Osgood Schlatter syndrome

Knee Pain, Joint Loading, and Structural Abnormalities on MRI in 13-Year-Old Children in a Population-Based Birth Cohort

BACKGROUND

Knee pain is a common problem in children and adolescents, and it often has a chronic character.

PURPOSE

To examine the prevalence of knee pain in 13-year-old children and assess associations of knee pain with physical factors and the presence of structural abnormalities on magnetic resonance imaging (MRI).

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

Data from the Generation R Study, a population-based birth cohort, were used. Prevalence and characteristics of knee pain were assessed, using a pain mannequin, in children 13 years of age (N = 1849). Patient characteristics and data on physical activity were extracted from questionnaires. The body mass index standard deviation score and waist-hip ratio were calculated from objectively measured weight and height. Structural abnormalities were assessed by MRI. The differences between children with and without knee pain were also analyzed.

RESULTS

A prevalence of 8.0% was found for knee pain in children, of which 92.3% persisted for >3 months (ie, chronic); 37.5% of the children experienced pain daily, and the pain was almost always located on the anterior side of the knee (98.6%). Higher body mass index standard deviation scores were seen in children with knee pain than in the children without knee pain. No differences in physical activity were seen between children with and without knee pain. Moreover, in children with knee pain compared with children without knee pain, characteristics of Osgood-Schlatter disease (6.8% vs 1.9%) and bipartite patella type 3 (4.7% vs 0.3%) were more often seen on MRI.

CONCLUSION

This study shows that knee pain is a relatively frequent problem in children. It is almost always located on the anterior aspect, has a chronic character, and is often experienced daily. However, the possible implication of structural abnormalities on MRI in children with knee pain and the possible relationship with the development of future knee complaints are still unclear.

Effect of load reduction on the calcification of rat tibial tuberosity: Focus on calcification factors and chondrocyte mechanosensors

The tibial tuberosity has a superficial patellar tendon-embedded portion and a deep uncalcified cartilage portion. Suppressed calcification of the tibial tuberosity leads to Osgood-Schlatter disease. The tibial tuberosity calcifies with age; load reduction degrades the cartilage matrix and promotes calcification, suggesting that reduced mechanical stimulation of the tibial tuberosity promotes calcification. However, this is yet to be clarified. Therefore, in this study, we aimed to investigate the effects of mechanical stimulation reduction on the tibial tuberosity tissue structure and calcification mechanism. Specifically, we examined the effect of load reduction on tibial tuberosity calcification in 20 male 7-week-old Wistar rats classified into two groups: hind-limb suspension (HS, n = 10) and control (CO, n = 10). We observed superficial and deep tibial tuberosities in both groups. The tibial tuberosity in the HS group had narrower areas of deep portions than did those in the CO group (p = 0.000539), and immature bone tissue and cartilage tissue were observed in the HS group. Enpp1 expression did not significantly differ between the groups (p = 0.804). In contrast, Alpl (p = 0.001) and Mmp3 (p = 0.006) expression increased whereas Timp3 expression decreased (p = 0.002) in the HS group. Thus, these results showed a maturing of bone ossification, and this gene expression trend was similar to that observed in a murine join instability model of osteoarthritis with articular cartilage calcification and ossification. The HS tibial tuberosity also showed immature bone tissue. In conclusion, reduced mechanical stimulation caused tibial tuberosity calcification and pathological changes. These findings highlight the importance of optimal exercise to avoid premature pathological structural changes in bones and joints.

The Effectiveness of Treating Osgood-Schlatter Disease (OSD) with Leukocyte-Rich Platelet-Rich Plasma (LR-PRP) Depending on the Duration of the Disease

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.

A comprehensive MRI investigation to identify potential biomarkers of Osgood Schlatter disease in adolescents: A cross sectional study comparing Osgood Schlatter disease with controls

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.

Evaluation of posterior tibial slope relationship with common knee pathologies in pediatric and adolescent age groups in the Turkish population

Anterior cruciate ligament rupture (ACLR), tibial eminence fracture (TEF), and Osgood-Schlatter disease (OSD) have been linked to a steep posterior tibial slope (PTS) in children and adolescents. This study aims to examine and compare these associations. 418 patients aged 8-18, 237 males and 181 females with knee pain between 2010 and 2019 were included and the patients belonged to the Turkish population. They consisted of ACLR (n = 47), TEF (n = 22), OSD (n = 51), and a control group (n = 298). The study and control groups were compared for PTS, sex, and age, with ACLR, TEF, OSD, retrospectively. The ACLR, OSD, and TEF groups had higher PTS values than the control group (P < 0.001). There was no significant difference in ACLR-OSD, ACLR-TEF, and OSD-TEF comparisons (P = 0.22, P = 0.99, and P = 0.99, respectively). PTS increase was linked to ACLR, TEF, and OSD in the multinomial regression analysis, (P < 0.001). Increase in PTS was associated with ACLR, TEF, and OSD for both males and females (independently of other factors; ACLR: P < 0.001, P < 0.001, OR: 1.59, OR: 2.63, TEF: P = 0.001, P < 0.001, OR: 1.98, OR: 1.44; OSD: P = 0.001, P < 0.001, OR: 1.49, OR: 1.28 for males and females respectively). ACLR, TEF, and OSD are associated with increased PTS in the pediatric and adolescent age groups, and there are differences between these pathologies in terms of the amount of PTS increase, age, and sex. Consideration of age and gender in pediatric and adolescent patients with increased PTS may be useful in predicting pathologies associated with increased PTS. Level of evidence: III retrospective comparative study.

Maturation-dependent patterns of knee injuries among symptomatic pediatric soccer players on MRI

OBJECTIVE

To systematically investigate the prevalence of knee MRI findings among symptomatic pediatric soccer players with respect to skeletal maturity and to identify predictors of surgery.

METHODS

This IRB-approved, HIPAA-compliant retrospective study included soccer players (< 18 years of age) who underwent MRI examinations in the past 5 years (2018-2023). Two radiologists retrospectively and independently reviewed all examinations to categorize skeletal maturity and to identify osseous and soft tissue findings. Findings were compared between maturation groups, and logistic regression models were used to identify predictors of surgery.

RESULTS

Ninety-seven players (45 boys, 52 girls) included 39 skeletally immature, 21 maturing, and 37 mature knees. Kappa coefficient for interobserver reliability ranged between 0.65 and 1.00. Osgood-Schlatter disease (OSD) was more common among immature than maturing and mature knees (25% vs 14% and 5%, p = 0.04); anterior cruciate ligament (ACL) injury was more common among maturing and mature than immature knees (59% and 48%, vs 15%, p < 0.01); and meniscal tears were more common among mature than immature and maturing knees (medial, 41% vs 18% and 14%, p = 0.03; lateral, 43% vs 21% and 19%, p = 0.04). Players in the mature group were more likely to undergo surgery (p = 0.01). The presence of an effusion (OR = 19.5, 95% CI 2.8-240.9, p = 0.01), ACL injury (OR = 170.0, 95% CI 1.3-6996.9, p < 0.01), and lateral meniscal tears (OR = 10.8, 95% CI 1.8-106.1, p = 0.02) were independent predictors of surgery.

CONCLUSION

Differential patterns of injury were found among symptomatic pediatric soccer players; the presence of an effusion, ACL injury, and lateral meniscal tears were independent predictors of surgery, likely contributing to the higher rates of surgery among skeletally mature players.

The mid-term effect of Osgood-Schlatter disease on knee function in young players from elite soccer academies

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.

The development of an informative leaflet for children and adolescents suffering from Osgood-Schlatter disease

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.

Multipartite patella: A review of diagnostic techniques and management of the symptomatic patient

Multipartite patella is an anatomical variant classified by the fragmentation of the main patellar body. The cause of this variant is due to failure in fusion of the patellar ossification centers. It is commonly misdiagnosed as a fracture of the patella in clinical practice, leading to unnecessary treatment measures. The aim of this review is to provide an overview of the development and classification of this variation, diagnostic imaging techniques, and assess the optimal management technique for the symptomatic patient. Multiple radiographic methods are used to identify this variant, with recent studies highlighting high sensitivity rates for nonradiative methods (ultrasound). In terms of symptomatic management, accessory fragment excision and vastus lateralis release provide the greatest alleviation of symptoms, with screw fixation being less favorable.

Bone Health in Young Athletes: a Narrative Review of the Recent Literature

PURPOSE OF REVIEW

The aim of this review is to discuss the most recent published scientific evidence regarding bone health in the pediatric athlete.

RECENT FINDINGS

Pediatric athletes commonly suffer from overuse injuries to the physes and apophyses, as well as bone stress injuries, for which magnetic resonance imaging grading of the severity of injuries may be useful in guiding return to sport. Adolescent athletes, particularly those who train indoors and during the winter season, are at risk for vitamin D deficiency, which has important implications for bone mineral density. However, the relationship between vitamin D status and traumatic fracture risk is still unclear. While the female athlete triad is a well-established condition, the current work has led to the recognition of parallel pathophysiology in male athletes, referred to as the male athlete triad. Recent evidence suggests that transdermal 17β-estradiol treatment in amenorrhoeic female athletes is an effective adjunctive treatment to improve bone mineral density in treatment of the female athlete triad. Young athletes are at risk for musculoskeletal injuries unique to the growing skeleton. Optimizing nutritional intake, particularly related to adequate vitamin D intake and prevention of the athlete triad, is critical to optimize bone health in the young athlete.

Eccentric contractions during downhill running induce Osgood‒Schlatter disease in the tibial tuberosity in rats: a focus on histological structures

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.

Basic Differences and Most Common Findings in Ultrasound Examinations of Musculoskeletal System in Children: A Narrative Literature Review

We present basic differences in the musculoskeletal ultrasound examinations between adults and children. Examiners who deal with adults on a daily basis have shared concerns about examining children. Such concerns may arise from the different approach to child ultrasounds, but they also come from differences in anatomical characteristics according to developmental age. We discuss the presence of growth plates, as well as non-mineralized parts of the bones. We also refer to the pathologies most often found in ultrasounds in early developmental stages. In the PubMed database, the set of keywords: "msk ultrasound in children", "pediatric msk sonoanatomy", "coxitis fugax", "pediatric Baker's cyst", "Baker's cyst ultrasonography", "bone septic necrosis in ultrasonography", "ultrasonography in juvenile idiopathic arthritis", and "ultrasonography in juvenile spondyloarthropathies", was used to identify a total of 1657 results, from which 54 was selected to be included in the article. We discuss the problem of osteochondritis dissecans, Osgood-Schlatter disease, examples of ligament injuries (especially in relation to the knee and ankle joints), exfoliation of growth cartilages, osteochondroma, exudates and inflammations affecting joints, and Baker's cysts. In this way, we have collected useful information about the most common diseases of the musculoskeletal system in children.

The people of the Cambridge Austin friars

The Austin friars in Cambridge was an important religious institution between the late thirteenth and mid-sixteenth centuries. Excavations have revealed well-dated and contextualised burials associated with the friary, as well as a range of material culture. The burials have been subject to a wide range of analyses including osteology, palaeopathology, stable isotopes, ancient DNA and geometric morphometrics. Significantly the distinction between clothed and shrouded burials allows members of the Augustinian order and the laity to be identified. This represents the best-understood published group of burials from an Austin friars in the British Isles and emphasises the importance of nuanced interpretation, as burial at friaries was a structured and multi-local phenomenon. These burials and other material can be interpreted in terms of both mendicant ideals and anti-fraternal criticisms.

Osteochondroma of the Tibial Tubercle Masquerading as Osgood-Shlatter Disease: A Case Report

Background:

Osteochondromas are a relatively common primary bone tumor, which may share common clinical features with Osgood-Schlatter disease (OSD). A limited number of cases have described tumors misdiagnosed as OSD.

Case Presentation:

We report the case of an 11-year-old male with a sessile osteochondroma of the tibial tubercle and concomitant involvement of the distal extension and attachment of the patellar tendon into the tibial periosteum. A prior diagnosis OSD had been made. The lesion was resected and repair of the extensor mechanism was required at the time of surgery. The patient was followed for 20 months postoperatively and had restoration of knee function with minimal pain, as demonstrated by a PEDI-IKDC score of 94.6 at 19-month.

Conclusion:

This is a rarely reported case of benign tumor masquerading as OSD requiring excisional biopsy with extensor mechanism repair.

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.

Arthroscopic Resection of Symptomatic Tibial Tubercle Ossicles for Recalcitrant Osgood-Schlatter Disease Using a 2-Portal Technique

Arthroscopic resection of symptomatic unfused tibial tubercle ossicles causing chronic anterior knee pain due to recalcitrant Osgood-Schlatter disease has been shown to be a reproducible arthroscopic technique. Although a number of other surgical techniques have been described, including ossicle excision and tubercle-plasty, drilling of the tibial tubercle, bone peg insertion to induce fusion, open excision of loose fragments, direct bursoscopic ossicle resection, and closing-wedge tubercle osteotomy, with varied outcomes, this technique offers a minimally invasive approach with low risk. Complications including injury to the patellar tendon and scarring of the anterior fat pad have been previously reported, but this approach can be performed with minimal fat pad debridement and direct visualization of the patellar tendon during all resections. This article presents a technique for arthroscopic resection and debridement of unfused ossicles in patients with chronic anterior knee pain due to Osgood-Schlatter disease by use of minimally invasive arthroscopic techniques that are used in standard knee arthroscopy and should be familiar to most arthroscopists.

The Lateral Knee Radiograph: A Detailed Review

Initial imaging evaluation for a variety of knee pathologies often begins with a radiographic series. Depending on the specific indication, this will include at least two different projections of the knee. In most cases, these are the anteroposterior and lateral radiographs of the affected knee, and sometimes with the contralateral knee for comparison. Typically, knee pathologies visible on lateral view can also be appreciated on the anteroposterior view. However, several pathologic processes occur in anatomic locations typically obscured on other projections because of superimposed osseous structures. Examples of these pathologies include injuries involving the quadriceps or patellar tendons, avulsion fractures involving anterior or posterior structures, and many soft-tissue injuries. Knowledge of the relevant anatomy and typical pathologies typically visualized on the lateral radiograph of the knee is imperative to avoid overlooking these disease processes.

Therapeutic interventions in Osgood-Schlatter disease: A case report

RATIONALE

The purpose of this case study was to identify factors of bilateral etiopathogenesis of Osgood-Schlatter disease (OSD) and those supporting the effectiveness of the therapeutic process in a 12-year-old elite female Olympic karateka.

PATIENT CONCERNS

The present case study concerns OSD female karateka who started her sport-specific training at the age of 4 years.

DIAGNOSES

The results of subjective palpation by the orthopedic surgeon and objective medical examination using ultrasonography, wall slide test, magnetic resonance imaging, and body height and weight measurements were collected.

INTERVENTIONS

The therapeutic intervention for the athlete's knee joints lasted 20 months (5 stages). Physical therapy, kinesiotherapy, and pharmacological treatment were administered, and physical activity was gradually introduced.

OUTCOMES

The developmental trajectory was uniform for body height and labile for body weight. OSD was diagnosed after the second growth spurt, and significant progression was reported during the subsequent height and weight gains and increased volume and intensity of sports training. The rate and dynamics of changes in the distance from the patellar ligament to the tibial apophysis were irregular, with dominance in the right knee with the highest rate of change (-3.3 mm) and twice the regression of the rate of change (-2.5 mm). The analyzed distance never exceeded the baseline value (5.5 mm), which was the case in the left knee. Return to sports competition was possible from the second month of therapy, in which kinesiotherapy and static stretching were the most effective. A relatively correct distance of the patellar ligament from the tibial apophysis was recorded at the time of stabilization of the body height and weight gain. No pathological changes were observed following OSD, and full recovery was observed.

LESSONS

In the case discussed in this study, growth spurt, the specificity of the sport practiced, and early specialization including high-volume and high-intensity training should be considered as factors causing OSD and its progression. Kinesiotherapeutic management and static stretching are crucial for the treatment of OSD. Quick return to sports competition was possible due to early therapeutic intervention, which could also lead to the absence of pathological changes in the tibial tubercle and the absence of recurrence of OSD.

The Incidence and Management of Osgood-Schlatter Disease in General Practice

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.

The 45-second anterior knee pain provocation test: A quick test of knee pain and sporting function in 10-14-year-old adolescents with patellofemoral pain

OBJECTIVE

To test 1) if the 45-second Anterior Knee Pain Provocation Test (AKPP-test) could differentiate between adolescents with patellofemoral pain (PFP) and pain-free controls and; 2) whether improvements in the AKPP-test over 12 weeks were associated with improvements in self-reported knee function and pain.

DESIGN

Prospective cohort.

PATIENTS

151 with PFP and 50 pain-free controls (age 10-14 years).

OUTCOMES

The AKPP-test was performed at baseline, 4- and 12-week follow-up. Pain and function were collected using Knee Injury and Osteoarthritis Outcome Score (KOOS).

RESULTS

At baseline, the AKPP-test provoked pain to a median of 5 points (IQR: 3-7) on the 0-10 Numeric Pain Rating Scale in adolescents with PFP, compared to 0 (IQR 0-0) in controls. Higher pain during the AKPP-test was associated with worse KOOS-Sport/Rec (r = -0.33, P < 0.001), worse KOOS-Pain (r = -0.47, P < 0.001), and pain intensity (worst pain last 24 hours) (r = -0.39, P < 0.001) at baseline. Improvements in the AKPP-test over 12 weeks were associated with improvements in KOOS Pain (r = 0.48, P < 0.001) and KOOS Sport/Rec (r = 0.40, P < 0.001).

CONCLUSIONS

Improvements in the AKPP-test were associated with improvements in self-report knee pain and limitations in sports, suggesting the AKPP-test may be a clinically responsive test of knee pain and sporting function in adolescents with PFP.

Is the Prognosis of Osgood-Schlatter Poorer Than Anticipated? A Prospective Cohort Study With 24-Month Follow-up

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.

Surgical Treatment Outcomes of Unresolved Osgood-Schlatter Disease in Adolescent Athletes

The purpose of this case series is to report the outcomes of ossicle excision and tubercleplasty for unresolved Osgood-Schlatter disease that has failed conservative treatment in six adolescent athletes. A retrospective chart review was completed, and data collected include age at onset of symptoms, age at surgery, sex, laterality, mechanism of injury, conservative treatment regimen, radiographic findings, sports played, time to return to sport, length of follow-up, and Lysholm score. Surgery involved an open ossicle excision, tubercleplasty, and repair of the patellar tendon to bone using a suture anchor. Postoperatively, patients were allowed to fully weight-bear in an extension knee brace for 4 weeks and then allowed to gradually resume activity. Four males and 2 females were studied. The right knee was involved in 3 cases and the left knee in 3. The average age at onset of symptoms was 15.8 (range 12-18) and at surgery was 17.3 (range 17-18). Radiographic findings included a large bump in 4 cases, an ossicle in 2, and free fragments at the tendon insertion in 3. Sports played included basketball, football, running, and dancing. All patients returned to sports at an average of 21 weeks and 6 days postsurgery (range 8-56). The average length of follow-up was 14.2 weeks (range 5-27). The average Lysholm score postsurgery was 97.2 (range 94-100). Surgical treatment of unresolved Osgood-Schlatter disease was successful in all patients. No patients reported any postoperative complications or additional surgery. For skeletally mature and symptomatic patients, we recommend removal of the ossicle and adjacent bursae, smoothing the bump, and repairing the patellar tendon to bone.

A systematic review on conservative treatment options for OSGOOD-Schlatter disease

OBJECTIVES

Osgood-Schlatter disease (OSD) is a sport- and growth-associated knee pathology with locally painful alterations around the tibial tuberosity apophysis. Up to 10% of adolescents are affected by OSD. Treatment is predominantly conservative. The aims of this systematic review are to comprehensively identify conservative treatment options for OSD, compare their effectiveness in selected outcomes, and describe potential research gaps.

METHODS

A systematic literature search was conducted using CENTRAL, CINAHL, EMBASE, MEDLINE, and PEDro databases. In addition, ongoing and unpublished clinical studies, dissertations, and other grey literature on OSD were searched. We also systematically retrieved review articles for extraction of treatment recommendations.

RESULTS

Of 767 identified studies, thirteen were included, comprising only two randomised controlled trials (RCTs). The included studies were published from 1948 to 2019 and included 747 patients with 937 affected knees. Study quality was poor to moderate. In addition to the studies, 15 review articles were included, among which the most prevalent treatment recommendations were compiled.

CONCLUSION

Certain therapeutic approaches, such as stretching, have apparent efficacy, but no RCT comparing specific exercises with sham or usual-care treatment exists. Carefully controlled studies on well-described treatment approaches are needed to establish which conservative treatment options are most effective for patients with OSD.

Current management strategies in Osgood Schlatter: A cross-sectional mixed-method study

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.

Tibial tuberosity lesions

Lesions of the tibial tuberosity are very rare but often present a diagnostic dilemma due to their unusual location and appearances. Although some pathologies affecting this region are commonly seen elsewhere in the skeleton, they may have atypical imaging appearances and morphological characteristics when present at the tibial tuberosity. The present review describes the developmental stages of the tibial tuberosity, explaining why this area is prone to degenerative tractional changes and injury, and also highlights various pathologies including benign and malignant osseous lesions and trauma/degenerative related abnormalities.

Bio-Banding in Youth Sports: Background, Concept, and Application

Inter-individual differences in size, maturity status, function, and behavior among youth of the same chronological age (CA) have long been a concern in grouping for sport. Bio-banding is a recent attempt to accommodate maturity-associated variation among youth in sport. The historical basis of the concept of maturity-matching and its relevance to youth sport, and bio-banding as currently applied are reviewed. Maturity matching in sport has often been noted but has not been systematically applied. Bio-banding is a recent iteration of maturity matching for grouping youth athletes into 'bands' or groups based on characteristic(s) other than CA. The percentage of predicted young adult height at the time of observation is the estimate of maturity status of choice. Several applications of bio-banding in youth soccer have indicated positive responses from players and coaches. Bio-banding reduces, but does not eliminate, maturity-associated variation. The potential utility of bio-banding for appropriate training loads, injury prevention, and fitness assessment merits closer attention, specifically during the interval of pubertal growth. The currently used height prediction equation requires further evaluation.

Conservative treatment of Osgood-Schlatter disease among young professional soccer players

BACKGROUND

The present-day conservative treatment algorithms of Osgood-Shlatter Disease (OSD) are often inadequate for young athletes because they require extremity immobilization and avoidance of sports, and hence the longer duration of rehabilitation. Therefore, the development of safe and efficacious treatment protocols for young athletes is of great practical importance.

THE AIM OF THE STUDY

The aim of the study was to assess the efficacy and safety of the conservative treatment of Osgood-Schlatter disease in young professional soccer players.

MATERIALS AND METHODS

Medical records of young soccer players from two different Russian soccer-academies from the period January 2016-July 2019 were analyzed in a retrospective cohort study. Trauma records of young soccer players aged 11-15 years were included in the analysis. Statistical analysis was performed using IBM SPSS Statistics software, 23.0. Descriptive statistics tools were applied for the analysis.

RESULTS

A total of 280 soccer players were included in the study. The aged ranged between 11 and 15 years. Ten percent of players (n = 28, mean age 12.9 ± 1.3) were diagnosed with OSD during the observation period. The mean OSD treatment duration was 27.3 ± 13.9 days. Bilateral symptoms were observed in 42.9% of cases, and unilateral symptoms in 57.1%. In 53.6% of players, the first manifestation of OSD symptoms was observed during wintertime. All players were training on artificial turf playing fields. Conservative treatment without immobilization was applied to all patients. It included kinesiotherapy for quadriceps muscle lengthening and physiotherapy as well as gradual increase of physical activity. A total of 35.7% of players reported having discomfort upon resuming regular training, which caused some restrictions in exercise. However, the symptoms resolved spontaneously with time. Surgical treatment or complete avoidance of exercise was not used in any of the patients.

CONCLUSION

High incidence of OSD was revealed among young soccer players of the leading Russian soccer academies. The OSD most commonly occurred during wintertime. Conservative treatment of OSD-i.e., physiotherapy and kinesiotherapy-enabled disease-free resuming of sports activity for the majority of patients.

Activity Modification and Knee Strengthening for Osgood-Schlatter Disease: A Prospective Cohort Study

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)

The Passive Mechanical Properties of Muscles and Tendons in Children Affected by Osgood-Schlatter Disease

BACKGROUND

Osgood-Schlatter disease (OSD) is a sports-related disorder involving apophysitis, which affects the tibial tuberosity. The identification of factors related to OSD is important for its prevention and early recovery from the disease. This study aimed to compare the passive mechanical properties of the muscle-tendon unit in children affected by an OSD and healthy children, by using ultrasound real-time tissue elastography.

METHODS

Eighteen legs affected by OSD (OSD group) and 42 healthy legs (control: CON group) were assessed. The elasticity was obtained from the quadriceps muscles and patella tendon (PT) using real-time tissue elastography. The strain ratio (SR; muscle or tendon/reference ratio: strain rate of the muscle or tendon divided by that of the reference material) was calculated as an indicator of the elasticity of the tissue of interest.

RESULTS

The SR of the PT in the OSD group was significantly lower than that in the CON group (P<0.05). We found no significant difference between the groups in terms of the SR value of all muscles (P>0.05).

CONCLUSIONS

The results suggest that a PT with a lower SR may be associated with an OSD and that the passive mechanical properties of the quadriceps muscles have limited association with an OSD.

LEVELS OF EVIDENCE

Level IV.

Osgood-Schlatter Lesion Removed Arthroscopically in an Adult Patient

Osgood-Schlatter disease is a traction apophysitis of the tibial insertion of the patellar tendon. It consists one of the most common causes of knee pain in adolescents and usually presents in young males and it is considered a self-limiting condition. Although the symptoms disappear after the closure of the growth plate in most cases, in some patients they may persist. A variety of conservative treatments are used in most cases, however surgical intervention can be successful for patients who have intolerable symptoms. Most surgical options of the Osgood-Schlatter disease include open procedures, while arthroscopic or direct bursoscopic excision has been reported. We believe that the arthroscopic removal of an unresolved Osgood-Schlatter might be the most appropriate treatment for this condition, and we present a case of a male patient with an ununited ossicle due to an Osgood-Schlatter lesion, which was removed arthroscopically using a multidirectional arthroscope and a motorized semi-hooded barrel burr.

Pain, Sports Participation, and Physical Function in Adolescents With Patellofemoral Pain and Osgood-Schlatter Disease: A Matched Cross-sectional Study

OBJECTIVE

To compare pain, physical activity, quality of life, strength, and knee function in adolescents with patellofemoral pain (PFP) and Osgood-Schlatter disease (OSD) to those in pain-free controls.

DESIGN

Cross-sectional study.

METHODS

Self-report questionnaires were used to describe pain, physical activity, knee function, and quality of life in participants with PFP (n = 151) or OSD (n = 51) and in pain-free controls (n = 50) between 10 and 14 years of age. Hip and knee strength were measured by handheld dynamometry. Physical activity levels were measured using wearable accelerometers.

RESULTS

Adolescents were highly active (accumulating greater than 120 minutes of vigorous physical activity per day), with no differences between the OSD, PFP, and control groups. Adolescents with PFP or OSD scored 22 to 56 points lower (P<.001) on the Knee injury and Osteoarthritis Outcome Score subscales compared with controls, with the lowest scores on the "sport and recreation" and "quality of life" subscales. Adolescents with OSD had lower knee extension strength compared to controls (P<.05; effect size, 1.25). Adolescents with PFP had lower hip extension strength compared to controls (P<.05; effect size, 0.73).

CONCLUSION

Adolescents with PFP or OSD had high physical activity levels, despite reporting long-standing knee pain and impaired knee function that impacted on their sports participation and quality of life. Clinicians treating adolescents with PFP or OSD may use these findings to target treatment to the most common deficits to restore sports-related function and sports participation. J Orthop Sports Phys Ther 2020;50(3):149-157. Epub 6 Jan 2020. doi:10.2519/jospt.2020.8770.

Increased Posterior Tibial Slope in Patients With Osgood-Schlatter Disease: A New Association

BACKGROUND

Osgood-Schlatter disease (OSD) is a traction apophysitis of the tibial tubercle caused by repetitive strain and chronic avulsion from the patellar tendon. No widely accepted anatomic risk factors have been associated with OSD.

PURPOSE

To determine if OSD is associated with increased posterior tibial slope (PTS).

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

Forty knees with OSD and 32 control knees examined by the senior author between 2008 and 2019 were included. Patients 10 to 15 years of age with a clinical diagnosis of OSD and available lateral radiograph and magnetic resonance imaging (MRI) were eligible. Age- and sex-matched patients with a history of knee pain but no evidence of OSD on clinical examination and without significant pathology on lateral radiograph and MRI were included in the control group. PTS was defined as the angle between a reference line perpendicular to the proximal anatomic axis and a line drawn tangent to the uppermost anterior and posterior edges of the medial tibial plateau. Measurements were carried out in duplicate on true lateral radiographs by 2 blinded investigators. Interrater reliability of PTS measurements was evaluated using intraclass correlation coefficient (ICC). The independent samples t test was used to compare PTS between the OSD and control knees.

RESULTS

The mean age was 12.6 ± 1.6 years and 51% (37/72) of the knees were from male youth. There were no differences in age, sex, and laterality of knees between the OSD and control groups. The mean PTS was significantly higher in the OSD group (12.23°± 3.58°) compared with the control group (8.82°± 2.76°; P < .001). The ICC was 0.931 (95% CI, 0.890-0.957), indicating almost perfect interrater reliability.

CONCLUSION

This study identifies an association between OSD and increased PTS. The clinical implications of this finding have not yet been elucidated. It may be speculated that in patients with OSD, stress from the extensor mechanism through the patellar tendon loads the anterior portion of the tibia disproportionately to the posterior segment, thereby resulting in asymmetric growth and an increased PTS.

Osgood-Schlatter disease: a 2020 update of a common knee condition in children

PURPOSE OF REVIEW

Osgood-Schlatter disease (OSD) is one of the most common causes for anterior knee pain in children and adolescents resulting from a traction apophysitis of the tibial tubercle. While a peak in boys aged 12-15 years old was well documented, there seems to be no difference in sex distribution nowadays. This may result from increased participation of young females in high-impact sports. This review provides an up-to-date account on contemporary prophylaxis as well as diagnostic and therapeutic approaches.

RECENT FINDINGS

Numerous studies have examined risk factors for OSD. These include body weight, muscle tightness, muscle weakness during knee extension and flexibility of hamstring muscles. In particular, shortening of the rectus femoris may substantially alter biomechanical functions of the knee. Conservative management remains successful in over 90% of patients. However, if disabling symptoms and pain persistent after physeal closure, operative treatment may be necessary.

SUMMARY

OSD is a mostly self-limiting apophysitis of the tibial tubercle and the adjacent patella tendon in young active patients with open physis. Prevention strategies include quadriceps and hamstring stretching and therefore should be implemented in everyday practice routines for children who partake in regular sports activities.

No superiority of dextrose injections over placebo injections for Osgood-Schlatter disease: a prospective randomized double-blind study

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.

Clinics in diagnostic imaging (202). Osgood-Schlatter disease (OSD)

A 14-year-old boy presented with left anterior knee pain, which was aggravated by exercise and relieved by rest. On clinical examination, there was tenderness at the tibial tuberosity with reproducible pain on resisted active extension of the knee. Radiographs showed heterotopic ossification of the patellar tendon with irregularity and fragmentation of the tibial tubercle. Clinical and radiological findings were consistent with Osgood-Schlatter disease, which is a traction apophysitis of the tibial tubercle commonly occurring in adolescents. The clinical presentation and imaging features are discussed.

Long-term Prognosis and Impact of Osgood-Schlatter Disease 4 Years After Diagnosis: A Retrospective Study

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.

Screening of the Maturity Status of the Tibial Tuberosity by Ultrasonography in Higher Elementary School Grade Schoolchildren

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.

Relationship Between Lower Limb Tightness and Practice Time Among Adolescent Baseball Players With Symptomatic Osgood-Schlatter Disease

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.

Immediate effect of infrapatellar strap on pain and jump height in patellar tendinopathy among young athletes

BACKGROUND:

Infrapatellar strapping is a treatment technique used in various knee pathologies; however, its effect on pain and functional performance among young athletes has not been studied.

OBJECTIVES:

To evaluate the effect of infrapatellar strap on pain and jumping performance among young athletes diagnosed with patellar tendinopathy.

STUDY DESIGN:

Pre-/post-test (within-subject research design).

METHODS:

A total of 16 young male basketball and volleyball athletes (age range, 12-18 years) diagnosed with patellar tendinopathy were included in the study. Infrapatellar strap was applied beneath the patella, over the patellar tendon. The athletes performed four jumping tests: squat jump, drop jump, single-leg jump, and jumps 30 s test, with and without the strap. Pain severity in the symptomatic knee during jumping was assessed using a visual analog scale and jumping performance parameters were assessed using an Optojump Next optical measurement system.

RESULTS:

Pain severity reported by the participants decreased in drop test, single-leg jump test, and jumps 30 s test while using the infrapatellar strap compared with no strap condition ( p < 0.05). No significant difference in jumping performance was found between jumping with and without the strap.

CONCLUSION:

The infrapatellar strap was effective in reducing local pain among young male athletes without altered jumping performance.

CLINICAL RELEVANCE

The infrapatellar strap can be recommended to use during physical activity as part of the physical therapy treatments for patellar tendinopathy. Given the low cost, ease to use, and being a non-invasive method without adverse effects, it is an appropriate intervention for young athletes.

Injuries of the adolescent girl athlete: a review of imaging findings

With the rising participation of girls in sports at both the recreational and elite levels, there has also been increased awareness of injuries common in this athlete population. Anatomic differences between boys and girls cause girl athletes to be predisposed to certain injuries. Certain behavioral patterns, such as eating disorders, also cause problems specific to girl athletes that may result in injury. Imaging plays a large role in diagnosis and ongoing management, but there has been only scant literature dedicated to the specific topic of imaging in girl athletes. The purpose of this article is to review the imaging findings and recommendations for injuries and other conditions affecting the adolescent girl athlete. This article first provides an overview of the key anatomic differences between boys and girls, including both static and dynamic factors, as well as non-anatomic differences, such as hormonal factors, and discusses how these differences contribute to the injury patterns that are seen more typically in girls. The article then reviews the imaging findings in injuries that are commonly seen in girl athletes. There is also a discussion of the "female athlete triad," which consists of osteoporosis, disordered eating, and amenorrhea, and the role of imaging in this condition.