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Guszczyn T, Kulesza M, Maciąg G, Kicman A, Ławicki S. The Effectiveness of Treating Osgood-Schlatter Disease (OSD) with Leukocyte-Rich Platelet-Rich Plasma (LR-PRP) Depending on the Duration of the Disease. J Clin Med 2024; 13:4220. [PMID: 39064260 PMCID: PMC11278405 DOI: 10.3390/jcm13144220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Osgood-Schlatter disease (OSD) occurs mainly in physically active adolescents, causing significant physical activity restrictions. The aim of this study is to compare the effectiveness of treating OSD with leukocyte-rich platelet-rich plasma (LR-PRP) depending on the duration of the disease and to attempt to develop an alternative treatment method to the currently used conservative therapy. Methods: Treatment efficacy was evaluated using the VAS, Tegner, Lysholm, and KOOS scales. Subject satisfaction, return to sports activity, potential adverse effects, and X-ray evaluation were likewise used to assess the success of the procedure. Results: Analysis across all scales showed statistically significant treatment effectiveness with LR-PRP in both groups of patients. When comparing the two groups, significantly better treatment outcomes were achieved in the acute phase of OSD. Treatment satisfaction in the acute OSD group was 95%, compared to 64% in the chronic group. The MCID value after LR-PRP injection in acute OSD compared to chronic OSD reached 100% vs. 81% on the VAS scale, 95.5% vs. 55% on the Tegner scale, 95% vs. 47% on the Lysholm scale and 91% vs. 27% on the KOOS scale. No adverse effects were recorded in either group. Conclusions: The high efficacy of LR-PRP treatment in patients with acute OSD, in correlation with high safety, as well as rapid and lasting results, can be an effective and beneficial alternative to conservative treatment. This single procedure seems particularly justified in a group of young professional athletes, where absence from training can lead to serious consequences.
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Affiliation(s)
- Tomasz Guszczyn
- Department of Pediatric Orthopaedics and Traumatology, Medical University of Bialystok, 15-274 Bialystok, Poland
| | - Monika Kulesza
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.K.)
| | - Grzegorz Maciąg
- Department of Pediatric Orthopaedics and Traumatology, Medical University of Bialystok, 15-274 Bialystok, Poland
| | - Aleksandra Kicman
- Department of Aesthetic Medicine, Medical University of Bialystok, 15-267 Bialystok, Poland;
| | - Sławomir Ławicki
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, 15-269 Bialystok, Poland; (M.K.)
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Sørensen LB, Holden S, Oei EHG, Magnusson SP, Olesen JL, Dean BJF, Hever M, Lyng K, Rathleff MS. A comprehensive MRI investigation to identify potential biomarkers of Osgood Schlatter disease in adolescents: A cross sectional study comparing Osgood Schlatter disease with controls. Scand J Med Sci Sports 2024; 34:e14634. [PMID: 38682790 DOI: 10.1111/sms.14634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/15/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Osgood-Schlatter disease (OSD) is the most common knee pain complaint among adolescents playing sports. Despite this, there remains controversy over the pathophysiology and whether specific anatomical characteristics are associated with OSD. PURPOSE This study aimed to systematically and comprehensively characterize adolescents with OSD using magnetic resonance imaging (MRI) compared to pain-free controls, including both tissue abnormalities that may be associated with OSD, as well as anatomical characteristics. A secondary objective was to identify potential imaging biomarkers associated with pain. STUDY DESIGN Cross-sectional study. METHODS Adolescents with OSD and controls were recruited from 2020 to 2022. Following a clinical exam, demographics, pain, sports participation, and Tanner stage were collected. Knee MRI was conducted on the participants' most symptomatic knee (OSD) or the dominant leg (controls). RESULTS Sixty-seven adolescents (46 with OSD and 30 controls) were included. 80% of participants with OSD had at least one tissue alteration compared to 54% of controls. Compared to controls, OSD had 36.3 (95%CI 4.5 to 289.7) higher odds of bony oedema at the tibial tuberosity, and 32.7 (95%CI 4.1 to 260.6) and 5.3 (95%CI 0.6 to 46.2) higher odds of bony oedema at the tibial epiphysis and metaphysis respectively. Participants with OSD also had higher odds of fluid/oedema at the patellar tendon (12.3 95%CI 3.3 to 46.6), and superficial infrapatellar bursitis (7.2). Participants with OSD had a more proximal tendon attachment (mean tibial attachment portion difference, -0.05, 95% CI: -0.1 to 0.0, p = 0.02), tendon thickness (proximal mean difference, -0.09, 95% CI: -0.4 to 0.2, p = 0.04; distal mean difference, -0.6, 95% CI: -0.9 to -0.2, p = 0.01). Those with bony/tendon oedema had 1.8 points (95% CI: 0.3 to 3.2) higher pain on palpation than those without (t = -2.5, df = 26.6, p = 0.019), but there was no difference between these groups in a functional single leg pain provocation. CONCLUSION Adolescents with OSD present with tissue and structural abnormalities on MRI that differed from age-matched controls. The majority had findings in the patellar tendon and bone, which often co-occurred. However, a small proportion of OSD also presents without alterations. It appears these findings may be associated with clinical OSD-related pain on palpation of the tibial tuberosity. CLINICAL RELEVANCE Our highlight the pathophysiology on imaging, which has implications for understanding the mechanism and treatment of OSD.
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Affiliation(s)
- L B Sørensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - S Holden
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
- Institute for Sport and Health, University College Dublin, Dublin, Ireland
| | - E H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - S P Magnusson
- Department of Orthopaedic Surgery M, Institute of Sports Medicine, Copenhagen, Denmark
- Department of Physical Therapy, Bispebjerg Hospital, Copenhagen, Denmark
| | - J L Olesen
- Center for General Practice at Aalborg University, Aalborg, Denmark
| | - B J F Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK
| | - M Hever
- Department of Radiology, Aalborg University, Aalborg, Denmark
| | - K Lyng
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Center for General Practice at Aalborg University, Aalborg, Denmark
| | - M S Rathleff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
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Krommes K, Thorborg K, Clausen MB, Rathleff MS, Olesen JL, Kallemose T, Hölmich P. Self-management including exercise, education and activity modification compared to usual care for adolescents with Osgood-Schlatter (the SOGOOD trial): protocol of a randomized controlled superiority trial. BMC Sports Sci Med Rehabil 2024; 16:89. [PMID: 38643184 PMCID: PMC11032598 DOI: 10.1186/s13102-024-00870-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/25/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Osgood-Schlatter is the most frequent growth-related injury affecting about 10% of physically active adolescents. It can cause long-term pain and limitations in sports and physical activity, with potential sequela well into adulthood. The management of Osgood-Schlatter is very heterogeneous. Recent systematic reviews have found low level evidence for surgical intervention and injection therapies, and an absence of studies on conservative management. Recently, a novel self-management approach with exercise, education, and activity modification, demonstrated favorable outcomes for adolescents with patellofemoral pain and Osgood-Schlatter in prospective cohort studies. AIM The aim of this trial is to assess the effectiveness of the novel self-management approach compared to usual care in improving self-reported knee-related function in sport (measured using the KOOS-child 'Sport/play' subscale) after a 5-month period. METHODS This trial is a pragmatic, assessor-blinded, randomized controlled trial with a two-group parallel arm design, including participants aged 10-16 years diagnosed with Osgood-Schlatter. Participants will receive 3 months of treatment, consisting of either usual care or the self-management approach including exercise, education, and activity modification, followed by 2 months of self-management. Primary endpoint is the KOOS-child 'Sport/play' score at 5 months. This protocol details the planned methods and procedures. DISCUSSION The novel approach has already shown promise in previous cohort studies. This trial will potentially provide much-needed level 1 evidence for the effectiveness of the self-management approach, representing a crucial step towards addressing the long-term pain and limitations associated with Osgood-Schlatter. TRIAL REGISTRATION Clinicaltrials.gov: NCT05174182. Prospectively registered December 30th 2021. Date of first recruitment: January 3rd 2022. Target sample size: 130 participants.
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Affiliation(s)
- Kasper Krommes
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre, Copenhagen University Hospital, Kettegaard Allé 30, Hvidovre, DK-2650, Denmark.
| | - Kristian Thorborg
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre, Copenhagen University Hospital, Kettegaard Allé 30, Hvidovre, DK-2650, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark
| | - Mikkel Bek Clausen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Sigurdsgade 26, DK-2200, Copenhagen N, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice at Aalborg University, Aalborg. Fyrkildevej 7, DK-9220, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, DK-9220, Aalborg, Denmark
| | - Jens Lykkegaard Olesen
- Center for General Practice at Aalborg University, Aalborg. Fyrkildevej 7, DK-9220, Aalborg, Denmark
| | - Thomas Kallemose
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Sigurdsgade 26, DK-2200, Copenhagen N, Denmark
- Department of Clinical Research, Amager-Hvidovre, Copenhagen University Hospital, Kettegaard Alle 30, Hvidovre, DK-2610, Danmark
| | - Per Hölmich
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre, Copenhagen University Hospital, Kettegaard Allé 30, Hvidovre, DK-2650, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen N, Denmark
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Bezuglov E, Pirmakhanov B, Ussatayeva G, Emanov A, Valova Y, Kletsovskiy A, Khaitin V, Usmanova E, Butovskiy M, Morgans R. The mid-term effect of Osgood-Schlatter disease on knee function in young players from elite soccer academies. PHYSICIAN SPORTSMED 2023; 51:590-595. [PMID: 36413052 DOI: 10.1080/00913847.2022.2148492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of the study was to evaluate the effect of Osgood-Schlatter disease (OSD) on knee joint function in elite young soccer players. Our hypothesis was that knee joint function in elite young soccer players was impaired following OSD compared with soccer players with no history of OSD. METHOD In young male soccer players (n = 36) from elite academies (mean ±SD, age: age: 15,3 ± 1,7 years; height: 1,7 ± 0,06 m; weight: 63,5 ± 8 kg; BMI: 20,7 ± 2). The duration between the completion of treatment or the last complaint to the study commencement was 31 ± 19 months. RESULTS The average treatment duration of OSD among study participants was 18,5 ± 12 days (95%, 14-23), and the disease most often manifested in winter and spring, 33% and 31% of cases, respectively. Soccer players with a history of OSD were statistically different in IKDC and KOOS scores when compared with soccer players with no previously reported OSD (Mann-Whitney, p < 0,0001). The soccer players with a history of OSD also use NSAIDs more frequently compared with soccer players with no history of OSD (36% vs 3% respectively). CONCLUSIONS OSD among young soccer players, when symptoms resolve, continue about one month and they can return to regular training and participation in games. Wherein, the negative effects in knee joint function were significantly more likely in soccer players with previous OSD history when compared with their peers with no history of OSD. While oral non-steroidal anti-inflammatory drugs was also more widely employed in soccer players with previous OSD history. Potentially this may lead to performance deficits and disadvantages for their future careers and coaches and physicians should be informed.
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Affiliation(s)
- E Bezuglov
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
- High Performance Sports Laboratory, Moscow Witte University, Moscow, Russian Federation
- The Academy of the Russian Football Union, Moscow, Russia
| | - B Pirmakhanov
- Faculty of Medicine and Health Care, Department of Epidemiology, Biostatistics and Evidence-Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
- Football Club Kairat, Almaty, Kazakhstan
| | - G Ussatayeva
- Faculty of Medicine and Health Care, Department of Epidemiology, Biostatistics and Evidence-Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - A Emanov
- Academy of Talents, Moscow, Russian Federation
- Sports medicine clinic "Smart Recovery", Moscow, Russian Federation
| | - Yu Valova
- Kuban State Medical University, Krasnodar, Russian Federation
- Academy of Football Club "Krasnodar", Krasnodar, Russian Federation
| | - A Kletsovskiy
- Kuban State Medical University, Krasnodar, Russian Federation
| | - V Khaitin
- Pavlov First Saint Petersburg State Medical University, Department of Physical Methods of Treatment and Sports Medicine, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russian Federation
| | - E Usmanova
- Sports medicine clinic "Smart Recovery", Moscow, Russian Federation
| | - M Butovskiy
- Department Neurology and Rehabilitation, Kazan State Medical University, Kazan, Russian Federation
- Football Club "Rubin" Kazan, Russian Federation
| | - R Morgans
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Hansen R, Rathleff MS, Lundgaard-Nielsen M, Holden S. The development of an informative leaflet for children and adolescents suffering from Osgood-Schlatter disease. Scand J Med Sci Sports 2023; 33:2608-2612. [PMID: 37726948 DOI: 10.1111/sms.14498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 08/07/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
The mainstay in the treatment of Osgood-Schlatter Disease (OSD) is guidance on activity modification alongside exercises. The purpose of this study was to create an informative leaflet for patients with OSD, based on evidence and stakeholders perspectives. A synthesis of the literature, including national reference work, clinical research, and systematic reviews informed the initial leaflet. Twelve children with OSD and four clinical experts provided feedback through semi-structured interviews. After incorporating stakeholder input, the leaflet 'Osgood-Schlatter-Information and guidance' was developed. This provides a resource to assist the provision of information and translation of the current evidence.
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Affiliation(s)
- Rudi Hansen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Mathilde Lundgaard-Nielsen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Sinead Holden
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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6
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Suito H, Fujikawa K, Ohsako M. Eccentric contractions during downhill running induce Osgood‒Schlatter disease in the tibial tuberosity in rats: a focus on histological structures. Sci Rep 2023; 13:9863. [PMID: 37332037 PMCID: PMC10277288 DOI: 10.1038/s41598-023-36914-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
Osgood-Schlatter disease (OSD), a condition that affects adolescents, causes inflammation, pain, and prominence at the tibial tuberosity. The causes of OSD are not well understood, but eccentric contractions in the quadriceps have been suggested as a possible factor. To investigate this, a study was conducted in which 24 rats were divided into two groups: the downhill treadmill running (DR) group and the control (CO) group. The DR group underwent a preliminary running program for 1 week, followed by a main running program for 3 weeks. The results showed that the deep region of the tibial tuberosity in the DR group was larger than that in the CO group, and inflammatory cytokines involved in gene expression were upregulated in the DR group. The anterior articular cartilage and deep region in the DR group were also immunoreactive to substance P. Additionally, high-activity chondrocytes of small size were observed in the non-calcified matrix. Thus, the DR group exhibited symptoms similar to OSD, including inflammation, pain, and prominence. These findings suggest that eccentric contractions in the quadriceps may play a role in the development of OSD. Further research is needed to better understand the pathophysiology of this condition and develop effective treatment options.
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Affiliation(s)
- Hirai Suito
- Graduate School of Human Life Design, Toyo University, 1-7-11 Akabanedai, Kita-Ku 115-8650, Tokyo, Japan.
- Japan Society for the Promotion of Science Research Fellowships DC, Tokyo, Japan.
| | - Kaoru Fujikawa
- Department of Oral Anatomy and Developmental Biology, Showa University School of Density, Tokyo, Japan
| | - Masafumi Ohsako
- Graduate School of Health and Sports Science, Toyo University, Tokyo, Japan
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7
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Johnson D, Williams S, Bradley B, Cumming SP. Can we reduce injury risk during the adolescent growth spurt? An iterative sequence of prevention in male academy footballers. Ann Hum Biol 2023; 50:452-460. [PMID: 37823577 DOI: 10.1080/03014460.2023.2261854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
Background: The adolescent growth spurt is associated with an increased risk of injury in young athletes.Aim: This study aimed to use an interdisciplinary collaboration between technical coaches, sports scientists, and medical staff to mitigate this risk.Subjects and methods: 77 male academy footballers were followed across two seasons. At-risk players were identified using somatic maturity status and growth rate in stature and the lower limbs, using thresholds of 88% to 92.8% of predicted adult stature, ≥7.2 cm/year, and ≥3.6 cm/year, respectively. During the 2019-20 season, players with symptoms of a growth-related injury or two of three risk factors were included in an intervention strategy that included modified training load, football-specific skills, balance, coordination and landing drills, and an individualised strength program.Results: For players with the three risk factors, there was a significant reduction in the incidence (rate ratio [RR] = 0.14 (5.2 per 1000h → 0.8 per 1000h, p = 0.05) and burden (RR = 0.08 (216 per 1000h → 17 per 1000h, p = 0.02) between the seasons. For players with ≤2 risk factors, there were no significant differences in injury risk between the baseline and intervention seasons.Conclusion: Overall, it may be possible to mitigate injury incidence and burden during the adolescent growth spurt in high-risk athletes.
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Affiliation(s)
- David Johnson
- Department for Health, University of Bath, Bath, United Kingdom of Great Britain and Northern Ireland
- Sports Science and Medicine, AFC Bournemouth Football Club, Bournemouth, United Kingdom of Great Britain and Northern Ireland
| | - Sean Williams
- Department for Health, University of Bath, Bath, United Kingdom of Great Britain and Northern Ireland
| | - Ben Bradley
- Sports Science and Medicine, AFC Bournemouth Football Club, Bournemouth, United Kingdom of Great Britain and Northern Ireland
| | - Sean P Cumming
- Department for Health, University of Bath, Bath, United Kingdom of Great Britain and Northern Ireland
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Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10061011. [PMID: 35742062 PMCID: PMC9222654 DOI: 10.3390/healthcare10061011] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
Osgood-Schlatter disease is the most common osteochondritis of the lower limb in sport-practicing children and adolescents. Its manifestation usually coincides with the appearance of the secondary ossification center of the tibia and is linked to the practice of sports with an explosive component. In the present study, a review of the factors related to its appearance, diagnosis and treatment was carried out. Its appearance seems to be multifactorial and related to multiple morphological, functional, mechanical and environmental factors. Given all the above, risk factor reduction and prevention seem the most logical strategies to effectively prevent the appearance of the condition. In addition, it is essential to create prevention programs that can be objectively assessed and would allow to stop the progress of the pathology, particularly in those sports where high forces are generated on the insertion zone of the patellar tendon at sensitive ages. More studies are needed to clarify which type of treatment is the most appropriate—specific exercises or the usual care treatment.
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9
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Johnson DM, Cumming SP, Bradley B, Williams S. The influence of exposure, growth and maturation on injury risk in male academy football players. J Sports Sci 2022; 40:1127-1136. [DOI: 10.1080/02640414.2022.2051380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- David M. Johnson
- Department for Health, University of Bath, Bath, UK
- Academy Sports Science and Medicine Department, AFC Bournemouth, Bournemouth, UK
| | | | - Ben Bradley
- Academy Sports Science and Medicine Department, AFC Bournemouth, Bournemouth, UK
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10
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The Incidence and Management of Osgood-Schlatter Disease in General Practice. Br J Gen Pract 2021; 72:e301-e306. [PMID: 34990396 PMCID: PMC8869186 DOI: 10.3399/bjgp.2021.0386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background Osgood–Schlatter disease (OSD) is a non-traumatic knee problem that is primarily observed in sports-active children and adolescents aged 8–15 years. Aim To determine the incidence of OSD and to gain an insight into the management of children and adolescents with OSD in general practice. Design and setting A retrospective cohort study was conducted using a healthcare database containing full electronic health records of over 200 000 patients in general practice in and around the Dutch city of Rotterdam. Method Patients with a new diagnosis of OSD from 1 January 2012 to 31 December 2017 were extracted using a search algorithm based on International Classification of Primary Health Care coding and search terms in free text. Data on the management of OSD were manually interpreted. Results The mean incidence over the study period was 3.8 (95% confidence interval [CI] = 3.5 to 4.2) per 1000 person–years in those aged 8–18 years. Boys had a higher incidence rate of 4.9 (95% CI = 4.3 to 5.5) compared with girls (2.7, 95% CI = 2.3 to 3.2). Peak incidence was at 12 years of age for boys and 11 years for girls. Advice was the most commonly applied strategy (55.1%), followed by rest (21.0%), referral for imaging (19.5%), and physiotherapy (13.4%). Conclusion To the authors’ knowledge, for the first time the incidence of OSD has been calculated using GP electronic medical files. There is a discrepancy, especially for imaging and referral to a medical specialist, between the current Dutch general practice guidelines and how GPs actually manage the condition in clinical practice.
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Sørensen LB, Rathleff MS, Dean BJF, Oei E, Magnusson SP, Olesen JL, Holden S. A systematic review of imaging findings in patients with Osgood‐Schlatter disease. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Line Bay Sørensen
- Department of Health Science and Technology Aalborg University Aalborg Denmark
| | - Michael Skovdal Rathleff
- Department of Health Science and Technology Aalborg University Aalborg Denmark
- Center for General Practice at Aalborg University Aalborg Denmark
- Department of Occupational Therapy and Physiotherapy Department of Clinical Medicine Aalborg University Hospital Aalborg Denmark
| | - Benjamin John Floyd Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS) Botnar Research Centre University of Oxford Oxford UK
| | - Edwin Oei
- Department of Radiology & Nuclear Medicine of Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Stig Peter Magnusson
- Department of Orthopaedic Surgery M Institute of Sports Medicine Bispebjerg Hospital Copenhagen Denmark
| | | | - Sinéad Holden
- Department of Health Science and Technology Aalborg University Aalborg Denmark
- Center for General Practice at Aalborg University Aalborg Denmark
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12
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The Osgood-Schlatter disease: a large clinical series with evaluation of risk factors, natural course, and outcomes. INTERNATIONAL ORTHOPAEDICS 2021; 46:197-204. [PMID: 34427770 DOI: 10.1007/s00264-021-05178-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aims of this prospective study were to define sport specific incidence rates in a large Osgood-Schlatter-disease group, to follow the natural course, and to determine late effects, i.e., changes in sport activities and resting pain. METHODS A total of 126 consecutive patients with functional pain in and after physical activity and local TT swelling were included in a longitudinal study. Physical examination, ultrasound, and a lateral X-ray were performed in a standardized clinically common manner. Sport participation, growth rate, BMI, and muscle status were recorded and assigned statistically. Follow-up took place after subsidence of functional pain. RESULTS Exactly 101 boys and 25 girls showed a mean age at diagnosis of 12.8 years (boys 13.2, girls 11.4 years) complaining an average period of pain of 6.7 months before diagnosis. A sport distribution displayed 64 football (soccer) players, 18 basketball players, seven athletes in track and field, six martial arts sportsmen, and five handball players, all participating in organized sport clubs, 16 patients in other and ten patients in no sports. The standing leg was affected in 69.6% of all football players, whereas the other disciplines did not show any significance. A total of 105 patients could be followed up after a median of 3.6 years; six of them were still symptomatic. Final outcome could be recorded for 99 patients (79 boys, 20 girls). Osgood-Schlatter disease (OSD) symptoms in or after sport activity were reported to last an average of 19.1 months (3-48 months) without differences according to sex nor sport. Exactly 50% of the patients may expect to be free of functional symptoms after the 16th month, 75% after the 25th month. A total of 78.8% of the patients still complained of persistent but not impairing pain in kneeling or on direct TT contact. Exactly 28.3% of all patients responded having switched their sport activity to other disciplines due to OSD. CONCLUSION OSD affects mainly adolescent boys active in football and basketball and represents a structural answer to repeated biomechanical stress. Only in football, the statically dominant side is more prone to develop OSD. Age at onset, growth rate, BMI, and muscle imbalance are not significantly predisposing. OSD runs a self-limiting course without specific treatment.
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Holden S, Olesen JL, Winiarski LM, Krommes K, Thorborg K, Hölmich P, Rathleff MS. Is the Prognosis of Osgood-Schlatter Poorer Than Anticipated? A Prospective Cohort Study With 24-Month Follow-up. Orthop J Sports Med 2021; 9:23259671211022239. [PMID: 34435066 PMCID: PMC8381442 DOI: 10.1177/23259671211022239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/24/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Osgood-Schlatter disease (OSD), an apophyseal injury of the tibial tuberosity, affects up to 1 in 10 adolescents. This condition has previously been assumed to be innocuous and to self-resolve with limited intervention. PURPOSE To investigate the 24-month prognosis of OSD and examine if ultrasound (US) classification is associated with outcomes. STUDY DESIGN Case series; Level of evidence, 4. METHODS This study included a preregistered prospective cohort of 51 adolescents (aged 10-14 years) diagnosed with OSD who were evaluated for 24 months. The primary outcome at 24-month follow-up was whether participants continued to experience OSD-related knee pain. Baseline US scans were collected and characterized by OSD type (De Flaviis classification) as well as maturation of the tibial tuberosity. Secondary outcomes included sports participation, Knee injury and Osteoarthritis Outcome Score (KOOS) Sport/Recreation subscale, and health-related quality of life (European Quality of Life-5 Dimensions-Youth [EQ-5D-Y]). All participants were invited for re-examination by US at follow-up. RESULTS A total of 51 patients preregistered for the study, with 90% (n = 46) available at follow-up. Of these 46 participants, 37% (n = 17) still reported knee pain due to OSD. In this subgroup, the median duration since symptom onset was 42 months (interquartile range, 38-51 months). More than 1 in 5 participants reported stopping sport due to knee pain, and those who continued to experience knee pain reported significantly worse KOOS Sport/Recreation scores at follow-up compared with patients with no knee pain (mean 74 [95% CI, 63-84] vs 91 [95% CI, 85-97]). Participants with continued OSD-related pain also had lower health-related quality of life (mean difference in EQ-5D-Y, 0.11 [95% CI, 0.06-0.13]). Higher De Flaviis classification at baseline was significantly associated with an increased risk of knee pain at 2 years. Diagnostic US at follow-up demonstrated primarily tendon changes (thickening, positive Doppler signal), as well as an ununited ossicle in 32% of participants who underwent US scanning at follow-up. CONCLUSION Over one-third of the study participants had knee pain at 2-year follow-up, which was associated with lower sports related function and health related quality of life. This questions the assumption that all patients with OSD experience quick recovery. Participants without any changes on imaging at baseline were less likely to report pain at follow-up.
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Affiliation(s)
- Sinead Holden
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Center for General Practice at Aalborg University, Aalborg,
Denmark
| | - Jens Lykkegaard Olesen
- Center for General Practice at Aalborg University, Aalborg,
Denmark
- Institute of Sports Medicine, Department of Orthopaedic Surgery M,
Bispebjerg Hospital, Copenhagen, Denmark
| | - Lukasz M. Winiarski
- Department of Physiotherapy and Occupational Therapy, Aalborg
University Hospital, Aalborg, Denmark
| | - Kasper Krommes
- Center for General Practice at Aalborg University, Aalborg,
Denmark
- Sports Orthopedic Research Center–Copenhagen (SORC-C), Department of
Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Kristian Thorborg
- Sports Orthopedic Research Center–Copenhagen (SORC-C), Department of
Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center–Copenhagen (SORC-C), Department of
Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Michael Skovdal Rathleff
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Physiotherapy and Occupational Therapy, Aalborg
University Hospital, Aalborg, Denmark
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Kamiya T, Teramoto A, Mori Y, Kitamura C, Watanabe K, Yamashita T. Nano-Arthroscopic Ultrasound-Guided Excision of Unresolved Osgood-Schlatter Disease. Arthrosc Tech 2021; 10:e1581-e1587. [PMID: 34258207 PMCID: PMC8252821 DOI: 10.1016/j.eats.2021.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/15/2021] [Indexed: 02/03/2023] Open
Abstract
The nano-arthroscopic ultrasound-guided ossicle excision technique is used in the management of an unresolved Osgood-Schlatter disease. The NanoScope is inserted slightly lateral to the proximal patella tendon and moved on between the ossicle and anterior surface of the proximal tibia under ultrasonographic guidance. The 5-mm skin incision is made as a working portal on the medial side of the proximal patella tendon. The proximal border of the ossicle is clearly identified after bursectomy. Then, the ossicles are removed piece by piece using a 2-mm arthroscopic punch. During the resection, the remaining ossicle is continuously confirmed by ultrasound. Finally, the complete excision of the ossicle is shown by the nano-arthroscopic view and ultrasound. The patient is allowed to have a full weight-bearing and an unrestricted range of motion on the day of surgery. Patients are permitted to resume their sports activities without any restriction after 6 weeks. This technique is recommended to athletes who suffer from painful unresolved Osgood-Schlatter disease because of the benefits of it being a minimally invasive surgery with an early postoperative recovery.
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Affiliation(s)
- Tomoaki Kamiya
- Address correspondence to Tomoaki Kamiya, M.D., Ph.D., Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Cuo-ku, Sapporo, 060-8543, Japan.
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15
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Long‐term outcome of conservatively treated lower limb apophyseal injuries in children and adolescents: A systematic review. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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16
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Lyng KD, Rathleff MS, Dean BJF, Kluzek S, Holden S. Current management strategies in Osgood Schlatter: A cross-sectional mixed-method study. Scand J Med Sci Sports 2020; 30:1985-1991. [PMID: 32562293 DOI: 10.1111/sms.13751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 03/12/2020] [Accepted: 05/25/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Osgood Schlatter disease (OSD) is the most common knee condition in adolescent athletes aged 9-16. Without evidence to guide clinical practice, it is unclear how OSD is managed. The aim of this study was to investigate how international healthcare professionals (general practitioners, physiotherapists, rheumatologists, sports and exercise medicine doctors, and orthopedic surgeons) diagnose and manage OSD. METHODS This mixed-method study used a convergent parallel design. A quantitative questionnaire and semi-structured interview covered prognosis, diagnosis, treatment, and return to play of adolescents with OSD. For quantitative data, those who reported likely/very likely considered "for" and unlikely/very unlikely "against" (for specific diagnostic/management strategy). Qualitative data analysis used a phenomenological approach. RESULTS Two hundred and fifty-one healthcare professionals completed the questionnaire. The most common diagnostic criterion was pain at the tibial tuberosity (97% for). The most common treatments were patient education (99%) and exercise therapy (92%). Other treatment options were more heterogeneous, for example, pain medication (31% for and 34% against). Managing training load (97%), pain intensity (87%), and psychological factors (86%) were considered the most important factors influencing the return to activities. Several themes emerged from the interviews (on N = 20) including imaging, pain management, family, and psychosocial factors influencing prognosis. CONCLUSION Diagnosis criteria of OSD were relatively well agreed upon, whereas the triangulation of qualitative and quantitative data showed heterogeneity of treatments. Psychosocial factors including family were highlighted as critical in the management of OSD.
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Affiliation(s)
- Kristian Damgaard Lyng
- Department of Clinical Medicine, Center for General Practice in Aalborg, Aalborg University, Aalborg East, Denmark
| | - Michael Skovdal Rathleff
- Department of Clinical Medicine, Center for General Practice in Aalborg, Aalborg University, Aalborg East, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Center for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg East, Denmark.,Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
| | - Benjamin John Floyd Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK
| | - Stefan Kluzek
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK.,Department of Rheumatology, Orthopaedic and Dermatology, University of Nottingham, Nottingham, UK
| | - Sinead Holden
- Department of Clinical Medicine, Center for General Practice in Aalborg, Aalborg University, Aalborg East, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Center for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg East, Denmark
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17
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Rathleff MS, Winiarski L, Krommes K, Graven-Nielsen T, Hölmich P, Olesen JL, Holden S, Thorborg K. Activity Modification and Knee Strengthening for Osgood-Schlatter Disease: A Prospective Cohort Study. Orthop J Sports Med 2020; 8:2325967120911106. [PMID: 32284945 PMCID: PMC7137138 DOI: 10.1177/2325967120911106] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Osgood-Schlatter disease (OSD) affects 1 in 10 adolescents. There is a lack
of evidence-based interventions, and passive approaches (eg, rest and
avoidance of painful activities) are often prescribed. Purpose: To investigate an intervention consisting of education on activity
modification and knee-strengthening exercises designed for adolescents with
OSD. Study Design: Case series; Level of evidence, 4. Methods: This study included 51 adolescents (51% female; age range, 10-14 years) with
OSD. The 12-week intervention consisted of an activity ladder designed to
manage patellar tendon loading and pain, knee-strengthening exercises, and a
gradual return to sport. The primary outcome was the global reporting of
change at 12 weeks, evaluated with a 7-point Likert scale (successful
outcome was considered “much improved” or “improved”). Additional endpoints
were at 4, 8, 26, and 52 weeks. Secondary outcomes included the Knee injury
and Osteoarthritis Outcome Score (KOOS), objective strength, and jump
performance. Results: Adolescents reported a mean pain duration of 21 months at enrollment. After
12 weeks, 80% reported a successful outcome, which increased to 90% at 12
months. At 12 weeks, 16% returned to playing sport, which increased to 69%
at 12 months. The KOOS subscores of Pain, Activities of Daily Living, Sport
and Recreation, and Quality of Life improved significantly (7-20 points),
and there were improvements in knee extension strength (32%;
P < .001), hip abduction strength (24%;
P < .001), and jumping for distance (14%;
P < .001) and height (19%; P <
.001) at 12 weeks. Conclusion: An intervention consisting of activity modification, pain monitoring,
progressive strengthening, and a return-to-sport paradigm was associated
with improved self-reported outcomes, hip and knee muscle strength, and
jumping performance. This approach may offer an alternative to passive
approaches such as rest or wait-and-see, often prescribed for adolescents
with OSD. Registration: NCT02799394 (ClinicalTrials.gov
identifier)
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Affiliation(s)
- Michael S Rathleff
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Center for General Practice at Aalborg University, Aalborg, Denmark.,Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Lukasz Winiarski
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Kasper Krommes
- Center for General Practice at Aalborg University, Aalborg, Denmark.,Sports Orthopedic Research Center-Copenhagen, Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Jens Lykkegard Olesen
- Center for General Practice at Aalborg University, Aalborg, Denmark.,Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Sinéad Holden
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Center for General Practice at Aalborg University, Aalborg, Denmark
| | - Kristian Thorborg
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
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18
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Rabago D, Reeves KD, Topol GA, Podesta LA, Cheng AL, Fullerton BD. Infrapatellar bursal injection with dextrose and saline are both effective treatments for Osgood-Schlatter disease. Letter to editor for: No superiority of dextrose injections over placebo injections for Osgood-Schlatter disease: a prospective randomized double‑blind study https://doi.org/10.1007/s00402-019-03297-2. Arch Orthop Trauma Surg 2020; 140:591-592. [PMID: 31982926 DOI: 10.1007/s00402-020-03355-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Indexed: 11/24/2022]
Affiliation(s)
- David Rabago
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Kenneth Dean Reeves
- Private Practice Physical Medicine and Rehabilitation, 4740 El Monte, Roeland Park, KS, 66205, USA.
| | - Gastón Andrés Topol
- Department of Physical Medicine and Rehabilitation, National University of Rosario, Rosario, Argentina
| | | | - An-Lin Cheng
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Bradley D Fullerton
- Department of Texas A&M, School of Medicine College Station, College Station, TX, USA
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Nakase J, Oshima T, Takata Y, Shimozaki K, Asai K, Tsuchiya H. No superiority of dextrose injections over placebo injections for Osgood-Schlatter disease: a prospective randomized double-blind study. Arch Orthop Trauma Surg 2020; 140:197-202. [PMID: 31713082 DOI: 10.1007/s00402-019-03297-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Osgood-Schlatter disease (OSD) is a traction apophysitis of the tibial tuberosity. Patellar tendinopathy and deep infrapatellar bursitis have recently been shown to contribute to pain in patients with OSD. We compared the effects of dextrose injection and saline injection. METHODS We performed a clinical trial from April 2012 to January 2016 and included 49 knees from 37 boys and 1 girl (mean age, 12.3 ± 1.1 years) for whom conventional conservative therapy for > 1 month was ineffective. They were randomly assigned to receive double-blind injections of 1% lidocaine (1 mL) with 20% dextrose (1 mL; dextrose group) or 1% lidocaine (1 mL) with saline (1 mL; saline group). Injections were administered monthly for 3 months by a single investigator. The Victorian Institute of Sport Assessment (VISA) score was used to evaluate anterior knee pain. RESULTS Overall, 43 knees were included; 6 knees were lost to follow-up. The mean pre-injection VISA scores in the dextrose and saline groups were 58.7 ± 18.3 and 63.4 ± 16.4, respectively. No significant differences were found between the two groups at any time point. The mean VISA score before injections significantly increased at the 1-month follow-up in both groups (P < .01). The injection had no adverse effects. CONCLUSIONS We were not able to show the efficacy of dextrose injections compared to that of saline. LEVEL OF EVIDENCE Randomized controlled trial. Level I.
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Affiliation(s)
- Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
| | - Takeshi Oshima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Yasushi Takata
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Kengo Shimozaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Kazuki Asai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
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20
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Holden S, Rathleff MS. Separating the myths from facts: time to take another look at Osgood-Schlatter 'disease'. Br J Sports Med 2020; 54:824-825. [PMID: 31892535 DOI: 10.1136/bjsports-2019-101888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2019] [Indexed: 01/07/2023]
Affiliation(s)
- Sinead Holden
- Center for General Practice in Aalborg, Aalborg University, Aalborg, Denmark .,SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice in Aalborg, Aalborg University, Aalborg, Denmark.,SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Guldhammer C, Rathleff MS, Jensen HP, Holden S. Long-term Prognosis and Impact of Osgood-Schlatter Disease 4 Years After Diagnosis: A Retrospective Study. Orthop J Sports Med 2019; 7:2325967119878136. [PMID: 31700938 PMCID: PMC6823982 DOI: 10.1177/2325967119878136] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Knee pain is common during adolescence, with Osgood-Schlatter disease (OSD) being the most frequent condition. Despite this, research regarding the long-term prognosis of OSD is limited. Purpose: To evaluate the prognosis 2 to 6 years after the diagnosis of OSD. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective cohort study included patients diagnosed with OSD at a single orthopaedic department between 2010 and 2016. Patients were contacted in 2018 and asked to complete a self-reported questionnaire regarding knee pain, knee function (Knee injury and Osteoarthritis Outcome Score [KOOS] Sports/Recreation subscale), Health-related quality of life (HRQoL) (youth version of EuroQol 5 dimensions 3 levels [EQ-5D-3L-Y]), and physical activity. Results: Out of 84 patients, 43 responded. Of these, 60.5% (n = 26) reported OSD-related knee pain at follow-up (median follow-up, 3.75 years). The median symptom duration was 90 months (interquartile range, 24-150 months) for those still experiencing knee pain, and 42.9% of these reported daily knee pain. Fifty-four percent with knee pain had reduced their sports participation compared with 35.3% of those without knee pain. KOOS Sports/Recreation subscale scores were significantly lower in those with knee pain compared with those without knee pain (53 [95% CI, 42-63] vs 85 [95% CI, 76-94], respectively). Participants with knee pain reported lower HRQoL (0.71 [95% CI, 0.57-0.84]) compared with those without knee pain (0.99 [95% CI, 0.97-1.00]). Conclusion: This study indicates that OSD may not always be self-limiting. The lower self-reported function and HRQoL in those with continued pain may be a consequence of impaired physical activity due to knee pain.
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Affiliation(s)
- Clara Guldhammer
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice at Aalborg University, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Hans Peter Jensen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Sinead Holden
- Center for General Practice at Aalborg University, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Ohtaka M, Hiramoto I, Minagawa H, Matsuzaki M, Kodama H. Screening of the Maturity Status of the Tibial Tuberosity by Ultrasonography in Higher Elementary School Grade Schoolchildren. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122138. [PMID: 31212938 PMCID: PMC6616442 DOI: 10.3390/ijerph16122138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 11/16/2022]
Abstract
This study aimed to obtain screening data on the maturity status of the tibial tuberosity in schoolchildren of higher elementary school grades for risk management of Osgood-Schlatter disease (OSD). The maturity stages and cartilage thicknesses at the tibial tuberosity were determined by ultrasonography on the occasion of a school-based musculoskeletal examination for 124 grade 5-6 elementary schoolchildren, and their associations with the students' demographic characteristics and OSD were examined. The time-dependent changes of the maturity status of the tibial tuberosity were also examined in grade 5 students (n = 26) by a longitudinal survey. The cross-sectional survey showed that the epiphyseal stage was reached in 89% of girls and 35% of boys. The girls who had experienced menarche (n = 28) were all in the epiphyseal stage and had a decreased cartilage thickness (p = 0.004, after adjusting maturity stages). Students with OSD (n = 5) were all girls in the epiphyseal stage, and only two of them had an increased cartilage thickness. During the longitudinal survey, a marked increase in cartilage thickness from the previous measurement was observed in three boys (without clinical symptoms) and a girl who newly developed OSD. Two students with OSD without chronic pain had thin cartilage. In conclusion, for schoolchildren of higher elementary school grades, the risk of OSD is higher among girls with the epiphyseal stage. Cartilage thickness may not contribute to the diagnosis of OSD, since thick cartilage is not very common in OSD. However, cartilage thickness may reflect the status of OSD.
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Affiliation(s)
- Maiko Ohtaka
- Department of Maternity Child Nursing, Akita University Graduate School of Medicine and Faculty of Medicine, Akita 010-8543, Japan.
| | - Izumi Hiramoto
- Department of Maternity Child Nursing, Akita University Graduate School of Medicine and Faculty of Medicine, Akita 010-8543, Japan.
| | | | - Masashi Matsuzaki
- Akita University Graduate School of Medicine, Akita 010-8543, Japan.
| | - Hideya Kodama
- Department of Maternity Child Nursing, Akita University Graduate School of Medicine and Faculty of Medicine, Akita 010-8543, Japan.
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23
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Omodaka T, Ohsawa T, Tajika T, Shiozawa H, Hashimoto S, Ohmae H, Shitara H, Ichinose T, Sasaki T, Hamano N, Takagishi K, Chikuda H. Relationship Between Lower Limb Tightness and Practice Time Among Adolescent Baseball Players With Symptomatic Osgood-Schlatter Disease. Orthop J Sports Med 2019; 7:2325967119847978. [PMID: 31192270 PMCID: PMC6540499 DOI: 10.1177/2325967119847978] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Osgood-Schlatter disease (OSD) is characterized by traction apophysitis of the tibial tuberosity. Few studies on symptomatic and asymptomatic OSD have correlated findings with clinical examination. Purpose: To investigate the relationship between lower limb tightness and practice time among adolescent baseball players with symptomatic OSD. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The study participants were 402 male baseball players (N = 804 knees) with a mean ± SD age of 10.9 ± 1.5 years (range, 7-14 years). Participant age, height, body weight, body mass index, practice time per week, range of motion of the hip and ankle joints, heel-buttock distance (HBD), and straight-legged raise angle were evaluated. Tibial tuberosity development, as assessed with ultrasonography, was classified into 4 stages: cartilaginous, apophyseal, epiphyseal, and bony. Knees that were classified as apophyseal or epiphyseal were investigated. Participants were divided into 3 groups: non-OSD, asymptomatic OSD, and symptomatic OSD. Results: Of 400 knees in the apophyseal and epiphyseal stages, 23 knees had asymptomatic OSD, and 11 had symptomatic OSD. Players with symptomatic OSD practiced for significantly longer than the non-OSD group (P = .001) and asymptomatic OSD group (P = .001). Players with symptomatic OSD also had a larger HBD (P = .006) and smaller range of motion regarding internal rotation of hip (P = .023) and dorsiflexion of the ankle (P = .013) than the non-OSD group. Conclusion: Players with symptomatic OSD had longer practice times than the non-OSD and asymptomatic OSD players. Symptomatic OSD was also associated with tightness of the lower limbs as assessed by the HBD and range of motion in the hip and ankle joints.
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Affiliation(s)
- Takuya Omodaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Takashi Ohsawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hiroyuki Shiozawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Syogo Hashimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hiroaki Ohmae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Noritaka Hamano
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
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Lang SD, Irons MRH, Gilmer BB. Repair of Patellar Tendon Avulsion from the Tibial Tubercle: Case Report. J Orthop Case Rep 2019; 9:26-30. [PMID: 32547998 PMCID: PMC7276613 DOI: 10.13107/jocr.2250-0685.1518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: Pre-existing conditions and surgical interventions, such as those associated with Osgood-Schlatter disease, can lead to atypical patellar tendon ruptures. These cases can present irregularly and be challenging to diagnose. Patellar tendon rupture from the tibial tubercle insertion region is a rare, and currently undocumented condition, requiring surgical intervention to restore knee joint functionality for daily activities. This presentation requires a unique treatment approach, as standard reconstruction techniques do not apply. Case Report: A 65-year-old Caucasian male, with a remote history of gout and surgical intervention for symptomatic Osgood-Schlatter disease, suffered sudden hyperflexion with eccentric contraction of the right knee while hiking. The patient presented with massive right knee effusion and significant tenderness over the tibial tubercle, with an inability to extend the knee. After radiographs were inconclusive, magnetic resonance imaging was performed showing a tear of the medial aspect of the distal patellar tendon. Conclusion: Surgical intervention for Osgood-Schlatter disease can be a potential risk factor for patellar tendon rupture from the tibial tubercle. Since a variety of surgical interventions for symptomatic Osgood-Schlatter disease exist, it is important to consider the long-term effects and counsel patients on the associated risks of the procedures. Initial diagnosis of patellar tendon rupture can be surprisingly challenging when the presentation is atypical. Attention to detail during physical examination and evaluation of imaging is a necessity for early detection and treatment, which can afford excellent functional outcomes
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Affiliation(s)
- Sarah Dawn Lang
- Department of Orthopaedics, Mammoth Orthopedic Institute, PO Box 660, Mammoth Lakes, California 93546, U.S.A
| | - Matthew Robert Henry Irons
- Department of Orthopaedics, Mammoth Orthopedic Institute, PO Box 660, Mammoth Lakes, California 93546, U.S.A
| | - Brian Brandon Gilmer
- Department of Orthopaedics, Mammoth Orthopedic Institute, PO Box 660, Mammoth Lakes, California 93546, U.S.A
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Watanabe H, Fujii M, Yoshimoto M, Abe H, Toda N, Higashiyama R, Takahira N. Pathogenic Factors Associated With Osgood-Schlatter Disease in Adolescent Male Soccer Players: A Prospective Cohort Study. Orthop J Sports Med 2018; 6:2325967118792192. [PMID: 30182029 PMCID: PMC6113738 DOI: 10.1177/2325967118792192] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: A previous cross-sectional study reported that pathogenic factors associated with Osgood-Schlatter disease (OSD) in adolescent athletes include increased quadriceps muscle tightness, lower leg malalignment, and development of apophysitis in the tibial tuberosity. Purpose: To confirm these pathogenic factors associated with OSD in a longitudinal study with regard to physical function and performance. Study Design: Cohort study; Level of evidence, 2. Methods: In this study, 37 boys (mean age, 10.2 ± 0.4 years) were recruited from 2 soccer teams at an elementary school. This cohort study was conducted over an observation period of 1 year, with measurements recorded at baseline, followed by screening for OSD every 6 months. Variables evaluated at baseline included physical function (morphometry, joint flexibility, and lower extremity alignment), presence of Sever disease, and kicking motion. Results: Pathogenic factors associated with OSD in the support leg of adolescent male soccer players included height, weight, body mass index, quadriceps femoris muscle tightness in the kicking and support legs, and gastrocnemius muscle tightness, soleus muscle tightness, and medial longitudinal arch in the support leg. Additional factors included a diagnosis of Sever disease and distance from the lateral malleolus of the support leg’s fibula to the center of gravity during kicking. Conclusion: The onset of OSD was found to be affected by many factors, including developmental stage, physical attributes, and pre-existing apophysitis. In particular, a diagnosis of Sever disease and backward shifting of the center of gravity during kicking increased the risk of the subsequent onset of OSD, suggesting that these factors are very important as a possible focus for interventions.
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Affiliation(s)
- Hiroyuki Watanabe
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Meguru Fujii
- Nishifuna Clinic, Funabashi Orthopedic Hospital, Funabashi, Japan
| | - Masumi Yoshimoto
- Department of Physical Therapy, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan
| | - Hiroshi Abe
- Department of Rehabilitation, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan
| | - Naruaki Toda
- Department of Rehabilitation, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan
| | - Reiji Higashiyama
- Department of Orthopedic Surgery, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
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Cairns G, Owen T, Kluzek S, Thurley N, Holden S, Rathleff MS, Dean BJF. Therapeutic interventions in children and adolescents with patellar tendon related pain: a systematic review. BMJ Open Sport Exerc Med 2018; 4:e000383. [PMID: 30167318 PMCID: PMC6109948 DOI: 10.1136/bmjsem-2018-000383] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2018] [Indexed: 12/19/2022] Open
Abstract
Objective Evaluate effectiveness and harms of interventions for patellar tendon related pain in children and adolescents. Design Systematic review and meta-analysis. Data sources Medline via Pubmed, Embase via OVID, CINAHL via Ebsco, SportDiscus up until 24 November 2017 were searched. Eligibility criteria for selecting studies Inclusion criteria were (1) controlled or randomised controlled clinical trials (RCTs), (2) participants with diagnosis of patellar tendon related disorder, (3) participants≤18 years of age at enrolment and (4) published in a peer-reviewed English or Scandinavian language journal. Results Of 530 studies identified, eight were included after screening, with three included in data synthesis. To be included in data synthesis, we required studies to have included (and have data available for) a minimum of 10 participants under 18 years. All studies were rated as being at high risk of bias. For adolescents with patellar tendinopathy, one RCT compared eccentric exercises to usual care and found no difference between groups. In adolescents with Osgood-Schlatter disease (OSD), injection of local anaesthetic with dextrose proved superior to either usual care or local anaesthetic alone (three armed RCTs). In a retrospective case controlled study in adolescents with OSD, surgery provided no benefit over conservative management in terms of persistent symptoms and had a higher complication rate. Conclusion There is weak evidence to support the use of dextrose injection with local anaesthetic and no evidence to support the use of specific types of exercises to treat children/adolescents with OSD/patellar tendinopathy. Until further evidence arises, clinicians should include load modification and advise on a return to sport based on symptoms.
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Affiliation(s)
- George Cairns
- Bristol Medical School, University of Bristol Medical School, Bristol, UK
| | - Timothy Owen
- Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Stefan Kluzek
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Neal Thurley
- Bristol Medical School, University of Bristol Medical School, Bristol, UK.,Bodleian Health Care Libraries, Cairns Library, John Radcliffe Hospital, Oxford, UK
| | - Sinead Holden
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Benjamin John Floyd Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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27
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Abstract
Osgood–Schlatter disease (OSD) is known as a self-limiting condition but surgical excision of the ossicles may be required in adults resistant to conservative treatments. The ossicle associated to OSD is generally small and located outside the joint near the tibial tubercle; however, large or intra-articular ossicle has been reported rarely. Here, we report an unusual case of OSD with a separated, large-sized ossicle that protruded into the knee joint and treated by arthroscopy-assisted excision of the ossicle.
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Affiliation(s)
- Wonchul Choi
- Orthopaedics, CHA University/Cha Bundang Medical Center, Sungnam, KOR
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Kaneuchi Y, Otoshi K, Hakozaki M, Sekiguchi M, Watanabe K, Igari T, Konno S. Bony Maturity of the Tibial Tuberosity With Regard to Age and Sex and Its Relationship to Pathogenesis of Osgood-Schlatter Disease: An Ultrasonographic Study. Orthop J Sports Med 2018; 6:2325967117749184. [PMID: 29344541 PMCID: PMC5761927 DOI: 10.1177/2325967117749184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although tensile force on an immature tibial tuberosity is considered the main cause of Osgood-Schlatter disease (OSD), the relationship between bony maturity and the pathogenesis of OSD remains obscure. PURPOSE To survey the bone maturation process of the tibial tuberosity by age and sex and clarify its relationship to OSD. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 731 Japanese basketball players aged 6 to 14 years were enrolled in this study. Ultrasonographic examination was performed in all participants (1462 knees) to evaluate the bony maturity of the tibial tuberosity by use of the Ehrenborg classification. The age- and sex-specific prevalence of each stage was investigated, and the prevalence of symptomatic OSD and its relationship with bony maturity were also assessed. RESULTS The process of bone maturation occurred 1 to 2 years earlier in female participants compared with male participants. Among female participants, 59.2% were already at the epiphyseal stage (stage E) by 10 years of age, and 47.4% were skeletally mature by 14 years. Among male participants, conversely, only 8.0% were at stage E by 10 years of age, and only 13.8% were skeletally mature by 14 years. The overall prevalence of symptomatic OSD was 6.8% (males, 6.4%; females, 7.2%), and the onset was 1 year earlier in the female participants. The prevalence of symptomatic OSD tended to increase with age and bony maturity, significantly increasing from the cartilaginous stage (stage C) to the apophyseal stage (stage A) (odds ratio, 9.48) and from stage A to stage E (odds ratio, 2.22). CONCLUSION The tibial tuberosity matures earlier in female participants. The risk of OSD is greater in stage A than stage C and in stage E than stage A. The risk of OSD increases with age in males but not in females.
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Affiliation(s)
- Yoichi Kaneuchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Orthopaedic Surgery, Southern TOHOKU General Hospital, Miyagi, Japan
| | - Kenichi Otoshi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Sports Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Michiyuki Hakozaki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takahiro Igari
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shinichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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Pagenstert G, Wurm M, Gehmert S, Egloff C. Reduction Osteotomy of the Prominent Tibial Tubercle After Osgood-Schlatter Disease. Arthroscopy 2017; 33:1551-1557. [PMID: 28454996 DOI: 10.1016/j.arthro.2017.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 02/03/2017] [Accepted: 02/10/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the functional and clinical outcome of a new closing-wedge osteotomy for the prominent tibial tubercle after Osgood-Schlatter disease. METHODS Between 2010 and 2014, 7 consecutive adults (mean age, 28.6 years; range, 26-35 years) were treated by closing-wedge reduction osteotomy of a painful tibial tubercle. All patients had prior nonsurgical and surgical treatment. Preoperative and postoperative tubercular prominence, Caton-Deschamps index for patellar height, the Kujala Anterior Knee Pain Scale, Lysholm Knee Score as well as visual analog scale score and Tegner activity scores were recorded. RESULTS Mean follow-up after reduction osteotomy was 31.3 months (27-41 months). The bony prominence of the tibial tubercle was significantly reduced (mean 8 mm, P < .001) and the Caton-Deschamps index was lowered from 1.29 to 1.09 (P < .001). From preoperative to last follow-up, the Kujala Anterior Knee Pain Scale increased from 54.71 preoperative to 84.71 (P < .001); the Lysholm Knee Score improved from 72.42 to 94.14 (P < .001); the Tegner activity score increased from 3.1 to 5.7 (P < .001), whereas the visual analog scale significantly decreased from 5.8 to 1.2 (P < .001). No complications were recorded, and all patients were satisfied with clinical outcome. CONCLUSIONS Closing-wedge osteotomy of the tibial tubercle effectively reduced the bony prominence after Osgood-Schlatter disease and consecutively improved the outcome in terms of knee pain and function. Thus, we can recommend this procedure in selected patients. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Geert Pagenstert
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Markus Wurm
- Department of Orthopaedic Sports Medicine, Technische Universität München (TUM), Munich, Germany
| | - Sebastian Gehmert
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Christian Egloff
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel, Switzerland.
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Lee DW, Kim MJ, Kim WJ, Ha JK, Kim JG. Correlation between Magnetic Resonance Imaging Characteristics of the Patellar Tendon and Clinical Scores in Osgood-Schlatter Disease. Knee Surg Relat Res 2016; 28:62-7. [PMID: 26955614 PMCID: PMC4779807 DOI: 10.5792/ksrr.2016.28.1.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/13/2015] [Accepted: 09/18/2015] [Indexed: 11/04/2022] Open
Abstract
Purpose This study aims to evaluate magnetic resonance imaging (MRI) findings in young adults with symptomatic Osgood-Schlatter disease (OSD) and compare those in young adults without OSD. Materials and Methods We compared MRI findings between young adults with OSD (OS group, n=30) and the equivalent number of young adults without OSD (control group). Visual analog scale scores and Kujala scores were evaluated and correlation analysis was performed in the OS group. Results In the OS group, MRI revealed that the patellar tendon was attached to the tibia more widely, resulting in a reduced free tendon portion, and more proximally to the articular surface (p<0.001). The correlation analysis between MRI findings and clinical scores showed statistically significant correlations (p<0.01). In the OS group, 43% presented with patellar tendinopathy or bone marrow edema at the distal attachments. Conclusions Compared to the control group, the relatively small free portion and relatively proximal attachment of the patellar tendon were observed with MRI in the OS group. The free portion of the patellar tendon was positively correlated with the clinical scores. Patellar tendinopathy was also frequently encountered in the OS group.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopedic Surgery, Daejeon Military Hospital, Daejeon, Korea
| | - Min Jeong Kim
- Department of Raiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Woo Jong Kim
- Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jeong Ku Ha
- Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea
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31
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Lui TH. Endoscopic Management of Osgood-Schlatter Disease. Arthrosc Tech 2016; 5:e121-5. [PMID: 27073771 PMCID: PMC4811213 DOI: 10.1016/j.eats.2015.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/27/2015] [Indexed: 02/03/2023] Open
Abstract
Osgood-Schlatter disease is a common cause of anterior knee pain in sports-practicing adolescents. The long-term outcomes have not always been favorable, and some adolescents have persisting knee pain into adulthood. Excision of the ossicle together with debridement of the tibial tuberosity is indicated if the pain is not relieved with conservative measures. An endoscopic technique for excision of the ossicle associated with Osgood-Schlatter disease is reported. It has the advantages of avoidance of painful surgical scars and preservation of the integrity of the patellar tendon, with the potential for improved cosmetic and functional results.
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Affiliation(s)
- Tun Hing Lui
- Address correspondence to Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S., Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.Department of Orthopaedics and TraumatologyNorth District Hospital9 Po Kin RoadSheung ShuiNTHong Kong SARChina
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32
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Eun SS, Lee SA, Kumar R, Sul EJ, Lee SH, Ahn JH, Chang MJ. Direct bursoscopic ossicle resection in young and active patients with unresolved Osgood-Schlatter disease. Arthroscopy 2015; 31:416-21. [PMID: 25442658 DOI: 10.1016/j.arthro.2014.08.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 08/20/2014] [Accepted: 08/27/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to determine the outcomes of bursoscopic ossicle excision in young and active patients with unresolved Osgood-Schlatter disease. METHODS This retrospective study included 18 male military recruits. A direct bursoscopic ossicle excision was performed using low anterolateral and low anteromedial portals. Outcomes were evaluated using the Lysholm knee score, pain score on a visual analog scale (VAS) (from 0 to 10), and Tegner activity scale score. In addition, patients were asked whether they could kneel or squat and whether they were able to return to their duty after surgery. Patient satisfaction was evaluated using the VAS and by asking whether patients thought that the prominence of the tibial tuberosity was reduced and whether they would recommend the same surgical treatment to others. Complications after surgery were also evaluated. RESULTS The mean Lysholm knee score was 71 preoperatively and improved to 99 after surgery. The mean VAS pain score was 6.5 in the preoperative period and decreased to 0.9 after surgery. In addition, the mean Tegner activity scale score improved from 2.7 preoperatively to 6.2 at final follow-up. However, 4 patients were not able to return to their duty, and 4 patients still had difficulties with kneeling after surgery. A superficial infection occurred in 1 patient, and a recurrent ossicle formation was found in 1 patient. Of 18 patients, 17 were satisfied with their surgical outcomes, and the mean VAS score for patient satisfaction was 8.8. Furthermore, all but 1 patient would recommend the same surgical treatment to others. However, 6 patients did not believe that the prominence of the tibial tuberosity was reduced. CONCLUSIONS Bursoscopic ossicle excision showed satisfactory outcomes in selective young and active patients with persistent symptoms. However, bursoscopic surgery showed limitation in reducing the prominence of the tibial tuberosity. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Sang Soo Eun
- Department of Orthopedic Surgery, Wooridul Spine Hospital, Seoul, Republic of Korea
| | - Seung Ah Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ramakant Kumar
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Republic of Korea
| | - Eun Jin Sul
- Department of Orthopedic Surgery, Wooridul Spine Hospital, Seoul, Republic of Korea
| | - Sang Ho Lee
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Republic of Korea
| | - Jin Hwan Ahn
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Narayan N, Mitchell PD, Latimer MD. Complete resolution of the symptoms of refractory Osgood-Schlatter disease following percutaneous fixation of the tibial tuberosity. BMJ Case Rep 2015; 2015:bcr-2014-206734. [PMID: 25678612 DOI: 10.1136/bcr-2014-206734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Osgood-Schlatter disease is a common cause of anterior knee pain in adolescents. In a good proportion of cases the pain is relieved through stopping sport alone, or by doing so in conjunction with undertaking physiotherapy. However, resolution of symptoms may take several years. A proportion of teenagers are prevented from participating in sport for a prolonged period as a result of the condition, and some have persisting knee pain into adulthood. We report the use of a new surgical treatment for this disease. We describe the case of a 12-year-old boy who was unable to play rugby for a year due to this pain. Following percutaneous fixation of the tibial tuberosity his symptoms entirely resolved and he returned to competitive sport 6 weeks after surgery. A year later the screw was removed. As soon as he resumed sport his symptoms immediately returned and he requested that the screw be replaced. Following replacement his symptoms once more resolved.
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Affiliation(s)
- Nitisha Narayan
- Department of Plastic Surgery, Royal London Hospital, London, UK
| | - Piers D Mitchell
- Department of Orthopaedics, Peterborough and Stamford Hospitals, Peterborough, UK
| | - Mark David Latimer
- Department of Orthopaedics, Peterborough and Stamford Hospitals, Peterborough, UK Department of Orthopaedics, Addenbrookes Hospital, Cambridge, UK
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Yanagisawa S, Osawa T, Saito K, Kobayashi T, Tajika T, Yamamoto A, Iizuka H, Takagishi K. Assessment of Osgood-Schlatter Disease and the Skeletal Maturation of the Distal Attachment of the Patellar Tendon in Preadolescent Males. Orthop J Sports Med 2014; 2:2325967114542084. [PMID: 26535345 PMCID: PMC4588527 DOI: 10.1177/2325967114542084] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Osgood-Schlatter disease (OSD) is a traction apophysitis of the tibial tuberosity. Ultrasonography (US) is able to detect pathologic changes, such as cartilage swelling and fragmentation of the tibial tubercle ossification center. PURPOSE To compare the US stages of tibial tuberosity development and the physical features and prevalence of OSD in this patient cohort. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Subjects included 238 males (n = 476 joints) with a mean age of 11.4 ± 1.6 years (range, 7-14 years). The tibial tuberosity development on US was divided into 3 stages: the cartilaginous stage (stage C), apophyseal stage (stage A), and epiphyseal stage (stage E). It was then investigated whether the subjects had pain in the tibial tuberosity on application of pressure. Age, height, body weight, body mass index (BMI), heel-buttock distance (HBD, cm), and straight-leg raise angle (SLRA) were evaluated. To confirm the diagnosis of OSD, the participant had to fulfill the following clinical criteria: pain with direct pressure on the tibial apophysis, fragmentation of the bone, and irregularity of the ossification center detected by US. RESULTS The tibial tuberosity was stage C in 195 knees, stage A in 105 knees, and stage E in 176 knees. The subjects' heights, weights, and BMIs significantly increased with advancing development of the tibial tuberosity. The HBD increased in stage E (P < .01). The SLRA was not significantly different among groups. There was fragmentation of the bone and irregularity of the ossification center in 32 knees (6.8%): 0 in stage C, 21 (4.3%) in stage A, and 11 (2.3%) in stage E. Fragmentation of the bone and irregularity were observed significantly more often in stage A (P < .01). On the other hand, there were 10 joints with OSD (2.1%): 0 in stage C, 3 (0.6%) in stage A, and 7 (1.5%) in stage E. OSD was observed significantly more often in stage E than in the other stages (P < .05). CONCLUSION The present study showed that the HBD increased from stage A to stage E. The prevalence of OSD was highest in stage E.
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Affiliation(s)
- Shinya Yanagisawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takashi Osawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Kenichi Saito
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tsutomu Kobayashi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Atsushi Yamamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Haku Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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35
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Kabiri L, Tapley H, Tapley S. Evaluation and conservative treatment for Osgood-Schlatter disease: A critical review of the literature. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.2.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Howell Tapley
- Program Director for Physical Therapy at Indiana State University, USA
| | - Stasia Tapley
- Clinical Coordinator at Indiana State University, USA
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Nakase J, Aiba T, Goshima K, Takahashi R, Toratani T, Kosaka M, Ohashi Y, Tsuchiya H. Relationship between the skeletal maturation of the distal attachment of the patellar tendon and physical features in preadolescent male football players. Knee Surg Sports Traumatol Arthrosc 2014; 22:195-9. [PMID: 23263228 DOI: 10.1007/s00167-012-2353-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 12/10/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to compare ultrasonography stages of the tibial tuberosity development and physical features. METHODS This study examined 200 knees in 100 male football players aged 10-15 years. Tibial tuberosity development on ultrasonography was divided into 3 stages: Sonolucent stage (stage S), Individual stage (stage I), and Connective stage (stage C). Age, height, quadriceps and hamstring muscle tightness, and muscle strength in knee extension and flexion were determined. These findings were compared with the respective stages of development. RESULTS The tibial tuberosity was stage S in 27 knees, stage I in 69 knees, and stage C in 104 knees, with right and left sides at the same stage in 95 %. Average age and height significantly increased with advancing tibial tuberosity development. Quadriceps tightness increased with tibial tuberosity development. Hamstring tightness decreased with development. The strength of both knee extension and flexion increased with advancing development, with a greater change seen in knee extension, hamstring/quadriceps ratio: stage C, 0.74; stage A, 0.64; stage E, 0.53. CONCLUSIONS Osgood-Schlatter pathogenesis reportedly involves increased quadriceps tightness with rapidly increasing femoral length during tibial tuberosity development. In this study, it was confirmed that quadriceps tightness increased, yet hamstring tightness decreased, suggesting that quadriceps tightness is not due to femoral length alone. Other factors, including muscle strength, may be involved. The study shows that thigh muscle tightness and thigh muscle performance change with the skeletal maturation of the distal attachment of the patellar tendon. These results add new information to the pathogenesis of Osgood-Schlatter disease.
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Affiliation(s)
- Junsuke Nakase
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan,
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