering TL, Kluchurosky L. Overuse injuries in adolescents. Adolesc Med State Art Rev. May 2007;18(1):95-120, ix. [Medline].

  3. Krause BL, Williams JP, Catterall A. Natural history of Osgood-Schlatter disease. J Pediatr Orthop. Jan-Feb 1990;10(1):65-8. [Medline].

  4. Kujala UM, Kvist M, Heinonen O. Osgood-Schlatter''s disease in adolescent athletes. Retrospective study of incidence and duration. Am J Sports Med. Jul-Aug 1985;13(4):236-41. [Medline].

  5. Lazerte GD, Rapp HH. Pathogenesis of Osgood-Schlatter's disease. Am J Pathol. Jul-Aug 1958;34(4):803-15. [Medline].

  6. Ehrenborg G. The Osgood-Schlatter lesion. A clinical study of 170 cases. Acta Chir Scand. Aug 1962;124:89-105. [Medline].

  7. Ehrenborg G. The Osgood-Schlatter lesion. A clinical and experimental study. Acta Chir Scand Suppl. 1962;Suppl 288:1-36. [Medline].

  8. Woolfrey BF, Chandler EF. Manifestations of Osgood-Schlatter's disease in late teen age and early adulthood. J Bone Joint Surg Am. Mar 1960;42-A:327-32. [Medline].

  9. Ogden JA, Southwick WO. Osgood-Schlatter''s disease and tibial tuberosity development. Clin Orthop. May 1976;(116):180-9. [Medline].

  10. Rosenberg ZS, Kawelblum M, Cheung YY. Osgood-Schlatter lesion: fracture or tendinitis? Scintigraphic, CT, and MR imaging features. Radiology. Dec 1992;185(3):853-8. [Medline].

  11. Orava S, Malinen L, Karpakka J, et al. Results of surgical treatment of unresolved Osgood-Schlatter lesion. Ann Chir Gynaecol. 2000;89(4):298-302. [Medline].

  12. Trail IA. Tibial sequestrectomy in the management of Osgood-Schlatter disease. J Pediatr Orthop. Sep-Oct 1988;8(5):554-7. [Medline].

  13. Visuri T, Pihlajamäki HK, Mattila VM, Kiuru M. Elongated patellae at the final stage of Osgood-Schlatter disease: a radiographic study. Knee. Jun 2007;14(3):198-203. [Medline].

  14. Binazzi R, Felli L, Vaccari V. Surgical treatment of unresolved Osgood-Schlatter lesion. Clin Orthop. Apr 1993;(289):202-4. [Medline].

  15. DeBerardino TM, Branstetter JG, Owens BD. Arthroscopic treatment of unresolved Osgood-Schlatter lesions. Arthroscopy. Oct 2007;23(10):1127.e1-3. [Medline].

  16. Weiss JM, Jordan SS, Andersen JS, Lee BM, Kocher M. Surgical treatment of unresolved Osgood-Schlatter disease: ossicle resection with tibial tubercleplasty. J Pediatr Orthop. Oct-Nov 2007;27(7):844-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

Related eMedicine topics

Osgood-Schlatter Disease (Emergency Medicine)

Osgood-Schlatter Disease (Radiology)

Osgood-Schlatter Disease (Sports Medicine)

Tibial Tubercle Avulsion

Tibial Tubercle Fracture

[ CLOSE WINDOW ]

Keywords

Osgood-Schlatter disease, tibial tubercle apophyseal traction injury, OSD, OS condition, apophysitis tibialis adolescentium, Schlatter disease, Schlatter-Osgood disease, osteochondritis, osteochondrosis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

J Andy Sullivan, MD, Clinical Professor of Pediatric Orthopedics, Department of Orthopedic Surgery, University of Oklahoma College of Medicine
J Andy Sullivan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, Oklahoma State Medical Association, and Pediatric Orthopaedic Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Albert W Pearsall IV, MD, Associate Professor, Department of Orthopedic Surgery, University of South Alabama; Director, Section of Sports Medicine and Shoulder Service, Department of Orthopedic Surgery, University of South Alabama Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas M DeBerardino, MD, Director, John A Feagin, Jr, Sports Medicine Fellowship at West Point, Associate Professor of Orthopedic Surgery, Uniformed Services University of the Health Sciences and Keller Army Community Hospital
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Arthrex, Inc. Grant/research funds None; Arthrex, Inc. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.