Osgood-Schlatter Disease in Emergency Medicine Workup

  • Author: Andrew K Chang, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 5, 2010
 

Laboratory Studies

  • Laboratory evaluation is not indicated for Osgood-Schlatter disease unless other diagnoses are being entertained.
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Imaging Studies

  • Knee radiography (anteroposterior and lateral)
    • The Osgood-Schlatter lesion is best seen on the lateral view with the knee in slight internal rotation of 10-20 degrees.
    • Not all patients with Osgood-Schlatter disease need radiography since the diagnosis is clinical. Plain films are helpful to rule out other etiologies, such as neoplasm, acute tibial apophyseal fracture, and infection.
    • 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
  • Bone scan may demonstrate increased uptake in the area of the tibial tuberosity.
  • Magnetic resonance imaging
    • 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. The role in diagnosis, prognostication, and management is currently limited.[3]
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Procedures

  • Corticosteroid injections are not recommended because of case reports of complications, primarily related to subcutaneous atrophy.
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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.

Specialty Editor Board

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  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

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 

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

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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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.
 
 
 
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