Diagnosis
The diagnosis of Osgood-Schlatter’s disease is made by In case of unclear findings may also:
- Ultrasound examination (sonography) and
- X-ray of the knee joint in 2 planes (from the front and from the side)
- A nuclear spin tomography of the knee (magnetic resonance imaging, MRT)
- Or perhaps a scintigraphy, with which a statement about the metabolic function can be made, may be necessary.
X-ray and MRT
In most cases, the diagnosis of Osgood-Schlatter’s disease can be made very well by a simple X-ray image in conjunction with the typical symptoms.In most cases, a typical growth plate, as well as free so-called ossicles (bone particles) and loosening in the affected area are visible. However, today, it is often not necessary to perform an X-ray and instead an MRI is used. This has the advantage that the very young patient can be spared the radiation of an X-ray.
A further advantage of the MRI examination of the knee is that the MRI usually provides a good picture of the initial stage of the disease, which can often be easily overlooked in an X-ray. The MRI also offers the possibility to better estimate the exact extent of the disease and to show the surrounding inflammation, if present. In principle, it is also possible to visualize the disease by means of an ultrasound, but whether this is used depends very much on the preferences and experience of the respective examiner. In principle, the disease can be displayed and diagnosed well with all possibilities.
TherapyTreatment
Freedom from pain is the predominant treatment goal of Osgood-Schlatter’s disease. In most cases, the reduction or discontinuation of sport with additional anti-inflammatory (antiphlogistic) medication is sufficient. In overweight children, a reduction in weight should also be aimed for.
In the inflammatory phase with redness, swelling and pain in the knee, systemic anti-inflammatory medications are prescribed and local cryotherapy using cool pack and curd wraps is performed. Local gel applications, e.g. with Dolobene Gel, also have an analgesic effect. During this time, sport is also to be restricted.
What does this mean exactly? A general ban on sport is not necessary. Only the duration and maximum load should be reduced.
However, indoor sports with extreme braking loads should be prohibited by the parents. The temporary relief should only be short-term. Bandages are often used to treat Osgood Schlatter’s disease.
Under no circumstances should a plaster cast be applied, as it has not shown good results in the past. As soon as the inflammatory phase is over, a build-up program should be started. These are exercises that train and thus strengthen the thigh and hip muscles.
Low-intensity endurance training by bicycle is often suggested, as it should improve the blood circulation in the damaged area, which should lead to accelerated regeneration. In cases of transformation processes that cause bone loss and cause discomfort despite existing pain therapy, surgical removal of the exostoses becomes necessary. Here, if possible, the completion of growth is awaited.
Only in the rarest cases is surgery necessary, namely when free bone parts (sequestra, joint mouse) or bone extractions occur during transformation processes on the bone and subsequently rub against ligaments and tendons or even restrict the joint’s ability to move. As soon as the inflammatory phase is complete, a rebuilding program should be started. These are exercises that train and thus strengthen the thigh and hip muscles.
Low-intensity endurance training by bicycle is often suggested, as it should improve the blood circulation in the damaged area, which should lead to accelerated regeneration. In cases of transformation processes that cause bone loss and cause discomfort despite existing pain therapy, surgical removal of the exostoses becomes necessary. Here, if possible, the completion of growth is awaited.
Only in the rarest cases is surgery necessary, namely when free bone parts (sequestra, joint mouse) or bone extractions occur during transformation processes on the bone and subsequently rub against ligaments and tendons or even restrict the joint’s ability to move. So-called “jumper knee straps” are used as a bandage in Osgood-Schlatter’s disease. These adjustable straps are designed to improve patella guidance by applying light pressure to the tendon below the kneecap.
The tubular insert provides even pressure and helps relieve pain. In addition, there are anatomically shaped knitted bandages that provide local pressure relief to the tibial tuberosity to support therapy. These include the patellar tendon bandage, which helps to relieve pressure in the affected area.
The typical complaints below the patella and pressure pain in the same area usually signal the diagnosis. An X-ray or CT is then taken to confirm the diagnosis. The aim of the therapy is to relieve the patient of pain.However, surgery is not the treatment of choice.
First, conservative measures are taken, such as cooling, less sports activities, protection of the knee or bandages. As drug therapy, NSAIDs such as paracetamol, ibuprofen and similar drugs are mainly used. Surgery is only necessary if the remodeling processes cause free bone parts or bone pulls, which lead to persistent complaints of the adolescents.
Then surgical removal of the exostosis (the bony prominence) is necessary. In addition, the completion of growth is awaited, if this is possible. General risks of an operation: The attending physician must mention the risks of the operation before every surgical procedure.
During the procedure, the surrounding tissue, as well as muscles, nerves and blood vessels could be injured. This can cause permanent damage, although this is rarely possible. In the course of the operation, bleeding or post-operative bleeding may occur, which in rare cases may require another operation to stop the bleeding.
If too much blood is lost, a blood transfusion may be necessary, which carries the risk of an intolerance reaction or infection with hepatitis or HIV. Infection with viruses or bacteria can occur, the risk is about 0-10%. After the operation one usually has a slightly longer period of hospitalization, so that there is a possibility of a leg vein thrombosis, which in the worst case leads to a pulmonary embolism and can be fatal.
Blood-thinning agents are administered as a preventive measure and compression stockings are recommended. It should also be remembered that every anaesthetic has its own risks. Osgood-Schlatter’s disease often affects young people without any other illnesses, so by and large the general risk of the operation is usually low.
Homeopathic treatment of Osgood-Schlatter’s disease also focuses on the use of remedies that are believed to have analgesic or anti-inflammatory effects. These include, for example, Rhus Toxicodendron, Calcium Phosphoricum, Guaiacum or Arnica. These remedies are supposed to achieve in a homeopathic way almost exactly the same effect as the painkillers would otherwise achieve.
Hekla Lava is also said to help improve the symptoms and even reduce the formation of the ossicles. Whether this is possible, however, is questionable. Also in homeopathy it is recommended to supplement the treatment with cooling and physiotherapeutic concepts. Injections with homeopathic and naturopathic substances, such as deadly nightshade or devil’s claw, are also sometimes offered. However, since the disease cannot be treated causally, the benefit is rather questionable, since each injection into an inflamed area also carries additional risks.