Osgood-Schlatter Disease (OSD) is a common overuse growth plate injury, typically occurring in growing children (boys, 12-15 years; girls, 8-12 years) [Gholve et al, 2007; Corbi et al, 2022].
Osgood-Schlatter Disease occurs when the patellar tendon, repeatedly pulls on its bony attachment site on the shinbone (tibia). This causes a traction apophysitis of the tibial tubercle, leading to inflammation of the growth plate [Lam et al, 2019; Ladenhauf et al, 2020; Gholve et al, 2007].
In many cases Osgood-Schlatter Disease is self-limiting and resolves with the closure of the growth plate, but in some cases the growth plate will not fuse as a patient reaches skeletal maturity and patients can be left with chronic pain.
HOW DO YOU KNOW IF YOU HAVE OSGOOD-SCHLATTER DISEASE?
Osgood-Schlatter Disease is characterized by pain, swelling, and tenderness over the tibial tuberosity, which is exacerbated by activities that involve running, jumping, or kneeling [Lam et al, 2019; Ladenhauf et al, 2020; Gholve et al, 2007].
Pain can increase when direct pressure is applied to the front of the knee, such as when kneeling.
Pain typically starts gradually and becomes more constant or severe over time. A painful bony bump may be felt just below the kneecap where the patellar tendon attaches to the tibia.
HOW IS OSGOOD-SCHLATTER DISEASE DIAGNOSED?
Diagnosis of Osgood-Schlatter Disease is based on detailed history, and physical examination.
In some cases advanced imaging, including x-ray, magnetic resonance imaging (MRI) or ultrasound may be used to assess the tibia, tendon and surrounding structures.
Radiographs, or x-rays, typically show irregularity and fragmentation of the tibial tubercle, and in some cases, heterotopic ossification of the patellar tendon [Lam et al, 2019].
HOW IS OSGOOD-SCHLATTER DISEASE TREATED?
Conservative management
Conservative management
is successful in over 90% of cases [Ladenhauf et al, 2020; Gholve et al, 2007], treatment typically includes rest, activity
modification, icing, and stretching exercises for the quadriceps and
hamstrings to alleviate symptoms and prevent recurrence.
Rest and Activity Modification: Reducing or temporarily ceasing activities that exacerbate symptoms, such as running, jumping, and kneeling, is crucial [Ladenhauf et al, 2020; Gholve et al, 2007].
Physical Therapy: Stretching and strengthening exercises for the quadriceps and hamstrings are recommended to alleviate symptoms and prevent recurrence [Antich & Brewster, 1985; Gaweł et al, 2021; Bezuglov et al, 2020]. Several studies have highlighted the need for inclusion of core stabilization exercises to maintain good knee mechanics while jumping [Sasaki et al 2019], and to reduce peak torque in knee flexion while running [Chaudhari et al 2020].
Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for pain relief [Achar & Yamanaka, 2019]. However, given these potential adverse effects, the use of NSAIDs in treating Osgood-Schlatter Disease should be limited, and alternative pain management strategies should be considered to avoid impairing bone and cartilage healing. Studies have shown that NSAIDs can suppress bone repair and delay endochondral ossification, which is critical during the growth phase in children and adolescents [Pountos et al, 2021; Achar & Yamanaka, 2019; Wheatley et al, 2019; Pountos et al, 2011; Chang et al, 2006].
Bracing: Wearing infrapatellar straps significantly decrease forces of the patellar tendon on the growth plate during running potentially reducing symptoms of OSD, although the evidence is limited. There are minimal contraindications and bracing with infrapatellar straps can be beneficial in reducing symptoms of Osgood-Schlatter Disease [Zhang et al, 2024; Hunter et al; 2022].
Patient Education: Educating patients and their families about the self-limiting nature of the condition and the importance of adherence to treatment protocols is essential [Lyng et al, 2020].
Shockwave
Shockwave therapy has been explored as a treatment for Osgood-Schlatter disease (OSD) in children and adolescents, with some evidence supporting its efficacy. Shockwave therapy initiates the body’s natural healing process by improving circulation and speeding up healing and tissue regeneration with the aim of reduction in pain and increase in function.
In a case series, Lohrer et al. treated 14 adolescent patients suffering from recalcitrant Osgood-Schlatter disease (16 symptomatic knees) with radial extracorporeal shockwave therapy. This pilot study demonstrates that radial ESWT is a safe and promising treatment for adolescent athletes with recalcitrant Osgood-Schlatter disease with 75% of the patients reaching complete pain relief [Lohrer et al, 2012].
In a retrospective case study, Shafshak and Amer reviewed data from 22 growing athletes [15 patients with Osgood-Schlatter disease and seven patients with Sever's disease] who received level-focused shockwave therapy. The time from treatment initiation to previous activity level was 2 weeks in 14 patients (63.3%), 4 weeks in seven patients (31.8%) and 11 weeks in one patient (4.5%). No adverse events were reported. No recurrence occurred up to 3 months after the last session, suggesting that shockwave is a safe and effective treatment for apophyseal injuries and may facilitate an early return to sport [Shafshak and Amer, 2023].
Liao et al. conducted a meta-analysis of randomized controlled trials on the efficacy of ESWT for knee tendinopathies and other soft tissue disorders. They found that ESWT had significant effects on pain reduction and functional improvement, which could be extrapolated to conditions like OSD [Liao et al, 2018].
One study by Omodani and Takahashi investigated the effect and safety of ESWT on ischial apophysitis in young high-level gymnasts, which shares similarities with OSD in terms of being an apophyseal injury. The study found that ESWT was effective in relieving pain and allowing a full return to gymnastics without causing early closure of the apophyseal line [Omodani and Takahashi, 2023].
Orthobiologic Treatments
Platelet-rich plasma (PRP) therapy
has shown promise in the treatment of Osgood-Schlatter disease (OSD) in
children and adolescents, particularly when used as a complementary
treatment to standard conservative therapy.
A study by Guszczyn
et al. evaluated the efficacy of leukocyte-rich PRP (LR-PRP) in 152
children with chronic OSD.
The study found significant improvements in pain and function.
Specifically, 75% of subjects were satisfied with the treatment results,
and 72% returned to full physical activity. The study concluded that
LR-PRP injections are effective and safe, with no observed adverse
effects [Guszczyn et al, 2023].
Another
study by Guszczyn et al. compared the effectiveness of LR PRP in
treating acute versus chronic OSD.
The results indicated that LR-PRP was more effective in the acute
phase, with higher treatment satisfaction and better outcomes as
measured by pain and function. No adverse effects were recorded in
either group, suggesting a high safety profile for LR-PRP therapy [Guszczyn et al, 2024].
In chronic cases, ultrasound guided resection of the tibial tubercle has been described in case reports using the Tenex bone device [Sung et al, 2021].
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