Osgood-Schlatter Disease
Osgood-Schlatter disease is a condition characterised by pain and tenderness over the most prominent bony part over the tibia just below the front of the knee (the tibial tubercle). It is the commonest form of traction apophysitis.
Clinical presentation:
It usually occurs in children in the age group of 10-14 years especially those involved in running or jumping sports. It is almost 4 times commoner in boys than in girls. It is characterised by anterior knee pain and tenderness which worsens on activity. A typical feature is difficulty in kneeling down.
Symptomatology:
Pain, tenderness and swelling over the tibial tubercle
Pain can be elicited by pressing down on the shin in a flexed knee position with the subject trying to extend against resistance
long standing cases show weakening and eventual wasting of the quadriceps on the affected side
long standing cases also show limited ability of knee flexion
Investigations:
X-ray: usually not required as diagnosis is clinical. However, when performed, it shows soft tissue swelling over the tibial tubercle as well as fragmentation of the tibial tubercle (both features when present in combination are considered diagnostic).
Indications for X-ray:
when diagnosis is in doubt
when a more severe injury (avulsion of the tibial tubercle) is suspected
when in spite of proper treatment, symptoms are relieved
Treatment:
Rest from activity is probably the best mode of treatment esp. in severe cases
In milder cases, some level of activity can be allowed to be performed
To reduce the level of traction force on the tibial tubercle, a graded flexibility program for the quadriceps and hip flexors is undertaken
Strengthening of the quadriceps also is a great way to reduce traction on the tibial tubercle
Abnormalities of joint movements like hyperpronation as well as patellar malalignment should be corrected by educating the subject as well as undertaking exercise programs and orthotics
Prognosis
Usually very good
Calcification may occur in a small number of cases; symptoms persist longer, instability of the knee joint can occur. Such cases may require surgical intervention
