Osgood-Schlatter Disease Workup

  • Author: James R Gregory, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: Aug 16, 2015
 

Approach Considerations

While the diagnosis of Osgood-Schlatter disease (OSD) is usually pretty straight forward and purely a clinical diagnosis, due diligence must be considered to verify a more severe diagnosis is being missed.

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Histologic Findings

Lazerte and Rapp, in examining resected operative specimens in patients with Osgood-Schlatter disease, demonstrated avulsion fractures in the distal portion of the tibial tubercle.[7]

Ehrenborg examined histologic specimens of bone excised from portions of tibial tubercles and found viable cancellous bone without evidence of inflammation or avascular necrosis.[8, 9]

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Radiographs

Not all patients with Osgood-Schlatter disease (OSD) need radiography, since the diagnosis is clinical. However, plain films are should be obtained at least once in the evaluation and treatment to rule out other etiologies, such as neoplasm, acute tibial apophyseal fracture, and infection.

Radiographs may indicate:

  • Superficial ossicle in the patellar tendon
  • Irregular ossification of the proximal tibial tuberosity
  • Calcification within the patellar tendon
  • Thickening of the patellar tendon
  • Soft-tissue edema proximal to the tibial tuberosity

The Osgood-Schlatter lesion is best seen on the lateral view, with the knee in slight internal rotation of 10-20°.

The most common finding is that the knee films are normal, especially if the child is in the preossification phase.

The acute phase of OSD may reveal a prominent and elevated tibial tubercle with anterior soft-tissue swelling.

In severe cases, radiographs may reveal radiodense fragments or ossicles separated from the tibial tuberosity. (An ossicle is seen in the image below.)

Radiograph of a patient who is skeletally mature. Radiograph of a patient who is skeletally mature. Note that the tibial tubercle is enlarged and there is an ossicle. A bursa was overlying this.

Occasionally, the radiographs may reveal irregularity, fragmentation (seen below), or increased density of the ossification of the tibial tubercle. This pattern may be a normal variant in asymptomatic children.

Radiograph of a patient who is skeletally immature Radiograph of a patient who is skeletally immature. The tubercle is elongated and fragmented
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Other Imaging Modalities

Advanced Imaging is not necessary to make the diagnosis of Osgood-Schlatter disease (OSD) but may be necessary to verify that another diagnosis is not present.

Ultrasonography may reveal a normal tubercle and signal changes consistent with thickening (more echogenic) in the patellar tendon and hypoechoic area of the adjacent soft tissue.[10, 11]

Nuclear Medicine Bone Scan if obtained may demonstrate increased uptake in the area of the tibial tuberosity.

Computed tomography (CT) scanning or magnetic resonance imaging (MRI) may reveal changes at the insertion of the patellar tendon.

MRI may assist in diagnosis of an atypical presentation. It may eventually play a role in staging of the disease and prognosticating the clinical course. However, MRI’s role in diagnosis, prognostication, and management is currently limited.[6] Magnetic resonance imaging if obtained to rule out other diagnoses may show increased bony edema of the tibial tuberosity.

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Laboratory Studies

Laboratory evaluation is not indicated for Osgood-Schlatter disease (OSD) unless other diagnoses are being entertained.

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Contributor Information and Disclosures
Author

James R Gregory, MD Assistant Professor, Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

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, Oklahoma State Medical Association, Pediatric Orthopaedic Society of North America

Disclosure: Nothing to disclose.

Acknowledgements

Andrew K Chang, MD Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center

Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Thomas M DeBerardino, MD Associate Professor, Department of Orthopedic Surgery, Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician, Orthopedic Consultant to UConn Department of Athletics, University of Connecticut Health Center

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 Other; Arthrex, Inc. Consulting fee Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, and Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Gyorgy Kovacs, MD Consulting Surgeon, Department of Orthopedic Surgery, GOC Clinic

Disclosure: Nothing to disclose.

David B Levy, DO, FACEP, FAAEM Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Munisha Mehra Bhatia, MD General Academic Pediatrics, Faculty Development Fellow, Children's Memorial Hospital of Northwestern University

Munisha Mehra Bhatia, MD is a member of the following medical societies: Academic Pediatric Association and American Academy of Pediatrics

Disclosure: Nothing to disclose.

Albert W Pearsall IV, MD Associate Professor, Department of Orthopedic Surgery, University of South Alabama College of Medicine; Director, Section of Sports Medicine and Shoulder Service, Department of Orthopedic Surgery, University of South Alabama Medical Center

Disclosure: Nothing to disclose.

Andrew L Sherman, MD, MS Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, University of Miami, Leonard A Miller School of Medicine

Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Pfizer Honoraria Speaking and teaching

Mark S Slabinski, MD, FACEP, FAAEM Vice President, EMP Medical Group

Mark S Slabinski, MD, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Ohio State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
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  10. Ducher G, Cook J, Spurrier D, Coombs P, Ptasznik R, Black J, et al. Ultrasound imaging of the patellar tendon attachment to the tibia during puberty: a 12-month follow-up in tennis players. Scand J Med Sci Sports. 2010 Feb. 20(1):e35-40. [Medline].

  11. Ducher G, Cook J, Lammers G, Coombs P, Ptazsnik R, Black J, et al. The ultrasound appearance of the patellar tendon attachment to the tibia in young athletes is conditional on gender and pubertal stage. J Sci Med Sport. 2010 Jan. 13(1):20-3. [Medline].

  12. Pihlajamäki HK, Mattila VM, Parviainen M, Kiuru MJ, Visuri TI. Long-term outcome after surgical treatment of unresolved Osgood-Schlatter disease in young men. J Bone Joint Surg Am. 2009 Oct. 91(10):2350-8. [Medline].

  13. Binazzi R, Felli L, Vaccari V, Borelli P. Surgical treatment of unresolved Osgood-Schlatter lesion. Clin Orthop Relat Res. 1993 Apr. 202-4. [Medline].

  14. Eun SS, Lee SA, Kumar R, Sul EJ, Lee SH, Ahn JH, et al. Direct bursoscopic ossicle resection in young and active patients with unresolved Osgood-Schlatter disease. Arthroscopy. 2015 Mar. 31 (3):416-21. [Medline].

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

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

 
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Radiograph of a patient who is skeletally mature. Note that the tibial tubercle is enlarged and there is an ossicle. A bursa was overlying this.
Radiograph of a patient who is skeletally immature. The tubercle is elongated and fragmented
Image courtesy of John T. Killion, MD; OSA Pediatric Orthopaedics
Image courtesy of John T. Killion, MD; OSA Pediatric Orthopaedics
 
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