Muscle stiffness of the rectus femoris and vastus lateralis in children with Osgood-Schlatter disease

Biomechanical alterations in Osgood-Schlatter disease: a systematic review

This systematic review aims to identify the biomechanical alterations in Osgood - Schlatter disease (OSD). A comprehensive electronic search was undertaken by two independent researchers of PubMed, Lilacs, CINAHL, Embase, Scopus, Sportdiscus, Web of Science, SciELO, and Cochrane using search terms referring to OSD, following PRISMA 2020 recommendations. Cross-sectional/observational studies or baseline measurements of longitudinal studies that provided comparisons of individuals with OSD and control participants were included. There were no restrictions on language and publication date. Studies were selected based on titles, abstracts, and full texts, and duplicates were excluded. Study quality was rated according to the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. The search yielded 568 studies, and after applying the eligibility criteria, 554 studies were excluded, resulting in a final sample of 14 studies. Participants identified in the studies were adolescents (10-16 years) and were mostly male. People with OSD displayed a greater height and body mass index, as well as the presence of pelvic tilt, increased posterior tibial slope, increased condylomalleolar and tibial torsion angles, lower hip abduction (in women) and knee extension strength, and greater stiffness of the quadriceps femoris, gastrocnemius, and soleus muscles. Overall evidence quality is moderate based on JBI guidelines.

Quantitative Analysis of Quadriceps Forces in Adolescent Females during Running with Infrapatellar Straps

Osgood-Schlatter disease (OSD) is caused by high, repetitive, and continuous traction exerted by the quadriceps on the tibial tuberosity, primarily occurring in adolescents. Infrapatellar straps are commonly recommended for its prevention and treatment, yet their impact on quadriceps forces in adolescents remains unstudied. Furthermore, current research on OSD predominantly focuses on adolescent males, with limited attention to adolescent females, despite similar incidence rates in both groups. This study aimed to quantify the quadriceps forces during running, both with and without infrapatellar straps, in adolescent females. Kinematic data, ground reaction forces, and electromyography (EMG) data of knee muscles from 16 adolescent females were recorded as they ran at self-selected speeds with and without infrapatellar straps. OpenSim was employed to estimate quadriceps activations and forces, from which accumulated forces were derived. The simulation's reliability was validated by calculating the correlation between muscle activations obtained from OpenSim and EMG data, which revealed a strong correlation. Wearing infrapatellar straps during running decreased the peak and accumulated forces of the quadriceps (p < 0.001, and p < 0.001, respectively). The significant reduction in accumulated forces was associated with decreased vastus muscle forces during the stance phase (p = 0.002, p = 0.003, and p = 0.016 for vastus lateralis, vastus medialis, and vastus intermedius, respectively). The use of infrapatellar straps had limited effect on the rectus femoris muscle forces. The reliability of the simulation was validated through EMG data. Wearing infrapatellar straps may reduce the load exerted on the tibial tuberosity by decreasing vastus muscle forces during the stance phase. Adolescents aiming to reduce excessive rectus femoris muscle forces due to a shortened or tight rectus femoris, which may contribute to the occurrence of OSD, might experience limited benefits from wearing infrapatellar straps.

Osgood-Schlatter Disease: Ossicle Resection and Patellar Tendon Repair in a Symptomatic Adult

Chronic Osgood-Schlatter disease can cause significant knee pain and can result in severe functional deficits. For large, painful Osgood-Schlatter disease ossicles refractory to conservative management, surgical ossicle excision can provide resolution of symptoms. After diagnostic arthroscopy and intra-articular debridement, our preferred excision technique uses an open incision for direct visualization and removal of intratendinous ossicles, followed by distal patellar tendon repair and subsequent fixation with FiberTape sutures and knotless anchors to the tibial tubercle.

Validity of Elastic Imaging Evaluation of Hamstring Muscles With Knee Contracture Using Ultrasound Shear Wave Elastography

PURPOSE

This study used ultrasound shear wave elastography (SWE) to evaluate the mechanical properties of hamstring muscles from cadaveric specimens with knee flexion contractures.

METHODS

Hamstring muscles for tensile testing were harvested from Thiel soft-embalmed cadavers with and without knee flexion contracture. Muscle specimens were mounted on a testing machine. The initial load detected when a tensile load was applied to the distal end was used as the slack length. The cross-sectional areas of the muscle at slack length were measured at the proximal and distal sites using B-mode ultrasonography. Subsequently, the muscle specimen was elongated from the slack length to 8% strain, with the shear modulus measured using SWE. Young's modulus (stress/strain) was calculated based on the displacement and tensile force obtained from the tensile test.

RESULTS

Regression analysis showed a significant positive linear relationship between the Young's and shear moduli for all specimens at all the sites (P < 0.01 and coefficient of determination: 0.95-0.99). The Young's and average shear moduli at the proximal and distal sites were higher in all hamstring muscles with contractures than in those without contractures.

CONCLUSIONS

SWE can be used to estimate Young's moduli of hamstring muscles with contractures. Muscle specimens with contractures exhibited higher resistance to elongation, thereby indicating that their mechanical properties differed from those of muscles without contractures.

Diagnostic utility of shear wave elastography in musculoskeletal injuries: A narrative review

Shear wave elastography (SWE) is an emerging and promising ultrasound modality, and is more recently employed in the diagnosis of musculoskeletal (MSK) pathologies. SWE evaluates tissue stiffness by measuring the speed of propagating acoustic waves through body tissue structures. Knowing the variations in stiffness of MSK soft tissue can provide helpful diagnostic insight for the evaluation of pathology in muscles, tendons, ligaments, nerves, and other soft tissues. The goal of this review is to synthesize recent literature on the utility of SWE for MSK pathology diagnosis. This review reveals that SWE adds important diagnostic data for the evaluation of several pathologies, such as median mononeuropathy at the wrist, Achilles tendinopathy, and plantar fasciitis. The review also reveals a lack of evidence pertaining to appropriate standardization of use and the connection to reliable and valid diagnostic benefit in the clinical setting.

Role of Physiotherapy in Osgood-Schlatter's Disease in Adolescent Volleyball Smasher: A Case Report

A 14-year-old female presented to the sports physiotherapy with a diagnosis of Osgood-Schlatter's disease (OSD), a condition particularly prevalent in adolescents engaged in sports with repetitive knee motions, such as volleyball. This ailment commonly manifests at the tibia, directly beneath the patella, eliciting discomfort and inflammation. The chronic overuse injuries involve repetitive activities inducing fatigue in specific anatomical structures. Adequate recovery mechanisms allow for tissue adaptation, mitigating the risk of injury. In the absence of proper recovery, microtrauma ensues, instigating inflammation mediated by substances like histamines. The release of inflammatory cells and enzymes inflicts damage on local tissue, and prolonged stress contributes to degenerative changes, resulting in weakness, diminished flexibility, and chronic pain. These manifestations are intimately associated with OSD in chronic or recurrent instances. The primary symptom of OSD is knee pain, often of sufficient severity to induce limping. Patients report discomfort during activities such as kneeling, descending stairs, prolonged stationary positions, prolonged episodes of sitting with the knee rendered immobile, and engagement in sporting activities. This case study specifically underscores the efficacy of tailored physiotherapy in the management of OSD among adolescent volleyball players. The study's findings indicate that the patient successfully alleviated symptoms, facilitating recovery with improved outcomes. Furthermore, the physiotherapy regimen appears instrumental in enhancing the patient's functional mobility, as evidenced by the study's outcomes.

Analysis of Quadriceps Muscle Tightness as a Risk Factor for Osgood-Schlatter Disease: A Prospective Cohort Study

Background

The prevalence of Osgood-Schlatter disease (OSD) is unknown. Tightness of the quadriceps femoris has been reported to be a risk factor for OSD.

Hypothesis

Quadriceps muscle tightness would not contribute to the development of OSD.

Study Design

Cohort study; Level of evidence, 2.

Methods

We enrolled 150 Japanese male junior high school soccer players (N = 300 knees), with a mean age at first examination of 12.5 years (range, 12-13 years). All players were assessed annually and evaluated for 2 years. Ten players (n = 14 knees) had a history of OSD before the first medical examination. After excluding these 10 players (n = 20 knees), the remaining 140 players (n = 280 knees) were included in this prospective analysis. Age at the time of starting soccer, history of injury (including OSD and time missed), height, weight, annual increase in height, body mass index (BMI), straight-leg raise angle, heel-buttock distance (HBD), and ultrasound images of the tibial tuberosity (maturity and morphology) were compared between players who developed OSD and those who did not.

Results

OSD was identified in 8 knees of 6 players, with an incidence of 2.9% of knees (8/280) and 4.3% of players (6/140). Univariate analysis revealed significant differences between the OSD and non-OSD groups regarding BMI (17.1 ± 1 kg/m2 vs 18.5 ± 1.6 kg/m2, respectively; P = .018), HBD (1.5 ± 1.6 cm vs 4.8 ± 4.5 cm; P < .001), and stage of tibial tuberosity maturity (P < .001). The maturity of the tibial tuberosity was the only independent risk factor for the development of OSD in multivariate logistic regression analysis (odds ratio, 9.848 [95% CI, 3.297-29.41]; P < .001).

Conclusion

Study findings indicated that quadriceps muscle tightness did not contribute to the development of OSD.

Do adolescents with Osgood-Schlatter display nociplastic pain manifestations compared to controls: A cross-sectional study

OBJECTIVES

Osgood-Schlatter disease is an overuse musculoskeletal pain condition. The pain mechanism is considered nociceptive, but no studies have investigated nociplastic manifestations. This study investigated pain sensitivity and inhibition evaluated through exercise-induced hypoalgesia in adolescents with and without Osgood-Schlatter.

DESIGN

Cross-sectional study.

METHODS

Adolescents underwent a baseline assessment comprising clinical history, demographics, sports participation, and pain severity rated (0-10) during a 45-second anterior knee pain provocation test, consisting of an isometric single leg squat. Pressure pain thresholds were assessed bilaterally at the quadriceps, tibialis anterior muscle, and the patella tendon before and after a three-minute wall squat.

RESULTS

Forty-nine adolescents (27 Osgood-Schlatter, 22 controls) were included. There were no differences in the exercise-induced hypoalgesia effect between Osgood-Schlatter and controls. Overall, an exercise-induced hypoalgesia effect was detected at the tendon only in both groups with a 48 kPa (95 % confidence interval 14 to 82) increase in pressure pain thresholds from before to after exercise. Controls had higher pressure pain thresholds at the patellar tendon (mean difference 184 kPa 95 % confidence interval 55 to 313), tibialis anterior (mean difference 139 kPa 95 % confidence interval 24 to 254), and rectus femoris (mean difference 149 kPa 95 % confidence interval 33 to 265). Higher anterior knee pain provocation severity was associated with lower exercise-induced hypoalgesia at the tendon (Pearson correlation = 0.48; p = 0.011) in participants with Osgood-Schlatter.

CONCLUSIONS

Adolescents with Osgood-Schlatter display increased pain sensitivity locally, proximally, and distally but similar endogenous pain modulation compared to healthy controls. Greater Osgood-Schlatter severity appears to be associated with less efficient pain inhibition during the exercise-induced hypoalgesia paradigm.

Developmental stage and lower quadriceps flexibilities and decreased gastrocnemius flexibilities are predictive risk factors for developing Osgood-Schlatter disease in adolescent male soccer players

PURPOSE

This study aimed to elucidate the influential predictive risk factors of Osgood-Schlatter disease (OSD) on the support (non-kicking) leg among adolescent soccer players considering peak height velocity (PHV) age and investigate the cut-off values of the predictive variables.

METHODS

A cohort of 302 Japanese adolescent male soccer players aged 12-13 years were followed over 6 months. All players underwent physical examination, tibial tubercle ultrasonography, anthropometric and whole-body composition measurements, and muscle flexibility test of the support leg at the baseline. The developmental stage was evaluated from the PHV age. The OSD of the support leg was diagnosed 6 months later; players were divided into the OSD and control (CON) groups. The predictive risk factors were analyzed by multivariate logistic regression analysis.

RESULTS

There were 42 players who had developed OSD at baseline and they were excluded from the study. Among the 209 players, 43 and 166 belonged to the OSD and CON groups, respectively. The predictive risk factors of OSD development were PHV age ± 6 months at baseline (p = 0.046), apophyseal stage of tibial tuberosity maturity at baseline (p < 0.001), quadriceps flexibility ≥ 35° at baseline (p = 0.017), and decrease in gastrocnemius flexibility in 6 months (p = 0.009).

CONCLUSION

PHV age ± 6 months at baseline, apophyseal stage of the tibial tuberosity at baseline, quadriceps flexibility ≥ 35° at baseline, and decrease in gastrocnemius flexibility in 6 months are predictive risk factors of OSD development in the support leg among adolescent male soccer players. It is crucial to know the PHV age of each player, and not only the flexibility of quadriceps muscle but also the gastrocnemius should be monitored to predict OSD.

LEVEL OF EVIDENCE

II.

Acute and Prolonged Effects of Dermal Suction on Joint Range of Motion and Passive Muscle Stiffness: A Preliminary Study

This study aimed to investigate the acute and prolonged effects of dermal suction on joint range of motion (ROM) and passive muscle stiffness. Eight-minute dermal suction was prescribed for the quadriceps femoris in 15 participants. Hip extension ROM, knee flexion ROM, and passive muscle stiffness of the rectus femoris (RF) and vastus lateralis (VL) were measured before and immediately, 30 min, 60 min, 120 min, 24 h, and 48 h after dermal suction. Passive muscle stiffness was measured using shear wave elastography. Hip extension ROM significantly increased immediately (p = 0.032), 60 min (p = 0.029), and 120 min (p = 0.031) after dermal suction compared with before dermal suction; however, it was not significantly different at 30 min, 24 h, and 48 h after dermal suction (p > 0.05). Passive muscle stiffness of the RF and VL and knee flexion ROM did not significantly change at any measurement time compared with before dermal suction (p > 0.05). Our preliminary results suggest that dermal suction improves hip extension ROM immediately after dermal suction of the quadriceps femoris, followed by a return to the pre-prescription level 30 min after. However, the effect was prolonged for 120 min and disappeared before 24 h.

The Etiology and Risk Factors of Osgood–Schlatter Disease: A Systematic Review

The etiology and etiopathogenesis of Osgood–Schlatter Disease (OD) are not fully understood. The aim of this review is to systematically analyze the available literature about the etiology and risk factors of OD. The literature was systematically reviewed using the PRISMA criteria to evaluate all studies published in the last 25 years (between 1996 and 2021) dealing with the etiology of OD. A total of 16 articles were included. The etiology and risk factors of OD are controversial. The main articles focused on muscular factors (mainly tightness of the rectus femoris), alteration of the patellar tendon or extensor mechanism, mechanical factors (repetitive solicitation, trauma, sports), tibial anatomy (tibial slope or tibial torsion), and histological alteration. Associations with ankle kinematic and behavior disorders were also reported. Many theories about the etiology, risk factors, and associated factors of OD have been reported in the literature, but more studies are needed to fully understand the etiopathogenesis of this disorder.

Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review

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.

The Biomechanics Effect of Hamstring Flexibility on the Risk of Osgood-Schlatter Disease

Background

The relationship between hamstring flexibility and the risk of OSD continues to be a debate, and whether hamstring stretching exercises should be considered as one of the conservative treatments of OSD is still unclear.

Objectives

To investigate the relationship between hamstring flexibility and the risk of OSD by assessing the changes of loading on the tibial tuberosity caused by the changes of hamstring optimal lengths.

Methods

Experimental data of a young adult running at 4 m/s were used, which were collected by an eight-camera motion capture system together with an instrumented treadmill. Muscle forces were estimated in OpenSim when hamstring optimal lengths changed in the range of 70–130% of the control case in 5% increments. The force and accumulated force of quadriceps muscle were calculated to evaluate the impact of hamstring optimal lengths on the loading on tibial tuberosity. The changes in muscle forces throughout the gait cycle were compared by using statistical parametric mapping (SPM). The average peak force and accumulated force of five gait cycles were compared.

Results

Although the maximum force of the quadriceps muscle was slightly affected by changes in hamstring optimal lengths, the accumulated force of quadriceps muscle increased by 21.97% with hamstring optimal lengths decreased by 30% of the control case. The increase of the muscle force mainly occurred in the early stance phase and terminal swing phase (P < 0.05). However, when hamstring optimal lengths were longer than the control, it had a little effect on accumulated force of quadriceps muscle.

Conclusions

The results of this study indicate that a shorter hamstring optimal length, which means lack of flexibility, can cause a high accumulated force on tibial tuberosity, thus increasing the risk of OSD. Hamstring stretching exercise is only effective for people with lack of hamstring flexibility.