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

A Video App for Screening Osgood-Schlatter Disease Using Soccer Instep Kicking Motion Analysis

BACKGROUND

Osgood-Schlatter disease (OSD) is a type of osteochondrosis and traction apophysitis that results from repeated contractions of the quadriceps femoris muscle on the tibial tuberosity. Its prevention, early diagnosis, and treatment are crucial because it causes chronic knee pain and surgical approaches are required if left untreated. Three-dimensional motion analysis is a useful approach for elucidating the pathological factors of OSD; however, it requires advanced cameras, sophisticated facilities, and expensive software. Conversely, the advent of technology has provided affordable video recording devices, and smartphone/tablet-based applications have enabled two-dimensional (2D) motion analysis. This emerging tool and artificial intelligence technology were used to analyze the pivot leg from videos recorded on a tablet device during the instep kicks of adolescent soccer players. Therefore, in this study, we aimed to determine whether the pathological factors for OSD occurring in the pivot foot can be identified through a simple 2D motion analysis using a tablet device.

METHODS

In total, 94 knees of 47 soccer players (aged 14.1±0.8 years, all male) who belong to a single soccer club were evaluated. OSD was diagnosed using ultrasonography and physical examination (a positive bone fragment on ultrasonography or tenderness at the tibial tuberosity). Lower limb muscle tightness was evaluated using the finger-floor distance, straight leg raising test, heel-buttock distance, Thomas test, and ankle range of motion using a goniometer. We then performed motion analysis, and the instep kicking motion was recorded using a video camera on a tablet device. The joint angles of the hip, knee, and ankle were measured using a real-time human-pose detection system. Data were compared between the OSD and non-OSD groups.

RESULTS

Overall, six of the 47 players (12.8%) were diagnosed with OSD. No correlation was found between lower limb tightness and the occurrence of OSD in all indices. However, the 2D motion analysis revealed that the knee flexion angle at the time of plantar placement during the instep kick movement was significantly larger in the OSD group than in the non-OSD group (OSD group: 42.0±7.2˚, non-OSD group: 33.5±6.6˚, *p=0.013).

CONCLUSION

 A video motion analysis revealed that the knee flexion angle during the instep kicking motion was significantly greater in athletes with OSD of the supporting foot.

Prevalence and associated factors of non-traumatic knee pain in high school volleyball players: a cross-sectional study

OBJECTIVES

This study aimed to determine the prevalence of knee pain among high school volleyball attackers, identify associated factors, and explore the relationship between knee pain and lower back pain (LBP).

METHODS

A cross-sectional study involving 82 high school volleyball attackers (15-17 years) used questionnaires, interviews, and field-based assessments to collect data on demographics, volleyball-specific factors, flexibility, and jumping ability. Logistic regression analysis was used to identify factors associated with knee pain.

RESULTS

The prevalence of knee pain was 19.5%. Factors significantly associated with knee pain were a history of LBP (OR, 4.64; 95% CI, 1.28 to 16.8; p = 0.019) and flexibility determined by the absolute difference in heel-buttock distance (OR, 1.37; 95% CI, 1.02 to 1.83; p = 0.037). Participants with knee pain had more volleyball experience and a higher proportion of players who competed as starters in the previous year. Both groups reported approximately 18 hours of practice per week during the school year and around 27 hours during school holidays, with no significant difference observed.

CONCLUSION

Factors associated with knee pain include a history of LBP and reduced flexibility on the heel-buttock distance test. The study highlights the need for a comprehensive approach, considering the coexistence of LBP and focusing on improving anterior thigh flexibility.

Referential values for lower limb flexibility in healthy children and adolescents in Japan: A five-year cross-sectional study

BACKGROUND

Lower limb flexibility (LLF) is an essential motor function. However, assessing LLF during adolescence is difficult because of the influence of marked physical changes. We, therefore, assessed LLF and investigated the relationship between LLF and sex and age in healthy children and adolescents.

METHODS

We conducted a five-year cross-sectional study with students aged 8-14 years at a single school in Japan. We evaluated the heel-buttock distance (HBD), straight leg raising angle (SLRA), and dorsiflexion angle of the ankle joint (DFA) at the beginning of each year. We conducted a comparative analysis on the performance of the HBD, SLRA, and DFA techniques, stratified by both sex and age. The statistical significance of observed differences was assessed through the application of Mann-Whitney U and Kruskal-Wallis tests. Furthermore, we analyzed the effects of sex, age, height, and weight on LLF using a multivariable linear regression model.

RESULTS

Of the 4221 initial study participants, 3370 were analyzed. Mean HBD, SLRA, and DFA values were 1.6 cm, 77.0°, and 15.7°, respectively. Girls showed significantly higher HBD and lower SLRA and DFA values than boys and 14-year-olds (p < 0.01). Median HBD value for girls was 0 cm, whereas for boys, it exceeded 0 cm after age 13. The median SLRA value for girls was 80-85°, while for boys, it was 70-75°. The median DFA value for girls was 15-19°, and for boys, it was 12-15°. A multivariable linear regression model indicated that boys had significantly greater tightness than girls (p < 0.01).

CONCLUSIONS

The reference values of HBD, SLRA, and DFA differed according to age and sex. Furthermore, we showed that sex differences were significantly associated with LLF. Data in this study provide the reference value for assessing LLF in children and adolescents.

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.

Knee function and quality of life in adolescent soccer players with Osgood Shlatter disease history: a preliminary study

The aim of the study was to assess psycho-physical deficits among young athletes with history of Osgood Shlatter Disease (OSD-H) compared to adolescents without history of knee pain (Control group). Eighteen participants were recruited from a group of 80 young (U14-U17) male soccer players. Medical records, and Knee Osteoarthritis Outcome Score (KOOS) were performed from both groups. The tests were conducted to assess the anthropometric characteristics, knee and ankle range of motion (Ely's and Weight Bearing Lunge tests), and muscle power of the lower limbs (Leg Press, Single Leg Countermovement Jump, and Single Leg Hop for Distance). Results showed that overall patient-relevant outcomes following OSD (87%) were significantly lower than in the Control group (95%) (p < 0.05). Scores of the KOOS subscales revealed that Quality of Life and Function, Sports and recreational activities were significantly lower in the OSD-H group (p < 0.05). Although, there were no differences in subscale scores for Pain, Symptoms and Daily Activities. There were, also no difference between groups in range of motion angles and muscle power of the lower limbs values. The preliminary results support existing knowledge indicate that OSD may have a long-term influence on function, sports and recreational participation, and quality of life on young athletes.

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.

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.

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.

The Falcon Test: An Observer Agreement Study in Subjects With and Without Anterior Knee Pain

Introduction

A shortened rectus femoris muscle has been associated with many different musculoskeletal problems. Assessing rectus femoris muscle length is commonly performed using the Modified Thomas Test. However, this test position is often difficult to assume and there are difficulties with reliably measuring rectus femoris length. A method that that uses an easier position to assume and could be more reliable would be beneficial to therapists. The purpose of this study was to determine observer agreement using a new test for assessment of rectus femoris length. A second purpose was to determine if those with anterior knee pain have different rectus femoris muscle length than those without anterior knee pain.

Method

Fifty-three participants with and without anterior knee pain were enrolled. Rectus femoris muscle length was measured lying prone with the leg measured on the table while the non-measured leg was off the table in a position of 90° hip flexion. Rectus femoris muscle was lengthened by passively bending the knee until a firm end-feel. The angle of knee flexion was then measured. The process was then repeated after a brief rest period.

Results

Observer agreement assessing rectus femoris length using this method showed "almost perfect" reliability for both intra- and inter-rater testing: intra-rater: ICC = .99, [CI95: .98-.99], inter-rater: ICC = .96, [CI95: .92- .98]. Agreement for the sub-sample of those with anterior knee pain (N=16) showed "almost perfect" reliability for intra-rater (ICC 1,1 = .98); [CI95: 0.94-.99] and inter-rater reliability (ICC 2,1 = 0.88); [CI95: 0.70 -.95]. No differences were noted in rectus femoris length between those without and those with anterior knee pain (t= 0.82, p> 0.01); [CI95: -7.8 -3.33]; (SEM = 1.3°; MDC=3.6°).

Conclusion

This new method of assessing rectus femoris length is reliable between and within raters. No differences were noted in rectus femoris length between those with anterior knee pain and those without.

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.

Hyperosmolar dextrose injection for Osgood-Schlatter disease: a double-blind, randomized controlled trial

OBJECTIVE

Osgood-Schlatter disease (OSD) is one of the common causes of long-term knee pain, leading to functional limitations, long-term deformity of the tubercle interfering with kneeling, and impaired peer-important sport participation. Nonetheless, patient management continues to rely on the usual conservative methods. This study examined the use of hyperosmolar dextrose injection in patients with OSD.

METHODS

We conducted a randomized, double-blind clinical trial involving 70 patients with OSD. One group received a hyperosmolar dextrose injection (12.5%), while the other received a saline injection. The injections were conducted under ultrasound guidance. The Victorian Institute of Sport Assessment (VISA) score was used to assess each patient's pain and sport level.

RESULTS

The dextrose group outperformed the saline group in improvement in the VISA-Patella (VISA-P) score from baseline to 3 months (27.1 ± 6.5 vs. 1.4 ± 2.6; mean difference 25.4 (22.4 to 28.3); p < .0001), 6 months (31.7 ± 7.9 vs. 25.2 ± 7.8; mean difference 6.2 (3.2 to 9.4); p < .0001), and 12 months (34 ± 9.0 vs. 28.2 ± 7.5; mean difference 5.5 (1.9 to 9.1); p = .0026). The changes in both groups were clinically important, suggesting that both therapies were active treatments. The dextrose group improved too rapidly for spontaneous improvement to explain much of this change.

CONCLUSION

After three injections, at the 6-month and 12-month follow-up visits, the VISA-P scores of the two groups were significantly improved; the dextrose group score was better than the saline group score, and there were significant differences between the two groups.

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.

Risk factors for the occurrence and protraction of patellar and patellar tendon pain in children and adolescents: a prospective cohort study of 3 years

Background

Patellar and patellar tendon pain is a common limitation to children’s participation in social and physical activities. Some factors have been implicated in the occurrence and protraction of knee pain, but the causal relationship is unknown. The purpose of this study was to investigate whether participants’ physical characteristics and activity level are risk factors for the occurrence and protraction of patellar and patellar tendon pain in children and adolescents.

Methods

A three-year prospective cohort study was conducted with healthy students who were aged 8–14 years old, in Japan. Height, weight, heel-buttock distance, straight leg raising angle, and dorsiflexion angle of the ankle joint were collected as individual physical factors at the beginning of each year. The presence of self-reported patellar and patellar tendon pain and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) was collected every month. Protraction was defined as either (1) pain lasting for more than three continuous months or (2) recurrent pain after more than three months of complete recovery. Participants who did not have any pain at the beginning of the observation period were included in the analysis. We analyzed the odds ratio (OR) of pain occurrence within a year of registration and protraction throughout the study period for all physical factors and HSS Pedi-FABS.

Results

We included 1133 participants in the analysis and 252 participants developed knee pain within a year. 34.8% of participants with pain experienced protraction during the follow-up period. A high HSS Pedi-FABS significantly predicted knee pain occurrence (OR 1.03, 95% confidence interval [CI] 1.01–1.05) and protraction (OR 1.03, 95% CI 1.00–1.05). In addition, younger children and girls were at a significantly higher risk of patellar and patellar tendon pain protraction (age, OR 0.81, 95% CI, 0.73–0.90; sex, OR 1.69, 95% CI, 1.09–2.64). Other physical factors did not significantly predict the occurrence or protraction of knee pain.

Conclusions

This study showed that a greater physical activity level was a risk factor for the occurrence and protraction of patellar and patellar tendon pain in childhood. In addition, younger age and female sex predicted higher risk of protraction of pain.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05349-y.

Survey with Innovations to Increase Response Rate Reveals Low Compliance with Guidelines among Youth Baseball Coaches - Including a Survey of Differences between Cities

Background

Compliance rates of youth baseball team coaches with guidelines regarding pitch count limits have been reported, but response rates from previous surveys have not been high, which may introduce substantial non-response bias. In addition, differences between cities in guideline compliance rates have remained unclear.

Purpose

The aim of the present study was to obtain data on coach compliance with guidelines for pitch count limits with a high survey response rate. Secondary aims were to determine compliance with guidelines other than pitch count limits, and to determine whether differences in compliance exists between cities.

Methods

A questionnaire was developed for coaches of youth baseball teams in Gunma to assess knowledge of and compliance with the Japan Softball Baseball Association's recommendations for preventing injuries. In the preparation, distribution, and collection of the questionnaire, four strategies were applied to increase the response rate. The questionnaire surveyed basic descriptive information about the team and coach and coaches compliance with guidelines. Survey items were compared between compliant and non-compliant groups for pitch count limits, and by city.

Results

Valid responses to the questionnaire were obtained from coaches of 58 of 62 teams surveyed for a response rate of 93.5%. Despite the fact that almost all coaches were aware of the recommendations regarding pitch count limits and felt these limits were needed, only 15.5% were compliant. For guidelines other than the pitch count limits, the recommended values were exceeded for practice time on holidays. Differences between cities were evident in the compliance rate with the pitch count limit, but no differences between cities in other items were observed.

Conclusion

The results of this research revealed that compliance with pitch count limits in this sample of youth baseball coaches was much lower than previously reported. Differences between cities were identified in rates of compliance with pitch count limits. These results suggest a need to increase compliance rates with guidelines for pitch count limits and to address differences between cities.

Level of Evidence

Cross-sectional survey study, 3b.

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.

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

BACKGROUND

The relevance of the mechanical properties of muscles in relation to Osgood-Schlatter disease (OSD) remains unclear. The present study aimed to examine rectus femoris (RF) and vastus lateralis (VL) muscle stiffness in children with OSD.

METHODS

A total of 28 legs affected by OSD and 26 legs without OSD were assessed. The shear-wave velocity (SWV) of the RF and VL (in m/s) during passive knee flexion (0° (i.e., fully extended position), 45°, and 90° knee joint flexion) and isometric contraction (50% of maximal voluntary contraction) was measured using shear-wave elastography.

RESULTS

The SWV of the RF was higher in subjects with OSD than in those without OSD at 45° and 90° flexion (P = 0.033 and P = 0.035, respectively); however, the SWV of the RF did not significantly differ at 0° flexion (P = 0.469). Similarly, the SWV of the VL exhibited no significant difference between the tested groups (P > 0.05). No significant difference in the SWV of both muscles during isometric contraction was observed between the two groups (P > 0.05).

CONCLUSIONS

The results suggest that a stiffer RF under stretched conditions (45° and 90° flexion) is related to the presence of OSD. Furthermore, both muscles under unstretched and contracted conditions and the VL under stretched conditions have limited association with the presence of OSD. These results have important implications for understanding the association between the mechanical properties of muscles and OSD.

The Osgood-Schlatter disease: a large clinical series with evaluation of risk factors, natural course, and outcomes

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.

Posterior Tibial Slope is Increased in Patients With Tibial Tubercle Fractures and Osgood-Schlatter Disease

BACKGROUND

Osgood-Schlatter disease (OSD) and tibial tubercle fractures are pathologies that affect the tibial tubercle apophysis in preadolescents and adolescents. Anatomic alignment of the proximal tibia may explain why some children develop OSD or sustain tibial tubercle fractures and some do not. Recent data has shown an association between posterior tibial slope angle (PTSA) and both OSD and proximal tibia physeal fractures. In this study, we compare radiographic parameters between patients with non-OSD knee pain, knees with OSD, and knees with tibial tubercle fracture to elucidate a difference between these groups.

METHODS

Patients treated for OSD, tibial tubercle fractures, and knee pain, from 2012 to 2018, were retrospectively reviewed. Radiographic parameters for each study group included PTSA, anatomic lateral distal femoral angle, anatomic medial proximal tibial angle, patellar articular height, and the distance from the inferior aspect of the patellar articular surface. Caton-Deschamps index was then calculated. Demographic data was collected including age, sex, and body mass index. Demographic and radiographic data was compared using analysis of variance tests, χ2 tests, 2-sample t tests, and multiple linear regression.

RESULTS

Two hundred fifty-one knees in 229 patients met inclusion criteria for the study. In all, 76% were male and the average age of the overall cohort was 14 years old. In patients with tibial tubercle fractures, the majority of fractures were Ogden type 3b (65%). After controlling for demographic variability, average PTSA in the fracture cohort was significantly greater than that in the control cohort (β=3.49, P<0.001). The OSD cohort had a significantly greater posterior slope (β=3.14) than the control cohort (P<0.001). There was no statistically significant difference between the fracture and OSD cohorts. There was also no difference in Caton-Deschamps index between the 2 study groups when compared with the control group.

CONCLUSION

This study demonstrates that patients with tibial tubercle fractures and patients with OSD have an increased PTSA when compared with the control group. This information adds to the body of evidence that increased tibial slope places the proximal tibial physis under abnormal stress which may contribute to the development of pathologic conditions of proximal tibia such as OSD and tibial tubercle fractures.

LEVEL OF EVIDENCE

Level III; retrospective comparative study.

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.