eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Osgood-Schlatter Disease: Follow-up

Author: Andrew K Chang, MD, Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center
Contributor Information and Disclosures

Updated: Apr 22, 2009

Follow-up

Further Inpatient Care

  • Surgical treatment is rarely indicated and is generally reserved for patients with recurrent disabling pain unresponsive to conservative therapy. In general, surgical intervention yields good results, especially for patients with bony or cartilaginous ossicles.
    • Once the other physes have closed, surgery may be necessary for non-united ossicles.
    • Simple excision of the mobile ossicle may be necessary.
    • A tuberosity thinning procedure followed by ossicle excision may be performed.
    • In one case series, 67 patients (70 knees) with at least 1.5 years of symptoms despite conservative treatment underwent resection of an ossicle (62 cases) or excision of prominent tibial tubercle (8 cases). These patients (mean age, 19.6 y; 77% male) were observed for 2.2 years, with 56 (90%) of patients with ossicle-resection able to return to maximal sports activity without pain, tenderness, loss of motion, or atrophy.4

Further Outpatient Care

  • Conservative therapy is usually all that is needed.
    • Avoid physical activities that require frequent deep knee bending for 2-4 months.
    • Therapeutic exercises to strengthen the quadriceps and the hamstrings are prescribed.
  • Orthopedic devices
    • Infrapatellar strap
    • Knee brace
    • Walking cylinder cast (full extension for 3-6 wk)
  • Analgesics
    • Control pain and inflammation
    • Corticosteroid injections should be avoided because of the risk of degenerative changes and subcutaneous atrophy.

Deterrence/Prevention

  • Patients should avoid sports that involve heavy quadriceps loading.
  • Patients should increase hamstring and quadriceps flexibility.

Complications

Complications of Osgood-Schlatter disease may include the following:

  • Nonunion of the tibial tubercle
  • Upriding of the patella
  • Patellar tendon avulsion
  • Genu recurvatum
  • Patellofemoral degenerative arthritis
  • Patellar subluxation
  • Patella alta
  • Chondromalacia

Prognosis

  • The prognosis for patients with Osgood-Schlatter disease is excellent. Symptoms usually resolve spontaneously within 1 year.
  • Discomfort may persist for 2-3 years until the tibial growth plate closes.
  • In approximately 10% of patients, the symptoms continue unabated into adulthood despite all conservative measures.3 This may be from residual enlargement of the tuberosity or from ossicle formation in the patellar tendon.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider other diagnoses, such as underlying fracture or tumor
  • Failure to advise the patient of activity restrictions
 


More on Osgood-Schlatter Disease

Overview: Osgood-Schlatter Disease
Differential Diagnoses & Workup: Osgood-Schlatter Disease
Treatment & Medication: Osgood-Schlatter Disease
Follow-up: Osgood-Schlatter Disease
Multimedia: Osgood-Schlatter Disease
References
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References

  1. Demirag B, Ozturk C, Yazici Z, Sarisozen B. The pathophysiology of Osgood-Schlatter disease: a magnetic resonance investigation. J Pediatr Orthop B. Nov 2004;13(6):379-82. [Medline].

  2. 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].

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

  4. 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].

  5. Aparicio G, Abril JC, Calvo E, Alvarez L. Radiologic study of patellar height in Osgood-Schlatter disease. J Pediatr Orthop. Jan-Feb 1997;17(1):63-6. [Medline].

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

  7. Bloom OJ, Mackler L, Barbee J. Clinical inquiries. What is the best treatment for Osgood-Schlatter disease?. J Fam Pract. Feb 2004;53(2):153-6. [Medline].

  8. Dunn JF. Osgood-Schlatter disease. Am Fam Physician. Jan 1990;41(1):173-6. [Medline].

  9. Flowers MJ, Bhadreshwar DR. Tibial tuberosity excision for symptomatic Osgood-Schlatter disease. J Pediatr Orthop. May-Jun 1995;15(3):292-7. [Medline].

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

  11. Hussain A, Hagroo GA. Osgood-Schlatter disease. Sports Exer Injury. 1996;2:202-206.

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

  13. Micheli LJ. The traction apophysitises. Clin Sports Med. Apr 1987;6(2):389-404. [Medline].

  14. Rostron PK, Calver RF. Subcutaneous atrophy following methylprednisolone injection in Osgood-Schlatter epiphysitis. J Bone Joint Surg Am. Jun 1979;61(4):627-8. [Medline].

  15. Smith JB. Knee problems in children. Pediatr Clin North Am. Dec 1986;33(6):1439-56. [Medline].

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Further Reading

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Keywords

Osgood-Schlatter disease, OS, OS disease, knee pain, knee injury, apophysitis tibialis adolescentium, Schlatter's disease, Schlatter disease, Schlatter-Osgood disease, traction apophysitis, partial avulsion fracture, proximal tibial tuberosity, patellar insertion, extra-articular disease, quadriceps atrophy, exercise, chronic microtrauma, overuse of quadriceps muscle, repetitive jumping sports, rapid skeletal growth

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Contributor Information and Disclosures

Author

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.

Medical Editor

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.

Pharmacy Editor

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

Managing Editor

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.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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