Osgood Schlatter syndrome

Osteochondroses: a clinical review for the pediatrician

The purpose of this article is to provide the pediatrician with a thorough review of the variety of osteochondroses that affect children and adolescents. These conditions present in all different parts of the body in a wide range of patients: from the sedentary to athletic, the toddler to the pre-teen.The osteochondroses often are self-limiting and resolve with nonoperative management, but there are a few circumstances when operative treatment may be required. Recent literature confirms the heterogeneity of these conditions with respect to the clinical presentations and musculoskeletal manifestations.We think this article will heighten awareness of these disorders in the pediatric community, so that prompt intervention may be rendered.

Ultrasound imaging of the patellar tendon attachment to the tibia during puberty: a 12-month follow-up in tennis players

This longitudinal study investigated the ultrasound appearance of the patellar tendon attachment to the tibia throughout puberty in young tennis players with and without Osgood-Schlatter disease (OSD). Twenty-eight competitive players (17 boys), aged 10.6-15.3 years, had bilateral ultrasound imaging of the patellar tendon attachment to the tibia at baseline and 1 year later. On each occasion, anthropometric measurements, pubertal status and injury history were recorded. Ultrasound appearance of the patellar tendon attachment was categorized into three stages: cartilage attachment, insertional cartilage and mature attachment. Stage 1 appearance, a large anechoic region with or without ossicles and irregularity of the apophysis that are classically associated with OSD, was found in eight players, seven of them were pain free. A majority (62%) of the patellar tendons in stage 1 at baseline progressed toward stage 2 or stage 3 1 year later. Likewise the patellar tendon attachment in most athletes with cartilage insertion showed progression to a mature enthesis over 1 year. The imaging appearance that is classically interpreted as OSD was common in asymptomatic knees. This ultrasonographic description of the patellar tendon attachment to the tibia during growth provides a reference for the assessment of bone tendon attachments in adolescents.

The ultrasound appearance of the patellar tendon attachment to the tibia in young athletes is conditional on gender and pubertal stage

This cross-sectional study investigated the imaging appearance of the patellar tendon attachment to the tibia in young male and female tennis players of different ages and pubertal status. Forty-four competitive young players, who had been playing tennis at least for 2 years, were recruited from a tennis school and local tennis clubs. All subjects had bilateral ultrasound imaging of the patellar tendon attachment to the tibia. Standard anthropometric measurements, pubertal status and injury history were recorded. Ultrasound appearance of the patellar tendon attachment was categorised into three stages: cartilage attachment, insertional cartilage and mature attachment. Cartilage attachment was more prevalent in boys (32%) and extended further into puberty (until Tanner stage 4) compared to girls (6% and Tanner stage 1). Tendons with Osgood-Schlatter Disease symptoms (n=3) did not have a cartilage attachment. Imaging appearance commonly seen in young active athletes, consistent with a clinical diagnosis of OSD, was more common in boys and in the pre- and peri-pubertal stages.

Peri-epiphyseal and Overuse Injuries in Adolescent Athletes

CONTEXT

Overuse injuries of the musculoskeletal system in immature athletes are commonly seen in medical practice.

EVIDENCE ACQUISITION

An analysis of published clinical, outcome, and biomechanical studies of adolescent epiphyseal and overuse injuries was performed through 2008 to increase recognition and provide treatment recommendations.

RESULTS

Adolescent athletes can sustain physeal and bony stress injuries. Recovery and return to play occur more swiftly if such injuries are diagnosed early and immobilized until the patient is pain-free, typically about 4 weeks for apophyseal and epiphyseal overuse injuries. Certain epiphyseal injuries have prolonged symptoms with delayed treatment, including those involving the bones in the hand, elbow, and foot. If such injuries are missed, prolonged healing and significant restrictions in athletic pursuits may occur.

CONCLUSION

Some of these injuries are common to all weightbearing sports and are therefore widely recognized. Several are common in gymnastics but are rarely seen in other athletes. Early recognition and treatment of these conditions lead to quicker recovery and so may prevent season-ending, even career-ending, events from occurring.

Arthroscopic excision of an ununited ossicle due to Osgood-Schlatter disease

Surgical excision of the ossicles has been suggested for unresolved sequelae of Osgood-Schlatter disease in adults resistant to conservative measures. A 24-year-old, male semiprofessional soccer player had anterior knee pain during sports activity and climbing stairs that had been treated conservatively for 2 years. On physical examination, there was a permanent tibial tubercle with pain. On radiographic examination, an ununited ossicle was seen beneath the patellar tendon. Arthroscopy was performed through the standard low anterolateral and anteromedial portals close to the patellar tendon. Soft tissue at the retropatellar surface and the inflamed infrapatellar fat pad beneath the patellar tendon were debrided with a motorized shaver. Localization of the ununited ossicle was performed by use of an image intensifier. The ossicle was separated from the surrounding soft tissue with a motorized shaver and removed by use of a grasper. After excision of the ossicle, the inflamed surface of the retropatellar tendon was also debrided. The contouring of the irregular surface of the tibial tubercle was performed by use of a motorized bur. After 6 weeks, the patient returned to sports activities without any restrictions. This study showed that all of the described procedures might be done arthroscopically and sports activity may be allowed earlier.

Limited ankle dorsiflexion: a predisposing factor to Morbus Osgood Schlatter?

Quadriceps femoris muscle contracts eccentrically during the stance phase of running till the beginning of propulsion when the knee reaches the highest level of flexion. Limited dorsiflexion in the ankle joint is associated with a compensatory increased knee flexion, tibial inversion, and foot pronation during the stance phase of running. Theoretically, these compensatory mechanisms might cause increased stress on the quadriceps femoris muscle attachment to the tuberositas tibia. This study is aimed at evaluating a possible relationship between limited dorsiflexion of the ankle and the occurrence of Morbus Osgood Schlatter (MOS) in sports-active children. Forty-five children, including 40 boys (mean age 13 years, range 11-14) and 5 girls (mean age 12 years, range 10-12) with the clinical diagnosis of MOS, were studied. Dorsiflexion angle (DFA) of less than 10 degrees was found in 37 boys, whereas 3 of them had a DFA of more than 10 degrees . All five girls had a DFA of less than 10 degrees . In conclusion, limited dorsiflexion of the ankle joint might be of significant importance for MOS. Further studies are warranted to evaluate the cause-effect relationship.

Common Lower Limb Sports-related Overuse Injuries in Young Athletes

Introduction: Sports injuries in children and adolescent present a unique challenge to the physician. They are often seen for clinical conditions unique to their age group. This paper highlights the epidemiological aspect of sports-related overuse injuries in this age group. Materials and Methods: This retrospective study reviewed all the paediatric patients diagnosed with overuses injuries during a 5 years and 7 months period. The overuse injuries were anterior superior iliac spine avulsion fracture, Osgood-Schlatter disease, Sinding-Larson-Johansson disease, osteochondritis dissecan and Sever’s disease. We reviewed the literature and attempted to give an overview for each condition and the anatomical differences that contributed to their occurrence in this age group. Results: A total of 506 cases of the overuse injuries were seen during the study period. Seventy-three per cent were male patients. The knee joint was the commonest affected joint while the hip was the least affected joint. The mean age at diagnosis was younger in female compared to male for all conditions except in Sinding-Larson Johansson syndrome. Female was diagnosed at a mean age of 11.7 years while male at 10.8 years. Osgood-Schlatter disease was the commonest among the overuse injuries. There was no discernible racial predilection for these conditions except in the patients with anterior superior iliac spine avulsion. Conclusions: Overuse injuries are not uncommon in children and adolescent. An adequate understanding of the anatomy of the sports the children participated in as well as the anatomical differences between adult and children may assist the primary care providers better meet parents’ and coaches’ expectations. Key words: Apophysitis, Osgood-Schlatter disease, Osteochondritis dissecan, Overuse injuries, Sever’s disease, Sinding-Larson-Johansson disease