Osgood-Schlatter Disease in Emergency Medicine
- Author: Andrew K Chang, MD; Chief Editor: Rick Kulkarni, MD more...
Background
Osgood-Schlatter (OS) disease is one of the most common causes of knee pain in the adolescent. Consisting of pain and edema of the tibial tubercle (and hence this is an extra-articular disease), Osgood-Schlatter disease is generally a benign, self-limited knee condition associated with traction apophysitis of the tibial tubercle due to repetitive strain on the secondary ossification center of the tibial tubercle.
Paget first described the clinical syndrome in 1891. In 1903, Osgood and Schlatter published separate papers on the subject. Because of a lack of a precise definition, differentiating Osgood-Schlatter disease from avulsion fractures of the tibial tubercle is difficult.
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. Pathophysiology
Histologic studies suggest a traumatic etiology for Osgood-Schlatter disease. Bone growth is faster than soft tissue growth, which may result in muscle tendon tightness across the joint and loss of flexibility.
During periods of rapid growth, stress from contraction of the quadriceps is transmitted through the patellar tendon onto a small portion of the partially developed tibial tuberosity. This may result in a partial avulsion fracture through the ossification center. Eventually, secondary heterotopic bone formation occurs in the tendon near its insertion, producing a visible lump. Approximately 25% of patients have bilateral lesions.
In an MRI study of 20 patients with Osgood-Schlatter disease, the patellar tendon was noted to attach more proximally and in a broader area to the tibia in patients with Osgood-Schlatter disease.[1]
Epidemiology
Frequency
United States
The frequency of Osgood-Schlatter disease is not known, but the condition is uncommon.
International
One Finnish study found that Osgood-Schlatter disease affected 13% of athletes.
Mortality/Morbidity
Osgood-Schlatter disease is typically a benign and self-limited condition that waxes and wanes but often takes months to years to resolve entirely.
Sex
Osgood-Schlatter disease occurs more frequently in boys, probably because a greater number of boys participate in sports.
Age
- Osgood-Schlatter disease usually is seen in the adolescent years after undergoing a rapid growth spurt the previous year.
- Girls who are affected are typically aged 10-11 years but can range from 8-12 years.
- Boys who are affected are typically aged 13-14 years but can range from 12-15 years.
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