eMedicine Specialties > Sports Medicine > Lower Limb
Osgood-Schlatter Disease: Treatment & Medication
Updated: Apr 28, 2006
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Acute Phase
Rehabilitation Program
Physical Therapy
Medical Issues/Complications
Long-term immobilization is contraindicated because it may result in increased knee stiffness in mild cases, thus predisposing the athlete to additional sports-related injuries.
Surgical Intervention
If conservative treatment has failed, surgical excision of the united painful ossicle is recommended. Removal of ossicle fragmentation in immature patients with an unfused apophysis should be approached with caution, as a resultant recurvatum deformity may occur due to premature fusion of the tibial tubercle.
Tibial tubercle avulsions occasionally can occur due to the contracture of the extensor mechanism. Open reduction and internal fixation (ORIF) usually is recommended, depending on the size and displacement of the fragment as well as the phase of apophyseal closure. (See Osgood-Schlatter Disease in Orthopedic Surgery journal.)
Consultations
An orthopedic consultation is recommended.
Other Treatment
Cortisone injections are not recommended.
Recovery Phase
Rehabilitation Program
Physical Therapy
See Physical Therapy, Acute Phase.
The following regimen recommendations for patients with OSD are taken from Meisterling, Wall, and Meisterling:
- Straight leg raises
- Lie on the floor with the back propped up a few inches with the elbows.
- Bend the unaffected knee to a comfortable position. Using adjustable ankle weights with half-pound increments, determine the weight at which 10 raises can be performed on the affected leg.
- Tighten the thigh muscles and lift the affected leg 12 inches, keeping the leg straight.
- Hold for 5 seconds.
- Slowly lower the leg and relax.
- Start with 10 repetitions for each leg.
- When 15 repetitions have been performed comfortably, increase the weight by half a pound and drop back to 10 repetitions.
- Once 15 repetitions again can be performed comfortably, increase the weight again, to a maximum of 7-12 lb.
- Short-arc quadriceps exercises
- Lie back with the unaffected knee bent (same as for straight leg raises).
- Place a few rolled up towels under the affected knee to raise it 6 inches from the floor.
- Tighten the thigh muscles and straighten the leg until it is 12 inches from the floor.
- Hold for 5 seconds.
- Slowly lower the leg and relax.
- Start with 10 repetitions for each leg and increase to 15, using the same ankle weight and repetition progression as for straight leg raises.
- Wall slides
- To do wall slides or quarter seats, stand about 12 inches from a smooth wall and lean back against it with the feet shoulder width apart.
- Holding a light dumbbell in each hand with the arms straight down, bend the knees and slowly lower the body 4-6 inches.
- If pain is felt, the body has squatted too far.
- Hold for 5 seconds and then rise up quickly.
- Start with 10 repetitions and increase to 15, gradually increasing the dumbbell weight in the same type of progression as for straight leg raises.
A good rule of thumb with regard to squats and wall slides for patients with patellar pain of any kind is a relative restriction of not flexing the knee beyond 90°.
Maintenance Phase
Rehabilitation Program
Physical Therapy
The goal of rehabilitation is for the athlete to be able to return to his or her sport as quickly and safely as possible. The physical therapist and the physician determine when the athlete is ready to resume competition, depending on the findings of the clinical examination and functional testing. The pain may take up to 6-24 months to resolve. If an individual returns to activity too soon, he or she may worsen the condition. Athletes need to work on improving the flexibility and strength of the quadriceps and hamstring muscles throughout the course of rehabilitation to ensure that they are ready to return to sports.
Medication
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Short-term NSAIDs may be used for pain relief. Steroids are not recommended for use in this condition. NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclo-oxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.
Ibuprofen (Motrin, Ibuprin)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Adult
200-400 mg PO with food q4-6h while symptoms persist; not to exceed 3.2 g/d
Pediatric
5-10 mg/kg/dose PO q6-8h; not to exceed 40 mg/kg/24h
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently; may increase serum levels of digoxin
Documented hypersensitivity; peptic ulcer disease, recent GI bleeding or perforation, renal or hepatic insufficiency, or high risk of bleeding; ocular problems, granulocytopenia, and anemia may occur
Pregnancy
B - Usually safe but benefits must outweigh the risks.
Precautions
Category D in third trimester of pregnancy; caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy
Ketoprofen (Orudis, Oruvail, Actron)
For relief of mild to moderate pain and inflammation. Small dosages initially are indicated in small and elderly patients and in those with renal or liver disease.
Doses over 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe patient for response.
Adult
25-50 mg PO q6-8h prn; not to exceed 300 mg/d
Pediatric
<3 months: Not established
3 months to 12 years: 0.1-1 mg/kg PO q6-8h
>12 years: Administer as in adults
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity
Pregnancy
B - Usually safe but benefits must outweigh the risks.
Precautions
Category D in third trimester of pregnancy; caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in coagulation abnormalities or during anticoagulant therapy
Naproxen (Naprelan, Anaprox, Aleve, Naprosyn)
For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which results in a decrease of prostaglandin synthesis.
Adult
500 mg PO followed by 250 mg q6-8h; not to exceed 1.25 g/d
Pediatric
<2 years: Not established
>2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency
Pregnancy
B - Usually safe but benefits must outweigh the risks.
Precautions
Category D in third trimester of pregnancy; acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug
Flurbiprofen (Ansaid)
May inhibit cyclo-oxygenase enzyme, which in turn inhibits prostaglandin biosynthesis. These effects may result in analgesic, antipyretic, and anti-inflammatory activities.
Adult
200-300 mg/d PO divided bid/qid
Pediatric
Not established
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity
Pregnancy
C - Safety for use during pregnancy has not been established.
Precautions
Category D in third trimester of pregnancy; acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug
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
Behrman R, Kliegman R, Nelson WE. Osgood-Schlatter disease. In: Nelson Textbook of Pediatrics. Vol 14. Philadelphia, Pa: WB Saunders; 1992:1705.
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].
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].
Epstein B. Common problems affecting adolescents - Osgood Schlatter disease: A common cause of knee pain. In: Iowa Health Book: Family Practice. Iowa City, Iowa: The University of Iowa; 1995.
Flowers MJ, Bhadreshwar DR. Tibial tuberosity excision for symptomatic Osgood-Schlatter disease. J Pediatr Orthop. May-Jun 1995;15(3):292-7. [Medline].
Meisterling R, Wall E, Meisterling M. Coping with Osgood-Schlatter disease. In: The Physician and Sports Medicine. Vol 26. New York, NY: McGraw-Hill; 1998.
Ross MD, Villard D. Disability levels of college-aged men with a history of Osgood-Schlatter disease. J Strength Cond Res. Nov 2003;17(4):659-63. [Medline].
Staheli L. 2nd ed. Fundamentals of Pediatric Orthopedics. Philadelphia, Pa: Lippincott-Raven; 1998:56, 123.
Tachdjian MO. Clinical Pediatric Orthopedics: The Art of Diagnosis and Principles of Management. Vol 1. Stamford, Conn: Appleton & Lange; 1997:107-108.
Wall E. Osgood-Schlatter disease: Practical treatment for a self-limiting condition. In: The Physician and Sports Medicine. Vol 26. New York, NY: McGraw-Hill; 1998.
Further Reading
Keywords
OSD, tibial tubercle osteochondrosis, traction apophysitis, knee pain
