Osgood Schattler’s disease has many synonyms for itself like osteochondritis, tibial tubercle apophysitis, or traction apophysitis. The pain is usually experienced by the front part of the knee also known as the patella. The pain that is experienced is mostly muscular and not skeletal. Osgood Schattler’s disease is commonly found in skeletally immature athletes.
Osgoos Schattler’s disease typically shows symptoms like; tenderness around the joint, insidious pain, atraumatic and slight tenderness at patellar tendon insertion. Activities like jumping, and sprinting can aggravate the mechanical stress on the patellar tendon and increase further damage.
WHAT IS OSGOOD-SCHATTLER’S DISEASE?
In athletes with immature skeletons, Osgood Schlatter disease, also known as osteochondrosis or traction apophysitis of the tibial tubercle, is a frequent source of anterior knee pain. Sports that are frequently associated with the syndrome include:
- Basketball
- Volleyball
- Sprinters
- Gymnastics
- Football
The patellar tendon insertion site at the tibial tuberosity is typically painful in patients with an atraumatic, gradual development of anterior knee discomfort. Jumping and sprinting are examples of recurrent extensor mechanism stress exercises that might cause the self-limiting syndrome.
The severity of the pain determines the course of treatment, which includes symptomatic relief with ice and NSAIDs, activity adjustment, and relative rest from aggravating activities, as well as a stretching regimen for the lower extremities to address underlying biomechanical risk factors.
Despite the benign nature of the condition, it might take a while to recover and interfere with sports. The illness gradually develops, and repetitive knee movements are frequently linked to it. Over the tibial tubercle, there is typically discomfort.
Despite the benign nature of the condition, it might take a while to recover and interfere with sports. The illness gradually develops, and repetitive knee movements are frequently linked to it. Over the tibial tubercle, there is typically discomfort.
WHAT IS THE PREVALENCE OF OSGOOD-SCHATTLER’S DISEASE?
The cartilaginous tissue that makes up the patellar tendon inserts at the tibial tubercle. Ossification of the tibial tubercle occurs next, between the ages of 10 and 12 for females and 12 and 14 for boys. Osgood Schlatter’s disease manifests itself at this stage of bone development. According to the predominant idea, repeated pressure on the tubercle causes microvascular tears, fractures, and inflammation, which manifest as swelling, discomfort, and soreness.
Overuse injuries like Osgood Schlatter’s disease affect active teenage patients. The force applied by the powerful patellar tendon at its insertion into the relatively soft apophysis of the tibial tubercle results in secondary repeated strain and microtrauma.
Risk factors for the disorder include:
- Male gender
- Ages: male 12-15, girls 8-12
- Sudden skeletal growth
- Repetitive activities like jumping and sprinting
One of the most frequent causes of knee pain among skeletally immature, adolescent athletes is Osgood Schlatter disease. For males, onset occurs between ages 10 and 15 while for females, it occurs between ages 8 and 13. Males are more likely to get the syndrome than females, and athletes who compete in running and jumping sports are more likely to develop it. Osgood Schlatter’s disease affects 9.8% of teenagers between the ages of 12 and 15 (8.3% of girls and 11.4% of males). 20% to 30% of patients had bilateral symptom presentation.
PATHOPHYSIOLOGY OF OSGOOD-SCHATTLER’S DISEASE
The patellar tendon can join the tibial tubercle, which forms a secondary ossification center. Increased stress across the apophysis results from bone growth exceeding the ability of the muscle-tendon unit to expand enough to preserve previous flexibility.
As opposed to the tendon in an adult, the physis is the weakest point in the muscle-tendon-bone relationship, making it vulnerable to damage from repetitive stress. The apophyseal ossification center may soften and partially avulse with repeated contraction of the quadriceps muscle mass, especially with repeated forced knee extension as observed in sports involving running and jumping (basketball, football, gymnastics). This condition is known as osteochondritis.
The tibial tubercle develops and then closes or fuses in the order described below:
- (Age 11 years) The entire tibial tubercle is made of cartilage.
- Ages 11 to 14 are when apophysis forms.
- Between the ages of 14 and 18, the apophysis merges with the proximal tibial epiphysis.
- When a person is older than 18 years, the proximal tibial epiphysis and tibial tubercle apophysis fuse together.
HOW DOES THIS DISEASE PRESENT ITSELF?
The age group affected is between 8-year-old to 15-year-old children. This can also be caused to other age groups but it depends on the nature of the injury. Now when a child is playing the injury must have occurred once but due to healthy joint structure, the injury is not understood at an early stage.
The child typically complains of pain in the anterior or the patellar or as we can say on the front part of the knee joint. There might be pain presentation on both sides or a single side of the leg. You might notice increased swelling near the knee around the knee joint.
The pain that is felt might be insidious in nature, it may subside while the child is at rest or has stopped playing for a while. You might start noticing a bulge-like formation on the anterior part of the knee joint.
The pain aggravates after performing the following activities;
- jumping
- running
- kneeling
- squatting
- direct trauma to the knee
TREATMENT FOR OSGOOD SCHATTLER’S DISEASE
Osgood Schlatter disease is diagnosed clinically, thus radiographic testing is typically not required. If the presentation is severe or unusual, plain radiographs may be utilized to rule out further diseases including a fracture, infection, or bone tumor.
An apophysis avulsion injury or other injuries following a traumatic incident may also need a radiographic assessment. The tibial tubercle is raised in Osgood-Schlatter disease, and there may be soft tissue edema, apophysis fragmentation, or calcification in the distal patellar tendon. It should be noted that these findings are not always indicative of pathology and can alternatively be interpreted as normal deviations, making clinical correlation crucial.
Although the condition eventually resolves on its own, it may last for up to two years before the apophysis fuses. Relative rest and activity reduction from the problematic activity are part of the treatment, which is determined by the intensity of the discomfort. Although there is no evidence to support it, activity limitation is useful in lessening pain.
Rest does not appear to hasten recovery. As long as the discomfort goes away with rest and does not restrict sports-related activities, patients are allowed to play sports. NSAIDs and local cold treatment are both effective painkillers. To protect the tibial tubercle from direct impact, a protective knee pad can be put over it.
In addition, hamstring stretches and quadriceps strengthening exercises can be helpful. Formal physical therapy may be required if conservative pain management does not work. A brief duration of knee immobilization may be recommended in severe, ongoing instances.
There is insufficient evidence to endorse either surgery or injectable therapy for Osgood-Schlatter’s disease. The majority of the time, symptoms are self-limiting, and the pain goes away as the apophysis closes. A swollen or conspicuous tibial tubercle may be a long-term consequence, however, in the vast majority of cases, this is asymptomatic.
An interprofessional team composed of an orthopedic surgeon, physical therapist, primary care physician, orthopedic nurse, and sports physician is the most effective way to manage Osgood Schlatter’s disease.
It may be more useful to reduce athletic participation than to stop all activity because these injuries frequently occur in extremely active adolescent patients. Instead of complete rest, it may be more effective to suggest that a patient who plays on multiple teams or participates in multiple sports during the same season drop one of those teams or sports. This will reduce the amount of activity and strain that comes from frequent and repeated participation.
Limiting activity should be decided jointly by the patient athlete and parent, taking into account both short- and long-term objectives. The degree of pain felt should ultimately dictate the choice. Osgood Schlatter can be prevented by gradually increasing their workload (less than 10% weekly), utilizing the right tools and procedures, engaging in stretching exercises to maintain flexibility in the hamstrings and quadriceps and debating against early sports specialization.
TAKEAWAY
Always pay attention even to the slightest of injuries. Some injuries may not at all need medical attention and can heal on their own, But persistent pain in a specific joint needs to be assessed and treated immediately by a medical professional.
Keep in mind all the above-mentioned symptoms and causes and get treated by your orthopedic or physiotherapist.
The long-term effects of OSD are typically not severe. Some children may develop a lump below the knee that is painless and persistent. Surgery to eliminate a bothersome lump below the knee is very uncommon.
Kneeling causes some adults who had OSD as children or teenagers discomfort. Consult your doctor if your child’s knee pain persists after the bones have stopped developing. The medical professional can look for further knee pain sources.
