eMedicine Specialties > Radiology > Pediatrics
Osgood-Schlatter Disease: Imaging
Updated: Oct 12, 2007
Radiography
Findings
Findings vary with the age of the child and the stage of the condition at the time the radiograph is obtained.
In the acute stage, edema of the skin and tissues anterior to the tibial tuberosity are present, and the edges of the patellar tendon may be blurred. The Hoffa fat pad may be edematous. If the tibial tuberosity is cartilaginous, no change is seen initially; after 3-4 weeks, fragmented ossification may be visible within the tendon. In the older patient, whose tibial tuberosity is ossified, linear or nodular avulsed bony fragments may be concomitantly visible with the soft-tissue findings, and a bony defect may be visible at the donor site.
In the subacute stage, soft-tissue edema subsides. A previously visible avulsed ossific fragment may remain. New ossific opacities may develop in the injured patellar tendon.
In the late stage, ossific fragments may unite completely to form a normal-appearing tibial tuberosity. If the fragments are dislocated, they may remain superior and anterior to the tibial tuberosity. If they fuse to the tuberosity, the fragments form a bony excrescence from the tibia that extends into the patellar tendon.
Degree of Confidence
Soft-tissue edema in the region of the tibial tuberosity, with thickening and indistinct margins of the patellar tendon, enables the diagnosis of active Osgood-Schlatter disease with a high degree of confidence; usually, radiologic confirmation of this diagnosis is not necessary. Multiple ossification centers may represent sequelae of previous disease or may be a normal finding with accessory ossification centers.
False Positives/Negatives
Accessory ossification centers may mimic findings in the late changes of Osgood-Schlatter disease. The radiographic differential diagnosis of multiple ossific opacities in the area of the anterior tibial tuberosity includes accessory ossification centers, which are normal variants, and late changes from a previous Osgood-Schlatter lesion.
Computed Tomography
Findings
Tendon enlargement and focal decreased attenuation at the insertion of the tendon on the tibial tuberosity are seen in the active stage. Distended deep or superficial infrapatellar bursae may be seen in either the active or late stage. An ossicle may be visible in either the active or late stage, as explained in Radiograph, Findings. The donor site of an ossicle may be visible as a defect in the anterior tibial tuberosity.
Magnetic Resonance Imaging
Findings
In the acute stage, T1- and T2-weighted magnetic resonance images demonstrate increased signal intensity in the tendon at its insertion site. Distended deep and superficial infrapatellar bursae are frequently demonstrated. Ossicles are not depicted as well as they are on CT scans. Marrow edema may be seen in the tibial tuberosity and tibial epiphysis.
In the late stage, signal intensity in the abnormal tendon and marrow edema may normalize. In some cases, thickened cartilage is seen anterior to the tibial tuberosity.
Ultrasonography
Findings
Ultrasonograms can depict the same anatomic abnormalities as can plain radiographs, CT scans, and magnetic resonance images. The distal patellar tendon is thickened, and it is more echogenic than that of healthy control subjects.2 A hypoechoic zone of soft-tissue swelling may exist around the apophysis of the anterior tibial tuberosity. A curvilinear echogenic line may be seen anterior to the tibial tuberosity; this finding is consistent with the presence of an avulsed fragment of the tuberosity.
Nuclear Imaging
Findings
Little information is available regarding the scintigraphic findings of the Osgood-Schlatter lesion. In a published series of 3-phase bone scintigrams that were performed in 10 patients, the findings were normal in all but 1 patient.3 In this single case, increased flow was seen at the time the symptoms appeared, and normal activity was depicted on delayed images. A follow-up scintigram that was obtained in this patient after the symptoms resolved showed a return to normal activity on all 3 phases.
More on Osgood-Schlatter Disease |
| Overview: Osgood-Schlatter Disease |
 Imaging: Osgood-Schlatter Disease |
| Follow-up: Osgood-Schlatter Disease |
| Multimedia: Osgood-Schlatter Disease |
| References |
| « Previous Page | Next Page » |
References
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].
Lanning P, Heikkinen E. Ultrasonic features of the Osgood-Schlatter lesion. J Pediatr Orthop. Jul-Aug 1991;11(4):538-40. [Medline].
Rosenberg ZS, Kawelblum M, Cheung YY, et al. Osgood-Schlatter lesion: fracture or tendinitis? Scintigraphic, CT, and MR imaging features. Radiology. Dec 1992;185(3):853-8. [Medline]. [Full Text].
Flowers MJ, Bhadreshwar DR. Tibial tuberosity excision for symptomatic Osgood-Schlatter disease. J Pediatr Orthop. May-Jun 1995;15(3):292-7. [Medline].
Lynch MC, Walsh HP. Tibia recurvatum as a complication of Osgood-Schlatter's disease: a report of two cases. J Pediatr Orthop. Jul-Aug 1991;11(4):543-4. [Medline].
Ozonoff MB. Tibial tuberosity avulsion (Osgood-Schlatter lesion). In: Pediatric Orthopedic Radiology. 2nd ed. Philadelphia, Pa: WB Saunders; 1992:365-8.
Visuri T, Pihlajamäki HK, Mattila VM, et al. Elongated patellae at the final stage of Osgood-Schlatter disease: a radiographic study. Knee. Jun 2007;14(3):198-203. [Medline].
Weiss JM, Jordan SS, Andersen JS, et al. Surgical Treatment of Unresolved Osgood-Schlatter Disease: Ossicle Resection With Tibial Tubercleplasty. J Pediatr Orthop. October/November 2007;27(7):844-7. [Medline].
Further Reading
Keywords
Osgood-Schlatter lesion, tibial apophysitis, tibial tuberosity avulsion, tibial tuberosity osteochondrosis, knee pain in adolescents, knee pain in children, pediatric knee pain
